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What is the Preop Diet and Balloon Exercises? and Do I need to do it?
Each diet is designed by each doctor and it is important to follow the preop diet so that you reduce your chances of having complications during the surgery.

A sample preop diet may consist of: Breakfast, Lunch, and Dinner should be low calorie protein shakes or Non fat yogurt. You may go to a health store and look for a low calorie high protein shake. 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.

Where do you do the weight loss surgery?

All of the doctors who work with DRJOYA.com work out of Puerto Vallarta Jalisco Mexico. None of the doctors practice in the United States and each is solely licensed in Mexico as a surgeon. Each doctor works out of the finest State of the Art Hospital's in Puerto Vallarta.

What is Bariatric or weight loss surgery?
Bariatric surgery is the area of surgery that focuses on operations to reduce weight and treat obesity. The name comes from the Greek words baros, meaning weight, and iatrike, meaning treatment.

How is weight loss surgery different than liposuction?
Weight Loss Surgery is major surgery involving the gastrointestinal tract. The stomach and intestines are modified so that less food can be consumed or absorbed, which leads to a substantial loss of weight that can be maintained for years. Liposuction is a form of cosmetic surgery in which areas of the body are reshaped or resculpted by removing excess amounts of fat in those areas. The purpose of liposuction is not to produce weight loss.

How do I know if I'm a candidate for this surgery?
Each doctor who works with DRJOYA.com advises that you must have clinically severe obesity, also known as morbid obesity. This means your BMI must be higher than 35, or you must be at least 100 lbs above your ideal body weight. You may be a candidate if you're less than 100 pounds overweight, if you also have significant health problems due to your weight, such as Type 2 diabetes. Most people with clinically severe obesity are good candidates for surgical treatment-as long as you understand the procedure, don't have a severe, pathological eating disorder and are willing to come back for follow-ups.

What is BMI?
It stands for Body Mass Index and it determines someone's health risk related to their weight. A BMI greater than 40 or greater than 35 with associated medical problems means you have clinically severe obesity which is associated with diabetes, heart disease, high blood pressure, high cholesterol, heartburn, gallstones, arthritis, urinary stress incontinence, infertility, and some types of cancer.

Does my weight alone justify such extreme measures?
Yes. Morbid obesity is an independent risk factor for premature death, with the risk rising as the BMI increases. People with a BMI of 30 have a relative risk of dying early that is 1.3 times greater than normal weight individuals. By the time the BMI is 40, the risk is close to 3 times as great.

I feel so guilty about being obese. . . is it all my fault?
No, obesity tends to run in families. Identification of several genes and their corresponding hormones (leptin) have been found to be at least partially responsible for obesity. Therefore, there is evidence that obesity is at least partially biological, helping to reduce the misconception that it is a behavioral or psychological disorder. I consider obesity a disease which needs a cure, rather than a moral failing which is the fault of the individual.

Why should I consider WLS?
Because it works! Surgical treatment for obesity is the ONLY treatment that reliably produces significant and sustained weight loss. People with clinically severe obesity are at great risk for developing many associated medical conditions. Research has shown that surgical treatment results in significant weight loss and improvement in most problems associated with obesity. Surgical treatment for clinically severe obesity has been endorsed by the National Institutes of Health, the World Health Organization, Shape-Up America, the American Heart Association, the American Dietetic Association, and the American Obesity Association.

Why not just lose the weight through diet and exercise and skip the serious complications that could result from surgery?
If you can lose the necessary amount of weight (and keep it off) though diet and exercise-more power to you! Ninety five percent of the people considering WLS have tried (sometimes numerous times) and failed.

Why not take drugs to combat obesity?
Drug treatment does produce limited success (usually weight loss of about 35 to 40 pounds). However, concerns about safety of long-term treatment have limited the drugs available and the length of time people can take them. This in turn, limits their effectiveness because, as with any chronic disease, such as diabetes or high blood pressure, the drug is only effective as long as it is taken.

How this WLS promote weight loss?
Operations for the treatment of obesity usually induce weight loss by limiting the amount of food consumed, altering the normal absorption of nutrients, and/or altering the way the body utilizes energy. A Band Surgery or Gastric bypass does all three. They actually boost your metabolism for the first 18 months, which is one reason patients lose weight so quickly.

Is it unhealthy to lose weight rapidly after WLS?
I like to answer this question by asking another question: "Is it healthy to be 100 pounds overweight?" The rapid weight loss experienced after WLS is extremely gratifying psychologically and physically. If you eat properly, making sure you get enough protein, there should be no ill effects from it.

Is there any limit on how heavy one can be to have weight loss surgery?
No. Successfully operations have been done on patients who weighed 750lbs., who had a BMI of 100. The operative risks are higher the more you weigh, but they still don't approach the risk of remaining at such a high weight. I personally have operated on one gentleman who weighed over 500 pounds and we were still able to fit the Swedish Band on him.

How much weight can one expect to lose after surgery?
Most patients lose between 50 and 70% of their excess body weight over about 1-1 ½ years. Some reach their ideal weight, but some don't.

How long does it take to perform the operation?
The Laparoscopic Band Surgery takes less than 30 minutes, and the Gastric Bypass and revisions usually takes between 2 and 4 hours, depending on the surgery and complications. The Gastric Sleeve Surgery, takes about 1 hour. The Duodenal Switch takes about 1-2 hours.  The BIB Balloon procedure can be done in about 20 minutes.

Does it matter how long it takes?
The length of the operating procedure may make a difference. Many studies have documented an increase in the incidence of infectious complications, such as pneumonia and wound infection, after prolonged surgical procedures. Longer operations result in a fall in body temperature that interferes with the immune system. In addition, longer operative times mean increased exposure to general anesthesia, which often results in the collapse of portions of the lung and can lead to pneumonia. In general, shorter operations are safer.

