Answers To Frequently Asked Questions
The following are questions that have been asked very frequently over the years, with correspondingly common answers. Keep in mind that there are exceptions to many things, and there are also changes that are sometimes made that may not be immediately reflected in these answers. It is probably best to call us or
email if your question is not fully answered, or if you suspect you might be in one of those "exceptional" circumstances.
1) WHAT TYPE OF FOLLOW-UP CARE WILL MY PRIMARY CARE PHYSICIAN NEED TO BE PREPARED TO PROVIDE?
Answer: If you are local, Dr. Smith will see you at the following intervals- 1 week, 1 month, 3 months, 6 months, one year, and annually thereafter. Your PCP should see you soon after surgery and then at six month intervals as well. Your PCP helps with things like your blood pressure, diabetes, and things like colds and urinary tract infections, should they arise.
2) HOW MANY TIMES HAS DR. SMITH PERFORMED BPD/DS? LAPAROSCOPICALLY? HOW MANY RNY’S?
About 300 DS’s, and 600 RNY’s.
3) WHAT ARE COMMON COMPLICATIONS AFTER SURGERY AND HOW ARE THEY TREATED?
Answer: Vitamin deficiencies are probably the most common, followed by some of the minor complications that can occur with any major surgery in the morbidly obese population, such as dependency on oxygen for a day or two longer than usual. Bleeding, leaks and blood clots in the legs would be the most serious, but fortunately these are extremely rare. Vitamin deficiencies that occur can usually be corrected with supplements, enzymes, etc. Down the road, hernias and obstructions can occur. You’ll discuss all of these problems and more in great detail with Dr. Smith during your evaluation.
4) IS THERE A HIGH OCCURRENCE OF DUMPING OR LACTOSE INTOLERANCE FOLLOWING SURGERY?
Answer: There should be very little, if any, dumping with the BPD/DS, but there can be with the RNYGB. Lactose intolerance is sometimes unmasked by both kinds of surgery.
5) HAVE ANY OF DR. SMITHS’ PATIENTS DEVELOPED A PROBLEM ABSORBING ENOUGH PROTIEN?
Answer: Very few. This is not nearly the problem with the DS that it is touted to be on many sites on the Internet. Every patient with the DS has reduced protein absorption capability and needs to focus on protein intake. 1 out of every 100 on average may have some type of problem with protein, this can virtually always be treated if caught early, but in a very small percentage, the operation might have to be changed or even reversed if the problem can’t be corrected otherwise. Protein problems can show up years after surgery, and is one reason the BPD/DS patients must have follow-up for the rest of their lives. Protein deficiency can also occur after the RNY Gastric Bypass if a patient doesn't follow a proper diet.
6) HOW WILL THE SURGERY EFFECT ABSORBING MEDICATIONS?
Answer: There should be little or no change in the way your body absorbs medication. If you have the RNYGB or the Lap-Band, some changes in your medications might be necessary to allow passage through the outlet of your stomach pouch. We generally have patients avoid extended-release medications (in favor of multi-dose per day forms) to avoid the potential of poor absorption in those types of medications.
7) IN CASE OF EMERGENCY WILL THE SURGERY AFFECT THE WAY I WILL NEED TO BE TREATED (IN ER W/MEDICATIONS ETC)?
Answer: No. It is important, however, to notify all of your doctors, for the rest of your life, that you’ve had this surgery. If you have the RNYGB or the Lap-Band, and in a motor vehicle accident, passage of an NG tube might be a problem. Some patients prefer to wear a medical alert bracelet. This might be a good idea.
8) HOW FAR OUT ARE SURGERIES BEING SCHEDULED?
Answer: Dr. Smith’s current schedule he is doing 2 - 5 bariatric cases a week, and therefore surgery is currently being scheduled one to two months from the time of insurance approval. Dr. Smith feels it is very important to give each operation plenty of time and attention.
9) WHO, IN DR. SMITHS’ OFFICE, HANDLES SCHEDULING OF SURGERIES?
Answer: Julia handles the scheduling of operations and the other appointments that are required around that time.
10) WHAT PREOP TESTS DOES DR. SMITH REQUIRE?
