Gastric Bypass Surgery Support Group

I thought it would be useful to draw up a list of FAQ's, for people who are thinking about having the Gastric Bypass surgery, or currently waiting to have surgery. It is worth noting that the answers provided in these FAQ's are a collaboration of my own and other members' experiences, gathered from the forum posts on this site. EVERYONE is different, and your own personal experience may be different - if so, please let me know, and I will add your comments/FAQ points to this list

If you can think of any other common questions I have not covered, please message them to me, and I will add them to this list.

1/ How long does it take to be approved for surgery?

This depends on where you live, and who your surgeon is, and what country you're in.

In the UK, and British Isles, the funding and the cost of surgery is very high, and every PCT (Primary Care Trust) has a limited budget to spend on these surgeries. Sometimes, it's a postcode lottery, and it depends where you live, and how pushy your consultant is.

I had to wait close to 10 years for mine, as I was in the wrong area, but luckilly for me, it did give me chance to lose weight before surgery, and also address other issues. Others had consultations in September and the surgery was April, so less than 7 months.

I know in America, it comes down to insurances, and I will be honest, I don't really know a lot about how it works. I am hoping another, kind member who has experience of this can write something for me to insert here, to help others in America on insurance to know how long to expect to wait!

2/ What is a pre surgery diet?

This will differ, depending on surgeon and country. Personally, I had to follow a strict 2 week pre surgery diet, although other patients in the UK assigned to different hospitals only had to follow it for 1 week. I have heard patients in America only being told to go on it for 3 or 4 days. So, it will differ, depending on location and hospital.

As a general rule, if you have a 'keyhole' surgery RNY, the aim is to reduce the size of the liver. This organ lays pretty much over where the surgeon needs to work, and if it is damaged in any way, it cannot be repaired, and would need to be transplanted. Because of this danger, most surgeons require you to go onto a special diet, which will reduce the size of the liver, removing this risk.

When it comes to what you're allowed, again, it differs. On my diet, I had 2 weeks of only being allowed, water, sugar free ice pops, clear soups and gravy in a mug. That's all I was allowed, in whatever quantity I wanted. Some hospitals will allow you to have something like small cereal for breakfast, 1 slice of toast lunch, small piece of meat or fish with 2 tablespoons of veg for dinner and that's it!

Your hospital will advise on what your surgeon is requesting, my advice is to follow this strictly. On my surgery day, all 4 of us 'had' surgery, although 1 lady woke up from surgery to be told it couldn't be carried out as her liver was too enlarged. Don't be in that % of being dissapointed for the sake of a few days diet!

3/ What should I take in to hospital with me?

I would suggest you take some things into hospital that will help you pass some time. Usually, from early evening the night before surgery, you are 'nil by mouth' so you cannot have anything to eat or drink. In my personal case, my surgery was not until 3pm, so that was a long time to wait without having anything at all.

Take some PJ's and a change of clothing, usually, you will be given a gown to change into for surgery anyway. A few magazines, a book and/or a game (DS etc) would pass some of the boredom as well. I was quite lucky, and was allowed to take my laptop into hospital with me, check with your consultant to see if you can or not. Passing a few hours online was quite good for me, to take my mind off things, and be able to talk to my family, who were unable to fly to the UK with me.

Also, don't forget to take your usual medications with you, as you will still be able to take most of the before surgery. And take some peppermint tea bags with you, just in case! More on that next!

You should allow yourself to be in hospital for a couple of days after surgery. If you have open surgery, usually, you are kept in a day or so longer, due to increase risk of infection. As a guide, I was in Thursday night, surgery was Friday, I was allowed home 12 noon on Sunday

4/ Is there much pain after surgery?

This is dependent on a lot of different factors, which surgery you have (open or Keyhole) and if there are any complications during surgery. Generally, you do not have a lot of pain after surgery, you may feel sore, and you might ache a little. You will have a little pain if you're unfortunate and require a drain to be installed, which usually is there for the first evening and day after surgery.

