Tag: My pathway

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Klinik Obezite

KO-E-039 My pathway after surgery

 

My journey after surgery

A new and healthy life waits for you

In the first 6 months, it is very important that you strictly follow the instructions of your health team. Your health team will prepare an after-surgery diet protocol, vitamin and mineral supplements, and a physical exercise program. Besides, you should make a few follow-up visits to your health specialists. The Get Ready application will provide all the information you will need during this short-term follow-up period.

Contact your health team.

If you have any concerns related to how to follow the after-surgery instructions, please do not hesitate to contact your health team. If you feel a need for psychological support or support from persons in a similar position, do not hesitate to contact relevant centers. Contact our bariatric clinic for further information. During the short-term follow-up, the Get Ready application will request that you fill out some questionnaires, which will help your health team serve you better.

You can instantly contact our team from the message section of this application you use.

In addition, the contact information of our team is as follows:

Ali Durmuş MD: +90 532 691 4994    

Coordination: Betül Yüksek: +90 505 120 8262   

Aesthetic Coordination: Hatice Dalaz : +90 555 877 1562

Dietitian İrem Yılmaz:  +90 532 700 1871 

Dietitian Göksu Asay: +90 538 081 4474 

Patient Consultant Duygu Tunç : +90 534 013 2000

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Klinik Obezite

KO-E-027 My weight loss care journey for the long run

Bariatric surgery will impact your daily life – for the rest of your life. You will always need to pursue a healthy lifestyle. 

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My weight-loss journey for the long term

Bariatric surgery will affect your daily life throughout the rest of your life. It is important that you maintain a healthy lifestyle.

  • “Honeymoon phase”

During the first months after your surgery, it may seem easy to follow the recommendations of your health team. You will not stay too much hungry, and you will eat in very small amounts. It may be challenging to meet your daily food intake requirements. You will be in close contact with your health team. During this period, your weight may seem to decrease rapidly and spontaneously. Many patients define the first year after surgery as the “honeymoon phase”.

Unfortunately, “honeymoon” does not last forever…

It may change toward the end of the first year. Usually, after the first year, the feeling of hunger returns to some degree, the volume of consumed food increases and you may find it difficult to stick to your program. Your diet is essential throughout your journey. However, some patients believe that completing the first year is more important. Following the diet recommended by your dietitian for the long term is very important for maintaining your weight loss for the rest of your life.

Here are a few tips to continue your journey while you are approaching the end of the first year:

Eat solid foods: Patients should eat softer foods after surgery, but you will experience a substantial change in the food amount you eat and your hunger intensity if you do not switch to solid foods. Juicy and crunchy foods transit more rapidly through your stomach and your hunger quickly returns back which leads you to eat more.

Limit carbohydrates: With time you can start adding carbohydrates in reasonable amounts to your diet. However, you should be very careful. Some patients add cereal for breakfast, whole grain pasta for lunch or brown rice for dinner. All are acceptable, but it is better to limit your carbohydrate intake to one meal per day.

Protein, protein, protein: Protein is the center of your diet and will always be. You should meet most of your protein needs (60-80 g per day for most individuals) by eating three protein-based meals every day. Eating solid protein is an effective way to meet your protein needs and be full for a long time.

Limit snacks: If you prefer snacks, make smart choices. Keep protein-based snacks (cheese sticks, a bowl of yoghurt or nuts) and do not keep unhealthy snacks at home. This will satisfy you and prevent you from overeating until the next meal.

Keep an eating diary: When you take notes about what you eat, you will become more aware of what you are eating. It is very easy to eat a few bites of snacks at the workplace, take a bite from your child’s dinner plate, and eat cookies at a social event. You will never remember these if you do not take notes about them. If you feel challenged, start keeping a diary. You will see that you can rapidly identify what you need to improve.

Plan your meals: Planning your weekly meals may help you to control what you are eating and the ingredients you are using to prepare your meals. In busy times, keeping a diary may help you to avoid high-calorie foods that slow your weight loss process.

Drink your fluids: You should always drink 2 liters of fluid every day. Water is the best.

 

While reading these tips, please do not forget that you do not need to be perfect. Nobody is perfect. It is sufficient that you do not deviate much from the rules. If you drifted a little, put yourself back on the right path again. The more you follow the rules, the more you will be successful!

