Facilitator: Dustin Huff, PA-C
Dustin is Dr. Hamilton’s Physician Assistant, and assists Dr. Hamilton in all surgeries. He has worked with Dr. Hamilton for 4 years, and sees Dr. Hamilton’s patients post operatively. He graciously agreed to come to support group and answer any questions our support group members had. Below are the questions and answers.
- Is it normal to not have a normal menstrual cycle after surgery? Yes, there are a lot of changes that can occur after surgery due to the disruption in hormones after surgery. Some people have another cycle, some have a much heavier cycle due to the Lovenox, and some will have a delay. Your fatty tissue holds estrogen, so as you begin to lose weight, that estrogen is released and can cause a lot of changes over the next few months. That is normal, and we only worry if someone is having very heavy bleeding while still on Lovenox. They need to know about that, and may stop the Lovenox if someone is bleeding too heavily.
- How long do you need to be off estrogen/birth control before/after surgery? Generally, they like people off birth control pills 2 weeks before surgery and 30 days after surgery due to an increased risk of blood clots. For women who are taking estrogen (estradiol) for menopause, we would like to have patients off for the same time, but also do not want patients feeling too anxious if they become too symptomatic. In that case, you may restart your medication and just make sure you remain very hydrated and increase your mobility to prevent clots.
- Does pregnancy cause problems right after surgery? The first thing you need to do is have a meeting with the dietitian to ensure you are getting enough calories a day to feed both yourself and the baby. Then follow your weight with your OBGYN physician.
- When should I call the physician if I’m having trouble eating? If something is causing you to not be able to eat, you need to call the physician and be seen. It is always difficult to eat right after surgery, but once you get through the first month, if you find you cannot eat, do not just stay on liquids – call and be seen.
- Why do I have hiccups or pain after sleeve surgery? Both of those can be caused by eating too fast and eating a few bites too much. Food does not move down the esophagus into the stomach by gravity. It moves down through muscle contractions that push food on into the stomach. If you are eating too quickly, it gets backed up and can cause pain or painful hiccups. If you slow down your eating or stop eating a bit or two earlier, that should resolve.
- If you have had a bypass, it could also be an ulcer – when we do a bypass, the 2nd part of the small intestine, the jejunum, is brought up to the pouch. This part of the small intestine is not used to having any stomach/digestive acids on it. If you eat too fast or too much, the acid in the stomach can get on that jejunum and cause burning and eventually an ulcer where it meets the stomach. You need to eat slowly and stop before you are too full.
- How much food should I be able to eat at once after healing? Your stomach should be completely healed at 8 weeks after surgery. You should be able to eat about ½ cup of food, or 4 oz., of protein at a time.
- Why do I have reflux after stopping my omeprazole after 8 weeks? It could be too much intra-abdominal pressure, which should resolve as you lose more weight. It is best to wean off the omeprazole rather than stopped it suddenly.
- Why do alcohol cause effects so quickly after surgery? Alcohol is the only thing we take in that is absorbed in the stomach. Food gets absorbed in the intestines. Since you are not drinking with eating, you are drinking on an empty stomach, and get immediate absorption.
- How can you tell the difference between and ulcer and stricture? Both will have about the same symptoms – they will hurt and you will feel a “stuck” feeling every time you eat. We treat an ulcer with medication. We treat a stricture with dilation during an EGD. Because we always want to do the least invasive procedure, we will treat the symptoms medically for 2 weeks. If that doesn’t resolve it, then we will do an EGD to see if it is a stricture and dilate it. Frequently we have to do at least 2 dilations to completely resolve a stricture.
- When can I take ibuprofen (Advil) after surgery? We don’t want you to take ANY for at least 8 weeks after surgery. Then you can take an occasional one with food. If, however, you need to take them routinely, you will need to take omeprazole twice a day. You take omeprazole for 8 weeks after surgery to keep acid off the staple lines. Once they are healed, you still need to protect the stomach by not taking large amounts of non-steroidal anti-inflammatory medications, such as ibuprofen.
- Why is there so much swelling after surgery? You will feel a pressure in the center of your chest, which is normal reaction to the surgery. When we do the sleeve surgery, we place a long, snake-like rubber tube down through your mouth into the stomach, and we use that to know how big to make your sleeve. We always use a size 34Fr. Because the research shows that a 32 is too small for patients to eat enough, and a 36 is too big to get the best weight loss. We use a small balloon that is the size of a large egg to show us how big to make the pouch for bypass surgery. Because we are placing these into the stomach, there can be swelling which will get better every week.
- When they can fix an abdominal wall hernia? Abdominal wall hernias are where there is weakness in the abdominal muscle that allows some of the intestine to poke through, which is why you see a lump. The larger the hernia is, the less likely it is to kink off and cause a bowel obstruction. We want to wait until you have lost some weight in order to make the surgery easier. A hiatal hernia is where there is small hole in the diaphragm which allows a portion of the stomach to poke up into the chest. We always repair those type of hernias during surgery, as the surgery will not work well if you have a hiatal hernia.
- How will I take all the medications I’m on after surgery? You won’t be going home on nearly as many medications, and you won’t take them all at once.
- What should I do if my PCP doesn’t support my surgery? Call Dr. Saradih – he is also a PCP and takes care of a lot of our patients.
- When I can I go back to work after surgery? You should be off at least 1 week. You will be tired for a few weeks.
- Who should I have remove excess skin? Our surgeons will do an abdominoplasty (tummy tuck) for our patients once you have gotten down to your lowest weight. For other body parts, you need to go to a plastic surgeon.
- How long does it take to heal after tummy tuck? You will have 2 drains in place after a tummy tuck. We will remove 1 drain and half the staples after 1 week. We will remove the 2nd drain and the rest of the staples after 2 weeks. Then you can go back to work. The surgery takes about 1 ½ hours, and there are always 2 surgeons in the room, plus the PA.
- I have constipation – how often should I have a bowel movement? You probably won’t have a BM for the first week after surgery. Once you begin eating more, then if you feel constipated you can take Miralax every day until you have one. Once you begin eating more high fiber foods, which you don’t for 8 weeks, then you should eat more fiber. You must also get your water in every day. But Miralax is fine. If you are having very hard stool, use a suppository to get things started.
- I am moving to Texas – how do I find a doctor who understands the surgery down there? Call or email Chris, our coordinator, and she will find you one. (bovos@shawneemission.org) or call 913-676-8491,