Frequently Asked Questions
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Pre-Operative (Before Surgery) Questions
- Will my insurance pay for the surgery?
Some insurance do and some do not. We would have to contact your insurance company and obtain detail information on the “Coverage and Benefits”. In order to do this we ask that you complete the information on New Patient Inquiry page, and fax us a copy the front and back of your insurance card. We will verify the coverage and contact you within.
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- How long does it take before I can have surgery?
It usually takes 4 weeks between the time of the initial consultation in the office and the surgery.
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- Are there any other fees that are not covered by my insurance?
Yes, you are responsible for Copay, deductible, and share of costs. Additionally you may be required to pay a program fee for particular type of a surgery for services provided that are not covered by your health insurance plan. These will all be discussed with you in detail after your insurance coverage has been verified.
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- How long do I have to stay local to the hospital?
10-14 days. Some patients may be released back home sooner and some may need to stay longer.
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- How often do I have to come back for follow up?
If you have the Duodenal Switch operation, you are required and expected to follow up with us at months 1,3,6,9,18,and 24 after surgery (post-op). Additionally you are recommended to follow up yearly thereafter. This schedule is also the same if you are having another weight loss surgery revised to Duodenal Switch.
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- Do I need to keep my follow up appointments? Can’t my primary doctor do the follow ups closer to home?
Yes, it is very important to keep you appointments. . We need to know that you are absorbing your nutrients effectively, and that you are not loosing the weight too fast or slow. Additionally we can evaluate to make sure that the weight lost is mostly fat and not muscle. Failing to keep your appointments puts your health at risk. Your doctor will also play a big role in your follow up, however we need to see you as well and your labs need to be done when we send the requests to you.
If you are having adjustable gastric banding, Lap Band®, then you will be expected in the office 7-14 days after surgery. After that, then 4 weeks later is when the first adjustment takes place. Different patients will require different number of port adjustments to optimize the size of the band. The average patient may need 4-9 adjustments.
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- Are the surgeries done open or Laparascopically?
The Duodenal Switch operation is done both open and Lap. The majority of the revisions are done open. Lap Band® is performed laparascopic.
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- How do I decide if I should have the Duodenal Switch or the Lap Band®?
This is a decision that you can make after your consultation. Our office staff will screen all inquiries and will set up appointments for initial evaluation.
Most patients however, have done adequate research prior to their office visit and are leaning for one or another type of operation.
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- Will I have saggy/extra skin after my weight loss surgery?
You may or may not. It will depend on a number of factors such as your BMI, age, co-morbidities etc.
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- How much protein should I take every day?
An individuals protein intake is based on their weight in Killogram (this is where some conversion gimmick by you should come in). The requirements are also dependent on the patients need. After surgery more protein is needed for healing. Most patient should aim for 1 Gram of protein for each Kg of their lean body weight. This may be difficult to calculate precisely, so for most average patient it is safe to aim for 80 to 100 grams of protein every day.
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- How do I convert pounds (lb) to kilograms (kg)?
1 lb = 0.453 kg or 1 kg = 2.2 lb
Example: 5 kg equals 5x2.2=11.0 lb
Example: 5 lb equals 5x0.453=2.27 kg
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- What is Sugar alcohol?
Sugar and sugar alcohols are each considered nutritive sweeteners because they provide calories when consumed. Sugar alcohols, or polyols, contain fewer calories than sugar. Sugar provides 4 kcal/gram and sugar alcohols provide an average of 2 kcal/gram (range from 1.5 kcal/gram to 3 kcal/gram). Contrary to their name, sugar alcohols are neither sugars nor alcohols. They are carbohydrates with structures that only resemble sugar and alcohol.
Foods that contain sugar alcohols can be labeled sugar-free because they replace full calorie sugar sweeteners. Sugar alcohols have been found to be a beneficial substitute for sugar for reducing glycemic response, decreasing dental cavities, and lowering caloric intake.
Sugar alcohols naturally occur in many fruits and vegetables but are most widely consumed in sugar-free and reduced-sugar foods. The sweetness of sugar alcohols varies from 25% to 100% as sweet as table sugar (sucrose). The amount and kind being used will be dependant on the food. The following table lists the details on each of the sugar alcohols.
