Welcome to Pre-op Class…Please Standby (we will start soon)

Zoom

• We are going to take a few moments to

review how to use some of the functions

in Zoom, which may be helpful to you

during our class today

Where you communicate with clinic staff and ask questions

Press the Raise Hand button

Mute/Unmute

Zoom

• Out of respect for the group, please wait

until we call on you before speaking so

that we can ensure that everyone has a

chance to be heard

• If you’re having problems with Zoom,

please message us , as we are monitoring

the Zoom “chat”

Consent For Virtual Class

• Ensure that you conduct the virtual visit in a location that is private

• Eliminate sources of distraction

• Engage in the virtual visit as if you were meeting in-person

• Please respect yours and the other patients’ confidentiality

• No recording devices are permitted during this virtual visit.

Consent For Virtual Class

• No personal questions will be

addressed – we ask that you save any

personal questions (ex. Personal

health, financial) until your individual

appointments with practitioners

• We are going to be taking attendance

for this session so that we can

confirm that you have attended the

Surgery Class

Bariatric Surgical Program

Review:

•Getting Ready for Surgery

•What to expect in hospital

•What to do when you get home

•Diet before and after surgery

Welcome

Getting Ready for Surgery

Pre-Admission Assessment Visit

• Pre-Admission Assessment Unit will call you to

book an appointment.

• Your appointment should be a few days before

your surgery date

• Meet with a:

• nurse

• pharmacist

• anesthetist

• May have more tests (blood work, ECG)

During COVID-19

• You will be screened for COVID-19 at the hospital

entrance

• To speed up your entry you can do the screening

online the day of your visit at

www.sjhhscreening.com

• You will be given a mask if you do not already have

one and will be required to wear it throughout the

hospital

• Please sanitize your hands when entering and

leaving the clinic

Pre-Admission Assessment Visit

During COVID-19

• Physical distancing measures are in place –

Please stay 2m/6ft away from others

• You will need to come alone to your

appointment as no visitors are currently allowed

in outpatient clinics.

• If you need to bring a support person with you,

please let the clinic know before your

appointment so that they can approve this and

make necessary arrangements

Pre-Admission Assessment Visit

• Bring completed forms (www.stjoes.ca –

search pre-op clinic) OR Complete when

you arrive for the appointment

• Bring a list of your medications, as well as

all of your medications,

including all vitamin/mineral

supplements

• Important to discuss any medications,

vitamins or herbal products you are taking

as they can affect the anesthetic

Pre-Admission

Assessment Visit

Questions

Getting Ready Before Surgery

Before you come into hospital you need to:

Discuss medications with your doctor/ pharmacist

Make an appointment with your family doctor for 1 week after your surgery date

Buy your vitamin and mineral supplements

Buy your protein shakes

Grocery shop for the right foods

Make arrangements for childcare

Prescription

You will receive a

prescription before you

are discharged from

hospital

Medications

• After surgery you will take medication to:

• prevent stomach ulcers (Lanzoprazole/Prevacid)

• help control pain and discomfort (Acetaminophen with Codeine)

• Some of you may also take a medication to:

• prevent blood clots (Tinzaparin)

Preventing Blood Clots

• Nurse will inject medication called Tinzaparin in hospital

• Will start the day of surgery

• Given in lower abdomen once a day

• Before you go home, the nurse teaches you how to give this needle

• Best spot to give injection is in the stomach about 2 inches away from the belly button

Pharmacy

• Charlton Campus Outpatient Pharmacy is

located in the main lobby down from the

Information Desk and beside Tim Hortons

• Pharmacy Hours of Operation:

• May change due to COVID

• Monday - Friday – 9 am to 5 pm

• Saturday & Sunday - Closed

• Phone number: 905-522-1155 ext. 36170

Diet Before Surgery

Optifast

• OPTIFAST is a 900 calorie liquid diet that will help to shrink fat in your liver before surgery

• You will get a prescription for Optifastwhich will be faxed to the Charlton Outpatient Pharmacy once you have signed consent with the surgeon

• You will be on Optifast for 0 - 4 weeks

• You will be told when to start/stop Optifast once you have been given a surgery date

