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  • Center for Bariatric Surgery: A Program of Rhode Island and The Miriam Hospitals

  • Therapy

    During the postoperative period you will have pain in your incision which will limit your ability to move and breathe deeply.

    To prevent lung problems (pneumonia and lung collapse) and blood clots in your legs, it is extremely important that you get up immediately and walk. We expect that all patients will be out of bed on the day they have their operation and, if possible, walk. When laying in bed or sitting for long periods of time, you should practice the point and flex exercise with your legs and feet.

    Breathing exercises

    To decrease the likelihood of any respiratory problems, we require that you do frequent breathing exercises, as instructed by the respiratory and physical therapy, and the nursing staff, and cough. Some of these exercises are coughing and deep breathing and the use of an Incentive Spirometer. This reduces the risk of lung collapse and pneumonia.


    Going Home

    Once home, you can shower as you normally would unless you have been told otherwise at the time of discharge.

    For the first 4 to 6 weeks you should not: 

    • Drive a car
    • Lift heavy objects, such as grocery bags, laundry baskets, or small children
    • Shovel snow
    • Push heavy objects, such as raking leaves, pushing shopping carts or vacuuming
    • Start any formal exercise programs requiring lifting or straining 

    You should immediately begin a daily routine of walking. You should gradually increase the distance you walk per day until it is more than 1 mile. The more the better.

    You may resume normal sexual activity once you are comfortable, but do not strain. Most importantly, you should not get pregnant during the first 12-18 postoperative months. Since this is the period of weight loss, the baby may be in jeopardy of not getting enough nutrition. Although pregnancies have been successfully carried out during the first 12 months, they should be avoided.

    When to Contact Us

    You should call the office immediately if you develop:

    • A fever 101.5 degrees F or higher
    • Severe abdominal or stomach pain
    • Severe Vomiting
    • Swelling, redness, tenderness or drainage from your incision
    • Swelling in the legs, especially if only one leg is involved
    • Acute shortness of breath

    Medication

    Prior to discharge, we  will tell you what medications you should continue to take. Since it is not unusual to decrease dosage of high blood pressure or diabetes medications after discharge, it is important to check with us prior to going home.

    You will be sent home with a prescription for medication for pain control.

    If you have any heartburn or bile taste:

    • Elevate the head of your bed 3-4 inches
    • Don't wear any constrictive clothing
    • Try Maalox or Mylanta as directed

    After surgery you should take: 

    • Multivitamins, calcium, iron or other dietary supplements as directed by surgeon

    This is something you need to do for the rest of your life or until we tell you differently. If you don't take these vitamins and minerals, deficiencies, anemia and bone problems may result.

    • You may be prescribed a medication to help prevent blood clots to be used after you are discharged from the hospital.

    When Will I Be Functional Again?

    Depending on which bariatric procedure you have will set the length of time till you are back to your pre operative status. But for a general guideline:

    • The First Week
      If you live alone, you should plan to stay with other family or friends or have them stay with you for at least one week. If you are married, your spouse or some other person should plan to be home with you for your first week. This person is needed not only to help with your care but also with activities of daily living. It takes at least that time to become mobile and pain-free.
    • Weeks 2-4
      You should not schedule any extraneous activities for the first 2 weeks after discharge as it will take at least 2-4 weeks for you to begin to regain your strength. Don't forget, not only have you had an operation, but you are also on a very restrictive diet! It is normal to be tired and patients usually find themselves taking naps during the first few weeks.
    • After 4-8 Weeks
      By 4-8 weeks you will be ready to return to work and a full daily workload. If you return to a job outside your home, a gradual resumption of your workload over 2-3 weeks is ideal. If you can avoid heavy lifting you should do so for 4-6 weeks.

    Return Visits

    Once discharged from the hospital, you will return to see us in the office at:

    • 1-2 weeks
    • 6 weeks*
    • 3-4 months
    • 6-8 months
    • 12 months
    • 18 months
    • 24 months
    • Yearly in anniversary month thereafter

    *Note: first gastric band fill is done at 6 weeks and patients are seen at approximately every 4-6 weeks until they have achieved adequate band fills for proper restriction.

    These visits are mandatory. If you do not agree to follow up with us in this manner we will not do the procedure. There are two important reasons for these follow-ups:

    • We must be able to keep track of your weight and weight maintenance to be sure the procedure is working properly.
    • We must make sure you do not develop any vitamin or mineral deficiencies following the operation.
    • You will have routine blood work on a set schedule to make sure that no abnormalities are developing.

    Bariatric Surgery Nutrition Counseling Schedule

    In order to insure safety and to maximize weight loss results, regular nutrition visits are required both before and after your weight loss surgery. The bariatric registered dietitians staff at The Miriam Hospital is available to help you through your journey.

    Please be aware that certain health plans may not cover the cost of nutrition counseling and you will be responsible for the charge. Please contact your insurer to establish your payment responsibility.

    Expect up to about a one month wait time for appointments. Book your appointment early.

    For more information call 401-793-4719.

     


    Physical Changes

    During the weight loss period you will lose your body fat, with little change in your muscle mass.  This is very important, since loss of muscle mass is a form of protein malnutrition that can have serious consequences. Some physical changes are  commonly associated with weight loss:

    Sagging Skin

    As you get thinner, you will notice you will have a lot of extra skin. The younger you are, the greater the likelihood that your skin will still have enough elasticity to shrink as you shrink. This may be helped by daily exercises. Unfortunately, the shrinkage of skin is never 100 percent and usually is very little. Thus, it should be expected that your breasts will sag, as may your upper arms, abdomen and thighs. The firmness you had when you were obese is gone.

    About 15-20 percent of people who lose 100 lbs. or more ask for procedures to reduce the abdominal apron (tummy tuck), the sagging of breasts (mammopexy) or the extra skin on the upper arms (arm reduction) or thighs (thigh reduction). These are plastic surgery procedures which are usually not covered by insurance companies. Under some medically necessary circumstances, however, insurance may cover a large part of these expenses.

    Hair Loss

    Another frequent complaint by patients after bariatric surgery is hair loss. This is probably partly related to some decrease in protein nutrition, but other factors also appear to be important. By 3 months, you may feel that you are going bald. In fact, you are not going bald-almost all patients experience significant hair loss. By 6 months, hair growth should be returning to normal, and by 1 year, there should be little or no change from what you started with prior to surgery.