| Sugar Alcohol |
Calories/Gram |
Sweetness Compared to Sucrose |
Sources |
| Sorbitol |
2.6 |
50% to 70% |
Sugar-free hard and soft candies, chewing gum, flavored jam and jelly spreads, frozen foods, and baked goods |
| Mannitol |
1.6 |
50% to 70% |
Chewing gum, hard and soft candies, flavored jam and jelly spreads, confections, and frostings |
| Xylitol |
2.4 |
100% |
Chewing gum, hard candies, and pharmaceutical products |
| Erythritol |
0.2 |
60% to 80% |
Confectionery and baked products, chewing gum, and some beverages |
| Isomalt |
2.0 |
45% to 65% |
Hard and soft candies, ice cream, toffee, fudge, lollipops, wafers, and chewing gum |
| Lactitol |
2.0 |
30% to 40% |
Chocolate, cookies and cakes, hard and soft candies, and frozen dairy desserts |
| Hydrogenated starch hydrolysates (HSH) |
3.0 |
25% to 50% |
Sugar-free foods and candies, and low-calorie foods |
| Maltitol |
2.1 |
90% |
Sugar-free chocolate, hard candies, chewing gum, baked goods, and ice cream |
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- What is the process to getting an appointment?
Appointments can be made by contacting our office (extension 25). A new patient inquiry can also be submitted on-line and our staff will contact you to schedule a consultation.
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- How much am I looking at spending out of pocket?
This varies depending upon your insurance benefits. These can be determined by faxing your insurance card front and back to (661)725-8051 or e-mailing a copy to info(at)dssurgery.com.
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- Why do I have to see a psychologist?
Most insurance companies require that a psychological evaluation be performed prior to weight loss surgery based on the recommendation of the National Institute of Health (NIH). A psychologist is usually available for consultation at the time of your initial appointment with us. His fee of $200.00 is not included with the cost of your consultation.
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- If I go to my own psychologist, what do I tell him? Is there a guideline I can take to him?
We do not have a specific guideline that must be followed. Most psychologists are aware of the type of evaluation required for weight loss surgical patients.
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- How long does it take to get an approval?
This depends on how quickly the patient completes his/her work-up. Once the work-up is complete, authorization is requested from your insurance. The waiting period for approval depends upon the type of insurance you have. It can take anywhere from 5 to 45 working days.
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- Does my insurance usually approve the surgery?
We can’t give a general answer to this question. There are thousands of insurance policies each with their own requirements. Even if weight loss surgery is a covered benefit of your plan, this does not guarantee that your surgery will be approved. Each patient’s case requires individual review at which time coverage will be determined.
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- What is the Duodenal Switch and how is it different than the Gastric Bypass?
Duodenal Switch operation is a restrictive as well as a malabsorptive. Gastric bypass operation is only a restrictive procedure. Their mechanism of action, safety profile, short and long term complications, short and long term success are different. It is our opinion that the duodenal switch operation is a far better procedure compared to the gastric bypass surgery. It is very important however that each patient to educate themselves about all the surgical procedures prior to making a decision.
close answer - What does the program fee cover?
The program fee covers two years of follow-up care, workbook and education on topics critical to the patient’s health, nutrition, and weight loss, support group meetings, completion and processing of one disability/leave form.
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Post-Operative (After Surgery) Questions
- I cannot take much in by month. What is the most important for me to take?
Water is by far the most important to take. You need to avoid getting dehydrated. This will present itself at times with nausea, dark infrequent urine. Depending on your specific case, the surgeon will make specific recommendations.
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- Why do I need to drink so much fluid following surgery?
Dehydration can lead to nausea, vomiting, weakness, and confusion, but it can also lead to blood clots due to your blood becoming thicker, and stickier. You can get into a vicious cycle with the loss of fluids, as the more dehydrated you get, the less you may be able to take by mouth. This may require hospitalization so that Intravenous hydration can be provided. On the scope of importance fluids are #1. It is very important not to fall behind on fluids.
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- Should I avoid all fats to help me lose weight?
This will depend if you had the Duodenal Switch or the Lap Band® operation. Generally, It is O.K. to consume some fat after the Duodenal Switch operation, since you will be only absorbing a small portion of it.
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- I have been having diarrhea since my surgery, what causes that?
Increased in number of bowel movements is normal early after the Duodenal Switch operation. Some patients will also experience very lose bowel movements. Excessive diarrhea can lead to dehydration. You need to look at the amount of fats in your diet, as well as the type of protein you are consuming. If it is a whey protein it can cause diarrhea due to the milk products content. Other dairy products such as milk, cheeses, sour cream etc may also cause diarrhea as will fried or fast foods and they need to be avoided. Artificial sugars can also cause diarrhea. Try keeping a food diary in order to recognize trigger items. If your bowel movements continue to be excessive call the office for follow up.
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- I am constipated, should I take a laxative to help me go?
