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What do I need to do to prepare myself for surgery?

Once you have committed to undergoing weight loss surgery, it is essential you start to make changes to your diet and lifestyle.

Creating small changes over time can help you to form new habits, making it easier to sustain these changes for life. You may find it helpful to perform a "stock take" of your current eating habits, by writing a food diary for a week. Recording everything that you eat and drink, including portion sizes and volumes, will help you see where your areas of concern are. You will then be able to highlight just one area where you can improve or change, before moving on to the next. These small changes can make a big difference over time.

We have included a four day food diary on the following pages for you to complete if you wish.

This remains your record, and does not need to be shared with anyone. It will allow you to monitor your steady progress, and may be a helpful tool to look back on, to see changes that you have made. You may find it helpful to download a diet and exercise app onto your smartphone. "MyFitnessPal" is one of the most popular diet tracking apps and is free to download.

You can also set yourself some goals. These may be nutritional or exercise goals. An example of an exercise goal is to walk for 5 minutes a day, or walk a certain distance, and gradually increase this each week. Remember it is more motivating to exercise with others, so including your family, is one way of being successful in taking up a habit of regular exercise.

Start by following one of these goals below and once you are comfortable with that, you can add another.

  • Eat three meals a day - breakfast, lunch and dinner.
  • Down size your portion size. Try using a smaller plate.
  • Use a healthy plate model - ½ plate vegetables, ¼ plate of meat, chicken, fish etc, ¼ plate of potato, or rice or pasta etc.
  • You can have three small snacks a day. A snack is a piece of fruit OR 2 crackers with a topping OR one piece of bread with a topping OR a pottle of yoghurt.
  • Concentrate on quality of food not quantity - high sugar and high fat foods (eg takeaways, pies, lollies and biscuits) are NOT good quality foods.
  • Sip on water during the day. You will not be able to drink fizzy drinks after surgery so get used to it now.
  • Get into a habit of regular exercise.

Some things you may find helpful:

  • Sit at the table to eat your meals. This will make you focus on the food and take notice of what and how much you are eating.
  • Take small bites. This will slow you down so that you have a better chance of recognising those 'I have had enough' signals.
  • Cut food into small pieces and put your knife and fork down between each mouthful. This will slow your eating and maximise satisfaction with each mouthful.

 

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Take home points before considering Laparoscopic Gastric Sleeve surgery:

It is important that you understand the following expectations before surgery:

  • Understand the factors contributing to your obesity.
  • You will need to understand how important your medication is, attend appointments, do your medical testing and blood sugar monitoring (*if diabetic).
  • Understand the purpose and limitations of your surgery.
  • Understand the risks associated with your surgery.
  • Be motivated and willing to commit to a lifetime of healthy lifestyle changes, to maintain weight loss goals.
  • Show an improved level of physical activity and a change in eating patterns.
  • Describe strategies to reduce the speed of eating and portion sizes.
  • Have managed to lose weight before surgery, by lifestyle changes.
  • Have been a non-smoker for at least 12 months.

Patients not accepted for surgery will return to their GP for on-going care. Your GP may refer you for other medical advice.

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Advice for family / whanau and friends:

Weight loss surgery can have a significant effect on family and friends. When someone you care about is going to have weight- loss surgery, there are many things you can do to support them throughout this process.

Become involved, and learn about the operation

  • Learning how the operation will affect your loved one can help you to understand, and offer support to them. Join them at appointments and support groups, and research information together.

Be prepared to make life changes yourself

  • This may include joining your family member in exercise - go for a walk, bike ride, or swim. Join a gym, or take an exercise class together. You might choose to start new eating habits together. Making lifestyle changes can benefit the whole family, leading to a better quality of life, and improved health.

Respect your loved one's new eating habits.

  • Ensure the fridge and pantry contains only healthy food options. Don't accidentally sabotage their efforts, by giving them a box of chocolates as a gift, or by tempting them with food ("a little bit won't hurt you"). Encourage them to stop eating when they say they are full.

