Weight Loss Surgery - Gastric Bypass/Sleeve Gastrectomy: 1 Year Follow-Up

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Well, hi there.  Congratulations on your one-year anniversary from your weight loss surgery.  Now it’s time to take stock and think about what you’ve achieved over the course of the last year.  You are now past the rapid weight loss phase.  In fact, that probably finished at about six months, but you still should be losing some weight at a year.  And this probably will persist out to a year and a half.  By this stage, we hope that you will have lost the majority of your weight, so you should have lost probably between 60 and 70 percent of your excess weight, by now, maybe a little bit more over the course of the next six months or so.


If you have not reached your weight loss goal yet, at a year, don’t be too discouraged.  There are things that you can do to help yourself over the course of the next six months, until your weight loss stops completely.  Now, you know what these things are because you’ve been doing them right from the start, from the time you had your gastric bypass.  However, you may have fallen off the wagon a little bit.  Maybe you’re eating the wrong kinds of food.  Maybe you’re eating too many carbohydrates.  Maybe you’re not keeping up with your proteins.  And, also, maybe you’re not exercising quite the way you were, maybe six months or ago or so.


All of these things can be modified and changed by you.  Remember, at the start, right at the very start, when you came to your first community information session, or when you get on the website, to look up information on weight loss surgery, we told you that we were going to give you a tool so that you could help yourself lose weight.  Now, obviously, the tool has worked well for you, for the six months.  And, maybe, in fact, it has worked really well for you for the first year, but you’ve got to keep using the tool.


The problem with your weight never really goes away.  The problem will stay for the rest of your life, more than likely.  However, you have the ability, now, with this tool, to be able to deal with it.  So, every day, you get up, look at yourself in the mirror and make the decision that you’re going to use the tool to its maximum effect, today.  And, if you continue doing that every day, then you’ll be successful. 


So, at a year, you should have lost, like I said, between 60 and 70 percent of your excess weight.  You should have developed an exercise program of some kind for yourself because, over the course of the next six months, when your weight loss stops, your going to need to maintain the weight that you are right now, or the weight that you might be in six month’s time.  You need to have something in place to maintain that weight, and that is exercise. 


As time goes by, your pouch will stretch a little bit and you’ll be able eat a little bit more, and that’s really not a problem at that stage.  At this stage, you should probably be eating, maybe, three meals a day with much smaller portions, compared to the six meals a day you were eating initially, after you had your surgery, when you were eating tiny amounts.  So, the fact that you’re eating three meals a day is absolutely fine.  You don’t need to eat six meals a day now, like you did before.  But, by the same token, your pouch has stretched out some, so you can probably take in a little bit more than you used to.  So you’ve got to fill your pouch up with really good stuff.  You should, like I said, concentrate on high-protein, low-carbohydrate, low-fat foods and, of course, take your vitamins every day. 


Now, we want to see you at a year.  We need to take stock of how you’re doing.  You need to take stock of how you’re doing.  You need to meet with the dieticians.  And you need to meet with Diana or myself.  We need to go through your weight loss so far, see what your rate of weight loss has been like.  We should be able to tell you if you’re likely to lose more weight, depending on what the rate of weight loss has been over the course of the last six months.  And if your weight loss has stalled out, we can advise you, and we can help you try to lose more weight.


Apart from that, we have a new program in place with our behavioral medicine team.  If you’re having any type of psychological issues related to your weight, they can help you.  You can make an appointment to see them.  They can identify issues in your life that may be hindering your weight loss, or predisposing you to regain some of the weight you’ve lost.  These issues may be depression, marital problems, financial problems, or whatever might cause you to get off track completely.  So, let us know. 


At a year, we need to see you.  Come back and see us in the clinic and we’ll evaluate where you are.  We will send you to our consultants in Behavioral Medicine, if we think you need that.  Debbie and Nina, the dieticians, will talk to you about your diet, what you should be doing, and what you should not be doing, and so on. 


From the surgical point of view, you are probably out of the woods from an acute event.  The only thing that can happen to you now, at this stage, if you’ve had a laparoscopic or open gastric bypass, is that you’re always at risk for a bowel obstruction.  The symptoms of a bowel obstruction are crampy abdominal pain, sometimes a feeling of bloating, vomiting, and inability to have a bowel movement.  If you have those kinds of symptoms, and they come on acutely, you get pain that won’t go away, you need to go to an emergency room.  Let the emergency room staff know you’ve had a gastric bypass, and have them call us.  Many of the emergency rooms, now, are aware of the complications that can occur in patients with gastric bypass in the postoperative period.  Of course, if you’re anywhere close to MUSC, go to the Chest Pain Center in the Ashley River Tower, or to the main emergency room at MUSC. 


Another problem that can occur at one year is stomal stenosis.  That’s when the small intestine narrows and becomes too small.  The symptoms of that would be inability to eat solid food, then, eventually, inability to take liquids.  If that’s the case, please call us.  There’s a simple fix for this.  We can pass the endoscope down and balloon the stoma open.  Likewise, if you resume smoking, or have started taking nonsteroidal medications for arthritis, such as Motrin, Naproxen, and so on, you’re at risk for developing an ulcer.  The symptoms of that would be pain every time you eat.  So, if you’ve got those kinds of symptoms, you need to be seen as well. 


One way or another, at a year, you need to come back and see us.  So, congratulations on your weight loss so far.  Let’s keep it up.  Let’s keep the ball rolling here, and let’s stay healthy.

Your MUSC Bariatric Surgery Team wants you to be successful and stay in touch.  If you need an appointment, call us at (843) 792-7929 or visit us at www.muschealth.com/weightlosssurgery   

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