How long will I be in the hospital? How long does it take to recuperate?
For Lapband Patients 1 night in the hospital and 1 night recovery postop
For the Gastric Sleeve, Bypass and DS, 2 nights in the hospital and 2 nights postop for recovery

A year after the surgery, are most people generally happier with their lives?
Yes. Much happier. Most patients say they would do it again "in a heartbeat." Studies show that this kind of patient satisfaction is a true test of the surgery.

When it's over, will there be things I need to do after surgery?
Regular, follow-ups are needed to monitor weight loss, provide dietary counseling, and to monitor for the occurrence of nutritional deficiencies or complications. We recomemend visiting your local doctor once a year for a checkup and get a full blood panel drawn to make sure there are no defficiencies. 

Can someone be too young to be a candidate for this surgery?
Yes. People can be too young. You need to have stopped growing and you need to have a mature bone age. In addition, you must understand the surgery and want it. You can't have an operation because your friends or your parents want you to. You need to be able to give "informed consent", which means you make an educated decision and then give your permission for the procedure. It is also necessary that your parents are supportive of your decision and understand the role they will need to play in your care and recovery.

Can you be too old for this surgery?
Age is one factor that needs to be considered together with all other aspects of a person's health. I would not give an arbitrary or absolute cut off. Surgeries have been done on several patients in their late 60s and early 70s, with excellent results.

I am severely overweight, have diabetes, hypertension, and congestive heart failure. My internist tells me that I am "too sick" to be a candidate for WLS.
If you are overweight with associated problems due to obesity, you are not too sick not to have this operation! You are too sick NOT to have it. The only chance you have for improvement in your medical conditions is through weight loss surgery.

Is Drjoya.com affiliated in any way with Dr. Armando Joya Munguia?
As a matter of fact this website and the corporation DRJOYA.com Inc., are not affiliated in any way with nor have any further business relationship with Dr. Armando Joya Munguia.


Pre-operative Questions

Questions About the Surgery

Should I stop my medications before surgery?
Some anti-inflammatory medications make bleeding more of a problem and if they can be discontinued without too much discomfort a week or two preoperatively it is desirable.

Should my bowel be cleaned out before surgery?
Some surgeons believe that a 'bowel prep' decreases constipation after surgery and makes managing a colon injury safer. In our experience colon injury is extremely rare and constipation is not a post-surgical problem. Therefore the doctors do not recommend cleaning out the bowel prior to surgery.

Can I shower after surgery?
The reason for not showering after surgery is fear that infection will be introduced into the wound. However nearly all wound infections come from bacteria present at the time of surgery and the incision itself is sealed within hours after surgery. It is probably even safe to get the intravenous site wet so long as it is reprepped and dressed after the shower.

Can I drive after surgery?
So long as discomfort does not prevent you from rapidly hitting the brake or steering effectively and you are not taking medications that impair your reflexes or judgment, it is safe to drive after surgery.

What happens to the bypassed stomach?
The only change that appears to be of clinical significance is a marked decrease in the production of ghrellin and a consequent marked decrease in hunger sensations.

Can I get pregnant after surgery?
As a generality weight loss increases fertility and improves the likelihood of a normal delivery. However, getting pregnant while rapid weight loss is occurring may not be safe and commonly results in less final weight loss.

How much time should I take off work?
If you have had laparoscopic surgery there are no limitations on your activity except the presence of a drain and your general energy level. Most people are quite ready to return to work once they arrive home from surgery. When circumstances permit some people choose not to return to work until they feel completely 'on top of their game' again and they may take considerably more time off work than a week or two. Following open or incision surgery, heavy lifting must be avoided for eight weeks, Otherwise the timing of a return to work is as for the laparoscopic patients.

What about drinking alcohol after surgery?
The amount of alcohol absorbed before gastric bypass is limited to about 50% by the presence of an enzyme in the stomach which breaks down the alcohol before absorption. After a gastric bypass this enzyme does not come into contact with ingested alcohol and more is absorbed, so it is easier to get drunk. Also alcohol is a significant source of calories: 7 calories per gram as compared to 5 with carbohydrates or protein. After the adjustable band alcohol is digested the same as before surgery.

Are staples used during surgery and, if so, how?
Surgeons use staples much as they use stitches, to hold tissues together. Most abdominal surgery today makes use of both stitches and staples and the choice of which to use has more to do with the surgeon's personal preference than anything else.

Are carbonated drinks bad after surgery?
There is no evidence that carbonated drinks expand the pouch or otherwise impair the surgical result. The bubbles make some people feel 'gassy' and that seems to be commoner after weight loss surgery.

Is diarrhea a problem after weight loss surgery?
The first weight loss procedure was an intestinal bypass and it commonly caused diarrhea. Diarrhea is not a consequence of proximal gastric bypass or the adjustable band. Some increase in the frequency of bowel movements may occur after distal gastric bypass.

Does weight loss surgery cause bad breath?
Weight loss and the breakdown of fats cause the formation of ketones which are volatile and are partially exhaled. The odor however is not unpleasant and has been likened to that of Juicy Fruit chewing gum. It is important however to maintain normal dental hygiene and to brush your teeth even when taking only a liquid diet; otherwise, bacteria accumulate on the tongue and between the teeth and can cause bad breath.

Will I lose more weight on some place of my body than others?
Yes. There is a general tendency for weight loss to occur from the head and neck first and thereafter from the upper body and abdomen but people differ and where you lost weight before is likely where you will experience the most weight loss again.

What about loose skin after surgery?
The amount of loose skin after surgery depends on the amount of weight loss, your age - younger skin is more elastic than older skin - and individual differences. When weight loss is rapid, skin tightening may continue to occur after weight loss has stopped. In general, if you have lost a lot of weight you are likely to have some loose skin and may want some plastic surgery to correct it.

