PRE-OP INSTRUCTIONS

Any type of surgery is a serious procedure that carries certain risks,
and thorough preparation is essential for a successful outcome.

Regardless of whether you have acid reflux/heartburn or not, start taking Omeprazole (PPI medication, PPI stands for Proton Pump Inhibitor). It is availale over the counter (OTC).

Dosage: 1 pill of 20 mg twice a day, 30 min before meals (that is every 12 hours, total dosage 40 mg per day). Continue for two weeks prior to the surgery (the last pill to be taken the evening before surgery, do NOT take it on the day of surgery). This is to decrease stomach acid production and later acid reflux, nausea, inflammation, and swelling caused by the procedure.

Usually, the recommended dosage mentioned on the box will say 20 mg per 24 hours. Please disregard this recommendation. Our goal is to decrease stomach acid production prior to surgery and post-op; thus, a higher dosage is required.

Continue taking PPI medication after surgery for at least two months (gastric sleeve) and at least three months (gastric bypass RNY/Mini). After 2/3 months you may start weaning off PPI gradually only if you don’t experience acid reflux symptoms. Consult with your surgeon or nutritionist to make sure you are ready to stop the PPI.

VERY IMPORTANT!

Never skip the dosage! Take PPI for as long as prescribed twice a day. You must complete the 2- or 3-months therapy (for gastric sleeve or bypass accordingly) after surgery and shouldn`t stop sooner only because you don`t feel any discomfort. This may lead to marginal ulcers and other complications. Learn more at PPI & Antacid in Weight Loss Surgery.

Tip: you can purchase a 2-month supply of PPI medicine over the counter in Mexico for under $15 USD (inquire with your on-site facilitator to help you place an order with a local pharmacy). In case you are already taking PPI`s, continue as prescribed by your doctor. If your regular dosage is 40 mg once a day, you may continue. If your regular dosage is 20 mg once a day, increase it to 20 mg twice a day. If you usually use other brands of anti-acids (Omeprazole (Prilosec), Pantoprazole (Pantozol), Esomeprazole (Nexium)), you can continue your prescribed PPI.

During the last 3 days before surgery (not including the day of surgery, if surgery is on Monday, the 3 days before include Fri, Sat, Sun) it is required that you follow a full-liquid diet. This “liquid stage” can be increased to 5, 7 or more days by the surgeon depending on your BMI and duration of the solid food diet stage. The surgeon will let you know if you are required to increase the “liquid stage” during your pre-op consultation.

MACROS

Do not be overly concerned about your macros during this stage.
Stay under 1,200 calories per day.
Protein shakes or unflavored protein powder added to your savory liquid meals will satisfy your daily needs in protein.
Do not consume any regular milk or any fruit juices in order to keep your carbs under control.

Your liquid meals can include the following options:

• Plain Greek yogurt (or regular sugar-free yogurt), you may use natural liquid Stevia sweetener.
• Protein shakes with low (3 g) or “0” carbs and low or “0” fat (good protein shake should include no more than 3 g of sugar and no less than 20 g of protein); limit protein shakes to 3 or 4 per day as they are considered meal substitutes.
• Almond milk (regular or low-fat cow milk is not recommended due to high sugar levels – lactose).
• Broth (chicken/beef/fish/vegetable broth, or liquid part of any other type of soup), feel free to add a scoop of unflavored protein powder to your broth to feel full (do not add protein powder to hot liquids as it will curdle, add powder only to cold or slightly warm liquids and allow sufficient time to dissolve).
• Egg-drop soup (strained).
• Carrot, zucchini, or squash cream soups (well-blended and strained, so there are no solid pieces, add enough water to make it thin, NO cream to be added, a little bit of milk for better taste is acceptable); you may add unflavored protein powder.
• Sugar-free pudding/Jell-O/popsicles.
• Fruit-infused water, especially with electrolytes, and plenty of water or herbal/fruit tea without sugar, coconut water and other sugar-free fluids are recommended.
• Green juices (kale, spinach, celery, etc.) are allowed, fruit juices are not allowed as they contain too much fructose (another form of sugar).

We do not recommend chewing gum before or after surgery as it stimulates stomach acid production and could cause worse acid reflux after surgery as well as make you feel more hungry.

The purpose of the full liquid diet stage is to cleanse your stomach pouch and bowel from any kinds of solids; to reduce the amount of stomach acid produced, thus decreasing chances of having heart burn issue after surgery; giving your stomach a rest which helps to decrease stomach pouch swelling during the first days of recovery; shrink your liver. Thanks to this stage it is not necessary to take laxatives prior to surgery, the liquid diet will be sufficient.

