Pre-Operative (Before Surgery) Questions
Will my insurance pay for the surgery?
Your surgery may be covered depending on which insurance you have. We will contact your insurance company and obtain detailed information on the “Coverage and Benefits”. To do this, we ask that you complete the information on our New Patient Inquiry page, as well as fax us a copy of the front and back of your insurance card. We will then verify the coverage and contact you.
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.
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 a particular type of surgery with services provided that is not covered by your health insurance plan. This will all be discussed with you in detail after your insurance coverage has been verified.
How long do I have to stay local to the hospital?
10-14 days. Some patients may be released back home sooner, while others may need to stay longer.
How often do I have to come back for follow-up?
If you have the Duodenal Switch operation, you are required to follow up with us in months 1, 3, 6, 9, 18, and 24 after surgery (post-op). You are also recommended to follow up afterwards on a yearly basis. This schedule is also the same if you are having another weight loss surgery revised to the Duodenal Switch.
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 your appointments. We need to know that you are effectively absorbing your nutrients and are not losing the weight too fast or too slow. We can also evaluate to make sure that the weight loss is mostly fat and not muscle. Failing to keep your appointments puts your health at risk. While your primary doctor will play a big role in your follow up, we also need to see you and will send requests for the necessary lab tests.
If you are having adjustable gastric banding, or Lap Band®, you will then be expected in our office 7 to 14 days after surgery. The first adjustment will take place 4 weeks later. Different patients require different numbers of port adjustments to optimize the size of the band. The average patient may need 4 to 9 adjustments.
Are the surgeries done open or Laparascopically?
The Duodenal Switch operation is done both open and Laparoscopically. The majority of the revisions are done with open surgery. Lap Band® is performed with laparoscopic surgery
How do I decide if I should have the Duodenal Switch or the Lap Band®?
We do not recommend the adjustable gastric banding procedures for anyone. It has shown to have high complication rate and a very poor long-term weight loss.
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, or the presence of another disorder or disease.
How much protein should I take every day?
An individual’s protein intake is based on his or her weight in Kilograms. The requirements are also dependent on the needs of each patient. Additional protein is needed for healing after surgery. Most patients should aim for 1 Gram of protein for each Kg of their lean body weight. This may be difficult to calculate precisely, so the average patient may safely aim for 80 to 100 grams of protein every day.
How do I convert pounds (lb) to kilograms (kg)?
1 lb = 0.453 kg or 1 kg = 2.2 lb
Example: 5 kg equals 5×2.2=11.0 lb
Example: 5 lb equals 5×0.453=2.27 kg
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 (a range from 1.5 kcal/gram to 3 kcal/gram). Contrary to the 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% and is as sweet as table sugar (sucrose). The amount and type that is used will be dependent on the food. The following table lists the details of each of the sugar alcohols.
How do I make an appointment?
Appointments can be made by contacting our office at 818-812-7222. A new patient inquiry can also be submitted online and our staff will contact you to schedule a consultation.
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 818-952-0990 or e-mailing a copy to contact(at)dssurgery.com
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.
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.
What room and board accommodations are available in Glendale?
Accomodation options include hotel chains and vacation rentals.
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, as well as support group meetings and the completion and processing of one’s disability/leave form.
What is the Duodenal Switch and how is it different than the Gastric Bypass?
The Duodenal Switch operation is restrictive as well as a malabsorptive, which makes the stomach less absorbent of food. Gastric bypass operation is only a restrictive procedure. The mechanism of action, safety profile, short and long term complications, short and long term success between the two procedures 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 patients educate themselves about all the surgical procedures prior to making a decision.
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.
How long does it take to get an approval?
This depends on how quickly the patient completes his or her work-up. Once the work-up is complete, authorization is requested by your insurance. The waiting period for approval depends on the type of insurance you have. It can take anywhere from 5 to 45 working days
Post-Operative (After Surgery) Questions
I have been having diarrhea since my surgery. What causes that?
An increased number of bowel movements are normal shortly after the Duodenal Switch operation. Some patients will also experience very loose 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. Whey proteins can cause diarrhea because of the milk products content. Other dairy products, such as milk, cheese, sour cream, etc., may also cause diarrhea, as well as fried or fast foods, and 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 a follow up appointment.
Should I avoid all fats to help me lose weight?
This will depend if you have had the Duodenal Switch or the Lap Band® operation. It is generally okay to consume some fat after the Duodenal Switch operation, since you will only be absorbing a small portion.
Why do I need to drink so much fluid following surgery?
In addition to nausea, vomiting, weakness, and confusion, dehydration can also lead to blood clots, as your blood becomes 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 in by mouth. This may require hospitalization so that Intravenous hydration can be provided. Drinking a lot of fluid is a top priority and it is important not to fall behind in this regard.
I cannot take much in by mouth. What is the most important for me to take?
Water is by far most important to take in, as you need to avoid getting dehydrated. At times, this may result in nausea or dark infrequent urine. The surgeon will make specific recommendations depending on each case.
I am constipated, should I take a laxative to help me go?
The first step is to make sure that you are drinking enough water. No laxative is needed or recommended. After the Duodenal Switch operation, a patient will absorb far less amounts of ingested fats. Increasing your fat intake in moderation will sometimes help with constipation. Call our office if the problem persists.
