PACIFIC BARIATRIC SURGICAL MEDICAL GROUP, INC

CRIPPS

LINIC

PACIFIC BARIATRIC SURGERY PROGRAM

RITTEN

XAM

RINT

AME

_____________________________________________________

This exam, while not all-inclusive, will highlight what you need to know

before undergoing surgery. Scoring well on this test should be an enjoyable reward

for all your effort in gaining an understanding of obesity and its treatment.

Please use your consultation booklet and glossary as a reference

The following statements are either TRUE or FALSE. Please circle the correct answer.

True

False

Clinically severe (or morbid) obesity is caused by a lack of self-control

and laziness.

True

False

An accepted definition of clinically severe obesity is a body mass index

(BMI) of at least 40 or a weight of 100 pounds or more above ideal

calculated weight.

True

False

The disease of Morbid Obesity carries a greater mortality risk than

those who have average weight.

True

False

We recommend that you avoid chicken for 6 months after surgery as it

frequently causes nausea and vomiting.

True

False

The new stomach pouch outlet is 1cm in diameter. Eating chunks of

coconut or chicken may obstruct this outlet.

True

False

All patients with morbid obesity are considered good surgical

candidates.

True

False

Gastric bypass surgery guarantees lifetime successful weight loss.

True

False

You do not have to stay in San Diego following discharge from the

hospital, based on the recommendation of your surgeon.

True

False

If you have authorization from your insurance for surgery, you are

guaranteed to have the surgery.

10)

True

False

Walking begins before surgery and continues daily for the rest of your

life.

11)

True

False

Patients who attend the Support Groups are usually more successful

than those who do not.

12)

True

False

Chewable vitamins begin after hospital discharge & are taken daily for

the first 6 weeks. Regular high potency vitamin pills are taken daily

thereafter for life.

13)

True

False

Following surgery I can safely take over-the-counter cold medicine that

does not contain aspirin.

14)

True

False

For long-term success after DGB (Divided Gastric Bypass), lifelong

changes in lifestyle, dietary, exercise habit, and medical follow-up are

required.

15)

True

False

Scheduling medical follow-up is the patient's responsibility and should

be done at one, three, six, and twelve months post-op and annually

thereafter.

16)

True

False

Serious complications such as a leak or pneumonia may occur following

gastric bypass that can require additional surgery, lengthy

hospitalization, including a stay in intensive care, and potential

additional financial obligation.

17)

True

False

Gallbladder disease is possible after gastric bypass surgery or with any

program involving rapid weight loss.

18)

True

False

When gastric bypass surgery is successful, improvement in associated

conditions such as diabetes, hypertension, joint pains and sleep apnea

are usually seen.

19)

True

False

Meals after gastric bypass are much smaller, and are never to be taken

more than three times per day.

20)

True

False

After surgery we recommend you drink a minimum of 24oz of fluids

(water, crystal light, protein drink) per day.

21)

True

False

Example of preventative measures used to avoid a pulmonary embolus

include: low does heparin, inflatable foot pumps, early ambulation,

platelet thinning medication (i.e. Toradol), and pre-op weight loss.

Some or all of these may be used by your surgeon as deemed

appropriate.

22)

True

False

Vomiting after gastric bypass may be caused by overeating or eating

too rapidly.

23)

True

False

The most common cause of death after gastric bypass surgery is a

pulmonary embolus which can occur despite the use of multiple

preventative measures.

24)

True

False

Carbonated beverages may stretch the stomach and will increase risk

for failure after gastric bypass.

25)

True

False

One year after surgery, a follow-up visit, once a year with your

surgeon, along with lab tests, is usually sufficient. This is in addition to

visits with your primary care physician.

26)

True

False

Weight loss during the first 12 to 18 months after gastric bypass is

fairly easy, but patients who do not follow the exercise requirements,

post-operative diet guidelines, and follow-

up recommendations will

eventually regain significant weight.

