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Most insurance carriers require a physician-supervised weight-loss trial period of between 6 and 12 months as a prerequisite for approving weight-loss surgery. During the weight-loss trial, you will attempt traditional methods of weight loss, including reduced calorie intake, exercise and modified lifestyle behaviors. Your physician will document your degree of success or failure to lose weight by these methods.
If you are considering weight-loss surgery, we advise you to begin your physician-supervised weight-loss trial as soon as possible. Call to make an appointment with your primary care provider or with Dr. Martin, our nutrition and weight-management specialist (see our "Diet and Nutrition" tab). Of course, if you are self-paying for your procedure and will not be filing for insurance reimbursement, you will not need a supervised weight loss trial.
The following is a list of information that must be documented by your physician on each office visit note from your physician:
1. The patient's height, weight, and body mass index. The number of pounds lost or gained should be noted. A comment should be included if there is failure to lose weight or a weight gain is recorded.
2. Documentation of a low calorie diet with the number of calories listed on the office encounter form (ex. 1,000-1,200 calories per day).
3. The type and duration of exercise the patient is attempting must be recorded (ex. Walking 30 minutes per day; swimming 10 laps in pool; stretching for 20 minutes as patient is wheelchair bound, etc.). If you are unable to exercise, this must be documented on each visit.
4. Behavior modification must be attempted and documented (ex. Parking further away from store; putting fork down between bites, chewing each bite 20 times before swallowing; using stairs instead of elevator; walking instead of taking the shuttle bus, etc.).
5. Physician's comments on the patient's progress and further instructions should be included on the office visit note.
Download and print a letter from Dr. Lord to take to your primary-care physician.
Checklist of Required Training and Consultations Before Surgery:
Our 12-step program to long-term weight loss!
1. Informational Seminar Attendance
You may either attend a monthly seminar in Pensacola, or you may watch our online seminar video. This step is mandatory for potential patients to pursue weight-loss surgery with Dr. Lord.
2. Physician-Supervised Weight-Loss Trial
Most insurance carriers require a weight-loss trial period of 6 to 12 months. To learn more about the weight-loss trial please review the first accordion option on this page..
3. Attend Monthly Support Groups at Sacred Heart Hospital in Pensacola. Although attending our Support Groups is not required, they a great way to meet and interact with patients who have had weight-loss surgery and to get answers to your questions.
4. Clinical evaluation, one on one with Dr. Lord. This is a required office visit in our Pensacola clinic.
5. Nutrition Class: This instruction will help you prepare for a new way of eating after your surgery. The clinic staff will give you more information on this mandatory class for our patients.
6. Nutrition Consultation, one-on-one with our Dietitian. This is a required office visit in our Pensacola clinic.
7. Psychiatric Consultation, one-on-one with our Bariatric Psychologist. This is a required office visit in our Pensacola clinic.
8. Behavior Modification Class – this class, taught by our Dietitian, will provide strategies to help you develop good habits for a healthy lifestyle after surgery. The clinic staff will give you more information on this mandatory class for our patients.
9. Diagnostic Evaluations, if ordered by Dr. Lord (Lab Work, X-rays, EKG, EGD, Colonoscopy, etc.)
10. Pre-Op Instructions: This instruction, taught by our Program Manager, will help you know what to expect immediately before and after your surgery. The clinic staff will give you more information on watching this video before your pre-op appointment with Dr. Lord.
11. Pre-op Appointment With Dr. Lord and Pre-Admissions Paperwork. These are required office visits in our clinic and at Sacred Heart Hospital in Pensacola. If needed, we can try to schedule these both on the same day.
12. Surgery Date!
Stock up on your vitamin supplements that will be required after your surgical procedure, as well as your sugar-free, clear liquid dietary items for both the pre- and post-operative period.
For several days prior to your surgery (usually four to seven days), our dietitian will place you on a low-calorie, clear liquid diet containing at least 30-50 grams of protein. This will help shrink your liver, making the surgery easier for Dr. Lord to perform and safer for you because it will require less time under anesthesia.
Your pre-surgery diet will include fruit juices (no sugar added); clear broth; decaf coffee and tea; sugar-free Jell-0, popsicles, and juice bars; sugar-free, non-carbonated liquids; and water.