What causes hernias?
Hernias occur where the abdominal wall is weaker and from increased intraabdominal pressure. It is somewhat speculative but most incisional hernias probably occur with straining and coughing while the patient is waking up from anesthesia. Patients waking from anesthesia are pain free so when they strain their effort is not restrained. Sudden severe straining after surgery which happens more quickly than can be modified by reaction to discomfort is another likely cause for hernias. Examples include straining from falling, coughing, or vomiting. A sudden response to an unexpected weight (child jumps into your lap) can also cause hernias. A smaller contribution to the development of hernias can come from ordinary efforts that rely on abdominal musculature such as lifting and other forms of exercise. Standard advice is that following open surgical procedures with abdominal incisions, one should not lift a weight greater than 10 lbs for the first month and not greater than 30 lbs for the second month. Risk of hernia after laparoscopy is so low that full activity can be resumed almost immediately.

What type of previous surgeries would prevent me from having laparascopic surgery?
All previous abdominal operations make abdominal laparoscopic surgery more difficult but most do not force us to make an incision. A few, mostly those on the upper stomach like previous weight loss operations, make laparoscopic surgery so difficult that usually we find it is safer to make and incision in order to do the surgery.

What is the significance of the drainage tube?
With regards to the drain: The amount of drainage is not of much significance. If the drainage begins to look like oral intake that is of concern and should be confirmed by drinking something blue or purple (food coloring or grape juice) and seeing if the color appears in the drainage. If it does it should occasion a call to the physician. Drainage or wetness outside and around the drain tubing is usual and does not signify that anything is wrong, in particular it is not a sign of infection. Redness extending more than two inches from the drain site should be seen by the surgeon. The drain is protection against a wound infection at the drain site and against the life threatening consequences of a leak. Leaks are very rare after two weeks. Removal of the drain before two weeks after surgery entails some extra risk. Patients who want the drain removed early should consider the risk. About 2% of patients will develop a leak. It is ok to shower and get incision sites or drain sites wet and soapy after surgery. The area should be dried off afterwards and dressed if wetness at the site might stain clothing. A temperature greater than 101 degrees is reason to call the doctor. Lower temperatures are not usually of much significance. Patients often complain that the drain site hurts and that relates to two considerations: First, the drain is brought out the largest and therefore the most tender port site. Second, the drain is sutured to the skin so that it will not be accidentally pulled out and if it is not taped so that pulling on the drain does not pull on the suture a good deal of discomfort can result from normal activity

What if I'm having constipation?
Constipation after gastric bypass surgery is a common complaint. It is caused by decreased food and water intake and, in some people, supplemental iron, or narcotic pain killers, tranquilizers, and antidepressants. It is often aggravated by weak abdominal muscles or busy schedules wherein people defer having a bowel movement when the urge exists. Our approach is to provide the following advice: 

Do exercises that strengthen the abdominal muscles and assist in bearing down. Most people experience the need for a bowel movement after breakfast and that is the natural and easiest time to have a bowel movement and should not be ignored. Increase water intake. An increased intake of any vitamin except B12 and vitamin A tends to produce diarrhea and has not significant other side effects and is helpful in eliminating constipation. Especially useful in this regard is Vitamin C or ascorbic acid since in addition to preventing constipation it enhances the absorption of iron in Trinsicon or other forms. Next add fiber to the diet: Eat high fiber breakfast (bran-based cereals, oatmeal) add vegetables to other meals. Miller's unprocessed bran found in the cereal section of the grocery store can be taken with juice, or sprinkled into salad, meatloaf, cereal, etc. The same thing can be done with Metamucil, or psyllium seed. These are more expensive forms of non-digestible cellulose or fiber. The water content of stool can also be increased with a stool softener, docusate sodium, marketed as Colace, or Peri-Colace or P-Col-Rite. If the above measures are still not correcting the problem the electrolyte laxatives such as Fleet Phospho-Soda, Magnesium citrate, Milk of Magnesia, or Colyte, to name a few, should be tried. Avoid laxatives that directly stimulate the bowel smooth muscle eg. Senecot, as tolerance develops and more and more is required over time.

What if I'm having gas?
Excessive air swallowing is probably the commonest cause and may result from deliberately belching to relieve a sense of fullness or from swallowing frequently as sometimes occurs with anxiety and nervousness. A deliberate change in behavior is usually effective. Simethicone, marketed as Gas X, helps reduce large bubbles of gas to small ones and may relieve the cramping sensations. Nullo which is a chlorophyll derivative also may be helpful. 

After gastric bypass, excessive dietary intake of fat increases intestinal transit time and delivers undigested food to the colon. Food in the colon is broken down by resident bacteria and results in a very malodorous gas. A restriction of dietary fat intake may be sufficient to eliminate the problem. Bismuth subgallactate marketed as Devrom (1-800-972-5184) is also helpful. If the problem occurs soon after a distal gastric bypass, Pancrease - a pancreatic enzyme supplement - taken with meals may be useful. 

Milk sugar called lactose is digested by an enzyme called lactase the production of which declines with age and following gastrointestinal surgery. Lactase tablets, drops and milk products with pre-added lactase are available. Beans, cauliflower, onions, broccoli and other vegetables contain complex carbohydrates (oligosaccharides) which are broken down in the colon to form gas. Beano contains a-galactosidase which helps to convert the oligosaccharides to simple sugars which can be absorbed and gas is thereby prevented. 

An alteration in intestinal flora usually caused by antibiotics may produce gas. Ultraflora - a bacterial preparation - may be given to repopulate in intestinal tract normally. When the cause is fungal overgrowth, Diflucan (fluconazole) may be effective. Flagyl is sometimes tried to suppress anaerobic bacterial growth in bypassed portions of the intestine. 