27)

True

False

Taking the medication called “Actigall” for six months following gastric

bypass may reduce the incidence of gallstone formation. (read Protocol)

28)

True

False

Strict bed rest in the hospital and at home following surgery is required

to reduce the risk of blood clots forming and to reduce the risk for

pneumonia.

29)

True

False

In the absence of complications, hospital stay is usually 2-4 days.

30)

True

False

When traveling home after surgery, a five minute walk outside of the

car every 30 minutes is required to reduce the risk of blood clots.

The following questions each contain only one correct answer. Please circle the ONE CORRECT answer.

31)

Which of these complications might occur months or years after surgery?

a) Incisional hernia

b) Cholecystitis/Gallstones

c) Vitamin deficiency or Anemia (iron deficiency)

d) Gastrointestinal ulcer

e) All of the above

32)

Which of the following recommendations will NOT help you in achieving a new, healthy lifestyle after

the RYDGB:

a) Eat slowly, do not overfill the pouch

b) Eat protein first and most at each meal

c) Drink mostly water between meals

d) Snack between meals

33)

Certain things may cause ulcers in gastric bypass patients. Circle one that does not:

a) Aspirin & Non-steroidal anti-inflammatory drugs (Motrin, Ibuprofen, Aleve, etc.)

b) Alcohol

c) Nicotine (smoking)

d) Tylenol Extra Strength liquid or capsules

34)

Nutritional deficiencies remain a danger for life after gastric bypass. Which one of the following is

NOT recommended:***

a) Daily multi-vitamins and weekly B12

b) Eat adequate protein with every meal

c) Take daily calcium supplement beginning at 2 to 3 months after surgery

d) Iron supplements if recommended by your doctor

e) Eating more than recommended three (3) meals a day

35)

Which medications MUST NEVER be taken after gastric bypass?

a) Prescription or over-the-counter medications recommended by your physician

b) Anti-hypertension medications

c) Anti-depression medications

d) Lortab, Codeine, Vicodin, for pain

e) Aspirin, Motrin, and/or non-steroidal anti-inflammatory drugs

36)

Patients are instructed to take the following steps prior to surgery:

a) Increase total water intake to 64 oz. per day

b) Begin a HIGH Protein drink

c) Stop smoking at least 6 weeks prior to surgery. Stop caffeine & carbonation at least 4 weeks prior.

d) Increase activity to the equivalent of walking two miles per day

e) Begin Vitamin/Mineral supplementation with extra Vitamin C

f) All of the above.

37)

Exercise is the key to obtaining the maximum result from the gastric bypass surgery. Which one of the

following will eventually cause weight gain and a possible failed gastric bypass:

a) Walking immediately post-op 15 minutes 4 times per day

b) Aerobic exercise and strength training as recommended

c) Stop walking, stop organized exercise, stop water aerobics, etc.

d) Exercise 5 days per week 45 minutes per session starting 1month post-op

e) Discuss our recommendations with your primary care physician

38)

Choose one of the following that would be untrue during your hospital stay.

a) Each patient will be evaluated and treated on an individual basis

b) Walking within 4 hours of waking up is necessary to reduce the risk for blood clots and

pulmonary emboli

c) You will usually be started on ice chips the first post-op day

d) There is no discomfort following surgery

39)

While water is most important, which of the following liquids is NOT acceptable between meals:

a) Herbal teas (peppermint and chamomile)

b) Decaffeinated Coffee

c) Sodas, Beer or Champagne

d) Water

e) Crystal Light

40)

Nausea is common immediately after DGB surgery. Which of the following may increase nausea?

a) Avoiding dairy products

b) Peppermint extract on ice chips

c) Rest your stomach by taking only clear liquids for 24 hours

d) Advance your diet on your own until you overfill your stomach

e) Limiting intake to one ounce every 15 to 30 minutes to reduce gastric spasms

41)