How to Take Optifast

• Must take 4 OPTIFAST packets each day

• Mix 1 packet with 300 ml of cold water and ice

• Shake well or mix in a blender

• Do not drink less than 4 Optifast each day

• May drink 1 packet every 3 - 4 hours

Page 19

• There are several ways that you can

change the flavour of Optifast

• You are allowed a small amount of

vegetables with your Optifast

• Please refer to pages 19-24 in your book

for more information

How to Take Optifast

How to Take Optifast

• Drink at least 1 extra litre (4 cups)

of other sugar-free, calorie-free,

non-carbonated fluids daily:

• Water

• Coffee or Tea

• Crystal Light or Mio

• Low fat broth (20 cal per svg)

• Sugar-free jello

• Popsicles made from Crystal

Light or Mio

2 Days Before Surgery

• Stop OPTIFAST supplement

• Stop vegetables

Stop broth (book is wrong)

Continue clear fluids diet

No milk/cream or sugar in coffee/tea

Day Before Surgery

• Nothing to eat or

drink after Midnight

the day before

surgery

Questions

In Hospital

Day of Surgery

• Check into the Day Surgery Unit 2-3 hours

before your surgery

• Bring your health card

• Bring comfortable walking shoes with

non-slippery soles

• Leave any valuables at home – Can bring cell

phone

• You do NOT need to bring medications or

vitamins to hospital unless told otherwise

Day of Surgery

• CPAP machine

• Bring your machine

and mask to the

hospital the day

of surgery

Your Hospital Stay

Day surgery unit

Operating room

Recovery room

Nursing unit

Your Hospital Stay

• Length of stay in hospital is 2 to 3 days including surgery day

• Pain should be less and less each day

Visitor’s Policy

• Visitor’s are currently not allowed in

outpatient areas

• Inpatient Unit:

– Two visitors maximum daily, with only one

visitor allowed at a time

– Visitors must be designated by the patient

(Patients may designate one or two individuals

who will be the only people able to visit)

After Surgery

On The Nursing Unit

Activity

• Walking and moving are the most

important things you can do for yourself

• Your nurse will help you to the

bathroom on the day of surgery

• It is important to walk the first

evening of your surgery

• You should walk at least 4 times the next day

• Walking helps prevent blood clots, infection,

bowel problems and helps move the gas!

Leg Exercises

• Do leg exercises every hour that you are awake

• Helps with circulation and prevents blood clots

Deep Breathing and Coughing

• Do deep breathing and coughing exercises

every hour that you are awake

• Helps prevent lung infections and pneumonia

Activity is Important

• All of these exercises will help prevent

complications from surgery

• Do these activities in the hospital and at home

Questions

Diet

In Hospital

Stomach Size… How Small?

• At first, stomach holds about 60 to 120 ml or ¼ to ½ cup (due to swelling)

• Some people can eat more, some can eat less – this is normal because everyone heals differently

• Your stomach will hold more as your swelling goes down

Day 1 - Clear Fluids Diet

• Start with clear fluids in a medicine cup (30 ml)

• Take one sip at a time - no straws

• Start by taking at least 30 to 60 minutes to

drink what is in the medicine cup (30 ml/hour)

• Sip throughout the day

• Surgeon will increase the rate slowly

Your priority is to drink enough!

Day 1 - Clear Fluids Diet

• It is important

to write down

how much you

are drinking

• You will

be given a chart

to record how

much you are

drinking

• Water

• No added sugar fruit juice

(125 ml or 1/2 cup/day maximum)

• Low fat beef, chicken or vegetable broth

• Sugar-free jello

Day 1 - Clear Fluids Diet

• You will be offered 3 high protein drinks a day

• Glucerna

• Resource Diabetic

Day 2 – Add Protein Shakes

Questions

When You are Home

When You are Home

• Use your book as your guide

• Contains all the

information you need

• Call 905-522-1155

– Nursing ext 34231

– Dietitian ext 33437

– Clerical ext 33240

Recovery Time

• Do not lift or carry anything over 10 lbs or 4.5 kilograms

• The usual time off work is 4 to 8 weeks

• Return to work paperwork can be completed by your family doctor

When You are Home

• Try to keep incisions dry

• You can shower 4 days after surgery

or as advised by your surgeon and gently pat

dry incisions (do not rub)

• No swimming or baths for 8 weeks after

surgery

Contact your family doctor or health care

provider if you notice:

• any incision is red, swollen, painful, bleeding

• any incision has yellow, green or smelly

discharge

• you have a fever – a temperature 38.3 or above

• vomiting that lasts more than 3 hours

• dizziness that does not go away

• diarrhea that lasts for more than 3 days

Page 33

Go to St. Joseph’s Hospital or the nearest

Emergency if you have:

• leg pain or swelling

• shortness of breath

• chest or shoulder pain

Call 911 or your local emergency number. Do not

drive yourself.

