DrJoya.com LAPBAND, SWEDISH AND FRENCH BAND SURGERY: Laparoscopic Obesity Surgery

LAP-BAND Risks / Complications
The LAP-BAND System is designed to be adjustable after surgery and to assist you in losing weight and maintaining your weight loss. However, following the surgery there are risks of complications associated with the placement, movement, infection, or leakage of the band or port. In addition, some patients experience more post-operative gastric symptoms, such nausea and vomiting, than others. There also remains the possibility that you may not lose weight or that you may even gain weight or that very rapid weight loss could cause health problems.

Some of the specific major risks associated with the LAP-BAND and laparoscopic surgery are:

Please note that laparoscopic surgery is not always possible. In the event that one or several of these complications occur during surgery, the surgeon may need to switch to an "open" method. This happened in only about 5% of the cases in the U.S. Clinical Study, and has happened in less than 0.1% of the cases in our surgical experiences.

DIET: Breakfast, Lunch, and Dinner should be low calorie protein shakes or Non fat yogurt. Dr. Joya highly recommends a company by the name of REVIVAL SOY http://www.revivalsoy.com or go to a health store and look for a low calorie protein shake with high energy. The rest of the day or if you are still hungry at meal time you can have clear liquids. You should drink about 8 glasses of water or more a day. And Jell-O the low calorie kind is a clear liquid. Other clear liquids are beef and chicken broth, apple and grape juice, nonfat milk, and cranberry juice.

FOR SMOKERS:

Dr. Joya also wants you to do Balloon exercises if you are a smoker :

Just blow up 40 balloons for each day during the two week preop diet period. (the small party balloons that are hard to blow up). Discard each one after you inflate it.

The diet will reduce the risk of complications during your surgery and will reduce the size of your liver. The balloons will strengthen your lungs for surgery. Both are very important to do preop.

NOTE: IF YOU ARE A SMOKER: YOU MUST ALSO DO THE FOLLOWING:

Quit Smoking Immediately and Do the above mentioned Balloon exercises.

After your surgery in Puerto Vallarta Dr. Joya will place you on a 2 week liquid diet and then graduate you onto a puree/baby food type diet for one or more additional weeks. The longer you stay on liquids the more weight you will lose.

A few key things Dr. Joya wants you to remember:
• When you start your Puree diet, you may boil meat and/or chicken and vegetables and potatoes and then place them in a blender or food processor. This can be done for a variety of food and season to taste.
• Once you start solid food you should be aware of a few important things to remember: 1) Use smaller plates and dinnerware so that you do not need to fill up your plate. 2) Cook less food. 3) When you go out to dinner try to share a meal with a companion and order your own salad or soup. 4) If you pack leftovers for work, use smaller containers (1 cup of food at the most)
•“Bread” is very problematic down the road. Immediately after surgery, you may not have any problems with bread, however after your first or second fill, watch out. Bread slowly is eliminated from your diet as it causes great pain and tastes so good. Also fresh baked breads may cause indigestion, so start by eating crackers , pita bread, and Mexican tortillas.
• The most common “problem” meats include any type of Red Meat including: beef, lamb, lamb chops, many types of roasts, chunky beef, any type of over cooked tough meat including chicken. Mostly the problem exists with red meat, but dry chicken is very dangerous. Fish rarely causes any problems. If you need red meat, cut it into very tiny bites and chew it about 30 times. Once the meat gets stuck in the band, prepare yourself for a moment or two of pure pain that shoots through your abdomen area. The pain may last for a few minutes or even a few hours until the piece of food passes the band.
• Rice is very dangerous and should be avoided at all costs especially if it is sticky white rice. Some people tolerate fried rice better than others, and some don’t tolerate any rice. Whatever you do, if you need rice, please make sure it is coated in a gravy and you chew it really carefully. Take very small bites of rice, as a mouthful of rice will cause pain for hours on end if it gets stuck in the band.
• Skin on fruit may also get stuck in the band, we always recommend that you peel your fruit before eating it.
• Raw carrots and potato skins may as well cause problems.
• You may want to overcook your pasta as well as a very soft noodle may cause you great pain as it passes through the band. It also may cause indigestion.

LIQUID DIET UNTIL DAY 14 POST SURGERY…
For the first two weeks post surgery you will be on a liquid diet.

WEEK 1 DAY 1 POST OP TO DAY 7 - CLEAR LIQUIDS
• Clear liquids are any liquid you can see through, non carbonated beverages, basically water, tea, coffee, clear fruit juice and Jell-O. Note: Carbonation will cause gas and discomfort.
• Drink slowly. This is very important. If you drink to fast, you will feel like vomiting and you will feel pain in your stomach area. Take small sips and gradually increase them as the days go on. Drink A LOT of water.
• When in the hospital, do not feel that you need to drink everything sent on your tray at once. Drink everything slowly, pace yourself and take your time.
• When you get home, your body will need the nutrients from what you drink to heal itself. You need fluids which give you energy, protein, vitamins, and minerals. NOTE: The liquids must be able to pass through a straw to be considered liquid.