We were given mild pain relief and that was enough. Sometimes the pain is a little more, and usually, you are given a morphine injection which will last several hours. On my ward, 1 patient was given a shot of that, but didn't need it again after that.

Most of any pain or discomfort you will endure is from gas, if you have the keyhole surgery. They need to inflate your tummy with air, in order to see what they're doing, and some of that gas is 'trapped' inside when they have finished and seal up the entry points. I won't lie to you, it's isn't very nice, and it's more uncomfortable that painful. You will sadly not be able to resist releasing this gas over the evening and partly into the next day, but to reassure you, everyone is in the same position, so you will not feel embarrassed about it at all.

5/ What can I expect for the first 24/48 hours after surgery?

Following surgery, you will be hooked up to a fluid drip. Expect to be on this drip for at least 24 hours. This is the main source of your fluids at this point. You will be given ice cubes or chips of ice for the first evening, and not be allowed to drink usually, depending on your hospital and surgeon.

When ready, you will be given small amounts of water, and I mean small! In my case, 10ml, which is 2 teaspoons of water an hour! If you manage to keep this down, you will get 20ml, then 30ml. As long as you keep this down, you will be placed on unlimited fluids, and you get your water jug back! I can tell you, this moment is heaven.

Eventually, you will be given a small pot of low fat/non fat yogurt, or something similar, to see if you manage to keep it down. In the hospital I was in, this was the test on if you were to be allowed home or not. If you didn't manage to keep it down, you were told you would be in hospital an extra day. If you did, you were told you could go home the next day.

You will be taken to Radiology at some point, and given a really horrible, thick, sweet, metalic tasting small cup of liquid, and told to drink mouthfulls of it and swallow at certain times, while standing in front of an x-ray machine. This liquid shows up on x-rays, and is checking to make sure you have no leaks or problems with the surgery. The process takes around 20 minutes, and usually, you're asked to wait for 20 minutes and then go back, to make sure it's progressing down your tummy as it should.

Sorry again to be crude, but I prefer honesty than not. The liquid we were given, when you go to the bathroom, anything that comes out, usually is black, grey or green. Don't be alarmed, it's quite normal.

6/ How long will I be off work for?

It depends on how your surgery goes, and what advice your surgeon gives you. The standard advice is usually to stay off work for around 5 days after surgery, so if your surgery was on a Monday, you would usually be allowed to return to work the following Monday.

This is not a standard time scale though, and be prepared to be off a little longer if required. Usually, there are no complications, the pain is mild and goes in a day or so, and going back to work can actually be a good thing, as you will be distracted from anything around you, taking your mind off things. Obviously, you are limited to what you're allowed to do, sitting behind a desk would be usually ok, but if your job is more physical, expect to be light duties for a while

7/ Can I eat normally after surgery?

Simple answer to this is, no you can't. You will be on a very limited diet immediately after surgery, that won't contain any solid food at all. You basically will be going back to food you ate as a baby, literally, that thin.

Every hospital and dietician has different plans and advice on what you should do through stages 1 to 4 after surgery, and I cannot possibly list all the variables possible.

You should expect to have a liquid only stage, lasting between 2 weeks and a month, then a more solid stage, and then gradually increasing from there. You should follow the plans to the letter, and the best advice I personally can give you is DO NOT RUSH

Stick to the advice, and if you try more solid food, and you're sick or it doesn't feel good, then go back to the liquid diet for a few days, and try again later. There is no rush, and no prize for trying to race through the stages. Trust me, you will pay if you try and go too fast

Being sick can be a problem after surgery, and sadly, there's not much escaping it. If you try and rush the stages, you will definitely be sick more often than those who take their time and stick to the advice they were given. Again, it differs depending on patient. I was sick over 130 times in 8 weeks, other patients who I have kept in touch with, only a handful. I tried to rush, they didn't. So, it's quite clear the more patient you are, usually, the less sick you will be

8/ What will I be able to eat after surgery?