Other causes are gallstones, diverticulosis, irritable bowel syndrome, and parasites, and, rarely, cancer of the ovary or bowel.

Is hair loss typical?
Hair loss is commonly assumed to be due to lack of adequate dietary protein but a clear cause and effect relationship is lacking. Nevertheless, one should measure the prealbumin, and if it is low, increase protein intake. Ephedrine is said to be effective in restricting protein weight loss and enhancing fat weight loss. Hair loss due to dietary restriction is nearly always temporary. Rogaine and Nexium shampoo have both been reported to be effective and should be tried if the loss is excessive.

How is laparoscopic gastric bypass different than open gastric bypass?
Laparoscopic gastric bypass is accomplished with 5 small incisions rather than one long incision. A camera is placed through one of the incisions and long instruments through the others. The operation is performed while watching a video screen. The actual operation on the stomach and intestine is the same with both approaches.

The gastric bypass open incision is approximately 3/4 of the distance from the breastbone to the belly button. That is about 4-5 inches in some people and as much as 15 inches in others.

Is laparoscopic gastric bypass safe?
Many studies done by experienced laparoscopic bariatric surgeons have demonstrated laparoscopic gastric bypass to be safe. Laparoscopic gastric bypass is technically demanding and studies show that the amount of experience a surgeon has contributes to safety.

How does laparoscopic gastric bypass compare to open gastric bypass?
Laparoscopic gastric bypass results in a shorter hospital stay, less pain, less scarring, and a quicker return to usual activities. Complications such as wound infections and wound hernias are nearly eliminated with the laparoscopic approach. The risk for serious complications (such as leak) is similar with both laparoscopic and open gastric bypass.

Why aren't all gastric bypasses done laparascopically?
Laparoscopic gastric bypass is a difficult operation to learn to do safely. It also takes longer and is more expensive. The result is that most gastric bypasses in the United States are done open at this time. For most patients laparoscopic surgery is better (less pain, shorter hospital stay, less scarring, quicker return to usual activities). As more surgeons learn to do laparoscopic gastric bypass safely and patients demand it, more laparoscopic gastric bypasses will be done.

Is laparoscopic surgery right for me?
Laparoscopic surgery is a good choice for most people. People who have had previous bariatric surgery or surgery on the stomach are probably better candidates for the open approach. People with BMI > 60 (more than 200-250 pounds overweight) may be better candidates for open surgery.

Can the surgery be reversed?
Yes, but it would take another operation. No one, in my experience, has asked to have the surgery reversed.

What are the main risks of surgery after gastric bypass?
Put simply the main risks are death and complications. Mortality risk reported across the US is 0.5% or 1 patient in every 200. By recent count our mortality risk is less than one patient in every 500 gastric bypasses. The commonest causes for death are pulmonary emboli and infections. The commonest complications are wound infections, strictures, and hernias. The risks after adjustable band surgery and after gastric bypass are different (see Information Seminar). The major problems that occur with any frequency after gastric bypass are 1) leakage from the bowel connection to the pouch, 2) pulmonary emboli, 3) bowel obstruction or kinking, 4) bleeding, 5) stricture. The major problems after an adjustable band are 1) erosion, 2) slippage or herniation of the stomach up through the band, 3) pulmonary emboli, 4) esophageal dilatation.

What are the symptoms of a leak?
The symptoms can vary from sudden severe abdominal pain, weakness, chills, and abnormal drainage to no symptoms and unusual looking material coming from the drain site. The treatment depends on the severity of the leak but varies from no treatment, to hospitalization and iv's, to re-operation.

What are the symptoms of a pulmonary embolus?
Shortness of breath and pain on breathing. Treatment involves giving 'blood thinners,' anti-coagulants, and hospitalization.

What are the symptoms of a bowel obstruction?
Waves of abdominal pain, nausea and vomiting sometimes preceded by a loose bowel movement. Treatment involves surgery, usually laparoscopic, and correction of the kink or obstruction.

What are the symptoms of a stricture?
A stricture or too much narrowing at the connection of the pouch to the intestine is usually experienced as progressive difficulty with swallowing: first solid foods, then soft foods, finally liquids won't pass through. The treatment is endoscopy and balloon enlargement of the opening.

How would I know if I was bleeding?
Bleeding usually occurs in the first day or two after surgery and is recognized by a fast heart rate, weakness, paleness, and abnormal blood tests.

How is erosion recognized and treated?
If the band rubs on the stomach too much it can wear through into the lumen of the stomach where it can contact swallowed food and saliva. This may result in an infection which usually is seen as redness and swelling at the adjustment site. Sometimes no infection results and weight loss and a sense of restriction disappear. Treatment is removal of the band surgically. It can be replaced later or a gastric bypass can be done later.

What happens if 'slippage' occurs?
Slippage usually occurs in the first two weeks after surgery and is experienced as vomiting everything that is swallowed. It can be treated by taking the fluid out of the band and in most cases it can be re-inflated in two or three weeks. Sometimes surgery is necessary.

How do I know if I have 'esophageal dilitation' or enlargement?
A difficulty with swallowing is the usual experience. It is corrected by deflating the band, taking the fluid out, for a week or two. Sometimes the band has to be removed.

Are there long term risks after surgery?
Any abdominal operation sets the stage for a possible bowel obstruction the lifetime frequency of which is approximately 8%. Vitamin and mineral deficiencies can occur if calcium, B12, and iron supplements are not taken as prescribed. Less commonly protein deficiency can occur.

What are the risks of hernias after surgery?
Less than 1% after laparoscopic surgery and about 10% after the open procedure.

What is the risk of an ulcer?
Pretty small. We see one about every year or two.

Optional Surgical Procedures

Can I have a hysterectomy at the same time?
We do routine pelvic ultrasounds in patients who have not previously had a total hysterectomy. When the findings indicate the need a gynecologic surgeon may scrub in and do the appropriate surgery at the same time as the bypass.