Answer: This will vary per patient and be dependent on current health, medical history etc. Everyone will have upper GI or Upper Endoscopy, a Pulmonary clearance, and a Psychiatric evaluation. Comprehensive bloodwork is required. An ultrasound of the gallbladder is done, unless it’s been previously removed. If the patient has any special problems, such as heart problems, those are evaluated by appropriate consultants and studies.
11) DOES DR. SMITH REMOVE THE APPENDIX WITH THE DS?
Answer: Dr. Smith makes that decision once in surgery. It depends on the patient - if it is easily available for removal, then he will. If not, he won’t. In the end, about 75% of appendixes are removed.
12) DOES DR. SMITH REMOVE THE GALLBLADDER WITH THE DS? WITH THE RNY?
Answer: Dr. Smith feels that it is very important to remove the gallbladder with the DS. With the RNY, the gallbladders are taken out in patients who have significant gallbladder disease at the time of surgery. Those who don't are given a medicine that reduces the chance of forming gallstones and needing the gallbladder removed in the future to about 2%, and patients take this medicine for the first 6 months post-op.
13) WILL I HAVE AN EPIDURAL?
Answer: No. In our program Dr. Smith injects anesthetic medicine to the incision sites, and then patients use PCA pumps, and pain is generally very well-controlled. Epidurals are very difficult to place in morbidly obese patients, and do not always provide good relief. They also limit mobility, and require that the bladder catheter stay in longer than would otherwise be necessary. Medicines can be added and adjusted to make pain control effective.
14) WILL I BE IN THE ICU?
Answer: If you have severe sleep apnea or other severe medical conditions that Dr. Smith feels warrant ICU you will be placed in the ICU. Otherwise if surgery goes well you will not be placed in the ICU. About 98% of Dr. Smith’s patients do NOT go to the ICU.
15) WILL I HAVE A NASAL TUBE?
Answer: No, Dr. Smith does not use nasogastric tubes.
16) WILL I BE ON A VENTILATOR?
Answer: No, unless there are special circumstances. If you have severe sleep apnea that requires use of high levels of CPAP at home, you may be on the ventilator when you wake up, but you’d come off the ventilator, of course, as soon as possible.
17) WILL I HAVE DRAINAGE TUBES IN MY INCISION OR ELSEWHERE?
Answer: No, Dr. Smith no longer uses drains.
18) HOW LONG IS THE AVERAGE HOSPITAL STAY FOR THE LAP BPD/DS? FOR THE LAP RNY AND LAP-BAND?
Answer: For the Lap DS, it is about three nights in the hospital, with a chance of going home after two nights if doing very well. The Lap RNY patient usually stays three nights also, but has about a 30% chance of going home after two nights. The Lap-Band and Lap Sleeve Gastrectomy stays are one night in the hospital.
19) HOW FAST SHOULD I EXPECT TO LOSE WEIGHT?
Answer: Usually the weight loss occurs during the first 14 to 20 months following surgery. In the first 3 months, a patient usually loses about 30% of their excess body weight. At 6 months, a patient has usually lost about half of their excess body weight. Weight loss starts out fast, then slows down each month, until near the end, it’s about a pound every other week. Usually by about 20 months you’re not losing weight anymore, because your bowel and your metabolism have adjusted. Usually the BPD/DS has a slower rate of loss initially than the RNY, but it doesn’t slow down as quickly as the RNYGB.
20) WHAT KIND OF EXERCISE DOES DR. SMITH RECOMMEND AT WHAT STAGES OF POST-OP?
Answer: Try to work up to walking 20 minutes a day, as soon as you can. With these laparoscopic procedures, you should be able to do any kind of exercise after about two weeks. Work on increasing muscle mass; it is very important in feeling well, and will help you to lose weight in the long run. We have a series of exercises that are effective and more doable for morbidly obese patients, that we’ll go over with you before surgery. Exercise helps keep the body from dropping the metabolic rate to match the amount of energy that is entering the body after weight loss surgery, and this helps you maintain your energy levels and also helps maximize your weight loss.
21) HOW MUCH WATER SHOULD A POST-OP CONSUME A DAY?