  • Follow-up program for bariatric patients:

Under normal conditions, after the first 6 months, you will have follow-up control visits in the 9th and 12th months. In the second year after surgery, there will be two planned follow-up visits at 6-month intervals. Then, you will have one follow-up visit per year.

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Klinik Obezite

KO-E-029 Introduction to my preparation journey

Introduction to my preparatory journey

During the critical months before surgery, it is very important that you understand what bariatric surgery means for your health and quality of life and how to best prepare yourself for this surgery. Every day you can collect information about how you can prepare your body for surgery and how you can gradually modify your eating and exercise habits.

The Get Ready application will help you to prepare yourself for hospitalization and guide you to what you should know before surgery.

If you feel unsure to follow the instructions of your health team and change your eating and exercise habits, there is a risk that surgery will not lead to weight loss. From the moment you learn that you are eligible for surgery, you should start to follow a healthier lifestyle including a healthier diet, being more active and limiting alcohol consumption and smoking (it is better that you stop alcohol consumption and smoking completely as the surgery date approaches). These efforts not only prepare you for a successful surgery and recovery but will also be the start of a brand-new and healthier lifestyle.

 

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Klinik Obezite

KO-E-022 Eating after surgery FAQ

Eating after surgery FAQs

Which vitamins and minerals should I take after weight-loss surgery?

Multivitamins, vitamin D, calcium and in most cases iron and/or vitamin B12. In some cases, depending on the degree of malabsorption, vitamin A may be added to the diet. Chewable forms are recommended at least at the early stage after surgery. Be sure that you are taking adult supplements, do not take supplements designed for children. Ask your dietitian whether you should take vitamin A.

How much protein do I need per day?

60-80 g/day is recommended for most patients. However, some individuals need more protein depending on their response to surgery or the type of surgery. Your dietitian will give you further information.

How should I take my protein? What can I do if I am a vegetarian?

Meat, egg, dairy, and beans are common sources of protein. Soybean, brown rice, and protein extracts obtained from whey are meat supplements, which are preferred by vegetarians and sold commonly in the markets. Liquid protein mixtures or protein bars may be additional protein sources to meet your needs. Your dietitian can inform you about the protein sources.

In order to be sure that you are taking enough protein, it may be useful to calculate your daily protein intake. As you become more capable of digesting normal food, you will start to meet your protein need more and more with normal food and your need for supplements will decrease.

Should I avoid caffeine after bariatric surgery?

It was demonstrated that caffeinated drinks are as good as other drinks for your fluid requirements. Nonetheless, it is a good idea to avoid caffeine in the first 30 days after surgery, when your stomach is extremely sensitive. Then you may consult your surgeon or dietitian about caffeine consumption. Do not forget that caffeine usually comes with sugared, high-calorie drinks. Therefore, make sure that you make purposeful choices.

Why is fluid intake important?

Dehydration occurs when your body does not get enough fluid to function properly. Carry one bottle of water even if you are not at home. Remind yourself to drink water even if you are not thirsty.

Your goal is to drink at least 2 liters of water per day. If your urine is light-colored and you urinate several times a day, you are getting enough fluids. Thirst, headache, hard stool, dizziness while sitting or standing or dark-colored urine are among the symptoms of dehydration. If you cannot get enough fluid to meet your needs, contact your surgeon.

 

What happens if I do not take enough protein after surgery?

The body needs additional protein to preserve muscle mass during fast weight-loss periods. If you cannot take enough protein with the diet, your body starts to remove protein from your muscles, and you may be weakened. Furthermore, protein is essential for the sustainability of your metabolism.

Other

Bariatric surgery is a serious physical intervention. When you return home after surgery, you need to take special care of yourself and follow some strict rules. Some of the frequently asked questions you need to know when you return home after surgery, are given below.

About the symptoms and precautions FAQs

Will my hair fall out?

During fast weight-loss periods, calorie intake is much less than the needs of the body and protein intake is rather limited. You may also experience vitamin and mineral deficiencies like iron, zinc, or vitamin B. Your body gives several reactions to these deficiencies and hair loss and hair thinning are common. This transient side effect improves spontaneously with a better diet and balanced weight. Hair loss occurs between 3 and 9 months after surgery. Do not worry. You can minimize your hair loss by taking your daily multivitamin supplement and at least 60 g of protein per day.

