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Pre-op Weight Loss

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Pre-op weight loss can be essential to reducing the risk of bariatric surgery.  Therefore we set some goals for most patients at your initial consultation.  These goals are higher in patients with a higher body mass index.

Below you can see our typical pre-op weight loss goals to see where you will likely fall.  However in some cases there will be custom goals that are set that can differ from these guidelines.

 

BMI

30-45

Primary Weight Loss Goal

  • Maintain initial consult weight until pre-op/consent visit.

Secondary/Pre-op Diet Weight Loss Goal

  • Lose some weight.
45.1-50
  • Lose 5 pounds from initial consult weight to pre-op/consent visit.
  • Appetite suppressant optional.
  • Lose 5% of TBW from initial consult weight to surgery.
  • Appetite suppressant optional.
50.1-55
  • Lose 10 pounds from initial consult weight to pre-op/consent visit.
  • Appetite suppressant recommended.
  • Lose 8% of TBW from initial consult weight to surgery.
  • Appetite suppressant recommended.
55.1-60
  • Lose 5% of TBW from initial consult weight prior to scheduling a surgery date.
  • Appetite suppressant recommended.
  • Male: Lose 10% of TBW from initial consult weight to surgery or achieve a BMI of 55, whichever is the lower weight.
  • Female: Lose 10% of TBW from initial consult weight to surgery.
  • Appetite suppressant recommended.
60.1-65
  • Lose 5% of TBW from initial consult weight prior to scheduling a surgery date.
  • Appetite suppressant recommended.
  • Male: Lose 10% of TBW from initial consult weight to surgery, or achieve a BMI of 55 to qualify for surgery at JourneyLite.
  • Female: Lose 10% of TBW from initial consult weight to surgery or achieve a BMI of 55, whichever is lower weight.
  • Appetite suppressant recommended.
65.1+
  • Lose 10% of TBW from initial consult weight prior to scheduling a surgery date.
  • Appetite suppressant recommended.
  • Custom goal will be set.
  • Appetite suppressant recommended.

TBW = total body weight

5% of TBW: For example, in a 200 lb patient, 5% of 200 lb = 10 lbs

10% of TBW: For example, in a 300 lb patient, 10% of 300 = 30 lbs

 

JourneyLite and Transcarent, Inc Partner to Provide Lower Cost Weight Loss Surgery

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Transcarent, Inc home page screenshot

JourneyLite Surgery Center is pleased to announce that, effective October 1, 2022, we will be the regional provider for bariatric surgery services for Transcarent, Inc.

Transcarent describes their organization as “a health care experience company that makes it easy to get the high-quality, affordable health and care that everyone deserves. Transcarent puts consumers back in charge by directly connecting them with an integrated ecosystem of high-value providers and health solutions, transparent information, and trusted guidance in as little as 60 seconds, 24/7/365, from the palm of their hand, often at no cost to Members and at a lower cost to their employer.”

Transcarent and other companies facilitate “Employer Directed Healthcare” programs.  This helps large employers reduce healthcare costs for both the company and its employees by contracting with specialty facilities in various medical fields.  These facilities often focus on one particular area, such as weight loss or orthopedic surgery, and tend to have higher case volumes and lower complication rates.

Several major regional employers in Ohio, Kentucky, and Indiana have chosen the Transcarent network to increase quality of care and access in the field of bariatric surgery.  These include: 

The Transcarent network of providers will greatly increase access to care for much-needed weight loss surgery services, with lower (or no) out-of-pocket costs.

JourneyLite will continue to seek out new employer-directed health networks to continue to lower the significant barrier that patients frequently face when seeking out life-saving bariatric surgery.

 

Crushing Medications After Weight Loss Surgery-Should I or Shouldn’t I?

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As a rule we recommend against crushing medications after weight loss surgery.  There are some larger pills, however, that can be difficult to get down in the early days when there is still some swelling present.  There are many medications, however, that should NOT be crushed under any circumstances.  Generally speaking, these are extended release medications that have a special coating to cause the drug to be released slowly over a period of time.  Probably the most common medication like this is Prilosec.  If you crush it, the coating is destroyed and the medication will be absorbed all at once.  In the case of Prilosec, this would likely cause little harm, however this is not the case with all medications and in some instances life-threatening side effects could occur.

