Frequently Asked Questions

FAQ

Frequently Asked Questions

Yes! Dr. Kelly is one of the best bariatric surgeons in the world. He has committed the last 10 years of his life exclusively to Bariatric surgery. His peers in Canada and USA recommend him and his patients speak very highly of him. Please see our testimonial page for some of his patients comments. Dr. Kelly also operates on high risk patients that other surgeons do not feel qualified to help. He has fixed many surgeries that were not done correctly!

No one can guarantee you that you will not have a complication, no surgeon can. What is important to know is whether or not your doctor has the experience to deal with anything that might arise. Dr. Kelly has exclusively performed bariatric surgery for the past 10 years and it is safe to say that he has seen and done it all. He has perfected his surgery technique so as to minimize the chance for any complication to arise. His complication rate is very low, less than 1 out of 200.

Yes, it is safe for you to travel to Tijuana. In the 12+ years Dr. Kelly has been doing weight loss surgery none of his clients have had a single incident of violence. You should always take precautions no matter what city you are in, whether you are in Canada, US, Mexico or the world.

You will lose the weight and keep it off. This surgery helps you keep it off permanently. You still need to do your part by incorporating exercise and healthier eating into your lifestyle but surgery makes it much easier to follow the rules to help you maintain your weight loss permanently. Surgery is your best “weight loss tool”.

Yes! Dr. Kelly is concerned first and foremost with his patients health so hospital standards are always a top concern. He has worked for over 4 years at hospitals in Michigan and California so he is quite aware of the US standards. For Dr. Kelly it is pretty simple. If he didn’t think the hospitals that he performs surgery in were not clean and safe then he would not use them. While we cannot speak for all doctors and hospitals or medical centers in Mexico we can assure you that at Nova and Angeles Hospital standards are up to par with US and Canadian hospitals. The ORs are subject to government health department inspections. Daily lab tests are done to ensure quality control. Our hospitals have been granted the “ SAFE BUSINESS” from the government. Nova and Angeles Hospital are under close supervision to ensure safety to patients. Regretfully this is not the case in smaller clinics and medical centers.

Medical Tourism is becoming more and more common and many are choosing to use Dr. Kelly because of the testimonies of his very satisfied clients. Dr. Kelly takes his patients health very seriously. Please research Dr. Kelly’s credentials for both the US and Mexico here. You can verify these online. There are also hundreds of patients recommending us online, including doctors and nurses that have either had the procedure themselves or brought a family member to see Dr. Kelly for surgery.

No. If you have had the Vertical Sleeve or Gastric Bypass or Duodenal Switch there is no need to come back. All outer sutures are dissolvable. Dr. Kelly will recommend that you have blood work done by your family doctor during the first year after your surgery to make sure you are getting adequate nutrition. The quantities of food you will be eating will be much smaller than what you were used to so you will need to supplement your diet. Blood work will tell your doctor if your supplementation is adequate and if not then your doctor may need to adjust your supplements. Dr. Kelly will make himself available to help you if you are having difficulty getting proper nutrition.

Money is always a concern for most people but it shouldn’t be your biggest concern. You will live with the ramifications of your decision for many years to come so your biggest concern should always be first and foremost your health. If you don’t have your surgery properly done the first time and there are complications then this may cost you more money in the long run than doing it right the first time. An inexperienced surgeon increases your risk. This surgery should be the last thing you need to do to get to your goal weight! Quality medical care will always cost more. Some of us will only buy quality parts for our cars but will settle for less when it comes to our health. If your surgeon makes a mistake you could live with that mistake for the rest of your life. It is not worth the risk. Some have gone to less skilled surgeons and now come to Dr. Kelly to get the surgery done right. They could have saved themselves much heartache and money if they had come to him the first time. Consider it an investment in your health. It pays very well.

After more than 10 years of experience with bariatric surgery I see the need to do 6 things.

Plan what you put in your mouth. Don’t just wing this. Make up your meals so you eat healthier.

Eat every 3 – 4 hours even if it is only a small meal or snack. It is important that you don’t skip any meals.

Try to avoid liquid calories as they don’t fill you up. Save your calories for when you eat.

Don’t drink when you eat. This may be hard at first but it is important to not drink 1/2 hour before or after you eat.

Accountability. We all need someone to help us stay on the right track. It is much easier with support than without. Join a WLS support group online if there is not one near you.

Exercise. It is important to move. You may only be able to walk at first but as the weight starts to come off and you can get around easier than why push it a little more. Maybe take up jogging or join a recreational team sport or a fitness club. Why not go to the gym and push it a little harder on some exercise equipment. Maybe use some machines that work out the muscles. Resistance training will benefit even into our golden years.

