Alabama Bariatrics & Minimally Invasive Surgery

Bariatric Diet Orbera Gastric Band Sleeve Gastrectomy Gastric Bypass

W. Jay Suggs, MD, FACS, FASMBS
Madison, Huntsville, and Decatur
Phone: (256) 274-4523
Fax: (256) 203-8791

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Pre-Op

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6 Months Post

*Results may vary.

Bariatric Surgery FAQ’s (Pre-Op)

What is bariatric surgery?

    Surgery for weight loss, and therefore improved health.  The surgeries include the laparoscopic gastric bypass, laparoscopic gastric sleeve, and laparoscopic adjustable gastric band.  The Orbera intragastric balloon  and Obalon intragastric balloons are nonsurgical, removable weight loss devices placed through an endoscope.  Benefits of bariatric surgery include improvement, remission, or cure of type II diabetes, high blood pressure, acid reflux, sleep apnea, heart failure, asthma, abdominal pain, fibromyalgia, high cholesterol, and joint pain, to name a few.

Am I a candidate for bariatric surgery?

    If you are between the ages of 18 and 70 and have a Body Mass Index (BMI) of 40 or greater, or 35-39 with comorbidities such as diabetes, high blood pressure, sleep apnea, or congestive heart failure, you may qualify. Self-pay patients may qualify for the laparoscopic gastric sleeve surgery with a BMI of 30-40 with at least 1 comorbidity or a BMI greater than 40. Patients with a BMI as low as 30 also may qualify for the laparoscopic adjustable gastric band.  The Orbera intragastric balloon and the Obalon intragastric balloon are removable, non-surgical devices for people with a BMI of 30-40.

How do I find out my Body Mass Index?

    The easiest way is to use an app or internet calculator.  You’ll need to know your accurate height and weight.

What types of bariatric surgery does Dr. Suggs perform?

    The laparoscopic gastric sleeve, the laparoscopic gastric bypass, the laparoscopic adjustable gastric band, both laparoscopic and open bariatric revision surgery, the Orbera intragastric balloon, as well as the newest procedure, the Obalon intragastric balloons (which are non-surgical).

What are the risks of bariatric surgery?

    Leaks, bleeding, infections, pulmonary embolism.  Long-term, there is a risk of ulcer, vitamin deficiencies, and internal hernia with the laparoscopic gastric bypass; and risk of slip and breakage with the laparoscopic adjustable gastric band.

What information do I need to know in selecting a bariatric surgeon?

    Experience and outcomes are key.  The length of time the surgeon has been in practice, where the surgeon trained, how many surgeries he has performed, and success rates as well as complication rates are things you’ll want to know.  You’ll want to ask the surgeon about “leak rates” with the laparoscopic gastric bypass and laparoscopic gastric sleeve, bleeding and infection rates, as well as death rate.  Dr. Suggs trained at the Mayo Clinic in general surgery, and did his laparoscopic bariatric fellowship at the University Medical Center-Princeton.  He has been in practice since 2002, has performed over 1,800 bariatric operations with a leak rate of 1.5 % for the laparoscopic gastric bypass, leak rate of 0% for the laparoscopic gastric sleeve, no wound infections for either in the last 10+ years, < 1 % for bleeding, and a mortality rate of 0.13 %. The average excess weight lost for Dr. Suggs’ patients for the laparoscopic gastric sleeve and laparoscopic gastric bypass is 70 %, and for the laparoscopic adjustable gastric band 50 %.

What is Dr. Suggs’ patient satisfaction rates?

    99+ %.

How do I choose which bariatric surgery is best for me?

    Many patients choose based on how friends and family have done with their bariatric surgery.  Some patients don’t want anything permanent, so they choose the non-surgical Obalon intragastric balloon or the Orbera intragastric balloon (BMI 30-40 only).  Dr. Suggs helps you make the best decision based on your medical problems, weight-loss goals, and lifestyle.  Currently, 90% of patients are choosing the laparoscopic sleeve gastrectomy.

