Follow-ups are an integral part of your weight loss journey. If you’re considering surgery, dedication is needed to attend these follow-ups regularly. It involve consultation with the Surgeon, Nutritionist and others in intervals of 1 week, 1 month, 3 months, 6 months, 9 months and 1 year after the surgery. You will be meeting the team once in six months in the second year and annually for further follow-up after two years. These follow-ups require you to undergo some blood tests, the results of which you and the team will review together. The team at the Institute will call you during the month of the follow-up as a reminder for you. If you are unable to meet us in person, we encourage you to have the follow-up with us over phone, email or Skype.
The faster transit of food from stomach after sleeve or shorter intestinal length after any bypass can make regular mediation absorbed and the extended-release drug preparations even less effective. Because these formulations are intended to be absorbed over 1-12 hours, the pills may pass through the gastrointestinal tract before absorption is complete. This same principle also applies to delayed-release and enteric- or film-coated pills, which releases medicines only after the pill moves to the small intestine. Oral contraceptives may not be absorbed as effectively after surgery; thus, non-hormonal barrier contraception is recommended to prevent unwanted pregnancy for women who have had bariatric operations. Post surgery, you will be recommended medicines that are absorbed with in 20 minutes. For that matter, BAROS recommends chews and liquids to help with absorption from the moment it enters the digestive system. Tablets and capsules has to be easy dissolvable and if not the dosage has to be increased to balance the bio-availability after bariatric surgery.
After bariatric surgery, patients are prone to have an increased risk of anaemia due to inadequate amounts of iron, vitamin B12 and folate. Patients also may encounter deficiencies of the fat-soluble vitamins (A, D, E and K) and calcium. Deficiencies of protein leading to muscle loss are also restored. Because of these deficits, all patients should take a daily multivitamin, minerals, iron, and calcium and protein supplements. Additional supplementation with iron, vitamin B12 and folate may be necessary in certain group of patients.
Though bariatric surgery has been successfully utilized to reverse or prevent further progression of fatty liver (Non-Alcoholic Fatty Liver Disease), liver dysfunction can occur is certain individuals. Incidence of gallstone formation ae also increased after bariatric surgery. Hence all surgical patients are advised to start on liver enzyme treatment for a short-term period using Ursodeoxycholic acid, a natural occurring bile acid to reduce liver incidences.
Non-steroidal, anti-inflammatory medications are used primarily to treat inflammation, fever and mild to moderate pain from headaches, arthritis and menstrual cramps. Taking NSAIDs after surgery significantly increases the risk of developing reflux esophagitis and gastritis after sleeve gastrectomy and marginal ulcers at the connection between the stomach pouch and the small intestine after bypass surgeries. Thus, bariatric patients should avoid these medications. So Anti-acid medications are prescribed to prevent ulcers in the gastric pouch.
Since bariatric patients consume less food, smaller amounts of stool are formed, which can lead to constipation. Some people find that taking two or three tablespoons of milk of magnesia every few days helps. Drinking plenty of water is very important, and nothing works well for constipation if water intake is poor. It is not uncommon for bariatric patients to have a bowel movement every two to three days once it is regulated. A fiber supplement is usually recommended.
Patients are usually instructed to resume most of their preoperative medications. Those who are on diabetic medications will need to monitor their blood sugar closely at home. Some patients’ blood sugar decreases very quickly after surgery (even before any weight loss), and they will need less of their diabetic medications. The same applies to insulin, which should be given when blood sugar is under strict vigilance through sliding scale and under the supervision of an Endocrinologist or primary care Physician.
Hypertensive patients have to be careful as well, as the possibility of drug reduction may happen in the immediate post operative period itself. Regular checking of BP and constant regulation of medicine through your physician is important to avoid chances of low BP scenarios. Cholesterol and other medicines needs to be monitored as well for the first 3 months as their need will come down, and even discontinued. BAROS team will coordinate with your physician to help you manage the post operative medications.