Why should I quit smoking and alcohol consumption after surgery?

Smoking or electronic cigarettes or tobacco chewing decrease blood perfusion to the tissues and delay healing. In addition, smoking increases the risk of ulceration in the stomach sac, causes harm to every organ and is related to several other disease such as clotting, marginal ulcers after gastric bypass, and stroke. Try to stop smoking after surgery. We hope this will be an opportunity to quit smoking for the rest of your life.

May I get pregnant after surgery?

After your weight loss process is balanced, you may start to plan your pregnancy. However, you must not get pregnant in the first 12-24 months following surgery (follow the recommendations of your clinic). This measures are necessary to protect the health and safety of both you and your baby. While you are planning to get pregnant, undergo health control to see your vitamin and mineral status and optimize your food intake.

How should I behave about sexuality after surgery?

Two weeks after surgery you may carefully consider sexuality. During this process, the abdominal regions should be protected and not exposed to excessive pressure.

               

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SMS - Baria

SMS – Baria-E-029 My preparation journey

During the important months leading up to your surgery, it is imperative that you gain an understanding of what bariatric surgery means for your health and for your quality of life, and how you can best prepare for it. Day by day, you will be gathering new information about preparing your body for surgery while incrementally changing your eating and exercise habits.

 

Your digital patient engagement programme will help you prepare for your hospitalisation and surgery, guiding you through the information you need to know.

 

If you aren’t fully committed to following the instructions of your health care team and changing your eating and exercise habits, there is a serious risk that your surgery will not lead to weight loss. Therefore, from the moment you learn you are qualified for surgery, you should begin living a healthier lifestyle, including eating healthier, being more active and reducing alcohol consumption and smoking. (As the procedure draws closer, you will need to stop drinking alcohol and smoking completely.) Not only will this prepare you for a successful surgery and recovery, it will also be the beginning of a whole new, healthier lifestyle.

 

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SMS – Baria-E-032 Specialist consultations before surgery

The preparation journey

Bariatric surgery requires extensive preparation to ensure you are physically and mentally ready for the dramatic lifestyle change you are planning to undergo.

During the preparation phase, you will meet several specialists who will assess various aspects of your health. This is both to validate that bariatric surgery is the right option for you and, if so, to optimise your health prior to surgery.

Here is a list of some of the assessments required. Please note that each bariatric centre will follow its own protocol. Speak to your specialist for more information about pre-surgery assessments.

 

Respiratory medicine assessment and consultation

  • Respiratory diseases are common in connection with obesity and your team will advise if tests are required. The higher the BMI, the more common they are.
  • Respiratory testing investigates three obesity-related issues:
    • Sleep apnoea syndrome (SAS): Patients with sleep apnoea are at higher risk of anaesthesia-related complications. You may be required to wear a special device at night.
    • Respiratory failure
    • Asthma
  • The respiratory medicine consultation will consist of testing for these three issues by means of:
    • A history assessment and pulmonary examination
    • A Pulmonary Function Test (PFT) – breathing test
    • A blood gas measurement – a measurement of the amount of oxygen and carbon dioxide in the blood, done by pricking an artery in the wrist
    • A polysomnography – testing for sleep apnoea syndrome

 

Cardiology assessment and consultation

The two objectives of the cardiology consultation are:

  • To assess or detect any diseases associated with obesity: high blood pressure, coronary diseases (infarction, angina pectoris) and vascular diseases (damage to the vessels of the neck and the lower limbs)
  • To guide the anaesthesiologist to assess surgical risk

 

The cardiology consultation includes:

  • A history assessment and clinical examination
  • An electrocardiogram
  • An ultrasound
  • A test for ischemia is sometimes conducted – this is a non-invasive screening for coronary diseases (infarction or angina pectoris) by means of a stress test (on a bicycle or treadmill) or by means of a stress scintigraphy or ultrasound imaging

 

Endocrinology assessment and consultation

The four objectives of the endocrinology consultation are:

  • To rule out a hormonal cause of obesity that should be treated before considering surgery
  • To assess or detect possible high cholesterol in the blood
  • To assess or detect possible diabetes and adapt the treatment to reduce the risk of high blood sugar in the peri-operative period (the period around the time of surgery)
  • To prepare a plan for monitoring and treating diabetes beyond the surgical procedure (there will be a need to adjust treatment)

 

Dietetic assessment

The dietetic assessment comprises:

  • A dietary diagnosis
  • The development of personalised educational information

A dietician or nutritionist will assess your dietary profile to help you adjust and balance your diet and to set up the first preoperative counselling sessions.