Choose one of the following that may increase the risk of potential fatal emboli (clots to the lungs)

a) Walking immediately after surgery

b) Use of blood thinners

c) Foot pumps while in bed during the hospital stay

d) No movement, lying flat at complete bed rest

e) Adequate fluid intake

42)

Within the first month after gastric bypass surgery, you should call the surgeon's office if you

experience any of the following. Circle the one that does NOT apply:

a) Repetitive vomiting of liquids

b) Fever of 101 degrees or above

c) Bruised finger, sore knee, or common cold

d) Progressive increasing abdominal pain

e) Left shoulder pain or shortness of breath

43)

Following gastric bypass surgery, the patient takes responsibility to schedule which of the following:

a) Routine lab work

b) Visits to the surgeon or post-op clinics

c) Visits with personal physician after surgery

d) Regular exercise workouts

e) All of the above

44)

Some patient groups have increased risk for pulmonary emboli and anastomotic leaks after divided

gastric bypass. Choose the group with the lowest risk:

a) Patients with previous esophageal or gastric surgery (Revisions)

b) Males over 400 pounds

c) Patients who are active in their daily life and walk frequently

d) History of previous blood clots

e) Patients who are wheelchair bound and oxygen dependent

45)

After divided gastric bypass, the new stomach outlet is approximately 1.2cm (1/2 inch) in diameter.

Choose one of the following that would not obstruct the new opening or cause discomfort:

a) Chunks of chicken and red meat

b) Pasta, rice, and un-toasted bread

c) Orange slices and chunks of fresh coconut

d) Chewable and/or liquid vitamins

46)

Changes in the patient’s gastrointestinal system may occur following gastric bypass surgery. Which

one of the following is TOTALLY false: to

a) Patients may return to their old dietary habits without concern for weight re-gain

b) Patients who could previously drink milk may become lactose intolerant

c) Smells of food may cause nausea

d) Foods may taste different

e) Post-op constipation usually responds well to Metamucil and Fibercon

47)

When doing revisions of failed vertical banded gastroplasties or other failed obesity surgeries to Roux-

en-Y Gastric Bypass, which of the following is true:

a) The incidence of leaks is 10x higher

b) An increased hospital length of stay and additional expense may occur

c) Increased risk of pulmonary emboli and death

d) All of the above

48)

Which of the following poses significant surgical risk and must be disclosed to your surgeon before

your appointment:

a) History of Latex allergy

b) Current aspirin, cortisone or steroid usage - previous Phen/Fen usage

c) Prior obesity surgery

d) Previous or current history of drug dependence

e) All of the above

49)

Which activities may make you vomit:

a) Taking that one bite over your capacity

b) Drinking fluids just before your meals leaving no room for food

c) Advancing your diet before you are advised to do so by your surgeon

d) Eating too quickly (not chewing well) or gulping fluids

e) All of the above

50)

Which would apply during the final one day clear liquid preparation period before gastric bypass:

a) Absolutely nothing by mouth (not even water) after midnight before surgery

b) Push oral fluid intake (eight, 8oz glasses water a day)

c) Exercise and deep breathing, as much as possible

d) Study the protocol and fill your “Shopping List”

e) Absolutely no smoking, caffeine or carbonation

f) All of the above

PATIENT CERTIFICATION

I understand this test is part of my informed consent and certify that I have answered these

questions on my own without using someone else’s exam. I also understand that I may be

asked to retake this exam and may be required to attend another lecture if it is found that I

do not fully understand the risks, complications, requirements, and concept of this

operation. I am willing to pursue additional education as recommended by Pacific Bariatric

in order to reduce risks and to increase my opportunity for long-term success and good

health. My signature certifies that above statements are true.

Patient’s Signature __________________________________ Date ____________________

Please Print Name ___________________________________________________________

Reviewer __________________________________________Date ____________________

(Please sign, MAKE AND KEEP A COPY FOR YOURSELF, and FAX OR MAIL original to

Scripps Clinic

Pacific Bariatric Surgery Program)

CREATED ON 12/7/16