Thursday, March 31, 2011

Post Operative Instructions

SHOWER: You may shower beginning the day after surgery. Avoid aggressive scrubbing of the incision sites, but it is fine to allow water and soap to run over them. You may submerge your incisions in a bath or pool only once they have healed (typically 10-14 days).

WOUNDS: Your laparoscopic incisions will have a 'Derma-Bond' glue dressing. You may have a small amount of clear yellow or pink drainage from wounds; this is normal. The drainage should NOT look like pus, be foul smelling, or be red around the incision. Call the clinic if this occurs. *****NOTE: For laparoscopic procedures we inflate the abdomen with carbon dioxide. You may experience pain in your shoulder or lower rib cage due to retained carbon dioxide (this is temporary and will go away). A heating pad on the shoulder or lower rib cage, as well as changing positions, should help ease this discomfort.

DIET/VITAMINS: Follow your diet stages as per your Nutrition Handout. Remain on your 'full liquid' Stage 2 diet until your 2 week follow up appointment. Do not advance or change diets until directed by one of our surgeons. Take your chewable multivitamin and chewable Calcium citrate with Vitamin D every day.

RECOVERING: After 2-4 weeks you should begin to feel like yourself again. Fatigue occurs after every major surgery; the degree will vary from person to person. You probably will still tire easily for several months (up to 6) because your body is using a lot of energy to heal itself as well as adapt to the new physiology and calorie restriction. Make it a point to rest when you feel tired, but at the same time do your best to be active and alive!

CPAP: If you are on CPAP prior to surgery, you will need to continue to wear it for at least 3 months after your surgery. At your 6 month follow up visit a consult for a repeat sleep study may be ordered. Once the results are reviewed by the doctor, you will be contacted and informed about discontinuation of the device. Until then, it is imperative that you continue to wear the device.

EXERCISE: Do not lift anything over 20 pounds for 4 weeks. No heavy lifting, holding babies, children, or animals for 4 weeks. No heavy housework or strenuous exercise for 4 weeks. You may begin walking for exercise IMMEDIATELY, including the day of surgery. Begin in limited amounts, and gradually increase your time and distance. Back off of any activity if experiencing substantial discomfort, especially incisional or abdominal discomfort. Both water and 'regular' aerobics are fine 4 weeks after surgery. Typically there are no exercise or activity restrictions 4 to 6 weeks after surgery; confirm this with your surgeon.

DRIVING: Do not drive for 2 weeks following surgery, or at any time while continuing to take narcotic pain medicine, such as Lortab, Percocet, Vicodin, or Tylenol with codeine. Consider contacting your auto insurance company to inquire about restrictions they may have regarding driving following major abdominal surgery.

WORK: Generally speaking, plan on taking 2 to 3 weeks off from work. Some are able to return as soon as one week (especially gastric band patients), and some require more than three weeks. Ensure that you are able to tolerate your current diet stage in your work environment and that your energy levels are sufficient to permit the hours and physical activity required for your job.

MEDICATION: All medication must be crushed, chopped, chewable, or in liquid form for 4 weeks after surgery or until cleared by your surgeon. You will be given a prescription of Tylenol with codeine, Lortab, or some other pain medication. Over-the-counter liquid or crushed Tylenol may be used once this medication has been consumed. You may resume your routine medications, unless otherwise directed by your surgeon. Patients with diabetes: please check with your surgeon before restarting your diabetic medications for diabetes, as your requirements may be much different than they were prior to surgery. If you have pre-existing problems requiring narcotic pain medication, you will need to continue seeing the appropriate provider. These prescriptions for pre-existing chronic pain will not be renewed by the Bariatric Clinic. Make appointments with your Cardiologist and/or Primary Care Provider as appropriate within the first few weeks after discharge to monitor heart, blood pressure and diabetic medications.


PAIN MEDICATIONS TO AVOID: If you have had a GASTRIC BYPASS, you should permanently avoid medications which are classified as "NON-STEROIDAL ANTI-INFLAMMATORY DRUGS" ('NSAIDS'), such as the following:

ADVIL ASPIRIN NAPROXEN / NAPROSYN

MOTRIN EXCEDRIN ALEVE

IBUPROFEN BC Powder TORADOL

NSAIDs are notorious for causing ulcers after gastric bypass. If you have had a sleeve or band, you may use these medications WITH CAUTION, since these medications may cause ulcers in you, too.