Page 33

• No smoking

• No anti-inflammatory medications (NSAIDS)

• No alcohol for at least 3 months

• Caffeine – limit (avoid if causing heartburn)

• It is recommended not to get pregnant for

at least 18 months. Must be on a non-oral form of

birth control

Remember!

Medications

• Cannot take anti-inflammatory medication e.g. Advil, Motrin, Aleve, Ibuprofen

• If you take ASA or Celebrex you must stop for at least 3 months after surgery. After 3 months, if you need to start taking ASA or Celebrex again you must call the clinic or speak with your family doctor.

• Careful with other over the counter products that contain NSAIDS (eg. Cold remedies)

Medications

• After surgery, you cannot take any large

medications as whole pills or capsules

• Any pill bigger than a M&M or smartie should

be split or crushed

• Pills may be split in half or crushed and mixed

in applesauce, pudding, or yogurt

Take Your Vitamins

• Start taking your vitamins again

when you get home from hospital

• Your dietitian provided

individualized recommendations

for vitamins that you should take

• We may add extra vitamins after

your surgery

Vitamin and Mineral

Supplements

• Some of your vitamins are too big to

swallow whole

• You can cut or crush large pills

• You can use select liquid/chewable

products

• You cannot use children’s or gummy

products

Nutritional Deficiencies

• Vitamin deficiencies can have serious consequences, and can even be life-threatening

• You can prevent them by:

• Taking your vitamins every day

• Taking the correct doses

• Getting your bloodwork done

• Showing up to all of your follow-up visits

• Close monitoring after surgery is essential!

Follow-up after Surgery

• Important to be checked often:

• 1 week

• 1 month (Nurse + class)

• 3 months + blood tests

• 6 months + blood tests

• 12 months + blood tests

Questions

What to Eat

• Your diet will follow several stages and progress from clear fluids to a soft diet

• This will:

• decrease irritation and stress to the surgical area

• allow time to heal

• help prevent vomiting

Do NOT skip ahead in your diet!

Week 1 & 2 - Full Fluid Diet

• Start “Weeks 1 & 2 – Full Fluids” when you get home

• Mark your weeks on a calendar!

• You have 5 goals to work up to when you get home

1.Get enough fluids - 2 litres every day

2.Get enough protein - 60 grams every day

3.Write down and keep track of your diet every day

4.Take your vitamin and mineral supplements every day

5.Do some activity each day

Page 49

Week 1 & 2 - Full Fluid Diet

• Can still drink clear fluids

• Must use high protein supplements (2 to 3 every day for 2 weeks)

• Start by drinking 60 ml (¼ cup) every hour, and progress to about 120 ml (½ cup) every hour within a few days

• Your book provides a list of allowed foods and a sample menu

Week 1 & 2 - Full Fluid Diet

• Examples:

• Protein shakes

• milk or reduced-sugar soy milk

• yogurt or Greek yogurt

• Strained cream soup

• Oatmeal or cream of wheat

made with milk

Get Enough Fluids

• Goal is to get 2 litres or 8 cups of fluids

each day

• Anything you drink counts

• Sip all day long

• Carry a water bottle

wherever you go

• Write it down!

Get Enough Protein

• Goal is to get at least 60 grams

of protein each day

• Getting enough protein:

• Helps your body to heal

• Promotes the loss of body fat

• Preserves lean muscle tissue

• Use protein supplements to help

you meet your goal

• Write it down!