What if my insurance does not cover bariatric surgery?

    Even if your insurance does not cover it, bariatric surgery is important for your health.  That’s why we offer affordable bariatric surgery starting at $9,995 for the laparoscopic sleeve gastrectomy, and the non-surgical Obalon and Orbera intragastric balloon starting at $5,995.  Financing options are available.

Is there any reason I should not have bariatric surgery?

    Bariatric surgery is not for everyone.  There are dramatic lifestyle changes that ensue as well as a dramatically changing waistline.  Some medical conditions may influence which bariatric surgery you are offered, and occasionally a patient may be too high risk for bariatric surgery.

Is there anything special that I have to do to prepare for surgery?

    Very little.  We do a comprehensive work-up to make sure you are a good candidate for bariatric surgery, as well as comprehensive education.  Most people are not required to go on a special diet prior to surgery, although your insurance may require you to do 3 to 6 months of physician supervised dieting.

Will I need to see a dietician or other healthcare professional before surgery?

    Yes, you will need to be evaluated by a bariatric dietician.  Some patients need medical clearance from their primary care doctor, a psychology evaluation, and clearance from a cardiologist.  Your insurance may require you to be seen by other healthcare professionals as well.

Do I need to lose weight before surgery?

    In general, no, but if you weigh more than 500 pounds you will definitely need to lose before surgery.  Some patients are required to lose some weight before surgery, but this is on an individualized basis.

How long will I be in surgery?

    A laparoscopic sleeve gastrectomy takes about 45 minutes to perform, and a laparoscopic gastric bypass about 1 hour 15 minutes.  Add another 30 minutes or so for induction of anesthesia and waking you up before going to the recovery room.

Where is surgery performed?

    Crestwood Medical Center or Huntsville Hospital, both in Huntsville.  The Obalon intragastric balloon as well as the Orbera intragastric balloon is performed by Dr. Suggs in Decatur as well as in Madison.

How long will I be in the hospital?

    Generally, just overnight.  The laparoscopic adjustable gastric band, the Obalon intragastric balloon, and the Orbera intragastric balloon are all done as outpatients.

How much weight will I lose?

    About 70 % of your excess weight with the laparoscopic gastric bypass and laparoscopic gastric sleeve, and about 50 % with the laparoscopic adjustable gastric band. With the Obalon intragastric balloon as well as the  Orbera intragastric balloon patients lose about 3x more weight than with a diet alone, so around 30-40 pounds.

What will my diet be like after surgery?

    You’ll be on a progression from liquids for the first 2 weeks, then to pureed, then to a variety of healthy solid foods after about a month.  In the long run, you’ll be able to eat just about anything that you want, just in moderation.

Will I be hungry all the time?

    No.  That’s part of the beauty of how bariatric surgery works.

Is long-term follow-up important?

    Yes.  It’s critical.  We want to see you annually forever.

Will I regain weight?

    Not if you keep the healthy lifestyle and diet changes that you adopt the first year after surgery.

What is considered successful weight loss surgery?

    Improved health and lifestyle rather than a number.

What is important for long-term success?

    Staying with the healthy lifestyle changes and diet that you adopt in the first year after surgery or after Obalon or Orbera intragastric balloon, annual follow up with Dr. Suggs, taking your vitamins, and attending a bariatric support group.

Where are bariatric support groups?

     There are support groups in Huntsville, Decatur, Florence, and Athens in the north Alabama region.

What do I do about hanging skin?

    You lose the weight, but unfortunately not the extra skin.  Although some patients elect after a year out from bariatric surgery to have plastic surgery to remove extra skin from their belly, arms, and/or thighs, most patients do not.  Form-fitting garments, like spandex, work wonders!

How can I contact other patients about their experiences with bariatric surgery?

    Support groups in Huntsville, Decatur, Florence, and Athens are an excellent way to learn about bariatric surgery from a patient’s perspective.  You can also get a lot of that from patients in our waiting room when you’re waiting for your appointment.  Check out our Facebook page Alabama Bariatrics to hear what patients are saying, as well as visit online resources such as ObesityHelp.com.  We also keep a reference list of patients who will tell you about their experience.