After surgery, as you follow the stages, you will find that most of the food you like, know and love will be re-introduced into your diet, albiet in smaller amounts and sometimes blended. You should be able to eat pretty much anything in the following months after surgery, although, there are some foods such as red meat, pasta, rice, bread, fruit and fried foods that can sometimes be a problem. You need to accept that certain foods won't be tollerated for the rest of your life.

We're all different, and you will find that after surgery, you may not for example be able to eat ground mince, while someone else who had surgery the same day can eat cottage pie with no problems. It's always the case that some will tollerate foods where others can't.

Try and keep in mind that usually, the foods you will have problems with are probably the foods that helped cause the weight issue to begin with, so it's probably not a bad thing to abstain from these foods.

9/ How fast will I lose weight?

The average statement is that you can expect to lose around 70% of your excess weight within the first 12 to 18 months. That's average. Some lose less, some more. Some stop losing after around a year, and it becomes harder. Others will keep losing for 2 years, and then slowly start to plateau. It all depends on you.

If you try and 'cheat', and by that, I mean if you try and still eat high fat, fried food, after surgery, you will not lose as much as possible. If you do cheat, try and remember why you had the surgery done in the first place, is it worth going through all this pain, uncomfortable and stress for the sake of not sticking to the diets when you come out.

If you lose a few pounds each week, you're on track. My advice is, ditch the scales. You will be asked to regular follow up, let them weigh you, and let them let you know how you're doing. It means it's the same scale weighing you all the time, and you can't go far wrong then.

Try to remember as well that this surgery is not just going to work best on it's own, you need to change your lifestyle as well. Maybe it was hard to exercise and walk when overweight, but as the weight comes off, it should make it easier for you to start thinking about doing more movement and exercise that possibly you couldn't do before. Remember that it's not just a physical change, but a mental change as well.

I was quite mentally acceptant that I couldn't do things, and knew my limitations, and it's a hard habit to break when you realise that now, after losing weight, maybe it IS possible to do somethings, and you're not quite as disabled as you once were.

Your consultant will advise you on what you should and shouldn't do, and what you can safely do, and when. So listen to them. But a little extra walking, parking the car a little farther away from the store, and walking there, it all adds up to extra weight loss. And keep in mind, any weight you lose, it can't go back on, ever! What more motivation do you need?

10/ What aftercare can I expect?

This will depend on hospital and where you live. In the UK, we have a 2 years aftercare programme, which is a consultation appointment every 6-8 weels, and usually, blood tests done at least every 6 months, if not more.

Your iron and nutrient levels will be checked regular, as will your blood pressure and blood counts.

I have been told that some hospitals do not ask you back so regular, and rather have 3 months rather than 6 week appointments. You should still be assigned a dietician, who can advise you on problems, as and when you encounter them. Never be scared to ask!

11/ Some of the advantages and drawbacks of surgery

Advantages - You lose weight, other health issues usually improve, you find it easier to walk and live your life, new doors will open up for you, buying clothes becomes fun, you adapt a style you never ever had before, confidence increases, your life no longer revolves around food, you save money on your food shopping bill =]

Drawbacks - It's not an easy option, the first few months can be hard, you miss your favourite foods that you once loved, you miss red meats and pasta and some fried foods, depression sometimes kicks in, you feel isolated and lonely, loved ones can get jealous of your new attention, going out for a meal is not longer the same way it always was, you're contantly saying the line in answer to a question '..no, I am not getting anything removed, it's not a band I have had, it's the bypass'

Insurance in the US

My Experience:

I was told two means of having the surgery in the US.I was told it depended upon which insurance you had.

1. Go with an approved medically supervised programs-- (about 6 months of monthly exams-MD, nutrionist, mental health, exercise--all documented and sent over to the surgeon who will be doing the surgery

2. Same as above, but a 3 month program (this will depend on your insurance company)

Of course the insurance needed a weight history of a year, but this was easily obtained from my MD that I have for family care.