NOTE: The liquids must be able to pass through a straw to be considered liquid.
PLEASE try to stay away from Protein Drinks. If you feel that you do need Protein drinks, we recommend Revival Soy, you may order this online at http://www.revivalsoy.com

• When you are drinking liquids in the 7-14 days post surgery, try to drink slowly. Also drink plenty of water. You may also add into the mix, liquid yogurt, fruit juice, thin and smooth vegetable juice like V-8, chicken and beef broth, more water, and more water. We can not stress how important it is to stay fully hydrated.
• Also every day try to drink a small amount of apple, prune or pear juice to help prevent constipation.
• By the end of Week 2 before the 14 day mark, you should no longer be vomiting, regurgitating or feeling discomfort when you drink liquids. If you are still experiencing these symptoms contact us immediately or contact your post care doctor.

COMMON QUESTIONS RELATED TO THE LIQUID PHASE:
Why do I have Diarrhea?
• You may be experiencing Diarrhea because you are only drinking liquids and no solid foods. Your diarrhea should stop as you move to the solid food phase.
Why am I thirsty?
• You are not drinking enough water, you should carry a bottle of water with you at all times, and sip from it at will. When it is empty fill it up and do it again. Drink slowly, but drink often so long as you are not in any discomfort.
Why am I hungry?
• If you are hungry, it is because you are not drinking enough liquids that fill you up. Try liquid Yogurt, and milk. If you are still hungry ask yourself if your mind is playing games with you or are you really hungry. There is always a difference.
• Hunger also means that the liquids are passing through the band quite easily, and you may be ready to advance to the puree diet that starts at day 15
Why am I tired and how do I get more energy?
• Water is the key to life, and you may be lacking water. Try drinking more water! Also the anesthesia at times makes people feel tired as well.
Why is my shoulder hurting after my surgery?
• The gas used during the surgery to inflate your stomach at times causes this pain in your shoulder. It should go away in a few days post surgery, but if it lingers we recommend contacting us or your after care doctor.
PLEASE NOTE: We recommend that you contact a dietician near you to help establish a diet you can use after you have the band placed. We recommend showing the dietician these diet recommendations so that they may prepare a diet to help you lose the maximum amount of weight using the band as your tool.

• The Key to making Puree food great is all in the seasoning. If you prefer, you may always open a jar of baby food, but sometimes it is just better to make it yourself. Please see your food processor instruction and menu ideas for puree food ideas. Also remember that mashed potatoes are a viable food source in this week. And do not forget to drink a lot of water!

Tips:
• Use a small bowl for your puree food. (preferably one that holds about ½ cup of food.
• Use this bowl to serve yourself all your food for this week.
• Eat slowly, try to eat your food over 20 minutes.
• Eat up to six times a day, preferably 3-6 times a day, eating half cup portions each time.
• Drink a small glass of lowfat or nonfat milk, plus 1 cup of low fat yogurt each day. This will give you protein.
Here are some food ideas:
*Blended Fruit and water
*Blended fruit and milk
*Lowfat or non fat yogurt
*Breakfast cereal (soggy)
*Blended Healthy Choice or Stouffer Dinners
*Baby Food
*Low fat Jell-O Pudding
*Blended Meat and vegetables
*Mashed Potatoes
Menu Ideas for the Puree stage:
Breakfast: Mix ½ cup of yogurt, 1 glass of milk and 1 egg in a blender with your favorite fruit. This makes a great beverage that is filling and enjoyable.
Snack: Drink 1 glass of water, and blend juice and/or fruit with water and ice into a frothy beverage.
Lunch: ½ cup of boiled and blended chicken and vegetables with a small serving of apple sauce.
Snack: ½ cup of yogurt and blended fruit.
Dinner: ½ cup of boiled beef, and potatoes, blended, and served with a small serving of mashed potatoes.
Late Night Snack (if necessary): ½ cup of apple sauce.
ALWAYS: Keep drinking water, and vegetable juices with pulp, this gives you fiber. Also take a vitamin supplement if possible.
You may add additional Fiber to your diet.
• NO LONGER drink protein shakes, you will get enough protein from eggs and other sources of protein in your diet.
• NOTE: If you vomit or regurgitate your food, you are simply eating too much, cut back, and slow down in your consumption.
• ALSO, if you are really still hungry between meals and snacks you may add more yogurt (up to 1 cup, no more) to your shakes.
• PLEASE DRINK a lot of water, before your meal, and try not to drink any liquids for 30 minutes after your meal to prevent flushing the food through the band.

8 ounces of skim milk
1 medium egg
1 ounce sliced cheese
1/4 cup creamed cottage cheese
1 ounce lean meat or fish
1/2 cup low-fat plain yogurt
1/4 cup strained baby food meat
1/4 cup low-calorie custard
1/4 cup vegetables
1/4 cup cereal
1/4 slice toast
1/4 cup potato
1/4 cup fruit