Bariatric Booklet - Kaiser Permanente

Steps toward a healthier future:

Bariatric Surgery Program Guide

Please bring this notebook to: ? Provider Seminar Class ? Psych Assessment ? Pre-Consult with Surgeon ? Pre-Op Consult with Dietitian ? Day of Surgery ? Post Op Appointments

DEPARTMENT OF GENERAL SURGERY wa

Updated April 2020

DA1940000-01-20

Table of Contents

1. Welcome & Overview ................................ 2 Care Team Contact Information ............... 5 Map & driving directions ............................ 6

2. Pre-op checklist ....................................... 10 Provider Seminar ..................................... 11 Weight loss requirement .......................... 12 Nutrition counseling requirement............. 13 Support group .......................................... 13

3. Metabolic & bariatric surgery ................... 14

4. Pre-paring for surgery.............................. 24 Time-off for recovery ............................... 24 Birth control.............................................. 27 Smoking: .................................................. 27 Sleep apnea............................................. 28 wa ................................................ 29 Hotels...................................................... 30

5. Pre-op instructions................................... 32 day of surgery .......................................... 35 hospital stay............................................. 36

6. Nutrition plan............................................ 44 Laying the foundations ............................ 45 Pre-op diet ............................................... 64 Day before surgery diet ........................... 70 Post-op diets: stages 1-5 .................... 71-99 Protein 101 ............................................ 100 Frequently asked questions................... 118

7. Vitamins, supplements & medications............................ 124

Probiotics................................................. 134 Recommended supplement brands ........ 135

8. Post-op concerns .................................... 136 Hydration / dehydration ........................... 137 Nausea / vomiting.................................... 138 Constipation ............................................ 139 Dumping syndrome: ................................ 140 When/who to call ..................................... 141

9. Follow-up appointments .......................... 142

10. Keys to success ...................................... 144 Food journaling........................................ 145 Newsletter & web page ........................... 146 Emotions.................................................. 148 Sleep apnea / post op ............................. 149 Hair loss................................................... 150 Excess skin ............................................. 151

11. Resources you find helpful ...................... 152

12. Poem ....................................................... 154

13. Glossary of terms .................................... 156

14. Document your measurements ............... 160

15. Free space for documents you'd like to add to your notebook

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We are pleased to welcome you into our Bariatric Surgery Program.

Please be advised that your approval is for the program. You will need to have your bariatric benefit at the time of surgery, which will be verified once your surgery is scheduled. Please notify us if you have a change in your benefits. Do not be concerned about the expiration date on your authorization letter. Your surgery does not need to be completed by that date. We would like to introduce you to the overall process of this care and the team of health care providers who will be working with you throughout your experience. You are an important part of the team and will be actively involved in your care as you participate in this program. Adequate preparation and planning before surgery and your active involvement after surgery will help you accomplish the best possible results. This notebook is your program information guide. It describes the steps leading up to surgery, what to expect during your hospital stay and recovery, and how to maintain long term benefits from the procedure. Please keep this notebook! You will find the answers to many of your questions, both before and after your surgery. We are committed to helping you throughout this life-changing and sometimes challenging experience. Working together, we expect a difference in your long-term health. Keep this worthy goal in mind to help cope with any frustrations you may encounter along the way. In order to continue to improve the care we provide, we ask for your feedback and suggestions.

Did you know? Our bariatric surgery program helped earn Overlake Hospital a coveted HealthGrades 2018 Bariatric Surgery Excellence Award ? and status in the top 5% for bariatric surgery excellence nationally.

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Keep Up the Momentum

Once you get your notebook, read through it ? and begin your journey toward weight loss and improved health.

The medical testing and consults necessary will be ordered for you. Please keep in mind that if any follow-up is recommended as a result of any testing or consults, that must also be completed. This might include a sleep study or treatment / therapy for depression or eating disorder assessment and possible treatment. When further Gastroenterology testing is required, that also extends your time in the program. It may seem like a long and possibly intimidating to-do list and you can expect the medical testing and pre-op work-up process to take possibly 4-6 months to complete. You may also have the ability to complete the process in less time. This depends largely on your motivation and continued momentum through the steps. If you are delayed to treat depression, an eating disorder or other issue, please follow through with the recommendations. We know that this can be upsetting, to be delayed, however following through on the recommendations will only serve to benefit you. Untreated or under-treated depression and eating disorders can result is problems following surgery ? sometimes significant problems that could result in hospitalization and in rare incidence another surgery. Our goal is to make sure you are ready and thoroughly prepared for your surgery. Being proactive and motivated can make the process move along a bit faster and smoother. Our growing team of bariatric professionals are here to assist all along your journey, from today and for many years to come!