I started my procedure for lapband in early August 2009.My goal was to have everything completed and surgery done late in December. There were hangups and hiccups from the one facility I went to and I became quite agitated. I was on a deadline for insurance purposes as my insurance was changing Jan. 1. The paperwork was not approved however until January, so I went through the holidays complaining to those who would listen and ate whatever I wanted (I don't recommend this however).

I get the approval letter from the insurance company in early-Mid January. About a week after this, I received noticifation of surgery date set for March 1, which I had to approve before they put me on the books. Don't just assume when they give you a surgery date that you show up. No.. you have much more to do to 'prepare' for surgery (liver shrinking diet, pre-op testing, etc.)I did contact the surgeon's office and ask if I could be moved up to sometime in February and they said no, the schedule was full, but that they would contact me if they had a cancellation. I doubt right now if I would move the surgery up, as I am mentally preparing for what I need to be doing as well as physically. I am getting all the mental help here with this group and my once a month class at the hospital for lapband/gastric procedure (whether you have had the surgery last month or 5 years ago.. all are welcome). Physically, I am ordering my protein powders by shopping around and pray I'm reading all feedback on each product and I will not be disappointed. I just know for me, I need to have these things on hand so as I will have control of what goes into my mouth after surgery. Who wants to burden other family members to go on a search for these items, when I have the time now to order and sit and wait. Besides, I'm on a budget and when I order a cannister of protein shake mix, I am subtracting this amount from my weekly grocery money.

Note: Since I did not have the surgery done in December, I had to re-think finances as well. Before the change in insurance, I would have had to pay zero, but much much more for the fills comes January and for each additional fill. Due to this cost, I have chosen gastric bypass.

Thank you so much for adding that =]

you just have to check with your insurance (what they require). mine only needed me to be in a specific range of bmi. as soon as i got insurance, i made my appt with surgeon. the surgeon had several clearances i had to acchieve, but from my initial appt on nov 4, it took about 3 mos (surg will be feb 1).

I can answer the insurance question. It really depends on what insurance you have. Some insurances can require up to 2 years for a doctor's supervised diet before they will consider you, while others require that see a dietician for a period of time (which in most cases they will not pay for) but it is absolutely not impossible. If you want it bad enough you will be willing to do whatever it takes. Remember dont ever give up trying I had to go through it twice. Best of luck to everyone.

Of course you have to have requirements to meet the surgery. I was assuming all who have come this far in the chat knew this.

Aetna. I had to have bmi over 35, have a chronic problem, have tried to lose weight on my own and show a history of mild weight loss or a weight gain from primary care doctor.

I had all these and then a few added on for good measure.

This was on my form from the surgeons office:

AETNA. Letter of Support. Yes to include weight history for past 2 years, meds perscribed to assist weight loss & Length of time patient has been morbidly obese.

Nutrition Eval> YES

PSYCH Eval> YES

MED. Supervised Diet & Exercise>YES - 6 months continuous within the past 2 years

Significant Co-Morbid Condidions> 2 co-morbidities

LAPBAND Adjustment Requirements> Need referral on file from PCP if your policy requires referrals. Otherwise no pre-cert is needed.

There are 24 other insurance carrier/providers listed on this sheet. If anyone is looking for a certain insurance requirement, I can help to a certain degree.

But I think calling your insurance would be the wisest thing to do as typing all this stuff in would take up 4 pages.

Well, I can chime in now. I came home from the hospital on May 19th. My surgery was May 17th. Back in April I weighed as much as 345 [after eating that "last meal at Outback Steakhouse"]

My Primary Doctor's wife had the surgery. So he knew that I would need 6 months of diet and nutrition counseling. He kept notes of my regular monthly visits about my weight, height, and BMI.

My surgeon was top notch. They told me what to do from start to finish. It all began with a meeting at the hospital. There were maybe 30 people their who wanted to find out more about the surgery. Then I had a meeting with the "insurance assistant" and the surgeon. I was told that I needed a stress test [I'm 60 and just had some heart issues due to lyme disease]a psychologist to sign off for me and some blood tests. After the meeting with the surgeon and the "insurance assistant" I called my insurance company to make sure that was all I needed. They agreed that it was.