One Day Before Surgery:
You will be asked to take three showers within 24 hours of your surgery: two the day before your surgery and one on the morning of surgery.
You will be instructed on how and when to begin the bowel prep to clear your colon in preparation for surgery. You will need to drink lots of water to remain well-hydrated the day before surgery.
No drinking or eating after midnight the night prior to surgery! If your family physician or anesthesiologist has directed you to take a medication the morning of surgery, do so with a small amount of water.
In general, if you are diabetic you must follow your blood sugars closely and stop taking any oral diabetic medications from the clear liquid phase until the surgery. Consult with Dr. Lord and the clinical staff if you have questions.
Day of Surgery:
Remember, nothing to eat or drink after midnight the night prior to surgery!
On the morning of your surgery, you will check in at the Outpatient Surgery Center at Sacred Heart Hospital in Pensacola.
Once admitted, you will be taken to the pre-operative holding area where you will meet with a member of your care team to prep you for surgery.
Your surgical team will perform a final check of surgery preparations. You will then be taken to the operating room for your surgery. The anesthesiologist and/or CRNA will then sedate you for your operation.
Once you are sedated, a tube will be placed in your bladder to drain and monitor your urine output. It will be removed the following day. Your chest and abdomen will be prepared to prevent infection.
The operation will begin shortly after this step and can last one to three hours.
After surgery, you will be taken to the recovery room where you will spend one to two hours before being transported to the Bariatric Surgical Unit
You will remain in the hospital one to three days after surgery so your care team can monitor your progress and make sure that your stomach heals correctly.
Immediately after surgery, you will not be permitted to eat or drink anything by mouth. Instead, you will receive your nutrition and hydration from your I.V., which will provide everything you need to begin your healing process.
Getting Out of Bed
Several hours after surgery, your nurse will sit you up in bed and will encourage you to get out of bed and walk. Though it may seem hard at first, walking is very important to your overall recovery and healing. Walking will help move the air in your lungs and promote circulation in your legs. It is important that you increase the distance that you walk each time. You will be continually encouraged to walk as much as possible for the duration of your stay.
Clearing Your Lungs
To help increase your air flow and clear your lungs, your nurse will ask you to take deep breaths and to cough frequently. To aid in this, your nurse will provide you with an Incentive Spirometer to be used every hour while awake.
Pain management is usually accomplished using a Patient Control Analgesic (PCA) pump for the first 24 hours. Once you tolerate fluids, you will be placed on liquid pain medication. If you experience nausea, your nurse will provide you with additional medication.
Eating After Surgery
Once your doctor permits, you will be given ice chips to see how well you can tolerate liquids. Even though ice chips are small, you will need to chew them very carefully, as your stomach only has a small amount of room. Once you are permitted, you will advance to a clear liquid diet. Please remember to drink and eat very slowly to allow time for your food to digest properly.
Drinking Liquids Between Meals
To help keep you hydrated, you will need to drink liquids between meals. To ensure that your stomach is able to hold down solid foods, you will need to stop drinking liquids 30 minutes prior to eating, and do not start again until 30 minutes after eating.
Dr. Lord will give you a prescription for pain medication before your discharge. Most patients crush their pills to make them easier to swallow during this time and take them with a dollop of light yogurt or unsweetened applesauce. If you are taking other medications, please check with Dr. Lord about when you should resume taking them. We may need to coordinate your medication with your primary care physician. In addition, as you lose weight, the dosages of certain medications will need to be adjusted. This will require close follow-up with your primary care physician and our Nutrition and Weight-Management specialist, Dr. Anthony Huynh.
Lap-Band patients will be discharged on a liquid diet for the first two weeks. Your first post-operative appointment will be scheduled for roughly 7 to 11 days from your discharge date
Gastric Bypass patients will be discharged home on a soft-food diet. They will also be seen for a post-operative appointment within 7-11 days.
At home, you will begin to take short walks for exercise. As in the hospital, this will help get the air flowing in your lungs and reduce the risk of blood clots in your legs. Once you get used to walking, you may try any physical activity that feels comfortable to you. You may lift about 15 pounds -- roughly 1 bag of groceries or a gallon of milk -- but not much more. You should avoid any contact sports at this time.