We always recommend checking with your pharmacist, however you can also refer to this fairly comprehensive list of medications that should not be crushed under any circumstance!

Do Not Crush These Meds!

weight loss medications

Incisional Pain After Gastric Bypass Surgery

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pain

Pain after surgery is expected, particularly with the gastric bypass. This is a bigger, more involved surgery than the sleeve! Setting realistic expectations after surgery is important–you should expect to have some pain after surgery. 

 

We always inject local anesthetic in each incision, however the effect of this is only temporary. This can make it seem like your pain is getting worse, but it’s actually just the numbing medicine wearing off.  

 

Most of the discomfort in the gastric bypass there is one incision on the far left side of your abdomen.  This will commonly cause complaints such as: sharp or intense pain, dull cramping pain, burning, tugging, and pulling sensations. These are sometimes worsened by movements, or certain positions and the pain is not always felt directly underneath this incision.   These types of symptoms are normal and expected after bypass surgery. 

 

This incision is necessary in order to safely complete the surgery. Because of the size and depth of this incision, a suture is placed through the deep muscle layers to help prevent a hernia. This suture is almost always the cause of the symptoms described above. This pain will commonly last for 3-6 weeks and perhaps longer in some situations. 

 

We always do our best to minimize the discomfort associated with this incision, but we cannot completely eliminate this pain all together. Patients will be prescribed a narcotic pain medication, a muscle relaxer, and a pill which helps with neuropathic (nerve) pain. In addition to the medications, we recommend using ice packs over the incisions, 20 minutes on and 20 minutes off several times per day. This will help with the inflammation. After 2-3 days you may get better relief with a heating pad as the pain becomes more muscular in nature. 

 

This same far left incision can also be prone to infection, as at the end of the procedure we pull a little piece of small intestine out through it.  This can sometimes contain bacteria which can lead to infection, despite the fact that we place it in a sterile pouch before pulling it out.  Some of the first signs of infection are: fever, swelling at the incision site, redness around the incision, or drainage at the incision )particularly yellow thick foul smelling drainage).  Occasionally a clear or pale-red drainage will be present–this does not necessarily mean there is an infection. If you have concerns with your incisions, please contact us to have your incisions evaluated by our staff! 

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How To Achieve Success After Weight Loss Surgery-The Three “M’s”

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By Dr. Trace Curry

Patients always want to know what they need to do to be successful after weight loss surgery, it’s one of the most common questions I’m asked.  In my experience treating thousands of patients over the past 20 years, it all boils down to the three M’s:

  • Motivation
  • Menu
  • Movement

Motivation

I listed motivation first as it is the key.  If you are not motivated to lose weight and improve your health, even the most powerful weight loss procedure will not work in the long run.  Weight loss surgery can be life saving, by reducing or eliminating current or future medical issues such as diabetes, heart disease, high blood pressure, and high cholesterol.  You must have the motivation to make permanent lifestyle changes that include the changes listed below.  It’s worth the effort!

If you feel like you motivation is fading, even if you are 10 years out from surgery, reach out to us so that we can bring you in to meet with the team and formulate a plan to get you back on track.

Menu

Menu is the second item in the list because if you are not eating the right types of foods, you simply cannot move enough to burn off the excess calories.   First off, you need to “get the white out” of your diet!  White food refers to foods that are white in color, meaning that they have been processed and refined.  Things includes things like table sugar, flour, pasta, rice, bread, crackers, and cereal.  Secondly, eliminate liquid calories from your diet.  Everything you drink after surgery, with rare exception, should be zero (or very low) calorie.

Keep in touch with our expert registered dietitians for suggestions on healthy substitutions for these items in your diet.