After getting all the required work ups my surgery was scheduled and I had to meet with a hospital nutritionist. She gave me a lot of samples from a couple of companies and told me what to eat and what not to eat before surgery. She went over a list of foods I'm supposed to eat this week. Mostly clear liquids.

After that I was required to go through some training on what would happen day of and three days after surgery. I listened and took notes. They passed out a list of things to buy. Yes... we were told "we are not the hilton. Will provide some stuff for you to use but you should bring the items on this list",

I bought the little travel pack of shampoo, deodorant, conditioner, and mouth wash. I bought a new robe [that will be way to big in six months] but I only spent $12.00 at KMart. I found my battery operated personal fan and replaced the batteries.

Finally.... the day came and I went to surgery. It went exactly as explained. I woke in the recovery room and was transported to ICU because my family has HM all over the place so I needed to be watched carefully.

I was treated great. Every nurse, doctor, resident, and tech was brilliant. They monitored everything and there was minimal pain because they taped the pain medication button right to the top of my gown so I could always find it. It was great. I told them all they did excellent.

The following night I was moved to a room on the surgery ward. Well... that's when things went downhill. I hadn't been out of bed in ICU... it was midnight and I had to go to the bathroom. I pushed the button for the nurse they answered.... I waited and waited... 10 minutes.... ok maybe I can do it myself... I unplugged the IV machine form the wall.... because it wouldn't go into the bathroom while plugged.... then I made it into the bathroom... started to pee and the nurse barged into the bathroom... like she didn't get word I had to go to the bathroom and didn't know if I could make it.... I had obviously not only made it.... I was peeing... she wanted to watch... OMG!!!!

The resident in charge of my case... came in again and explained the process of ice chips to drink to shake. She incouraged me to walk as much as possible as soon as I could start. She said she'd be back to see me.

The next morning the only time I saw the nurse was when she came in to give me 1 oz containers of kool aid... the tech brought me ice chips, took my temp and blood pressure. I was anxious to get walking so I could put on my robe and use all my little items... then about noon I told the tech how I was now aware that I would not be using those items I had spent my money on.... she went to the nurse.

Nurse Millie came in on a refined rampage... how dare I complain about her... what in particular did I want from her? That afternoon she brought in 4 one ounce containers and poured ensure in them... "drink these over the next hour and you can go home".... Boy! I did... gladly...

Dr. Brown came in at the end of the day and my husband picked me up at 8PM....

Today I feel awesome. I've been home a couple of days with my new pouch. I got on the Wii yesterday and I weighed in at 308! I'm about to go out for a little walk with my mp3 player and a bottle of water... the vitamins have to be crushed... the food doesn't smell so tempting now [I'd love a ritz cracker but I know it's not time yet] and I love gelatine desserts!!!! I'll be back later to update for you!

according to the Wii I'm down to 302 today

I am less than a week from surgery, but I'll add my pre-surgery experience here.

I first went to an informational seminar in October of 2010. They told me my insurance required a 6 month waiting period before the surgery. I was pretty upset by this as I was ready for it to happen within the month. The only thing that happened in the next month was a meeting with the surgeon. Then the tests began. I honestly wondered if they were just doing every possible test on me just to bill my insurance company.

I had to have a sleep apnea study. That required an overnight stay in a 'hotel' type room with about 50 wires hooked up to my head, arms, chest, and legs. A microphone taped on my neck, and with the wires less than 2 feet of movement in any direction because of all of the attached wires. All night the wires record heart rate, oxygen rate, brain waves, stage of sleep, snoring, breathing etc while a technician observes you all night long, how often you move, how you sleep, etc. Once during the night I had to go to the bathroom and had to just yell out "I need to go to the bathroom." The tech came in, unhooked the wires from a machine and I had to hold the wires while using the bathroom. I went back to sleep and then I was woken up and told that I needed to sleep on my back and not on my side (which is how I normally sleep) Needless to say I woke up feeling very unrested. A few weeks later I got a letter saying I had severe sleep apnea and that I had to return for another night in the sleep study center with a breathing device (CPAP) That night involved all the same wires, monitors, microphone, etc, but also involved a contraption on my head to provide a positive air flow throughout the night. At one point I apparently started breathing through my mouth and they came in and put a velcro strap around my head to keep my mouth from opening.