Celebrate in different ways.

  • People celebrate and socialise with food. Talk about other ways to show your loved one you care, that don't centre on food. What they would like as a gift to help them celebrate? Plan other events, such as enjoying family activities together, travel, starting new projects around the home, or learning a new hobby.

Be aware that the relationship may change.

  • Significant changes in weight can affect people's energy levels, self-esteem, confidence, and motivation, opening doors to a new lifestyle. Change can be unsettling however, and this can create tension in the marriage or friendship. You may feel you are "losing" someone, and the new version is someone you don't really know. It may raise your own insecurities, or you may fear they will outgrow their relationship with you, due to their lifestyle changes.

    Keep talking about how this affects both of you, and attend support groups. Don't hesitate to seek counselling.

Keep a positive attitude; offer encouragement, praise and support.

  • Remember, the person you care about is going through major lifestyle changes, which can be very stressful and emotional. Supporting them during their successes will be easy, but it is just as important to be there when they are struggling. Praise their success, and support them when they have setbacks, without being judgemental or critical.

Having a family member or friend who has had weight loss surgery can be challenging for you too. It can mean changing your lifestyle as well, which can bring new stresses.

Remember to take care of yourself, and don't be afraid to ask for help if you have problems coping with these changes.

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Pre-assessment clinic / Anaesthetic

The pre-assessment nurse will ask you about your general health, medical history, previous anaesthetic, and if there were any problems.

It is important that you are assessed prior to your operation to minimise the risks associated with your surgery. This appointment usually takes place soon after you have seen the surgeon in the clinic.

The anaesthetist will discuss your general health, the types of anaesthetic and pain relief that can be used and their risks and benefits. Consent for your general anaesthetic will be obtained at this time.

A record will be made of any family history of anaesthetic problems, medicines, pills, inhalers or alternative medication that you use.

Check will also be made and recorded on allergies, smoking, alcohol and whether you have any loose, capped or crowned teeth. You may have investigations such as blood tests, a heart trace (ECG), urine tests and X-rays. This helps your anaesthetist consider any medical problems which may either affect the risks to yourself, or the likelihood of complications from the anaesthetic or surgery.

The operation will not go ahead until you understand and agree with what has been planned for you. You have the right to refuse if you do not want the treatment suggested, or if you want more information or more time to decide.

The pre-assessment nurse will give you time to ask questions about any possible problems, and give advice and education on your hospital stay, and activities following your surgery.

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Consent

You will need to sign a consent form that says you agree to the operation and the collection of specimens and technical data. A full explanation of the surgery and risks should be given to you before you sign the consent form.

You will usually meet your anaesthetist on the day of surgery, prior to your surgery. They will answer any further questions you may have.

General anaesthesia produces a state of controlled unconsciousness during which you feel nothing. You will receive anaesthetic drugs, strong pain relieving drugs, oxygen to breathe and sometimes a drug to relax your muscles. You will need a breathing tube in your throat once you are unconscious, and will be put on a breathing machine (ventilator) during your operation. When the operation is finished the anaesthetic is stopped and you regain consciousness.

Advantages

You will be unconscious during your operation.

Risks

Common side-effects (less than 1 in 100) include headache, sore throat, feeling sick or vomiting, dizziness, bladder problems, damage to the lips or tongue, temporary confusion or memory loss, aches and pains and bruising/soreness.

Uncommon side-effects (less than 1 in 1000) include chest infection, muscle pains, damage to teeth, becoming conscious during your operation, slow breathing and existing medical conditions getting worse.

Rare side effects (less than 1 in 10,000+) include damage to the eyes, serious drug allergy, nerve damage, equipment failure, heart attack, stroke or death.

Pain is not normally very troublesome after this procedure. Occasionally, the gas used to inflate the stomach can cause pain in the shoulder tip, but this rarely lasts long and is easily controlled. Any nausea and vomiting can be managed with medication.

