An Outline of Your Journey

Orientation and preparation:
Initially, you will be educated about what to expect and how to prepare for your new life. To this effect, you will be meeting with several professionals in addition to your primary care physician (PCP) and surgeon. This team is likely to include a dietician and psychologist/psychiatrist and consultants as needed based on your medical problems. The Metabolic and Bariatric Surgery Team members will guide you along and coordinate with your insurance provider. Based on these assessments and your medical conditions, tests and procedures will be ordered to prepare you for safe surgery.

Surgery:
When you are ready for surgery, the team and your surgeon will help you choose the most appropriate procedure for your situation. The aim is to select the most fitting procedure that addresses your medical and sociological needs and aspirations. There is no “one size fits all” approach here. Most procedures will require you to spend one or two nights in hospital. You will need to take some time off from work to recover from surgery and get acquainted with your new life. Throughout this period, our team will be there to help guide you as your diet and lifestyle changes.

Short term follow-up:
In the short term, you will be seen by your surgeon and dietician within two weeks of your surgery. Then again at six weeks and three months postoperatively. During these encounters, you will be guided as to the necessary changes in your diet and supplementation, your lifestyle changes and the necessary changes in your medications due to the improvement of your health. Typically, you are also encouraged to follow up with your PCP and any specialists who follow your medical conditions. At the 3 months point, our team will coordinate with your PCP any tests or changes in medications that you need.

Long term follow-up:
We want to see our patients for as long as they are willing to follow up with us! You will have scheduled visits with your surgeon at the six and 12 months postoperative points and yearly thereafter. During these visits, we will ensure that you are still on track and coordinate with your PCP any tests or changes in medications that you may need. Although most patients do not need the routine help of the dieticians at this point, the full services of the program are always at your disposal.

Support Groups:
Regular support groups will be coordinated by the team. These groups are aimed at pre and postoperative patients to provide support and education throughout your journey. They bring together people with shared experiences who tend to be the best source of advice and guidance for different issues you may encounter in your new life. You can choose to make these sessions an integral part of your life or an occasional drop-in for advice.

In summary:
You are embarking on a life-changing journey for the better. Our program will provide you with a multidisciplinary team of professionals who will ensure that you are safely guided and will coordinate with your other healthcare providers to help you achieve the best outcomes. Congratulations on taking this first step towards a healthier life!

Expected Timeline

Educational/Informational Session
You will be registered to attend at least one informational session about bariatric surgery, organized by the team (to make sure that you have a full understanding of the procedures and the processes). This will not always have to be done before your initial consultation.

Initial Consultation
On your initial consultation, you will meet with your surgeon and the program dietician. Your surgeon will try to fully understand your needs and medical conditions. At this meeting, your surgeon will let you know if you are a candidate for the program and what needs to be done to get you fully prepared for the surgery and thereafter. This will likely include lab tests, an endoscopy of your stomach, possible cancer screenings, consultations to other specialists if needed, psychological evaluation and any pre-op tests that may be required for safe anesthesia. The dietician will outline healthy eating habits and make sure you have an understanding of the dietary requirements before and after surgery. Depending on your medical condition and your weight, your surgeon and dietician may ask you to lose weight preoperatively and may also set you up with a physical therapist.

Follow-up Visit
This is typically about 4-6 weeks after the initial consultation. At this visit, your surgeon will go over your preoperative workup and consultations, ensure that you have a full understanding of the surgery and type of surgery suitable to you and your adherence to the preoperative plan. Some individuals may also need to follow up with the dietician based on what was decided on the initial visit. If your surgeon, dietician, psychologist and medical consultants have cleared you for surgery, you and your surgeon will agree on a surgical procedure and date.

Preoperative Visit
This is typically a few days before surgery. You will meet with your surgeon and the program dietician. Your surgeon will ensure that no contraindications have arisen since your last visit, examine you and answer any questions you may have about surgery. The dietician will make sure that you have a full understanding of the meal plan for the first two weeks after surgery. You will also be seen by the anesthesia team for a preoperative visit and will be given all the necessary instructions for the day of surgery.

Surgery
On the day of surgery, you will come in at the predetermined time. The surgical procedure will take place and you will likely spend 24-48 hours in the hospital post-operatively. During your hospitalization, your surgeon and the nursing team will check on you regularly to ensure that you are progressing as expected and free of complications. During your hospitalization, the program dietician will also visit you to make sure that you have a good understanding of your meal plan for the first two weeks at home.

Post-Operative Visit
Typically, this visit is 10-14 days after surgery. The aim is to check on how the healing process is going. X-rays may be obtained for Sleeve Gastrectomy patients. Typically, this is when vitamin supplementation is also started. You will also meet with the dietitian during this appointment to go over the diet plan.

Six-Week Visit
This visit is mostly about making sure that the you are adapting well to the diet plan, that weight loss is appropriate and that you have started exercising. You will also meet with the dietitian during this appointment to go over the diet plan.

Three-Month Visit
At this point, most patients have adjusted well to their diets and can eat very comfortably. The aim of this visit is to ensure that weight loss is on track, you are exercising properly, medications are adjusted based on improvement in medical problems, that are already noticeable by this time, and that necessary lifestyle modifications are underway. At this point, acid reducing medications are typically stopped and blood tests are ordered to look at certain vitamin levels and metabolic conditions. You will also meet with the dietitian during this appointment to go over the diet plan.

Six Month Visit
By this time, most patients are able to eat everything they want to eat in controlled portions. Weight loss is excellent, and starting to plateau, and significant improvements are noticeable in terms of overall health. The focus of this visit is to check a wide panel of laboratory tests to make sure there are no deficiencies in vitamins or minerals and either reduce or adjust the supplementation regimen. You will have the option to meet with the dietician if you wish during this visit.

One-Year Visit
The focus during these visits is to ensure that you have adjusted well to your new lifestyle, that you continue to maintain your weight loss and that you do not have any deficiencies that need to be addressed. A full panel of laboratory tests will again be ordered during this visit. You will have the option to meet with the dietician if you wish during this visit. The above is the fixed/ scheduled follow up plan. Of course, you are encouraged to follow up more closely if you feel the need or if you have pressing issues that need to be addressed.