Specifically, they will be assessing for possible eating disorders that require treatment to help you modify your habits before surgery. These modifications are important for the success of the surgery.

Some patients may be required to lose some weight before surgery to make the procedure safer and the recovery easier.

 

Psychological assessment and consultation

The psychological assessment:

  • Assesses your motivation, your ability to implement the necessary behavioural changes and your ability to adhere to the long-term postoperative follow-up programme.
  • Identifies contraindications for surgery, such as a serious eating disorder, which can have a dangerous impact on bariatric surgery.
  • Proposes additional behavioural management of any psychological problems identified before surgery. Psychotherapy may be prescribed before and after the procedure.

 

Digestive assessment

A digestive assessment aims to:

  • Diagnose and evaluate the state of the stomach by means of a gastro-duodenal fibroscopy using a tiny camera called an endoscope. This procedure looks for the presence of a hiatal hernia, acid reflux and its consequences, or ulcers. In this of an ulcer, a biopsy will be carried out to look for the presence of a bacteria called Helicobacter pylori, which may be causing the ulcer and must be treated before surgery.
  • Diagnose and assess the condition of the liver, which often has excess fat. This examination is done by means of an ultrasound and blood test.

 

Pre-anaesthesia consultation

A thorough medical examination is carried out by an anaesthetist or by a bariatric physician who will liaise with the anaesthetist. This exam gives your healthcare team a better understanding of who you are and your medical and surgical history. It determines which medications you should take, if any. 

You will be required to bring to the consultation the results of all the assessments that were prescribed for you.

 

The anaesthetist will consider all of the results and decide if there are any contraindications for the procedure ­ that is anything indicating that you shouldn’t have the procedure ­ and whether they are temporary or permanent.

 

If the assessment is incomplete, additional testing may be prescribed for you, such as an electrocardiogram, blood and urine tests and a dental examination. You must bring the results of these tests to the clinic on the day of your surgery.

 

At this consultation, the type of anaesthesia selected according to your health condition and the surgical procedure will be explained to you. In addition, you may be offered stress management techniques, such as hypnosis and relaxation.

 

The anaesthetist will explain to you how the procedure and the postoperative follow-up will be carried out (with respect to your personal treatment).

 

You will also be informed whether a blood transfusion will be necessary.

Please make sure to ask your anaesthetist any other questions you may have.

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SMS – Baria-E-034 What to pack for my hospital stay?

The following is a list of items you might consider packing in order to make your stay in hospital easier and more comfortable:

  • Paperwork: insurance card/information, completed health care proxy form, identity card
  • List of allergies
  • Contact information: An emergency contact number plus phone numbers of any physicians, family and friends you might need to contact
  • Medications: be sure to pack all medications you are taking in their original packaging, as well as your medication list and prescriptions (dosage and how often you take them)
  • Toiletries: soap, shampoo, deodorant, toothbrush, toothpaste, comb/brush, shaving kit, hand lotion, cosmetics etc.
  • Clothes and footwear: loose-fitting clothes such as tracksuit bottoms or jogging bottoms, jogging top, jumper or perhaps a cosy cardigan, t-shirts, pyjamas, bathrobe, slippers
  • Eyeglasses (not contact lenses)
  • Any assistive devices you use (walker, cane, etc.)
  • Prostheses, dentures, hearing aids and similar items

 

Bring only items that are completely necessary. Leave all valuables and personal items like jewellery, large amounts of cash or credit cards at home. Bring only a small amount of cash for purchasing newspapers, television access, etc. The hospital is not responsible for loss or theft of any personal belongings.

Your clinic will provide additional advice for your stay in hospital.

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SMS – Baria-E-039 My pathway after surgery

A healthy new you awaits

                                                                                      

During the first 6 months after surgery, it will be very important to follow the instructions of your health care team to the letter. Your team will prescribe a post-operative nutrition protocol, vitamin and mineral supplements and a physical activity programme. You will also need to attend several follow-up visits with your health care specialists. Get Ready will keep you on top of everything you need to remember during your short-term follow-up.