Then came the other tests. They did an ultrasound on my kidneys and found a very small cyst. So I had to see a kidney specialist, then he did an MRI. After that I was told the cyst was very small and causing no problems and probably never would.

Then they did an EKG on my heart, then an echocardiogram on my heart. No problems

Then they did an EEG on my brain, and then put me through an hour long brain test where they wanted me to sleep for 20 minutes, kept flashing lights while my eyes were closed, etc.

Then because of my chronic pain, I had to go through a medical consult meeting with a doctor, anesthesiologist, and a nurse. They all asked questions.

Every time I saw the doctors for one kind of appointment or the other there were blood and/or urine tests. I had to do a 24 hour urine sample to make sure that I didn't have any indicators of diabetes.

Then I had an appointment with the surgeon again. This seemed to be mostly a requirement kind of appointment where they make sure you know what kind of surgery you're getting, what it's going to change inside your body, how it's going to change your life and eating habits and then about how much weight I could expect to lose. The doctor told me he usually sees patients lose about 1/3 of their body weight.

Then I had an appointment with the bariatric surgery prep nurse.

Then I had an appointment with the nutritionist who told me I had to go on a 2 week, 1000 calorie per day diet to reduce my stomach capacity and reduce the size of my liver.

Then I had an appointment with the Anesthesia department to discuss how they were going to knock me out, what medicines I could take, what not to take between then and surgery and the day of surgery.

So it's been 9 months since I first attended the informational session until my surgery date. Since that informational meeting, I have had at least 60 different times that I have had to go to one kind of doctor or another, have all kinds of assessments and tests, and numerous lab tests. In the past 9 months, I have honestly spent over $600 in parking charges for doctor appointments and tests. It's very frustrating and seems like it will never end. Then after the doctor put me down to schedule my surgery, they did more blood work and one of my blood levels was slightly elevated. That put everything on hold. Finally my primary care doctor had to write a letter stating that this slightly elevated blood level would not cause any problems and I could proceed with the surgery. Then they finally put me on the schedule.

It's a long process. It takes a lot of effort. It takes a strong commitment to continue to go through test after test. It also involves a substantial level of frustration.

I've prepared myself for the after surgery with buying several containers of high potency whey protein powder as well as fiber supplements. I've also had to buy a pill crusher. I bought a role of wax paper also..if any of you remember BC powders, that's the purpose of the wax paper. Cut a 1inch x 3 inch rectangle of wax paper, crush my medication, fold the wax paper length way in half, put the crushed medicine/powder into the fold of the wax paper so that I can pour the crushed medicine all the way down my throat in the back of my mouth and it doesn't have to go on my tongue or taste buds.

The last thing I want to happen is for me to have internal stitches and external stitches and me start gagging from the taste of medications. As we all know gagging involves a reflex throughout most of the body and not just something in your mouth and throat. So I don't want to gag and heave and bust open any stitches (inside or out).

As I said in the beginning, I thought 6 months was going to take forever before the surgery. Now after 9 months, everything is on "GO" for now. I know several local newscasters. One station is loosely monitoring my pre-surgery life and requirements and wants to do a post surgery interview and then interviews at 3 months, 6 months and 1 year. When one of my friends first approached me with the story concept I was rather leery. However, after we agreed that my name would not be used and there would be no facial photography done until the 1 year interview(the final one) I agreed. I'm an educator so I thought it might be a way to help others. Additionally I thought, if the doctor knows the media is following my progress, he's likely to pay more attention to what he's doing and maybe not screw things up. (hopefully, anyway)

That's my story so far. After the surgery, I'll come back and update this post as things progress. Thoughts and prayers are appreciated.