Patients who come from outside the Baltimore area for obesity surgery arrive the day of the surgery. There are local hotels you can stay in the night before surgery. You can have one support person stay in the room with you post-operatively on Unit 48. Typically, you will be discharged on the second post-op day or third day if you count the day of the surgery. Therefore, you will need transportation at that time.

For the first six weeks post-operation, it is advised not to drink carbonated beverages. Some patients try carbonation after six weeks, and it still gives them a problem such as feeling uncomfortable from the gas produced. Some patients are able to drink sugar-free carbonated beverages. However, it is recommended not to drink any beverages one hour prior to eating a meal and one hour after eating a meal.

You can eat red meat, but you need to be very careful. It is best to avoid it for the first several months following surgery. Red meat contains a high level of meat fibers, or gristle, which holds the meat together, preventing you from separating it into small parts when you chew. It can plug the outlet of your stomach pouch and prevent anything from passing through, which is very uncomfortable.

Dumping Syndrome is caused typically by eating foods with high sugar or carbohydrate content on an empty stomach. These substances produce a high osmotic load. Your body handles this by diluting the food particles with water, which reduces blood volume and causes a shock-like state. Sugar may also induce shock due to the altered physiology of your intestinal tract. The result is an unpleasant feeling causing you to break out into a sweat, turn pale white, feel butterflies in your stomach and a pounding pulse. This may be followed by cramps and diarrhea. This state can last 30 to 60 minutes, and it is quite uncomfortable - most people have to lie down until it goes away. It can be avoided by not eating the foods that cause it, especially on an empty stomach. A small amount of sweets, such as fruit, is well tolerated at the end of a meal. Dumping Syndrome does not occur in patients who have the Gastric Band procedure because their intestines are not altered.

Milk contains a special sugar called lactose, or milk sugar, which is not well digested. This sugar passes through undigested until bacteria in the lower bowel act on it, which produces irritating byproducts as well as gas. Depending on individual tolerance, some people find even the smallest amount of milk or milk sugar will cause cramps, gas and diarrhea. Patients with lactose intolerance can use Lactaid products or supplemental enzymes.

Snacking is the worst thing you can do to your weight control process. Snacking, nibbling or grazing on foods, usually high-calorie and high-fat foods, can add hundreds of calories a day to your intake while defeating the restrictive effect of your weight loss surgery. Since most snacking is done out of impulse, hunger-limitation or satiety has a limited effect in preventing it. Snacking will definitely slow down your weight loss and can lead to a late regain of weight. Snacking is also a habit, which is easier to avoid than stop once it is started.

When you are losing weight there is a heavy load of waste products to eliminate, mostly in urine. Some of these substances tend to form crystals, which can cause kidney stones. A high water intake protects you and helps your body to rid itself of waste products efficiently, promoting better weight loss. Water will also fill your stomach and will help to prolong and intensify your sense of satisfaction with food. If you feel a desire to eat in between meals, it is because you did not drink enough water the hour before.

When you have gastric bypass surgery, you lose weight because the amount of food energy (calories), which you are able to eat, is much less than your body needs to operate. It has to make up the difference by burning reserves, or unused tissues. Your body will burn any unused muscle first before it begins to burn the precious fat it has saved up. If you do not exercise daily, your body will consume your unused muscle, and that means you will lose muscle mass and strength. Daily aerobic exercise for twenty minutes will communicate to your body that you want to use your muscles and force it to burn the fat instead.

It is very important not to get pregnant for the first year after weight loss surgery. During this time there could be a high risk (up to 90 percent) of miscarriage due to the inability of the fetus to obtain all the required nutrients. Other forms of birth control will be necessary during this time. It has been reported that hormonal-based birth control is ineffective for the first 18 months. That would include birth control pills, injections and implanted hormones. After the first year post-operatively, studies indicate that normal pregnancy occurs without any complications.

It is highly recommended that you attend the support group meetings. You would be surprised how helpful it is to listen to the experiences of other people in the same situation. Many questions will arise along the way, and the best way to get them answered is by the people who have had the same experience. Various emotions will accompany the changes experienced, and it is important to process this in a group with others. Remember for some people isolation was part of being morbidly obese, and the support group will ensure no one is alone.

Of course, we can't predict exactly how your life will change after losing 100, 150 or 200+ pounds. That old motto, "everyone is an individual" is wise and true! We can ASSURE you that your life WILL change, and the changes are very likely to be quite dramatic!

Over the last two years that we have monitored our patients, we find some of the major changes to be:

Improved physical status (for example, blood pressure, blood sugar and respiratory regulation), more energy, less body aches and pains, improved sleeping
Improved psychological status, including decreased depression, improved self-esteem, improved social skills, more confidence and realistic hope for the future
Changes in relationships, including family, love relationships, friends and co-workers
In general these changes are positive and exciting. They are also demanding. In order to participate fully with the program, patients must really put their own health care choices first. This is very often a change for our patients since many have felt depressed and hopeless; they have given their own lives the lowest priority. Our patients have to learn to make assertive, healthy decisions for themselves, even when these decisions upset their loved ones. For example, they may choose to go on their exercise walk instead of sitting down and eating pretzels, OR they may have to deal with their spouse's jealousy or discomfort when they become increasingly independent.

Patients undergo incredible changes in how they see and feel about their bodies. Losing 100 or more pounds creates drastic changes in body size, appearance and related areas, such as dressing choices and feelings of being attractive and sexy. Accepting normal body image is sometimes a major challenge for weight loss surgery patients! Even though wearing a size eight dress may be a lifetime goal, some patients require some adjustment time to accept this reality, sometimes still "feeling fat" or worrying that they will gain weight back. We find that as more time passes and patients learn to become experts in managing the program guidelines with their individual lives, they experience more real success, and the new healthy body image becomes more comfortable and reliable.