21 grams of

protein in

meat or fish

the size of a

deck of cards

Pre-mixed Protein Shakes

• Choose a pre-mixed shake that has:

• At least 15 grams of protein per drink

• Less than 10 grams of sugar per drink

• Less than 5 grams of fat per drink

• Examples:

• Boost Diabetic (16 grams of protein)

• Premier Nutrition (30 grams of protein)

Page 74

Protein Powders

• If you prefer to make your own protein shakes,

you can use:

• Whey Isolate

• Soy Isolate

• Choose a powder that has:

• 20-40 grams of protein per serving

• Less than 5 grams of carbohydrate per serving

• Less than 3 grams of fat per serving

Tracking Your Diet

• You must track your food and liquids after surgery

• Tracking your diet will help you achieve your goals

• Bring your food records to your appointments

• this will help us to give you feedback and suggestions

• You can track by hand using the charts in your book, or online or with your phone

• My Fitness Pal

• Baritastic

• My Net Diary

Tracking Your Diet

• For the first few weeks, we expect you to track fluids and protein

• Do not worry about calories during the first few weeks

• You must weigh/measure your portions so that your food records are accurate

• Refer to page 76 in your book for help with tracking protein

Tracking Your Diet

Time Food Fluid (ml) Protein (g)

8:00 amPremier

Drink325 30

9:00 am Greek Yogurt 125 14

10:00 am Water 125 0

12:00 pm Cream Soup 250 3

2:00 pm Water 250 0

4:00 pm SF Jello 125 0

6:00 pmPremier

Drink325 30

8:00 pm Skim Milk 250 7

10:00 pm Water 250 0

TOTAL 2025 ml 84 grams

Week 3 to 5 Soft Foods

• Can still eat all foods from previous weeks

• Focus on soft protein foods that are

easy to chew and digest

• You are adding new foods each week

• Limit grains and starches until you are

meeting protein target

Week 3 – Soft Foods

• Protein foods to add to diet:

• Poultry (soft, moist)

• Beef and pork (ground, lean or extra lean)

• Lean deli meats

• Fish (fresh, frozen, canned)

• Cottage cheese (2% or less milk fat)

• Cheese

• Eggs, Egg salad

• Legumes, hummus

• Tofu

Page 54

Week 4 – Soft Foods

ADD the following foods Vegetables and Fruits

• Soft, peeled, seedless fruits

• Canned fruit packed in water

• Soft well cooked vegetables

Grain Products

• Low sugar cereals

• Couscous, quinoa

• Mashed potatoes

Page 58

Week 5 – Soft Foods

ADD the following foods

Grain Products

•Whole wheat toast, whole grain crackers

•Whole wheat pitas, tortillas and wraps

•Baked or oven roasted potatoes/sweet potatoes

Page 59

Eating TechniquesHow you eat is just as important as what you eat!

1. Eat slowly

2. Take very small bites

3. Chew your food well

4. Make sure foods are not too dry

5. Always eat your protein first

6. Stop eating as soon as you feel full

7. Separate liquids and solids by 30 minutes

You will eventually be able to eat about 250 ml (1 cup) of food

Week 6 – Diet for Life

• We will review week 6 and beyond at your

1-month class

• Your book lists difficult foods under

“proceed with caution”

• You must continue to track and reach your

goals

Page 64

Questions

Diet Related

Problems

After Surgery

Page 85

Nausea and Vomiting

• You can prevent nausea and vomiting by:

• eating slow

• eating small amounts (follow your diet)

• chewing well

• avoid laying down after eating

• Don’t drink fluids with meals – Wait 30 minutes before or after meals

• If symptoms of vomiting persist for more than 3 hours call your family doctor

Dehydration

• Common with bariatric surgery

• Symptoms of dehydration:

• dark urine and less urine

• nausea and vomiting

• feeling tired

• lower back pain

• dry mouth and tongue

• feeling dizzy

• feeling irritable

Dehydration

• You can prevent dehydration by:

• drinking at least 2 litres or

8 cups of fluid each day

• sipping fluids all day long

• sucking on ice chips or

sugar-free popsicles if

you have nausea

Dumping Syndrome

• Emptying of the new, smaller stomach too fast

into small intestine. Symptoms include:

• bloating

• pain

• flushing

• sweating

• rapid heart rate

• light headedness

• diarrhea

Dumping Syndrome

• To prevent dumping syndrome:

• eat small portions (follow your diet)

• eat protein at each meal

• avoid foods that are very high in fat

• avoid foods and drinks that are high in

added sugars

• do not drink fluids with meals

Constipation

• Constipation is caused by:

• eating less fibre

• not drinking enough fluids

• decreased activity level

• pain medications

• It is normal to have a bowel movement usually every 1-2 days

• You may need a fibre supplement or medications

Diarrhea

• May take time for bowel to adapt

• To help prevent diarrhea:

• avoid caffeine

• you may need a fibre supplement

• Drink extra fluids with diarrhea

• If you have diarrhea that continues more than 3 days, call your family doctor

Keys to Success

• People who keep their weight off:

• Follow a healthy, balanced eating plan

• Exercise regularly

• Keep all appointments

• Have a good support system

• Ask for help when they

need it

Peer Support Group

• Meets monthly (virtually on Dovetale)

• Available to all patients who have

had surgery

• 3rd Tuesday of the month – 6 pm

• Send a Dovetale message with your

email to the Mental Health Team to get

monthly updates and to register for the

group

Questions

Diabetes and

Surgery

Diabetes and Bariatric Surgery

• Research shows that for some

patients having this surgery:

• Blood sugars improve and less

medication is required for diabetes

OR

• Blood sugars return to normal and

medications is no longer required

• Testing your blood sugars is very important

before, during and after surgery

Diabetes and Optifast

• Optifast is low in carbohydrates and

causes you to lose weight which changes

your blood sugars

• Your diabetes medications need to be

changed to prevent low blood sugars

Diabetes and Optifast

• Before starting the Optifast diet discuss

your medications with your family doctor,

health care provider or the diabetes

educator in the Bariatric Clinic

• Most people are able to decrease their

diabetes medication in half by the end of

the Optifast diet

Blood Sugar Testing

• If you take pills for diabetes:

• You should test your sugar 2 times each

day

• First thing in the morning before you

eat (fasting)

• Later in the day either before dinner

or at bedtime

Blood Sugar Testing

• If you take insulin for diabetes

• You should test your sugar 2 to 4 times

each day

• Each person is different

• First thing in the morning before you eat

(fasting)

• Before each insulin injection

Blood Sugar Targets

• Fasting and before meals

4.0 to 7.0 mmol/L

• 2 hours after meals

5.0 to 10.0 mmol/L

Blood sugar targets

•While on Optifast diet, targets for blood

sugars can be less strict

• Target of 6.0-12.0 in order to prevent

hypoglycemia

• Typically relates more to people taking

insulin or Diamicron, Glyburide

Questions

Medications for diabetes to be

adjusted•Any type of insulin-short acting or long

acting

•Glyburide

•Diamicron (Gliclazide)

•Repaglinide

Diabetes medications to

consider•Metformin

• Januvia

• Trajenta

•Onglyza

• Victoza

•Ozempic

• Trulicity

Diabetes medications to

STOP prior to Optifast• Jardiance

• Forxiga

• Invokana

• Synjardy

• Xigduo

• Invokamet

Questions

Low Blood Sugar

• Blood sugar less than 4.0

• You may feel:

• dizzy

• shaky

• sweaty

• hungry

• confused

• You may have no symptoms

Treating a Low Blood Sugar

• If your blood sugar is less than 4.0

1. Drink 180 ml or ¾ cup of regular fruit

juice or chew 3 to 4 dextrose tablets

2. Check your blood sugar in 15 minutes

3. If your blood sugar is still less than

4.0, repeat above treatment

Treating a Low Blood Sugar

4. If your blood sugar is above 4.0

eat a snack that contains both

starch and protein

5. Continue with Optifast diet

6. Talk to your family doctor or the diabetes

educator in the clinic to have medications

adjusted

Remember

• Even though on Optifast diet, must treat the

low blood sugar by eating a starch and protein

Questions

In the Hospital

• If you have diabetes your blood sugar

is tested:

• Before surgery

• After surgery – every 6 hours

• For blood sugars greater than 12.0

you receive insulin injections

Going Home

• When you are home from the hospital you

stop all your medications for diabetes –

insulin and/or pills

• It is important to assess your blood

sugars when your are home

• These results are reviewed at your first

clinic appointment

Blood Sugar Testing at Home

• Test your blood sugars 2x each day

• Fasting blood sugar

• Evening blood sugar

• Record your blood sugars in a log book or

journal

• BRING THIS BOOK TO EACH CLINIC VISIT

• These results are used to:

• change medications

• change diet

Diabetes after Bariatric Surgery

• Meal time blood sugars usually improve

first before the fasting blood sugars

• As the weight loss occurs the fasting

blood sugars improve

• Some people may need to go back on

medication for diabetes until there is more

weight loss

• Do not be discouraged if this happens.

It is often temporary.

Questions