Nutrition (food and supplements) and Fluids

Multivitamin, calcium with vitamin D, and in some cases, additional iron and/or vitamin B12 supplement. Sometimes additional fat-soluble vitamins (A, D, E, and K)are added to the regimen depending on the operation’s degree of vitamin malabsorption. A chewable form is recommended, at least initially after surgery.

Vitamin and mineral supplements will be a lifelong requirement.

Most patients get 60-80 grams daily, but some may require more depending on their response to surgery or their type of operation. Your dietitian can provide more detailed information.

Protein should be eaten at every meal and snack throughout the day. It is not known if there are additional benefits to having more than 30 grams of protein at once.Protein is a nutrient that helps you feel fuller for longer. If you try to include proteins in each meals or snacks, you’re less likely to feel hungry when it’s not time to eat.

There are many options even for those with special dietary needs or preferences. Your dietitian can provide additional information on protein sources. Meats, eggs, dairy products, tofu, beans, and lentils are common protein sources in everyday foods. Protein supplements made from whey and soy are commonly sold in stores and can help you meet your protein needs. You may find it helpful to calculate your daily protein intake to be sure you’re not falling short. As you are able to tolerate more regular foods, you get a higher portion of the requirement food sources and supplements become less necessary.

The body needs additional protein during the period of rapid weight loss to maintain your muscle mass. Protein is also required to have a healthy metabolism. If you don’t provide enough protein in your diet, the body will take its protein from your muscles and you can become weak.

Caffeine fluids have been shown to be as good as any others for keeping you hydrated. Still, it is a good idea to avoid caffeine for at least the first thirty days after surgery while your stomach is extra sensitive. After that point, you can ask your surgeon or dietitian about resuming caffeine. Remember that caffeine often comes paired with sugary, high-calorie drinks, so be sure you’re making wise beverage choices.

Dehydration is the most common reason for readmission to the hospital. Dehydration occurs when your body does not get enough fluid to keep it functioning at its best. Your body also requires fluid to burn its stored fat calories for energy. Carry a bottle of water with you all day, especially when you are away from home. Remind yourself to drink even if you don’t feel thirsty. Drinking 64 ounces of fluid is a good daily goal. You can tell if you’re getting enough fluid is if you’re making clear, light-colored urine 5-10 times per day. Signs of dehydration can be thirst, headache, hard stools or dizziness upon sitting or standing up. You should contact your surgeon’s office if you are unable to drink enough fluid to stay hydrated.

Medications

Prescription or over-the-counter drugs may be absorbed differently after surgery, depending on the type of procedure. Your medication therapy may be affected by this change. In the early period right after surgery, larger tablets or capsules may not be recommended by your surgeon so that pills do not become stuck. Because of this, your surgeon may recommend that you take medications different forms, such as crushed, liquid, suspension, chewable, sublingual or injectable. Some long-acting medications and “enteric coated” medication may not be crushable. Some medication may be crushed and administered with food.

Sleeve gastrectomy and adjustable gastric banding tend to have little to no change in the absorption of medications. Roux-en-Y gastric bypass and duodenal switch can have more significant changes in how medications are absorbed. Check with your surgeon and pharmacist about how you should take each of your medications. Some patients need a higher dose of anti-depressants to have the same effect. This is not a complication, but you need to be aware of how you feel, and speak up with all your caregivers.

Maybe. Some doses may change (see the previous question). Some medication doses may decrease as the obesity-related health conditions improve. For example, diabetic patients often require less insulin or other diabetes medications after surgery because glucose control can improve quickly. Patients who take high blood pressure and cholesterol medication can see their doses lowered if these disease states improve. Any changes in prescription medication should be overseen by your doctor; this is not something that you should do yourself.

Your surgeon or bariatric physician can offer guidance on this topic. One clear class of medications to avoid after Roux-en-Y gastric bypass is the “Non-steroidal anti-inflammatory drugs” (NSAIDs), which can cause ulcers or stomach irritation in anyone but are especially linked to a kind of ulcer called “marginal ulcer” after gastric bypass. Marginal ulcers can bleed or perforate. Usually they are not fatal, but they can cause a lot of months or years of misery, and are a common cause of re-operation, and even (rarely) reversal of gastric bypass.

Some surgeons advise limiting the use of NSAIDs after sleeve gastrectomy and adjustable gastric banding as well. Corticosteroids (such as prednisone) can also cause ulcers and poor healing but may be necessary in some situations. Some long-acting, extended-release, or enteric coated medications may not be absorbed as well after bariatric surgery, so it is important that you work with your surgeon and primary care physician to monitor how well your medications are working. Your doctor may choose an immediate-release medication in some cases if the concern is high enough. Finally, some prescription medications can be associated with weight gain, so you and your doctor can weigh the risk of weight gain versus the benefit of that medication. There may be alternative medications in some cases with less weight gain as a side effect.