Movement

It’s very difficult to be sedentary and maintain your weight loss in the long run.  These operations frequently have enough power to provide significant short-term weight loss without exercising at all.  However, once you reach your nadir (your lowest weight achieved after surgery) if you are not active AND exercising you will regain weight.  In some cases you could regain all your weight, especially if your motivation and menus are lacking.  No matter what your physical condition is, you must start somewhere!  Everyone’s definition of exercise is a little different, so just pick something you can do and build on it from there.  I highly recommend getting a good fitness tracker so that you can make sure you are reaching your move goals and modifying them as your health improves.  I’m partial to the Apple Watch as it does a good job not only to encourage you to exercise, but also not to be sitting for the rest of the day!

If your mobility is significantly limited, check out these low-impact exercise options for overweight patients.

overweight person exercising

If you keep the 3 M’s in mind, you will be successful in your weight loss journey.  The sky is the limit!

Other Posts From Dr. Curry

  • Pre-op Weight Loss

    Pre-op weight loss can be essential to reducing the risk of bariatric surgery.  Therefore we set some goals for most patients at your initial consultation.  These goals are higher in patients with a higher body mass index. Below you can see our typical pre-op weight loss goals to see where you will likely fall.  However [...]
  • Transcarent, Inc home page screenshot

    JourneyLite and Transcarent, Inc Partner to Provide Lower Cost Weight Loss Surgery

    JourneyLite Surgery Center is pleased to announce that, effective October 1, 2022, we will be the regional provider for bariatric surgery services for Transcarent, Inc. Transcarent describes their organization as “a health care experience company that makes it easy to get the high-quality, affordable health and care that everyone deserves. Transcarent puts consumers back in [...]
  • weight loss medications

    Crushing Medications After Weight Loss Surgery-Should I or Shouldn’t I?

    As a rule we recommend against crushing medications after weight loss surgery.  There are some larger pills, however, that can be difficult to get down in the early days when there is still some swelling present.  There are many medications, however, that should NOT be crushed under any circumstances.  Generally speaking, these are extended release [...]
  • pain

    Incisional Pain After Gastric Bypass Surgery

    Pain after surgery is expected, particularly with the gastric bypass. This is a bigger, more involved surgery than the sleeve! Setting realistic expectations after surgery is important–you should expect to have some pain after surgery.    We always inject local anesthetic in each incision, however the effect of this is only temporary. This can make [...]
  • overweight person exercising

    Low-Impact Exercise For Overweight Patients

    Movement is one of the critical keys to success after weight loss surgery. For some of our patients though, exercise (or even walking) can be a challenge.  Once the weight starts coming off however, patients will see a dramatic improvement in weight-bearing joint pain.  Even so, it's important to start some form of exercise as [...]

Gastric Sleeve

vertical sleeve gastrectomy

Gastric Bypass

gastric bypass anatomy

Low-Impact Exercise For Overweight Patients

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Movement is one of the critical keys to success after weight loss surgery. For some of our patients though, exercise (or even walking) can be a challenge.  Once the weight starts coming off however, patients will see a dramatic improvement in weight-bearing joint pain.  Even so, it’s important to start some form of exercise as soon as possible after surgery.  The definition of exercise can vary from patient to patient.  For some just walking out to get the mail and back can be very challenging.  Below are some very low-impact exercise routines that nearly any patient can do.  Just start off slow and start building your tolerance, even before surgery!

All of these workout routines require no special equipment and can be done at home!

Low Impact Exercise Routines For Overweight Patients

Also check out Joyn – it’s a free site with all sorts of options for patients with any kind of mobility issue. There is even have a section for chair exercises!

joyn icon

Breaking A Plateau After Weight Loss Surgery

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scaleBreaking a Weight Loss Plateau

Weight loss is a journey, and with that journey will come many struggles! A common discussion we have with patients is overcoming a stall or “plateau” in weight loss. Below are some tips to help break out of a weight loss plateau.