Under what conditions is the gallbladder removed?
In patients who do not have gallstones at the time of surgery only 4% subsequently develop stones. We therefore only remove the gallbladder in patients who have stones diagnosed before or during surgery. In general we do not remove the gallbladder unless it is diseased or there is a strong family history or gallstones and gallbladder removal.

Are there medications available for gallstones?
Yes, ursodiol is given to prevent gallstones in high risk patients. Because it is expensive, we do not prescribe it for every patient.

Other Issues

How can stomach surgery cause me not to crave ice cream or mayonnaise?
Food preferences change for many patients after surgery; others have to make do with discipline. The reasons for changes in food preferences are unknown.

I have irritable bowel syndrome. Will that go away after surgery?
Irritable bowel syndrome is neither improved nor worsened by surgery.

What if my friends accuse me of taking the easy way out?
You and your friends should be aware that there is no easy way out. Surgery makes the discipline of exercise and dietary control effective when it would not otherwise be effective. Obviously, surgery also entails risk and the courage to take that risk.

Will my sex life improve?
Not guaranteed, but it is a common experience.

The Early Post-Operative Period (the first month)


Do all medications need to be crushed after surgery?
Yes, with a few exceptions. Small tablets, the size of the end of a pencil or smaller, will pass readily through the pouch into the intestine and are not a concern. Examples include thyroid medication, BDP's, and other hormone tablets. Many larger tablets may stop in the pouch and sit in one spot, will slowly dissolve. As some are quite caustic, they will burn an ulcer, and cause pain that will last for days, until the ulcer is healed. It is therefore important to crush them prior to swallowing.

What is dumping?
Foods high in sugar and some fats will cause the intestine to release vasoactive chemicals which cause sweating, flushing, weakness, fatigue, and sometimes abdominal cramps and diarrhea - a phenomenon called 'dumping.' This is not a problem after LAP-BAND® placement.

After gastric bypass but not after placement of the adjustable band (LAP-BAND®) absorption of iron, B12, and calcium is impaired and extra amounts need to be taken. Trinsicon is an iron, B12, folate and intrinsic factor combination which is simply a convenient way to get iron and B12 which certainly can be taken separately and are available over the counter. Calcium should not be taken at the same time as iron since they compete for absorption. Iron absorption is enhanced if taken with vitamin C (ascorbic acid).

What is the reason for protein shakes after surgery?
The shakes ensure adequate protein and calorie intake after surgery which is important for healing and other reasons. A liquid diet ensures that the pouch and opening will not be stretched early on when that is more easily accomplished. The shakes also interpose a significant change between the way you have eaten and the way we hope that you will eat in the future. Because the shakes are somewhat monotonous when you switch to a low fat more healthy diet it is 'tasty' by comparison and therefore more likely to be preferred in the long run.

How long do I have to take the shakes?
Four weeks; and it is a good test of your willingness to make some dietary changes. Taking the shakes for a week or two before surgery will shrink the liver and make surgery easier and safer. This is advised in some very heavy patients.

How long do I have to take vitamins?
A daily multivitamin is probably a good idea for everyone to take to prevent the fairly common and widely varied deficiencies seen as people get older.. The iron, B12, and calcium supplements should be taken for life, if you have had a gastric bypass, but are not necessary if you have an adjustable band(LAP-BAND®).

How much food can I eat after surgery?
The gastric pouch although initially very small has a hole in the bottom so that a reasonable amount of food can be eaten if taken slowly. As time passes the pouch enlarges and where initially only one or two bites could be taken without a sense of fullness, later a small adult meal can be consumed. As it becomes possible to eat more food it becomes also more important to have developed good habits with regards to food choices.

Are there specific foods or drugs that I should avoid after surgery?
Except for the tiny hormone replacement pills most tablets should be crushed after surgery. Foods high in sugar and some fats will cause the intestine to release vasoactive chemicals which cause sweating, flushing, weakness, fatigue and sometimes abdominal cramps and diarrhea - a phenomenon called 'dumping.'.

What prevents wound infections?
Wound infections occur because bacteria inevitably get into the wound during surgery . Some types of bacteria may be difficult for the body to eliminate. Also, local factors like variations in tissue blood supply, small amounts of blood, sutures, and othe things beyond the surgeon or patient's control, influence the likelihood of wound infection. Antibiotics are routinely given and used to irrigate wounds. Wound infections occur about one time in ten after open gastric bypass. They are quite unusual after laparoscopic bypass because the wounds are much smaller.

Is it possible to rupture the staples after surgery?
Vomiting may sometimes cause a tear and a leak, but usually does not. After about three weeks it is nearly impossible to rupture the staples.

Why don't people just keep losing weight until they get sick or die?
Everyone who has gastric bypass surgery has a strong genetic capacity to use calories efficiently. So it is always possible to provide high calorie foods and induce weight gain. In practice what happens is that with time people are able to eat more at a time, they lose weight and require fewer calories just to move around and their metabolism becomes even more efficient that it was preoperatively.

How can I prevent stretching out my new stomach?
Don't eat after you feel full.

Does surgery affect how well I absorb my medications?
Generally speaking not, but with certain medications it may be wise to check blood levels after surgery.

Can I drink carbonated beverages after surgery?
They may make you feel gassy, but I know of no other problems. They idea that they may stretch the pouch seems to me illogical, since no real pressure buildup can occur when both ends are unobstructed. Try blowing up a balloon with a hole in the end; it is impossible and similarly it is impossible to distend your pouch unless the inlet and outlet are completely obstructed.