Important! Drink plenty of water. You should consume at least 64 oz of clear sugar-free liquids per day! Do not count protein shakes, soups or any other non-clear fluids toward these 64 oz.

Breakfast

Option1: 1 premier protein shake or 1 cup unsweetened almond milk + 1 scoop Isopure + ice (blended)

Option 2: 1 cup pf Greek yogurt (You can have flavored yogurt, just make sure its sugar free)

Snack

Option1: 1 cup sugar free Jell-O

Option 2: ½ cup sugar free pudding made with fat free milk.

Lunch

Option1: 1 cup of spinach/zucchini soup + ¼ cup of Greek yogurt for extra creaminess

Option 2: 1 cup of carrot/ squash soup + 1 scoop of flavorless protein powder

Snack

Option1: 1 cup miso soup

Option 2: 1 cup chicken broth

Dinner

Option1: Vegetable Garden soup (zucchini+ carrots + squash) + 1 scoop flavorless protein powder + ¼ cup Greek yogurt for extra creaminess

Option 2: Caramel macchiato protein shake: 1 cup of sugar-free almond milk +2 scoops of GENEPRO plant protein powder + ½ cup of ice +2 drops of Sweet Leaf Caramel Macchiato

Snack (if necessary)

Option1: Greek yogurt popsicle (Use a popsicle mold and fill it with vanilla or any flavored sugar free Greek yogurt)

Option 2: ½ cup sugar free pudding made with fat free milk.

Consider our featured bariatric-friendly “liquid” recipes:

Squash/Yellow Zucchini Cream Soup

Spinach & Zucchini Cream Soup

Homemade Protein Shake Recipes

• Stop drinking at midnight the night before surgery as the doctors may need to move your procedure to an earlier morning time slot. It is very important that you drink lots and lots of fluids during the 3-day liquid diet to be well hydrated for the day of your surgery.
• You may take medications for diabetes (insulin), high blood pressure, thyroid, anxiety, or antidepressants as indicated by your physician early in the morning with just a few sips of water (ideally take them no later than 6 am).
• If your surgery is scheduled later in the morning or afternoon, you may continue drinking plain water up to 4 hours before surgery.
• You may brush your teeth normally.
• Take a shower with soap the night before surgery or in the morning.
• There is no need to do bowel cleansing neither before gastric sleeve nor bypass surgery, as the liquid diet stage will cleanse your bowel sufficiently.
• Jewelry. Take off all the jewelry and leave it at home! If you cannot take your ring off, or piercing, anesthesiologist will wrap a piece of tape around it to protect your skin from burns. However, in rare cases jewelry may interfere with the electrocautery machine used during anesthesia, and may need to be cut off.
• Nails. Very important! At least one fingernail must be FREE FROM ANY TYPE OF POLISH (acrylic, gel, regular polish, transparent or colored, it doesn`t matter) as the layer of nail polish does not allow the oximeter to capture correct amount of oxygen in your blood during anesthesia and recovery. Thus, you must have at least 1 or 2 fingers available with natural clean nails, not too long (about 5-6 mm or ¼ of an inch), as you will have a clip-on oximeter attached to your finger and if your nails are too long, it will not stay on and a nurse will have to shorten your finger nail. Toenails can have any type of polish you like.
• Remove artificial eyelashes and makeup. During anesthesia when all body muscles are relaxed, to keep your eyes closed and avoid irritation and dry eyes, the doctor will apply either tape or special eye covers that may damage artificial eyelashes. For your own convenience and to avoid possible infection, please remove them prior to surgery.
• Remove dentures, contact lenses, eyeglasses, female sanitary items (tampons), any underwear, wigs.
• For male patients – BEARD & CHEST. If possible, please shave your beard (or trim if it is long), and your chest. A beard that is a few days old is acceptable although not recommended; a long beard may not allow for the medical equipment (oxygen mask) to be placed correctly; not to mention sanitary purposes. Shaving your chest will prevent discomfort from removing sticky items such as monitors during an ECG test.

For Same-Day Arrival (Vertical Sleeve or RNY Bypass Surgery)

• All the above applies. Stay on a full liquid diet 3 days before and arrive on an empty stomach the day of surgery (you may drink only water early in the morning).
• Wear compression stockings (medium pressure, knee high) during your flight (this is recommended especially for patients with high BMI over 50), practice leg muscle contraction during flight, get up and move every 45 minutes, move your feet – these are blood clot preventive measures.
• Plan to arrive in San Diego by 11 am at the latest on the day of surgery.

And last but not least: relax and trust your doctors! You are in good hands!