CARE OF DRAIN: If you have a sleeve or gastric bypass you may have a 'JP' drain while in the hospital. This is usually removed before discharge. If you do go home with it, you may shower with soap while the tube is in place. After showering, use a Q-tip saturated with half hydrogen peroxide/half water to cleanse the area around the tube; when finished apply gauze around the tube site.

FOLLOW UP APPOINTMENTS: Your 2 week, 1, 3 & 6 month appointments are scheduled. Call one month prior to schedule your yearly appointments. Fasting labs are required prior to your 1 month and all subsequent follow-up appointments. The lab orders will be placed in computer, once you have made the appointment. You should have them drawn one week prior to your appointment. **** YOU MUST BE FASTING TO HAVE LABS DRAWN.****

WHEN TO CALL YOUR SURGEON: Bleeding from incisions (moderate to large amount). Blood in vomit or stool. Nausea or vomiting that prevents fluid intake for 12 hours, not relieved by medication. Worsening abdominal pain that is not relieved by your prescribed medication. Signs of infection: temperature of 101 F or greater, redness and swelling at incision site(s). Foul-smelling drainage from incisions. Calf or leg pain and swelling. Call the Bariatric Clinic at 210-292-4303 during clinic hours Monday-Friday from 0730-1600. If after clinic hours, or on weekends or holidays, report to the nearest Emergency Room.

SIGNS/SYMPTOMS OF A LEAK: Increased heart rate > 120 beats per minute, increased respiratory rate >22 breaths per minute, persistent shoulder pain, chest pain, shortness of breath, fever, extreme tiredness or fatigue, severe abdominal pain, excessive thirst, difficulty breathing. IF YOU EXPERIENCE ANY OF THESE SYMPTOMS GO TO THE NEAREST EMERGENCY ROOM IMMEDIATELY or Call 911.

DIARRHEA/CONSTIPATION: Some patients my experience occasional diarrhea related to certain foods; first try switching to Lactose Free Skim Milk. Constipation may be related to your narcotic pain medication. In this case, you may take Milk of Magnesia, 1-2 tablespoons every 6 hours as needed until your constipation resolves. If this does not alleviate your constipation in 1-2 days, PLEASE CALL the Bariatric nurse at (210) 292-4303 during duty hours, Monday-Friday 0730-1600.

COUGHS AND COLDS: You may take Sudafed for your nasal congestion and Sugar Free Cough syrup for your cough. If symptoms do not improve within 48 hours, CONTACT YOUR PRIMARY CARE PROVIDER. All your routine medical care should be handled by your Primary Care Provider.

Make appointments with your Primary Care Provider within the first few weeks after discharge to monitor heart, blood pressure and diabetic medications. You may also want to schedule visits with your diabetes specialist (if not your PCP) or cardiologist.

FOR QUESTIONS /CONCERNS: Please contact the Bariatric nurse, at (210) 292-4303, during clinic hours, Monday-Friday from 0730-1600. IF after 1600 or on weekends or holidays, report to the nearest Emergency Department.



Wilford Hall Medical Center Bariatric Surgery Clinic

Wednesday, March 30, 2011

ACTIVITY AFTER SURGERY

--Avoid lawn mowing, running, skiing, exercise clubs, or strenuous activities/work for 4 weeks.
 --No lifting greater than 20 pounds for the first 4 weeks. This includes pets and children.
--Avoid heavy housework (vacuuming, mopping, lifting laundry baskets or carrying groceries) for 4 weeks.

--No abdominal exercises for 4 weeks for laparoscopic surgery (6 weeks after open surgery)
--Both regular and water aerobics can be started 4 weeks after surgery
--Begin walking for exercise the day of surgery. Gradually increase time and distance. Back off any activity if experiencing substantial discomfort.