How long before I can go to work? Exercise? Drive a car? Have sex?
We advocate walking and light weight lifting immediately after surgery. If you've had laparoscopic surgery you can lift weights immediately. If you've had open surgery, do not lift more than 10lbs for the first six weeks. After that, you can increase to 30 lbs. for 2 weeks and no limit after 8 weeks. This is because hernias almost never occur after laparoscopic surgery, but are quite common after open surgery with an incision. It is unlikely that effort that does not cause abdominal pain will affect the likelihood of hernia. Similarly, if you can hit the brake hard without discomfort and are not taking painkillers then it is ok to drive a car. The discomfort standard should be applied to sex as well: if it doesn't hurt, go for it.

Will I ever eat normally again?
It depends on what you mean by normal. Many overweight people eat more and make higher calorie food choices than the rest of the population. So it is possible that you were not eating 'normally' to begin with. After surgery although you can eat small amounts of anything, we hope that you will choose low fat foods for the most part. Also you will in general consume fewer calories than someone your size who was not previously overweight. Your could eat frequent small amounts of high calorie foods and gain your weight back.

What kind of exercise should I do after surgery?
We advocate increasing two kinds of exercise as part of a post surgical lifestyle change: 1) Increase the difficulty of unscheduled everyday activities. For example, try to walk farther - a pedometer is helpful in this regard - climb the stairs instead of taking the elevator; volunteer for small tasks that you might not otherwise choose. 2) Schedule workouts two or three or four times a week simply for the purpose of exercising. Although any activity is helpful, weightlifting is the most efficient for extra weight loss.

How soon after surgery can I bathe or shower?
Infections virtually always come from bacteria present in the wound at the time of closure. Wounds seal to the outside within hours after surgery so it is safe to bathe or shower the next day. Similarly, iv and drain sites can be cleansed and redressed with minimal likelihood of infection.

Psychological Concerns
What will the support group do for me?
It provides people with similar experiences to use as a sounding board for common problems. Like Church attendance serves to remind you to behave morally, support groups serve as a reminder to maintain a healthy lifestyle. Support groups can also educate you in what constitutes a healthy lifestyle.

What if my overweight friends reject me?
This is a difficult area. If you change your activity and dietary behaviors so as to be more healthy you may at the same time change what you had in common with your friends. Moreover, what you do may be threatening to them. In some cases it may be easier to find new friends. The support groups can help you make the change.

Cosmetic Concerns
How about my scar? Can I make it go away or become smaller?
Except for using steroid injections to stop keloiding I have heard of no tested way to diminish scarring, but lots of remedies are tried and perhaps some work. In any case it seems harmless to try.

Will I need plastic surgery after I lose weight to remove loose skin?
Whether plastic surgery is desirable depends on how old you are (skin is less elastic with age) how much weight you lose (the more the more skin) and individual differences in elasticity. Loose skin bothers some more than others, but there is nothing shameful about wanting to look your best and we will try to help anyway that we can. Getting rid of loose skin requires plastic surgery, some types of which we do ourselves.

Does exercise help prevent loose skin?
Exercise is wonderful for many things but unfortunately does very little for loose skin.

The Late Post-Operative Period

Weight Regain
What causes some people to regain their weight?

Most often it is forgetting that weight control is a lifelong project. But obviously the genetic pressure to gain is greater in some than others and although we cannot currently recognize it the surgery may be better for certain types of obesity than it is for others.


Current understanding is that the tendency to gain weight is largely genetic with a whole lot of modifiers or triggers like upbringing, stress, advertising, etc. Not surprisingly, short of genetic re-engineering, to effectively lose weight and maintain, it takes surgery and a lot of personal effort. In my opinion, the main component responsible for roughly 50%-60% of weight loss is the surgery. Weight loss in the first 10 to 12 months after surgery is much easier than later on and can be accelerated with dietary discipline and exercise. In general you lose weight in the first ten to twelve months and not much thereafter, so it is worth making an effort to maximize the early weight loss and not test the surgery with dietary lapses as many poorly committed patients do.
Another 20%-30% of weight loss is due to a combination of dietary discipline, exercise, and behavior modification: 

Dietary discipline means making a consistent effort to maintain a very low fat diet. Ideally it means three to five protein and produce meals a day and no 'grazing in between'. Trying to be a vegetarian, eat no salt, and avoid sugars, noble as it sounds, distracts from avoiding fats and processed carbohydrates and is likely to be counterproductive. Replace high cal snacks like cheese, nuts, crackers, seeds, with proteins like shakes (Carnation non-fat breakfast, Trader Joe's soy protein, HMR, etc), hard boiled eggs, jerky esp turkey, non-fat milk, non-fat yogurt, non-fat cottage cheese. Other snacks like baby carrots, lettuce with salt, fruits etc are low calorie and crisp substitutes but not as satisfying as proteins. Chocolate cravings can be managed somewhat with bananas or other fruit dipped in chocolate syrup - it makes a little chocolate ago a long way.

Exercise, exercise, exercise is the mantra of long-term success and short term weight loss acceleration. It should be one of life's rituals like showering or combing one's hair. If you have never exercised, pick any activity schedule it and try to increase the intensity and duration. Any exercise that you can do week in and week out is desirable but the best exercises are muscle building. Muscle has a higher resting energy expenditure than many other tissues and an increase in muscle mass, most effectively produced through weight lifting, can elevate resting energy expenditure for days rather than hours as is true with other forms of exercise.
Behavior modification in practical terms means struggling with your habits and inner demons. It is going to support groups to remind yourself that obesity is a chronic illness that requires lifelong attention. It is sessions with a counselor of your choice to discover and deal with the reasons you eat. It is part of your prayers and it is helping others to find a means to lose weight. 
Psychologic counseling: An occasional patient will be losing weight quite satisfactorily and then without explanation begin to sabotage the process. An underlying anxiety with regards to the danger—often sexual—of being thin may be the cause and can be helped with counseling. Other causes of an emotional nature are not uncommon and counseling is often helpful.