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 conditions may contribute to this. These include diabetes, a history of smoking, etc.
Keep the area clean and dry by showering 1 to 2 times daily. Wash the area with soap and water and remember to dry well. The drainage should subside after a short time, but varies from patient to patient. If the wound or drainage changes in any way, such as pain, redness, warmth, color, thickness, smell, etc., call the office immediately.
Is it normal to feel hungry after surgery?
Yes, you should still be able to tell when you are hungry, but need to learn to the difference between mental hunger and actual hunger. This is hard to do in the first few weeks as you learn to cope with the separation from food and allow yourself time to get through the situation. Most patients after the Duodenal Switch may not be able to tell the difference between feeling full or hungry. The safest approach to this is to err on the side of having small frequent meals rather than large meals to satisfy “hunger.”
For the past two weeks I have been having episodes of nausea and vomiting, is that normal?
No. It does not matter if days, weeks or months have passed since the operation. Whether you had the Duodenal Switch or the Lap Band®, persistent episodes of nausea and vomiting should be evaluated by a doctor.
What happens if I lose too much weight?
We can usually stop excessive weight loss with prescription supplements that allow you to absorb more of the food that you eat. This process will generally slow or stop the weight loss and prevent you from needing surgery to correct the problem. Call us if you are concerned that you may be losing too much weight. The treatment for excessive weight loss after Duodenal Switch includes enzyme supplementation and possible 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 there are no other issues.
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, which means you will absorb much more of what you eat and begin regaining weight. You must take the supplements recommended by your surgeon. If you have any questions regarding any product or supplement, contact your surgeon.
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 a very little amount of Calcium may block most of the Iron absorption.
How far apart should we separate taking Iron and Calcium?
60 minutes or so will provide adequate time for the stomach to empty.
Can we take Iron with other Medications?
No. The best way to take Iron is on an empty stomach with some orange juice.
What is ADEKs?
ADEK stands for the fat-soluble vitamins, A, D, E and K.
Others are taking ADEKs, should I be on ADEKs?
No. ADEK is prescribed to patients after the Duodenal Switch operation and only after their lab results demonstrate deficiency of one or more of these fat-soluble vitamins.
Calcium Citrate Vs. Calcium Carbonate is always a hot topic. Which is better. Why?
The above table indicates that Calcium Citrate is absorbed easier, but more is needed for the same amount of elemental calcium. Less Calcium Carbonate is needed to get the same amount of elemental calcium, but the absorption is less efficient. Medical literature provides supporting data for recommending either one. We believe that at least in the beginning, most people could take either type. The decision of which one to take should be based on which is tolerated better. Later recommendations for changes will be made.
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.
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 the Duodenal Switch operation, you may not absorb adequate fat and vitamin A (which is fat soluble). To resolve this problem, vitamin A is formulated to become “water soluble”. “Dry” or “water soluble” vitamin A does not rely on fat absorption to be absorbed.
What is a hernia?
A 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 move closer to the skin.
How do I get my hernia removed?
A hernia is repaired surgically, but not removed.
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 to know, however, is to ask your physician.
What does it feel like?
Depending on the location, size, and content of the hernia, the feeling may be different for each individual. Some patients may only have the protrusion under the skin, while others may get very sick with nausea and vomiting. As previously indicated, the best way of identifying a hernia is to be seen by your physician, who can provide the correct diagnosis and treatment options.
Why is a small hernia more dangerous than a large one?
Small hernias have a much higher chance of trapping their content, which is called an incarcerated hernia. A large hernia has such a large opening that it would be less likely for its content to not reduce back.
Should I wait to have my hernia fixed?
This is a very complex question and depends on the size and location of the hernia, as well as the presence or absence of any symptoms; based on this information, your surgeon’s recommendation will differ. Please be seen by your physician for an evaluation.
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 natural product. The synthetic mesh materials are permanent. The surgeon may choose which type of mesh to use depending on the details of each particular case.
Can I feel the mesh?
Most patients are unable to feel their mesh. Some will feel the edge where it is secured to your natural tissue.
Why do some people keep getting hernias?
The causes of hernias are multiple. A number of factors may cause recurrent hernias, including patient related conditions, such as the presence of infection, diabetes, smoking, etc. Large hernias in active males are also more prone to recurrences.
Can I prevent getting a hernia?
You can probably significantly reduce the chance of recurrence by following your surgeon’s recommendations. There is no sure way to prevent a hernia. Wearing an abdominal binder does not prevent a recurrence.
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, in which each procedure needs to be done separately.
How much weight will I lose after Lap band?
The amount of weight loss varies from patient to patient and depends on 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.
What is placed inside of the Lap Band®?
Sterile Saline (salt water) is used to adjust the Lap Band.
Does my insurance company pay for the adjustments?
This will depend to your insurance and the health plan.
On average, how much is spent on adjustments?
It only takes a few minutes to adjust the band, which is done in the office.
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, but less for others. It is very important to appreciate that a close follow-up is imperative for the successful weight loss after an adjustable gastric banding procedure.
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 to 90 days.
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.
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.
Do I have to worry about the access port? How do I care for it?
There is nothing you have to do for the access port. The port is placed in the fatty tissue under your skin. If there is any persistent discomfort, redness, or discharge from the port area, talk to your doctor as soon as possible.