If your wound areas become red and hot to the touch, please contact the office immediately, as this may signal an infection. A small amount of oozing of clear fluid is not harmful.
Your incisions will be covered with small paper bandages called "steri-strips." Most patients will not have any stitches or staples on their skin. Most patients will have internal stitches that will absorb on their own. The steri-strips on your incisions will start to curl up around the edges about a week or two after surgery. When they do, it's fine to remove them just like you would a band-aid.
You may take short showers beginning on the day after your surgery. No tub baths, no hot tubs, and no swimming for 3 weeks post-operatively.
You should do absolutely no driving or operating of mechanical equipment until you have been off your narcotic pain medication for 24 hours or until authorized by Dr. Lord. When you do resume driving, start with slow, easy trips around the neighborhood.
Returning to Work
Your return to work will depend on many factors. Most patients are able to return to work within 21 days after laparoscopic surgery or four to six weeks after open surgery, if the occupation does not require strenuous activity. The main determinant of your readiness to return to work is how you feel.
Initial Follow-Up Visit
We will schedule an initial follow up appointment with you at the time of discharge. This appointment is usually scheduled 7 to 11 days from your discharge date. At this visit, your surgeon will carefully examine your incisions to see if they have healed well. If so, you will be given a clean "bill of health" and will be able to resume all normal activities and all exercises.
Possible Complications After Bariatric Surgery
After your surgery, you may have some complications as your body gets used to your smaller stomach size. Because of this new size, you will need to eat much slower, chew your food very carefully, and be sure not to overeat. If you do not follow these instructions, complications can occur.
Common complications include:
1. Nausea, Vomiting, Bloating and/or Heartburn Caused by:
• Eating or drinking too quickly
• Drinking cold fluids
• Not chewing food adequately
• Eating too much (quantity)
• Using drinking straws
• Eating rich or sweet foods
• Eating gas-producing foods or drinking carbonated beverages
• Eating foods that are unusually distressful to the stomach
2. Dumping Syndrome
This occurs when food is dumped from the stomach into the intestine, which may result in a feeling of abdominal fullness, nausea, weakness, warmth, rapid pulse, or cold sweats. Dumping syndrome can be avoided by eliminating concentrated sweets and taking fluids 30 to 40 minutes before or after meals.
3. Blockage of the Stoma
The opening created by the surgery is smaller than the original opening that released food from the stomach into the small intestine. This new opening may become blocked when food has not been thoroughly chewed, resulting in vomiting. Chew all food to the consistency of applesauce before swallowing to prevent blockage from occurring.
4. Stretching and Tearing of Your Pouch
The purpose of surgical weight loss is to create a smaller stomach. Therefore, the stomach cannot hold the large volumes of food it once did. Constant overeating can stretch the pouch and tear the staple line. To prevent this from occurring, you must follow the nutritional instructions prescribed for you.
During the first year after surgery, it is important that your primary care doctor, Dr. Lord, and Dr. Huynh work closely with you in order to adjust your medications as needed and to make sure you are healing properly. You will be asked to come to our Pensacola clinic for follow up appointments at six weeks, three months, six months, nine months, one year and 18 months after surgery, and then every year on the anniversary of your surgery date. Lap-Band patients will need to be seen every month in order to have their bands adjusted.
At these visits you will have the opportunity to discuss with your care team how things are going and to ask any questions you may have. Additionally, a comprehensive set of blood tests will be drawn to check your electrolytes, blood count, vitamin, mineral, and hormone levels. If there are any abnormalities you may need to change the amount of vitamins or supplements you are taking.
Many patients notice changes during this period of rapid weight loss.
Some of these changes or side effects may include: loss of appetite, hair loss and skin dryness. These conditions should resolve themselves as your weight stabilizes, but, if they continue, please contact our bariatric program manager.
Bariatric Support Group
You are strongly encouraged to participate in our bariatric support group. Most people find that these are an excellent opportunity to improve life after weight loss surgery and to make new friends. Our support group holds monthly meeting at Sacred Heart Hospital in Pensacola. See our schedule of Support Groups.