The first step to take is to make sure that you have adequate water intake. No laxative is needed or recommended. After the Duodenal Switch operation a patient will absorb much less amounts of fat ingested. Sometimes, increasing your fat intake in moderation may help. If the problem persists call the office.
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- Is drainage from the incision normal? How do I care for it?
Some patients have some drainage from the top or bottom of the wound a few days after being discharged from the hospital. This is expected because of the poor healing properties of the fatty layer under the skin. In some patients other condition may contribute to this. These include diabetes, history of smoking etc.
Keep the area clean and dry, shower 1-2 times daily and wash the area with soap and water and dry well. The drainage should subside after a short time but it varies from patient to patient. If the wound or drainage changes in any way; pain, redness, warmth, color, thickness, smell, etc. call the office immediately.
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- Is it normal to feel hungry after surgery?
Yes, you should still be able to tell when you are hungry, but you need to learn to tell the difference between head hunger and actual hunger. This is hard to do the first few weeks as you learn how to cope with the separation from food, allow yourself time to get through this tough time. Most patients after Duodenal Switch may not be able to tell the difference between feeling full or hungry. The safest approach to this is the err on the side of having small frequent meals rather than large meals to satisfy "hunger".
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- For the past two weeks I have been having episodes of nausea and vomiting, is that normal?
No- Does not matter if days, weeks or months post op. Regardless of if had the Duodenal Switch or the Lap Band®, persistent episodes of nausea and vomiting should be evaluated by a doctor.
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- What happens if I lose too much weight?
If you are losing excessive weight we can usually stop the problem with prescription supplements that allows you to absorb more of the food that you eat. This process will generally will slow or stop the weight loss and prevent you from needing surgery to correct the problem. Call us if you are concerned you may be losing too much weight. The treatment for excessive weight loss after Duodenal Switch, will include enzyme supplementation, and possible a surgery, to lengthen the common channel. With Lap Band® it may be as simple as taking the fluid out of the band, and making sure that there are no other issues with the band.
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- The health food store has Enzymes that the clerk says would be good for me, should I take them?
No, enzymes will "undo" the malabsorbtion component of your surgery, by doing this you will absorb much more of what you eat and will begin to regain your weight. You need to take the supplements recommended by your surgeon, if you have any questions about any product or supplement contact your surgeon.
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- Why can't we take Iron and Calcium together?
Calcium inhibits Iron absorption. This blocking effect of iron absorption is dose independent; meaning that even very little amount of Calcium may block most of the Iron absorption.
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- How far apart should we separate taking Iron and Calcium?
60 minutes or so, will provide adequate time for the stomach to empty.
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- Can we take Iron with other Medications?
No, The best way to take Iron is on an empty stomach with some orange juice.
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- What is ADEKs?
ADEK stands for the fat soluble vitamins, A, D, E and K.
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- Others are taking ADEKs, should I be on ADEKs?
No. ADEK is prescribed to patient after the Duodenal Switch operation, only after they have lab results that demonstrate deficiency of one or more of these fat soluble vitamins.
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- Calcium Citrate Vs. Calcium Carbonate is always a hot topic. Which is better. Why?
| Types of Calcium |
Calcium Citrate |
Calcium Carbonate |
Coral Calcium |
| Example of Brand names |
Citracal |
Viactiv, Tums or Caltrate |
Is primarily Calcium Carbonate. Its absorption, bioavailability, risk and benefits have been poorly studied. In the scientific literature, there is a great deal of skepticism regarding the health benefits of Coral Calcium |
| Absorption |
Calcium is best absorbed in an acidic environment, hence calcium citrate is the best absorbed supplemental form of calcium. It does not require extra stomach acid for absorption, hence we may take it anytime in a day, even on an empty stomach |
Calcium Carbonate is alkaline based, it requires extra stomach acid for better absorption, hence it is best taken right after meals or with a glass of acidic juice such as orange juice. |
| Average Absorption rate |
38% |
27% |
| Absorbed Better |
Can be taken with meal or seperately |
When taken with meals |
| Dosing |
As prescribed by your surgeon. It is however important not to take more than 500mg at once, and allow 30-60 minutes between doses |
| Calcium content |
Calcium Citrate usually provides less elemental calcium per pill than Calcium Carbonate, therefore one may need to take a relatively more numbers of pills per day to meet the needs. |
Calcium Carbonate is the most prevalent calcium supplements in the market . It provides more elemental calcium than Calcium Citrate hence you may not need take as many pills. |
| Elemental Calcium Content |
21% |
40% |
The summary of the above table is that, Calcium Citrate is absorbed easier, but more of it needs to be takes to get the same amount of elemental calcium. Less of Calcium Carbonate is needed to get the same amount of elemental calcium, however the absorption is less efficient. A search of the medical literature will provide supporting data for recommending one or another type. I believe that most people at least in the beginning could take either type. The decision of which one to take should be based of which is tolerated better. Later on recommendations for changes will be made.