Answer: As much as possible. At least a liter and a half, or 64oz. a day as an even better goal. Flavored water drinks (Propel, etc.) are counted as water, even though they have a very small amount of calories. Drinks should be essentially non-caloric, and should have no carbonation, caffeine, or high levels of citric acid. You can count half the volume of your protein drinks toward your water requirement.
22) IS THERE A MONTHLY AFTERCARE MEETING FOR YOUR PATIENTS?
Answer: Yes, there are now three support group meetings in the Marietta area. Call 770-919-7050 for further information.
23) WHERE IS MARIETTA, GA?
Marietta is just Northwest of Atlanta, between where I-75 meets I-285 and I-575.
24) I WOULD LIKE TO KNOW WHAT THE WAITING TIME IS TO GET AN APPOINTMENT AND SURGERY DATE.
Answer: The waiting time for an appointment is fairly short. Once we confirm that you are an appropriate candidate, we can get you in for an appointment within a few weeks. From that time, it is usually a month to three months or so to the surgery date. This of course depends on your overall health, and the extent of the preoperative evaluation that needs to be done, and also depends to a large degree on how aggressive you are in pursuing the necessary studies and consultations.
25) DO MOST INSURANCE POLICIES COVER WEIGHT LOSS SURGERY?
Answer: It depends completely on your insurance company, and on your particular plan. Things also change with time. We try to maximize your chances of being approved the first time we submit. The BPD/DS is somewhat more difficult to gain approval for than the RNY, although more and more companies are covering the DS, including Medicare.
26) HOW DO THE SIDE EFFECTS AND WEIGHT LOSS OF DS COMPARE TO THE STANDARD RNY PROCEDURE?
Answer: The complication and morbidity rates are roughly about the same overall. The DS avoids some of the problems associated with the RNYGB, such as dumping and marginal ulceration. The DS does, however, carry a greater risk of protein malnutrition, which can be quite a problem, but which runs about 1%. The weight loss with the DS averages 80-85 of the excess body weight (which is the actual body weight minus the ideal body weight as determined from the Metropolitan Life Tables), and it is better sustained in the long-term than with the RNYGB. The RNYGB averages 70-75% of the excess body weight lost, but avoids some of the malabsorptive problems of the BPD/DS, such as protein, Vitamin A,D,E and K absorption, and avoids some of the greasy, foul smelling stools and gas that can occur with the BPD/DS. Maximum weight loss arrives at about 18 months after surgery for both. The RNYGB usually has a small amount of regain over the next few years, while the DS has much less.
27) HOW LONG WOULD I BE OUT OF WORK?
Answer: You'd be out of work approximately 2 weeks with any of the laparoscopic operations, in order to allow healing of the incision sites. Some people can go back to light duty earlier than that, if they have a job that will allow it. A few people also need an extra week or so off from work, in order to feel up to working again, but this would have to be decided after surgery, not before.
28) IF I CAN HAVE THE SURGERY LAPAROSCOPICALLY, HOW LONG WILL I NEED TO BE IN ATLANTA?
Answer: Dr. Smith wants you to be past the usual time for post-op problems and to be sure that you’re eating well and your GI tract is functioning before you go home if you live out of town, so he’d want you to stay in the area for about a week post-op. Add to that the day of surgery and a few days before surgery, and your total stay for an uncomplicated operation would be about 10 - 14 days.
29) I’VE HAD AN OPEN GALLBLADDER OPERATION. WOULD I STILL BE ABLE TO HAVE MY OPERATION LAPAROSCOPICALLY?
Answer: Dr. Smith does all of his bariatric procedures laparoscopically. He has done a great many patients with open surgeries in the past, including gallbladder operations, colon resections with colostomies, splenectomies, hysterectomies, etc. In fact, most of our patients have had open surgery of some kind before, and this does not at all mean laparoscopic surgery can’t be done.
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For any questions, comments, or to begin the process, contact us:
Phone: 770-919-7050
Fax: 770-919-7051
Toll-Free: 1-866-535-0966
or email us at:
inquiries@advancedobesitysurgery.com
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The Advanced Obesity Surgery Center
A Certified Bariatric Surgery Center of Excellence
Marietta, Georgia, USA