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Welcome to the Kaiser Bariatric Surgery Program

We enjoy this field of surgery as we get to cure more disease than any other field of Medicine or Surgery. With one operation, we achieve resolution or remission of type 2 Diabetes, hypertension, high cholesterol, sleep apnea, morbid obesity, and urinary incontinence (females) in greater than 90% of patients. For less than the average-annual cost of insulin for a given patient, we induce a remission of the diabetes in 90% or more of patients (96% in the Kaiser Permanente (formerly Group Health) gastric bypass data base).

The Four Pillars of any successful Bariatric Surgery Program are the Surgical, Medical, Behavioral, and Nutritional components. Our Bariatric Program is expanding to include pre-operative and post-operative help from each of these components.

Our Bariatric Program was started in 1994.

Dr. Anirban Gupta joined Kaiser Permanente (formerly Group Health) in 2016, transitioning his practice from Ohio where he developed a MBSAQIP-Accredited bariatric program from the ground up. He completed a Laparoscopic and Endoscopic Fellowship in Bariatric Surgery at Johns Hopkins in 2008 and completed his General Surgery training in University of Toronto in 2007.

Dr. M. Imad Haque joined Kaiser Permanente in 2020, transitioning his practice after a 21 year career as an Army General, Trauma and Bariatric Surgeon at Madigan Army Medical Center. He completed a Fellowship in Advanced Laparoscopy (Bariatrics), Endoscopy, and Ultrasound Fellowship at St. Vincent Hospital Medical Center and Indiana University Medical Center in 2008. He completed his General Surgery residency at Madigan Army Medical in 2003. He established the first multidisciplinary bariatric surgery program for the Department of Defense in Europe in 2004. Dr. Haque retired as a Colonel in the Army. He has multiple deployments to Syria, Iraq, and Afghanistan. He is passionate about surgical process improvement and brings advanced Robotic Surgery (DaVinci) experience to the program. Dr Shireesh Saurabh joined Kaiser Permanente in 2019. He is a board certified general and bariatric surgeon. He was in a practice in Iowa for 5 years, where he established an accredited bariatric surgery program. He completed his general surgery training at Drexel University in 2013 and bariatric surgery fellowship at University of Iowa in 2014.

We look forward to continuing our tradition of Bariatric excellence, with you as our partners!

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Care Team

Your care takes place in different settings and is coordinated by the Bariatric Surgery Program team, to make sure you have a successful and safe procedure. The team will provide you with information to make sure you are ready for surgery and assist with your recovery afterwards. Each team member has a special role and responsibility.

Kaiser Permanente Bellevue Medical Center

Our Bariatric Clinic is a part of the General Surgery Clinic Hours: 8:00 am to 5:00 pm, Monday through Friday Phone: 425-502-3454 Toll-free: 1-800-995-5658, extension 3454 Bariatric Surgeons: A general surgeon with specialized training in bariatric surgery.

Dr. Anirban Gupta Dr. Shireesh Saurabh Dr. Imad Haque Bariatric RN Case Manager: A Registered Nurse (RN) manages the pre-op process/medical work up and post op triage for problems / concerns. Phone: 425-502-3454 Bariatric Dietitian: Dietitian with specialized training and experience to provide dietary evaluation, education, and counseling. Phone: 425-502-3454 Lisa Stariha Fionna Marave Bariatric Psychologist: Our bariatric psychologist specifically works with you to find successful ways to meet your healthy lifestyle goals. Dr. Janet Ng Bariatric Physician Assistants (PA) and Nurse Practitioner (ARNP): with special education and experience with bariatric surgery and bariatric follow up care. Medical Assistant (MA): will assist in scheduling of appointments and coordination of care

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