 

Don’t hesitate to contact your health care team

If you have any doubts about how to follow your post-surgery instructions, do not hesitate to contact your health care team. If you need psychological or peer support, do not hesitate to reach out to the relevant resources. For more information, contact your bariatric clinic. During the short-term follow-up phase, Get Ready will ask you to complete some questionnaires that will help your health care team better serve you.

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SMS – Baria-E-027 My weight loss journey post-surgery

Bariatric surgery will impact your daily life – for the rest of your life. You will always need to pursue a healthy lifestyle. 

‘The honeymoon phase’

In the first few months after your surgery, it may seem easy to follow the recommendations of your health care team. You won’t be very hungry, you will eat very small amounts of food, you may struggle to meet your daily food-intake requirements and you will have frequent contact with your health care team. During this period, it may seem like the weight is just melting away. Many people refer to the first year after surgery as the ‘honeymoon phase’.

 

Unfortunately, the honeymoon doesn’t last forever …

 

Things may seem different as you reach the one-year mark. Typically, after the first year, hunger returns a bit, food volumes increase, and it can be trickier to stay on track. Your diet is very important throughout your journey, but some argue that it is even more important as you reach the one-year mark. Adhering to the diet prescribed by your nutritionist in the long-term is critical to achieving lifelong weight loss.

 

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SMS – Baria-E-022 Eating after surgery FAQ

Which vitamin and mineral supplements should I expect to take after bariatric surgery? 

A multivitamin complex, calcium with vitamin D, and in many cases iron and/or vitamin B12 supplements. Sometimes vitamin A is added to the regimen depending on the procedure’s degree of malabsorption. A chewable form is recommended, at least initially after surgery. Be sure you are using a vitamin appropriate for adults, not a children’s multivitamin. Ask your health care team which nutritional supplements are appropriate for you.

 

How long will I need to take vitamin and mineral supplements?

You will need to take nutritional supplements for the rest of your life.

 

How much protein do I need daily? 

The recommended protein intake for most patients is 60 to 80 grams daily. However, some patients may require more depending on their response to surgery or the type of procedure. Your health care team can provide more detailed information.

 

Can I consume my daily allotment of protein all at once? 

Protein intake should be spread out across multiple meals and healthy snacks. Your muscles are capable of absorbing about 25 to 35 grams of protein per meal. Also, eating protein helps you feel fuller, longer. Including protein with every meal and snack will make it less likely that you feel hungry when it’s not time to eat.

 

How should I get my protein? What if I’m a vegetarian? 

Lean meats, eggs, dairy products and beans are common protein sources. Protein extracts made from soy, brown rice and whey are common meat replacements used by vegetarians and sold widely in stores. Protein shakes or bars may offer additional ways to meet your protein needs; however, they tend to be high in fat and sugar. Your health care team can provide additional information on protein sources.

You may find it helpful to calculate your daily protein intake to be sure you’re not falling short. As you are able to tolerate more regular foods, a higher portion of your protein requirement is met through regular meals, and supplements become less necessary.

  

Do I need to avoid caffeine after bariatric surgery?

Caffeinated drinks have been shown to be as good as any others for keeping you hydrated. Still, it is a good idea to avoid caffeine for at least the first 30 days after surgery while your stomach is extra sensitive. After that point, you can ask your health care team about reintroducing caffeine to your diet. Remember that caffeine often comes in the form of sugary, high-calorie drinks, so be sure you’re making wise beverage choices.

 

Why is fluid intake important? 

Dehydration occurs when your body does not get enough fluids to keep it functioning at its best. Carry a bottle of water with you all day, even when you’re away from home; remind yourself to take sips regularly, even if you don’t feel thirsty.

Drinking at least 2 litres of fluids is a good daily goal. You can tell you’re getting enough fluids if your urine is pale and you’re urinating many times a day. Signs of dehydration include thirst, headache, hard stools, dizziness upon sitting or standing up and dark urine. You should contact your health care team if you are having difficulty drinking enough fluids to stay hydrated.

 

What happens if I don’t take in enough protein after surgery?

The body needs additional protein during the period of rapid weight loss following bariatric surgery in order to maintain your muscle mass. If you don’t provide the body with enough protein through your diet, it will take its protein from your muscles and you can become frail. Protein is also necessary for a healthy metabolism.