Fine tuners: Five to ten percent of weight loss can be ascribed to a number of `fine tuners' some of which can become habits while others can be used when regain threatens:
Pills. Chromium may be particularly helpful to diabetics but is also of some small benefit to others. Two hundred micrograms three or four times a week appears safe and may aid in weight loss. DHEA in people over fifty has beneficial immune stimulation properties and may help slightly in weight loss and body fat distribution. Anorectic medications like phentermine have a role if you aren't where you want to be and some appear to be safe for long term administration. Ephedrine although victimized with a lot of bad press is inexpensive, relatively safe, and a very effective way to increase metabolic rate and decrease appetite over the long haul. Feeling like you had too much coffee is an early side effect that disappears after about 8 weeks. The metabolic effect increases slowly for at least one year.   
Eating behaviors. If you must snack choose a protein. Hardboiled eggs, jello as a drink, deli turkey or beef jerky provide longer periods of freedom from hunger and lower your metabolic rate less than do other foods. High paid models drink lots of water to turn off hunger and the same technique is available to the rest of us. Coffee, and tea may be better choices even than water as they contain caffeine and theophylline which speed the metabolism and increase the rate at which calories are burned and therefore promote weight loss. Unprocessed bran mixes well with juices, salads, cereals, meat loaf casseroles, pastas etc. and it prevents constipation, diverticulosis, and colon cancer as well as lowering cholesterol and decreasing appetite.
Casual exercise, the stairs instead of the elevator, kind of exercise is always available and an excellent habit to acquire. If you are desk bound all day long, do five minutes of isometrics two or three times a day against the desk even just flex and hold; it's exercise and it is every bit as effective as exercise that moves you if done for the same amount of time. A pedometer can be very useful as a means to recording and increasing the total number of miles you walk every day.  

Self-analysis. If you are tending to regain, start a diary and record your intake. Analyze what you eat: some innocent looking foods are actually quite high in fat and therefore calories. Examples include many crackers, nearly all cheese, nuts, and grain bars. Look at where you store what you eat. Do you keep it in your desk or somewhere quite handy or is some effort necessary to make it available? If stress is making you eat, identify the stressor and find ways to eliminate or reduce the stress. Nothing invigorates like a few decisions even if some of them are wrong and have to be changed later.

Pregnancy- When is it safe to get pregnant?

Ideally, pregnancy should be delayed until weight loss is maximal, usually around 12 to 18 months after surgery. Weight loss makes women more fertile and decreases the likelihood of complications related to pregnancy.
It is safest to get pregnant after weight loss is complete as there is some theoretical risk to the fetus with rapid weight loss

How much weight should I gain?
Enough to account for the baby, the placenta, and some amniotic fluid - about 35 lbs. Ask your obstetrician.
Will I be able to lose my pregnancy weight?
Excess weight is hard to lose. It is best to gain only the amount necessary for a normal baby and pregnancy.

Other Issues
How long after surgery before it is desirable to think about cosmetic surgery?
Results are best after weight loss has maximized - 12 to 18 months after surgery.
Will I lose hair after surgery? If I do will it come back?
Hair loss is common and has never been conclusively related to any particular deficiency although many suspect that protein intake is important. If you do not have an ongoing tendency to baldness, it will all come back.
I don't have a support group where I live. What is the best way to stay in contact?
It is very important to try to follow up with us at least once and better twice a year. At those times support groups can also be attended. We don't cure the tendency to gain excess weight; we manage it with discipline, support groups, accountability and sometimes adjunctive medications like ephedrine.

What post op blood tests are needed at each major post op visit?
The tests I do are Ferritin, B12, PTH (parathyroid hormone), Calcium and cbc. I usually do tests 6 months after surgery and repeat every 6 months to a year thereafter. I do it sooner if the patient is not taking supplements as they should, or if the patient has an abnormal result that I am trying to correct.


1. How does The Doctor check for leaks?
- First, the doctors treat the gastric sleeve with the exact same tests required for Gastric Bypass patients. The first tests is a blue dye test. Secondly there is a Flouro Xray that includes a swallow (this allows him to see your stomach and fluids flowing through it). Don't be fooled by inexperienced doctors, these are usually lapband doctors who are trying to start out with a new surgery. Leaks are important and the blue dye test is critical.

2. Does the doctor hand stitch the sleeve after using the staples?
- Any and every Gastric Sleeve surgeon hand stitches behind the triple line of surgical titanium staples. There is only one staple gun that is used for the Gastric Bypass and Sleeve surgery and this is made by Johnson and Johnson. This device is used by all of the doctors in the DRJOYA.com group, who then hand stitches the sleeve behind the staples to help prevent leaks. ALL DOCTORS SHOULD STITCH BEHIND THE STAPLES.  All materieals come directly from the manufacturer and are name brand medical supplies.  No black market equipment is every used.

3. Why do other doctors require a shorter stay?
- The main reason is money. They want to make more money while risking your life. Each doctor has implemented the ideal number of nights for recovery from the surgery prior to sending you home so that there is very little risk of having a complication once you get home. This in turn will reduce any future costs you may have to spend to return. Other doctors go with a shorter stay so they can either charge a lower price, or provide inferior care.

4. When did DRJOYA.com start offering the Gastric Sleeve?
- The initial Gastric Sleeve surgery was done in Europe in 2006. DRJOYA.com started offering the Gastric Sleeve surgery that year.