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- What is dry vitamin A? why can I not have regular vitamin A? Where do I get dry vitamin A from?
Vitamin A is fat soluble. After duodenal switch operation you may not absorb adequate fat and vitamin A (which is fat soluble). To resolve this problems, vitamin A is formulated to become "water soluble". "Dry" or "water soluble" vitamin A does not rely on fat absotpriton to get abosrbed.
You can get them from a number of sources on the internet.
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- I have received a letter from your office about a Vitamin D3-50 prescription and I am unable to have it filled at my local pharmacy. What do I do now?
Vitamin D3-50, is vitamin D3, 50000IU. There are a number of places that you can get it from. The letter sent to you had one of the sources. Another place where you can get it from is
here.
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Hernia Questions
- What is a hernia?
Hernia is a weakness in one of the layers of the abdominal wall. This allows for the content of the abdominal to be displaced and be closer to the skin.
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- How do I get my hernia removed?
A hernia is repaired surgically, but not removed.
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- How can I tell if I have a hernia?
A hernia may show itself in the form of an asymmetrical “bulge” around your incision. The best way however, is to ask your physician.
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- What does it feel like?
Depending on the location, size and the content of the hernia different individuals may feel differently. Some patients may only have the protrusion under the skin some patient may get very sick, with nausea and vomiting. As indicated previously, the best way is be seen by your physician for the correct diagnosis, and treatment options.
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- Why is a small hernia more dangerous than a large one?
Small hernias have a much higher chance of trapping their content. This is called incarcerated hernia. A large hernia, has such a large opening that it would be less likely for its content not reduce back.
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- Should I wait to have my hernia fixed?
This is a very complex question and depending on the size and location of the hernia, as well as the presence or absence of any symptoms, your surgeons’ recommendation will differ. Please be seen by your physician for evaluation.
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- What is a mesh?
Some hernias are large enough that the two edges cannot be secured together without tension. In those cases a mesh is used. A mesh can either be a synthetic, or harvested natural product. The synthetic mesh materials are permanent. Depending on the circumstances, a surgeon may choose to use one type or another in a particular case.
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- Can I feel the mesh?
Most patients are not able to feel their mesh. Some will feel the edge where it is secured to your natural tissue.
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- Why do some people keep getting hernias?
Causes of hernias are multiple. A number of factors may cause recurrent hernias. There include patient related conditions, such as presence of infection, diabetes, smoking, etc. Large hernias in active males are also more prone to recurrences.
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- Can I prevent getting a hernia?
You can probably significantly reduce the chance of recurrence by following your surgeons’ recommendations. There is no sure way to prevent a hernia. Wearing an abdominal binder does not prevent a recurrence.
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- Can my hernia and a tummy tuck be done at the same time?
In most cases two operations can be done at the same time. There are instances however, that the two procedures need to be done separately.
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Lap Band
- For the Lap Band, what does the insurance cover?
Most insurance, if they cover weight loss surgery, will cover the cost of the operation and the follow up for a period of 30-90 days.
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- How many adjustments will I need?
This varies from patient to patient. The goal for each patient is to stay in the “green zone”. For some patients this may require more frequent adjustments and for some less. It is very important to appreciate that a close follow-up is imperative for the successful weight loss after adjustable gastric banding procedure.
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- On average, how much is spent on adjustments?
It only takes a few minutes to adjust the band. It is done in the office.
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- Does my insurance company pay for the adjustments?
This will depend to your insurance and the health plan.
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- What is placed inside of the Lap Band®?
Sterile Saline (salt water) is used to adjust the Lap Band.
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- How much weight will I lose after Lap band?
This varies from patient to patient, and the amount of weight you may lose depends on patient lifestyle and eating habits. A weight loss of 2 to 3 pounds a week in the first year after the operation is possible, but one pound a week is more likely. Twelve to eighteen months after the operation, weekly weight loss is usually less.
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- Does the gastric banding system limit any physical activity?
No, the gastric band does not affect or hamper physical activity including aerobics, stretching and strenuous exercise.
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- Do I have to worry the access port? How do I care for it?
There are nothing that you have to do. The port is placed in the fatty tissue under your skin. If there is any persistent discomfort, redness, discharge from the port area, talk to your doctor as soon as possible.
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- Can the band be removed?
The band and the port can both be removed if there is a medical reason for it. Weight regain is almost certainly expected after band removal.
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