Should I ask my doctor about having bariatric surgery?

    Definitely.  This is an important, life changing decision that needs your doctor’s support.

How do I get started?

    Give Alabama Bariatrics a call at 256-274-4523.  We look forward to making this journey with you!

Bariatric Clinical FAQ’s (Post-Op)

What vitamins should I take?

   All patients need an adult multivitamin and calcium daily, and some need extra B12, vitamin D, and iron.  Gastric bypass patients are more likely to need these additional vitamin supplements.  There are a variety of bariatric and lower cost vitamins on the market that we can help you choose from.  Dr. Suggs is not a vitamin salesman, but we do keep samples in the office for you.

What should be in a multivitamin?

   Everything, including but not limited to thiamine (vitamin B1), biotin, B12, vitamin D, zinc, selenium, B6, vitamin A….Everything.  Many chewable or gummy vitamins leave out thiamine or other essential vitamins and minerals.  Check your vitamin to make sure it says “complete” or “multivitamin” and is designated for adults, not children.

Can I use a vitamin patch?

   No.  Vitamin patches do not work.  We have seen severe vitamin deficiencies in patients doing the patch.  Take a good quality oral multivitamin.

How can I prevent and treat Constipation?

   Constipation is common after bariatric surgery, especially the sleeve gastrectomy. Constipation is defined as struggling to have a bowel movement, or having bowel movements greater than every 3-4 days apart.  If you’re several days between BM’s, but if it’s soft and easy to pass, then no worries.  Otherwise, here are some tips for dealing with constipation: 

   First, drink lots of water.  You should drink at least 64 oz. per day.  And that’s water, not carbonated or caffeinated drinks.  Second, take a stool softener such as Colace or pericolace twice a day.  Don’t take it only when you feel constipated; take it every day to prevent constipation.

   If still having trouble, it’s time to add fiber, for example, Metamucil.  Do the drinkable fiber mixes, not wafers or bars, as they can swell and cause discomfort in your sleeve or pouch.  Try to avoid laxatives, as your colon will become easily addicted to them, and you will not be able to have a BM without it.

How do I treat Gas?

   Gassiness is a common mild problem after bariatric surgery, especially the gastric bypass. Avoid gulping air when you eat or drink.  Many people are unconsciously swallowing a lot of air when eating or drinking.  Simethicone (Gas-X) or even omeprazole (or the equivalent) may relieve your symptoms.  Also, try to figure out what foods make you gassy, and reduce or eliminate those foods. Some folks become lactose intolerant after bariatric surgery, particularly the gastric bypass.  This is usually also associated with abdominal pain after eating lactose containing food such as milk and cheese.  Unfortunately, you may have to eliminate milk and cheese from your diet.

What do I do about the symptoms of Acid Reflux?

   A fairly common symptom after the sleeve gastrectomy, especially in the first few weeks after surgery.

First, slow down your drinking.  Sit upright when eating or drinking so that gravity will help     the outflow from the sleeve.  Down lie down afterwards, and don’t eat too late.  Sometimes a food or even liquid is too thick, delaying passage out of the sleeve.  Basically, the tube is clogged.  What may feel like acid reflux may really be food reflux.  Give it time, but you may need to go back to thinner liquids or softer foods.

   If symptoms persist, you may take an over the counter acid reducer like omeprazole.  Tums and Rolaids are okay too, but you should let your bariatric surgeon know about your symptoms.  We would not want theses medications to mask an ulcer, gastritis, or esophagitis.

   New onset of acid reflux years after a sleeve or gastric bypass could represent a new hiatal hernia.  Make your bariatric surgeon aware, as this will likely need surgical repair.

How do you treat Nausea?

   Use your prescribed medications for nausea, such as Zofran, the scopolamine patch, and Emend.  Slow down your eating and drinking.  Go back to clear liquids.  And if persistent, contact your bariatric surgeon.  Sleeve patients may have a problem emptying the sleeve, or esophagitis. Gastric bypass patients may have an ulcer or stricture where the pouch empties into the Roux limb.