5. Why choose DRJOYA.com
- We provide support and experience.  We have been working in the medical tourism industry for the last 15+ years.  We have made doctors very famous and we provide top quality care and service to the patients both before and after surgery.  We have hand selected the very best doctors to provide you the best possible care once you choose your surgeon, we are here for you both preop as well as postop.  The service you get, the attention you recieve and the fact that we do not charge anything extra for the care we provide make having surgery with us a simple decision.  You will not pay extra by having surgery with us, in fact we offer bariatric surgery in Puerto Vallarta for thousands of dollars less than other doctors offices in Puerto Vallarta.
1. How many people reach their goals?
- About 60% of the patients reach their goal with the lapband. Those who do not reach their goal normally lose a lot of weight, but just lose about 60-80% of their weight with the Lapband and 80-90% with the Bypass. You need to set your goal reasonably and diet. The band is a tool, and as such, you need to work with it, it is not a miracle pill.

2. How many people keep their weight off for ever and never gain it back.
- Many, actually you should never gain weight using the band, unless you start eating high calorie liquid food (milk shakes, ice cream, beer, etc.)

3. How many people have the band slip and the surgery is unsuccessful?
- Less than 1%

4. How many people have the band be to irritating to keep and have to have it removed.
- Less than 1%

5. How much does it cost if it does need to be removed.
- The cost is comparable to placing the band. If it can be done via an endoscopic procedure then the cost would be much less, but on average it will cost around $4500 if you have to go to the hospital.

6.Will I never be able to drink Pop again?
- Yes, some patients have trouble with Pop and carbonated products however others have no problem other than a little gas, side effect.

7. Which surgery is right for me.
- The depends on your eating habits. If you are a sweet eater, than maybe you are a Bypass Candidate, if you are a large quantity and non sweet eater than the band or Sleeve is perfect.

8. Why are people so hungry at first
- They are hungry usually because they have not eaten for a few days because of the diet related to the preparation for surgery. However, you should feel full after consuming small amounts of water or juice.
State of the Art technology and procedures done in State of the Art facilities!  Our Doctors only use the finest  hospitals in Puerto Vallarta, ones that are state of the art, with clean, sterile, and the very best equipment available.  The operating rooms are designed specifically for bariatric surgery and the doctors make sure that they have met all of their requirements.

When you are in Puerto Vallarta and your doctor is providing you service during your medical tourism vacation, if there is an emergency you may contact the doctor, 24 hours a day via telephone or email.  Someone will be available to assist you!

You may also contact us at info@drjoya.com


Call us @: 866.509.0571
           or 817.405.2778
• Bariatric Surgery
• Gastric Bypass
• Gastric Sleeve
• Lapband
• Bariatric Revisions
• Hernia Surgery
• Duodenal Switch
• Dental Work available
• Plastic Surgery available
• Beach Resort Vacation
• Medical Staff visits the hotel
• Fly directly into PVR
• No 3 hour border crossing
• Airport Pickup
• All Tests included
• R/T Airfare available

• US Passport Book Required!
Please feel free to contact us with any questions, concerns, that you may have regarding our services. If you would like to contact us via e-mail, please forward your information to info@drjoya.com and one of our friendly staff members will contact you directly or via email within 24 hours.  We can provide you with a risk free price quote based on the information you provide.  You may also call us toll free at 866.509.0571 or 817.405.2778
At DRJOYA.com we are all well trained, and bilingual, speaking both English and Spanish.  We have been working in the Medical Tourism industry for more than 15 years.  By selecting to have your surgery with us, you not only get the best doctors in Puerto Vallarta to assist you during your surgery, you also get top notch care before surgery, where you questions are answered usually in less than 24hours, to post op where we are here for you as well.  If you don't have insurance and are looking to go overseas for weight loss surgery, then let us bring you to beautiful Puerto Vallarta.  Our staff will get you the answers to your questions and assist you with getting all of your travel preparation needs in order.  Our staff will also assist you with any other specific needs you may have.  

All of the Doctors and staff that work with our doctors speak English and are University trained.  The Hospitals are also accredited and are located  in the heart of Puerto Vallarta and accessible from every hotel.  The hotel and hospitals are about 10 minutes from the airport.  
We are completely committed to delivering quality medical care to prospective patients.  With our doctors you not only get the best doctors in Mexico for your surgery, but you also get doctors who specialize in the Gastric Bypass, Gastric Sleeve surgery, Gastric Bypass Revision surgeries, Duodenal Switch Surgeries and doctors who have helped patients worldwide lose millions of pounds a year, and all of these treatments can be done at savings over what they cost in the US. The  hospitals in Puerto Vallarta have been approved by and work with most major American Insurance companies.

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Copyright 2015 DRJOYA.com Inc., Puerto Vallarta Jalisco Mexico.   By clicking on any of the links on this website, I hereby agree to all of the Terms and Conditions set forth in the LEGAL section of this website.  Information contained in this website is provided for educational purposes only. It is imperative that you consult your own physician regarding the application of any opinions or information presented in this website or received in any e-mails from DRJOYA.COM. It is not intended to replace the advice of a medical professional or in any way to be prescriptive. The author and website administrator has used sources believed to be reliable in efforts to provide information that is complete and generally in accord with the standards accepted at the time of publication. Medical knowledge changes rapidly. In lieu of the possibility of human error and changes in medical science, neither the author or website administrator, nor any party who is involved in the preparation or publication of these works or e-mails warrants that the information contained is in every respect accurate or complete, and they are not responsible for any errors or omissions or for the results obtained from the use of such information. Readers and website users are strongly encouraged to discuss and confirm the information contained in the website and e-mails with their own physician. People who use this website do so with the understanding that the author, publisher, website administrator, DRJOYA.COM, DRJOYA.com Inc., Gerald Witt, and any and all other contributors, shall have neither liability nor responsibility to any person or entity with respect to any loss or damage caused or alleged to be caused directly or indirectly by the information contained in this website or the e-mails sent from DRJOYA.COM. This is a site dedicated to medical tourism and weight loss surgery in Mexico, it is owned and operated by DRJOYA.COM Inc. a Nevada Corporation dedicated to medical tourism and is not related in any way to Dr. Armando Magdaleno Joya Munguia.