  • First of all, consider how far you have come!
    • Before you hit your plateau, you were most likely experiencing successful weight loss for quite some time.
    • Remember your non-scale victories! This can include feeling better, having more energy, clothes fitting better, being able to do things you haven’t been able to in a while, and feeling more confident! Success is not always measured by the amount of weight that you lose!
  • Work with a dietitian to reassess caloric needs.
    • Based on the amount of weight you have lost so far, your calorie needs may have changed and will need to be adjusted. This can include changing the amounts of protein, carbohydrates, and fat in the diet as well, which all contribute to calories in the diet.
    • Sometimes the timing of your meals will need to be adjusted rather than the amount of calories.
    • Adding variety into your diet can help add different nutrients into your diet and ramp up weight loss.
    • If you aren’t tracking food already, get back into it to see if any extra calories are sneaking into your diet somewhere.  Ideally, use our Healthtrac app so that our team has access to your data!
  • Ramp up your workout routine.
    • Increasing the amount or intensity of your workouts could help you break out of a weight loss plateau because it can:
      • Help you burn more calories.
      • Make you feel better mentally and physically.
      • Bring more structure into your day.
  • Weight loss isn’t only related to what you eat. Consider if there are other factors in your life affecting your ability to lose weight.
    • Lack of sleep, excessive stress, and mental health issues can cause the body to produce more cortisol, which can tell the body to store more fat.
    • Seek medical advice if these things are affecting your life.

We hope these tips help you to explore the cause of a weight loss plateau and find ways to remedy it. Remember: You are NOT a failure for falling into a stall with weight loss, you are doing the best you can!

“When you feel like quitting, think about why you started” ~ Anonymous

Diabetes, weight loss surgery, and SGLT2 inhibitors

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SGLT2 Inhibitors

Diabetes management is a rapidly-changing field.  It seems like every few days there is a new medication being advertised.  If you are a diabetic, it’s important to understand how to manage your medications before and after surgery.

SGLT2 (sodium-glucose transport protein 2) inhibitors are a new class of medications used to treat type 2 diabetes.  They are also known as “gliflozins.”  If you are on a medication and the generic name of it ends in “flozin” you are likely on an SGLT2 inhibitor.  They work by preventing the reabsorption of glucose from the blood that gets filtered by your kidneys, causing excess glucose to flow out in the urine.

It is recommended that these medications be stopped 5 days prior to surgery, and not to be resumed until a reasonable amount of calories are consumed on a daily basis.  This would typically be around 4 weeks post-operatively (unless instructed otherwise).

Current medications in this class include:

  • Invokana (canagliflozin)
  • Invokamet (canagliflozin and metformin)
  • Farxiga (dapagliflozin)
  • Xigduo XR (dapagliflozin and metformin)
  • Jardiance (empagliflozin)
  • Glyxambi (empagliflozin and linagliptin)
  • Steglatro (ertugliflozin)

If you are on one of these medications, please make sure you formulate a plan with your provider at your pre-op visit!

Negative Sleep Apnea Test

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sleep apnea

Among the variables measured during sleep testing, the AHI (apnea-hypopnea index) is one of the most important.  The AHI is the sum of the number of apneas (pauses in breathing) plus the number of hypopneas (episodes of shallow breathing) that occur each hour, on average.

In patients with an AHI below 10, the test is considered negative (or normal) and no further treatment or follow-up is required.

For any questions please call or text our office at 513-540-1207.

Moderate-to-Severe Sleep Apnea

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sleep apnea

Among the variables measured during sleep testing, the AHI (apnea-hypopnea index) is one of the most important.  The AHI is the sum of the number of apneas (pauses in breathing) plus the number of hypopneas (episodes of shallow breathing) that occur each hour, on average.

In moderate or severe sleep apnea, the AHI is 15 or higher.  These patients will need to be treated with CPAP or some other type of device prior to surgery.

Our practice works with Cornerstone Medical to provide CPAP devices to patients with moderate-to-severe sleep apnea and help them get it set up.  They will contact the patient directly to make this arrangement.

If an order was sent to Cornerstone on your behalf and they do not contact you within the next 48 hours, please contact them at 888-594-0066.

Patients who are diagnosed with moderate-to-severe sleep apnea must use their CPAP devices as prescribed in order to proceed with surgery, otherwise anesthesiology will cancel the procedure!