 Driving
--Do not drive for 2 weeks after surgery while taking narcotic pain medicine. (Lortab, Percocet, Vicodin, or Tylenol with codeine)

Work
--Plan to take 2 to 3 weeks off from work
--Some patients may return as early as 1 week and some 3 weeks
--Ensure you are able to tolerate your current diet stage in your work environment and your energy levels are sufficient to permit the hours and physical activity required for your job

--If your job is physically demanding, you will be out at least 4 to 6 weeks.
--We will not release you back to work until after your two week follow-up.

Tuesday, March 29, 2011

Quit Smoking—Smoking Cessation

Free Patches...No Classes

The WHMC Tobacco Quit Line Research Study is available to Active Duty Members, Reservists, Guard, Retirees, and Dependents.  The study aims to assess the effectiveness of a tobacco quit line in the military.  The research project will include telephone counseling sessions and nicotine patches at no cost to the participant.  For more information, please call 1-877-726-6211.


 

**** All patients must be smoke free for 6 months before they will be given a surgery date

Monday, March 28, 2011

Friday, March 25, 2011

AT HOME from the hospital

 READ YOUR DIETARY MANUAL …. AGAIN !

-Remember your diet stages 1 to 4.Start taking your chewable multivitamin with iron and calcium with vitamin D.
-Fluid Goal: At least 48-oz/ on your first day, at home, and gradually increase you intake to goal 64 or more ounces a day (includes protein drinks)
-Protein Goal: Women 60-70 grams/day; men 70-80 grams/day  
-Maintain daily food diary.

    -Follow your discharge instructions.  
Do not advance your diet until directed by your surgeon.


TIP:
Divide your liquids:
 24 oz. before lunch
 24 oz. before supper
 24 oz. before bed
8 ounces x 9 glasses=72oz.


 

Thursday, March 24, 2011

On the Inpatient Surgical floor

Nursing staff will help you get situated into your room.

--You will have a patient controlled analgesic pump (PCA), so that you yourself can administer a pre-set dose of pain medication.

--Staff members will get you out of bed and walking around the hospital floor about 4-6 hours after your surgery.

--You will still get fluids through your IV.

--You will continue your breathing exercises.

--You will not be able to eat or drink till the next morning after your 'Swallow Study test'


 

Wednesday, March 23, 2011

IMMEDIATELY AFTER SURGERY

--After your surgery, you will be transported to the Post Anesthesia Care Unit (PACU), located in the surgical area. A nurse will monitor your heart rate, blood pressure and oxygen saturation. If needed, your nurse will give you pain and nausea medication that is injected directly into your IV (intravenous) line. Every effort will be made to make you as comfortable as possible.

--You will have oxygen either by mask or nasal cannula. You will have air stockings on your feet or legs that will inflate and deflate at alternate times to prevent blood clots.

--From the PACU, you will be taken to your room in the ICU (over night) or directly to the medical-surgical floor (depending on your past medical history, and what your surgeon feels is the best setting for you). You and your family member will be oriented to your room and the ward.

--While in the hospital it is very important to perform your breathing exercises using the incentive spirometer 10 times every hour while awake. BRING your favorite pillow to splint your abdomen when performing breathing exercises.


 

Tuesday, March 22, 2011

DAY AFTER SURGERY

 You will have a swallow study to ensure there is no leak.
 The first sips will be small sips of water, in 30cc medicine cups.
 Record your fluid intake while you are in the hospital, this will help get into the habit of recording your intake at home.
 Once you can tolerate water, you can have clear liquid such as broth, unsweetened gelatin, popsicles. Drink the liquids slowly so you don't put pressure on the new opening of your stomach pouch.
 Once you have tolerated the clear liquid diet, the next step will be to advance you to a full liquid diet prior to going home.

 

Morning of Surgery

You will report to the Same Day Surgery ward, located on the second floor, Ward 2B.

You will be greeted by one of the nursing staff, and checked in. A nurse will review your history and answer any questions you might have. You will then have your arm band placed for identification purposes and change into a gown. During this time all valuables should be given to a family member. You will remain here until it is time for you to report to the surgical holding area.

Remember: If you are on CPAP you must bring your machine with you for use during your time in the hospital.

You will then report to the surgical holding area where you will again be checked in and the nurse will review your history. You will have an intravenous catheter (IV) inserted. You will be given antibiotics (to prevent infection) and Heparin (to prevent blood clots). These may be given after you are under anesthesia. You will be visited by the Anesthesiologist and Surgeon and any remaining questions will be answered.