Some patients may require anti-acid medications, either temporarily or indefinitely. Some surgeons prescribe a temporary medication for gallstone prevention if you still have a gallbladder. Ask your surgeon if these will be needed.

Not all medications are crushable. Whether or not a medication can be crushed would depend on the drug formulation. In general, non-coated, immediate release tablets may be crushed. It is important that you are VERY careful with medications, so please always check with your surgeon, primary physician, or pharmacist prior to making medication decisions. An online list of non-crushable medications is available at http://www.ismp.org/tools/donotcrush.pdf.

Fitness

Physical activity is very important for long-term weight management. Different patients may have different needs and abilities. As you progress in your fitness program, your body becomes more efficient at the same activity, which means that you tend to burn fewer calories. As you lose weight, the number of calories burned per hour tends to decrease as well. And so, throughout time, it is necessary to gradually increase the intensity or length of your fitness activities. Your surgeon or fitness instructor may have specific recommendations for you in this regard.

Current recommendations for activity are 150 minutes of moderate activity each week such as brisk walking, jogging, Zumba, swimming, or using exercise machines. Please note that the ability to safely tolerate exercise differs from person to person. Please make sure that your chosen exercise and amount will be safely tolerated by you.

That depends on the type of exercise. You should begin walking while still in the hospital, unless instructed otherwise. As you heal, begin to increase your exercise time and intensity. Your doctor will release you to increase your activity based on your progress. After surgery, exercises such as weights, sit-ups, pull-ups, or any abdominal straining should wait until you get the go-ahead from your doctor.

Include aerobic (“cardio”), resistance (strength) and flexibility exercise into your routine for best results. Try different exercise programs to find what is right for you. Learn what is available in your community through your bariatric program, local fitness centers, and fellow patients. Warm water exercise (such as lap swimming or water aerobics) is excellent for those with joint pain. Home exercise videos are another option if you do not have access to a nearby gym.

Smoking and Alcohol

To have a lower risk of complications with weight-loss surgery, almost every bariatric surgery program will recommend that you quit smoking or using chewing tobacco prior to your surgery. Hopefully, this can be an opportunity for you to kick the habit for good.

Smoking or chewing tobacco leads to decreased blood supply to your body’s tissues and delays healing. (Haskins & Amdur, 2014). Smoking harms every organ in the body and is been linked to:

– Blood clots (the largest cause of death after bariatric surgery) – Marginal ulcers after gastric bypass – Heart disease – Stroke – Chronic obstructive pulmonary (lung) disease – Increased risk for hip fracture – Cataracts – Cancer of the mouth, throat, esophagus, larynx (voice box), stomach, pancreas, bladder, cervix, and kidney

Six weeks is needed to reduce the risk of fatal blood clots and pneumonia. Stopping just a week or two before can even make some risks worse; this is not unique to bariatric surgery. Your surgeon will have specific guidelines on how long you must be tobacco-free before surgery, and many will reschedule surgery until you are “clean.” There are blood tests that can show if you have been smoking, even if you are on a nicotine patch or gum, so don’t cheat!

Talk to your primary care practitioner; they would be glad to help!

Alcohol is not recommended after bariatric surgery. Alcohol contains calories but minimal nutrition and will work against your weight loss goal. For example, wine contains twice the calories per ounce that regular soda does. The absorption of alcohol changes with gastric bypass and gastric sleeve because an enzyme in the stomach which usually begins to digest alcohol is absent or greatly reduced.

Alcohol may also be absorbed more quickly into the body after gastric bypass or gastric sleeve. The absorbed alcohol will be more potent, and studies have demonstrated that obesity surgery patients reach a higher alcohol level and maintain the higher levels for a longer period than others. In some patients, alcohol use can increase and lead to alcohol dependence. For all of these reasons, it is recommended to avoid alcohol after bariatric surgery. (American College of Surgeons, 2011)

Pregnancy after Bariatric Surgery

It is recommended you avoid getting pregnant for 12-18 months after surgery. This allows you to have maximum weight loss and reach a stable weight. You will also be very limited in your nutrient intake for quite some time after surgery. (Abodeely, 2008).

You can experience a boost in fertility quite soon after surgery, so it is important to use a barrier method of birth control such as IUD, or condoms and spermicide to ensure you do not become pregnant. Birth control pills are much less effective patients with obesity and in the phase of rapid weight loss. If you do become pregnant, please contact your bariatric surgeon and your obstetrician to monitor your progress. You will need to closely monitor your nutrient intake and be evaluated for vitamin deficiencies.

Overall, pregnancy after weight loss surgery can be done safely, by taking steps to minimize risks to your body and to the developing fetus. Studies demonstrate a decreased risk of pregnancy-induced hypertension (high blood pressure) and a decreased risk for gestational diabetes. For best outcomes, discuss your options with your surgeon and obstetrician.