What should I do about a Dilated Pupil?

   This can happen to the eye on the side of a scopolamine patch.  If this happens, remove the patch.  If you don’t have a scopolamine patch on that side, you better get to the ER quick!

How do I prevent or treat Dehydration?

   It’s important prevent dehydration.  This is more of a potential problem after a sleeve gastrectomy than a gastric bypass.  Drink at least 64 oz. of liquids per day. This includes any source of liquid, such as water, soups, and protein shakes.  Use measured drinking cups to keep accurate track of liquid intake.  If you’re becoming dehydrated because of nausea or food/drink intolerance, then it’s important to take anti-nausea medications liberally.

   If dehydration becomes bad enough, you’ll need IV fluids.  Call early, so you can be set up for outpatient IV fluid and IV anti-nausea medications.  Otherwise, you may end up in the hospital.

What are the foods most difficult to eat after bariatric surgery?

   Certain foods are harder to digest and pass out of your sleeve or pouch than others.  Drier or chewier meats and stringy vegetables are harder to digest.  Fibrous foods like asparagus and celery are harder to digest.  Poultry such as chicken breast or turkey, pork, and some tougher beef are notoriously dry.  Pasta, rice, and bread (unless toasted) don’t pass out of your sleeve or pouch very quickly. “Slider foods,” such as processed foods and those with a lot of simple carbs and sugars, may pass through easily, but are usually bad for your weight.  They can also cause dumping syndrome, especially after the gastric bypass. 

   Surprisingly, salads are easy to eat and digest after about a month post-op from your bariatric surgery.

   Fatty, oily, greasy, or fried foods commonly cause diarrhea.  This includes salad dressings, as well as veggies to which a lot of oil or butter has been added.

What should I do if I have Weakness, confusion, or difficulty walking?

   This could be a very serious thiamine (vitamin B1) deficiency.  Call you bariatric surgeon right away, as you may need to be hospitalized for a full work up.  A severe thiamine deficiency is corrected by IV infusions of thiamine, but a mild deficiency can be corrected with oral supplements.

   Other symptoms may include tingling or numbness in extremities, or a poor short term memory.

   Make sure your multivitamins include thiamine.  This is commonly left out of gummy vitamins.  Also, vitamin patches do not work, and can lead to severe vitamin deficiencies including thiamine among others.

What is Dumping syndrome?

    Dumping syndrome occurs when you eat something high in simple sugars or simple carbs.  Symptoms including shakes, nausea, sweats, dizziness, weakness, and feeling just downright bad.  What happens is that the simple sugars/carbs are absorbed too quickly, causing your blood sugar to spike too quickly.  This causes insulin to peak too quickly, which then results in paradoxically lowering your blood sugar too low.  This is what people are experiencing when they complain of “low blood sugar”.  How do you avoid it? Don’t eat foods with sugar or simple carbs.  Go for complex carbohydrates.

Can I have caffeine after bariatric surgery?

    Many bariatric surgeons and dieticians advise their patients to stay off of caffeine, because they believe that caffeine will inhibit the patient’s weight-loss.  However, there’s no good solid scientific evidence for that, and the effect would be modest any way.  We take a lot of things away from patients, so I’ve got to let you indulge in at least one thing…So, enjoy that low-fat soy milk organic latte!

Are artificial sweeteners bad for me or cause weight regain?

    That’s a tough question to answer.  There can be side effects of artificial sweeteners (or even “natural” ones like stevia)  such as bloating, gas, and even causing more cravings for sweets.  For many artificial sweeteners, the long term effects on health are unknown. My stance is that if you need an artificial sweetener to keep you from excess sugar, carb, and calorie intake, then it’s fine to use it.

Our Patients

Before

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1 Year Post!

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Before: 685.0lbs

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5 years Post: 243.0lbs (-442.0lbs!)

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