When you go to the surgical suite, your family will be taken to the waiting room located outside surgery. There are restrooms, phones and a television available. Immediately after your operation, your surgeon will come to the waiting room to talk with your family or significant others. During surgery, a nurse will keep your family informed of progress.

Once in the surgical suite, Anesthesia will put you to sleep, and then intubate you (place the breathing tube). General anesthesia will be used. Your pre-operative antibiotics and Heparin may be given now. You will then be prepped, draped, and then your surgery will begin.


 

Friday, March 18, 2011

Support Group Daytime today

Come out and join us for the Daytime Support Group
At the General Surgery/Bariatric Clinic (WHMC) on Lackland AFB

11:30am to12:30pm (1130-1230)

No appointment needed - just show up!

No need to check in at counter, just have a seat in the waiting room and one the Clinic Nurse/Technicians will come out and call attendees to the conference room at 11:30.
**Reminder each patient must attend one meeting before surgery

Topic is selected and presented by the clinic Nurses'

Questions call (210) 292-4303 during duty hours

Tuesday, March 15, 2011

When you have completed the Pre Surgery Checklist

Call the clinic @ 210-292-4303, to let us know that you have completed the required testing.

--Please DO NOT call the clinic after each individual test is completed.

--We will gather all of your test results together so that the surgeon can review them as a completed set, not in increments.

--If any further testing is required; the bariatric clinic will order that testing and notify you.

--If no more testing is required you will then be placed on our waiting list in order of your last testing date.

--Your chart will be reviewed by the surgeons and you will be called in 2-4 weeks for a pre-operative appointment and surgery date.

--Approximately 2-3 weeks before your surgery, you will receive a call from the Bariatric Clinic. This is to notify you of a tentative surgery date. You will be asked to accept or decline the surgery date. *Note* that if you cancel on your accepted surgery date twice you will go to the bottom of the list.

--If you accept, you will then be given a Thursday morning pre-operative appointment. This is an all day appointment. Please schedule your time accordingly.

--At the pre-operative appointment, you will have a physical exam and speak with your surgeon. Also meet with a nurse to discuss: 2 week pre-operative diet, bowel prep, post-operative instructions and follow up appointments (2 week, 1,3,6 month). Pre-operative tests are ordered (EKG, chest xray, labs). You will also likely have your Anesthesia appointment this day in the afternoon.

****PLEASE UNDERSTAND****

JUST BECAUSE YOU HAVE ENTERED OUR PROGRAM DOES NOT GUARANTEE THAT YOU WILL HAVE BARIATRIC SURGERY.

If you are deemed as poor candidate for surgery we will contact you as soon as possible. Our surgeons make the final decisions.

THIS IS A MILITARY FACILITY AND SURGERY DATES ARE CONTINGENT UPON MILITARY DEPLOYMENTS AND COMMITMENTS.

Waiting time may vary from 2 months to 8 months. This is an elective surgery and can be cancelled at any time. Be assured that if your surgery is cancelled, it will be rescheduled for first available O.R. slot.

--There are NO urgent or emergent gastric bypass surgeries performed at this facility.

 
 

****PLEASE BE AWARE****

If you decline or cancel two surgery dates for any reason other than a emergency or illness, your record will be placed in the back and will be reconsidered after all other patients have been cared for.

Our O.R. time is limited and we need to be able to make good use of that time.

 
 

Monday, March 14, 2011

Motivational quote

Feeling healthy and feeling good about yourself is not a luxury - it's an absolute necessity.

Monday, March 7, 2011

Thursday, March 3, 2011

Support Group Tonight

Come out and join us for the Evening Support Group
At the Gateway Club on Lackland AFB

6:30pm to 8:00pm (1830-2000)

No appointment needed - just show up!
**Reminder each patient must attend one meeting before surgery

Many pre and post surgical patients attend
Bariatric Surgeons will be there

Directions to Gateway Club
Enter Lackland AFB at Main gate (Visitor Center) off Military Dr
Go straight from gate to stop sign club will be catty-corner to you
Questions call (210) 292-4303 during duty hours