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Blood Products

There is a small risk that you may need to have a blood transfusion. A transfusion of blood or blood products is only given when the benefits outweigh the risks.

You have the right to decide whether you want to have the treatment or not. You can ask as many questions as you need, to ensure you are making the right choice.

You will be asked to sign a consent form to show that the benefits, risks and alternatives for your treatment, including transfusion of blood products, have been explained to you. The consent form will confirm that you have been able to ask any questions and that you agree to receive the treatment.

If you refuse to have the transfusion when needed, the risks to your health are likely to increase.

Further information about blood transfusions can be found at: www.nzblood.co.nz

The contact for the Tauranga Hospital Liaison Committee for Jehovah Witnesses is Clarence Ririnui and he can be contacted on 07 572 3462 or 027 776 4898.

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Preparing for your discharge home from hospital

It is important to consider how you will manage your care in your home once you are discharged from hospital. It is important to start planning now. Before you come to hospital organise your daily living needs in preparation for your return home. As an example, you can prepare small pureed meals and freeze them.

Please make plans for someone to drive you home from the hospital.

This list will help you prepare for your return home:

  • Arrange for someone to take me to hospital.
  • Arrange for someone to take me home on the day I am discharged.
  • Arrange for someone to stay with me for a few days after discharge (if I live alone).
  • Tell family, friends and/or neighbours about my operation.
  • Organise family/friends who are willing to help with chores/ housework.
  • Cook extra meals and freeze them.
  • Buy extra groceries and/or arrange for someone to do my grocery shopping.
  • Organise someone to look after my pets.
  • Pack ALL my medication/herbal products/alternative medication and supplements.

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Preparing for your hospital stay

Smoking and your lungs

We strongly advise that you try to avoid getting chest infections (stay away from people with coughs and colds) and give up smoking. Continuing to smoke doubles your risk of complications. These complications can compromise wound healing, and can add to the risk of a leak developing from the stomach staple line.

If you need help to quit smoking, please contact resources such as your Doctor (GP) or Quitline (0800 778 778) www.quit.org.nz or www.health.govt.nz\tobacco

Bay of Plenty District Health Board has a "No Smoking" policy onsite and throughout hospital grounds.


Alcohol and drugs (such as Cannabis and P)

We encourage you to minimise your drug/alcohol consumption prior to and after your surgery. Drug/alcohol consumption significantly increases the risk of complications and compromises healing. It can also affect your anaesthetic and pain relief requirements.


Exercise

Exercise

It is advisable to remain as active as possible leading up to your surgery, to strengthen your muscles and speed up recovery.


What to do if you become unwell

It is important we know if you have any of the following:

  • A cold or cough.
  • Skin infections - such as a sore, graze, pimple or eczema, especially around your operation site.
  • Burning pain or passing urine more often than usual.
  • You are generally unwell - such as diarrhoea, vomiting or high temperature.

For your safety it is important that we know about any of the above prior to your operation. You will receive a phone call from the Surgical Admission Unit two days before your operation day to check whether you are well.

If you do not receive a call and you are unwell please phone the hospital where you are having your operation and ask to speak to someone in the Surgical Admission Unit, Tauranga 07 579 8000

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What do I bring to hospital?

  • CPAP (Continuous Positive Airway Pressure) - If you currently use CPAP, please bring your machine with you to hospital.
  • Medication - Bring in all medication including over the counter and herbal medication. Don't stop any medication unless told to do so by your anaesthetist or surgeon.
  • You should leave valuables at home (eg; jewellery, bank or credit cards etc.) The Bay of Plenty District Health Board does NOT take responsibility for stolen items.
  • You may bring something to read.
  • Night clothes, easy to wear day clothes, shoes or slippers, toiletries.
  • You may also bring your own pillow which will make your hospital stay more comfortable. Please make sure your pillowcase is not blue or white (these are hospital colours).
  • Please name your personal belongings.
  • Mobile phones may be used on the ward, but please be considerate of other patients.

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Last updated: October 3, 2017