1. Visit to Pre Admission Testing

2. The Center for Bariatric Surgery and Metabolic Disease ä Thank you for choosing our institution to have your surgery. ä We want your experience to be as pleasant as possible and will do what we can to ensure this happens.

3. Testing ä Blood work ä EKG ä Chest X-ray ä Anesthesia questionnaire and evaluation ä Health history

4. Eating ä Liquid diet for the 2 days before surgery ä Can have broth, sugarfree juice, sugarfree gelatin, decaffeinated tea, decaffeinated coffee, protein shake

5. Eating(cont’d) ä Do NOT eat or drink anything after midnight the evening prior to your surgery. ä Can NOT even have water, coffee, chewing gum or mints after midnight

6. Bowel Prep ä One half bottle of Citrate of Magnesia (Citroma) ä May want to try it chilled. ä May want to plan to be at home when drink it. ä At 12 noon the day before surgery.

7. Medication ä Some medications are permitted the morning of surgery and others are not.

8. Medications (cont’d) ä The anesthesiologist will instruct you about which of your heart, blood pressure, diabetes or asthma medications you can take. ä Check with Dr. Teixeira’s or Dr. McGinty’s office about how long to stop taking medications that may cause bleeding such as aspirin or arthritis medications.

9. Medications (cont’d) ä If you are instructed to take your regular medications that morning, take them with SMALL sips of water.

10. Medication to Avoid ä Aspirin ä Alleve ä Celebrex ä Motrin ä Naprosyn ä Vioxx ä Discuss with Dr. Teixeira’s or Dr. McGinty’s office if you take: ä Coumadin ä Heparin ä Fragmin ä Plavix

11. Smoking, Alcohol and Drugs ä For at least 72 hours prior to surgery do not: ä smoke ä drink alcohol (liquor, beer or wine) ä use recreational drugs ä These may interfere with the anesthesia medications.

12. Illness ä If you develop a cold, virus, sore throat or other illness during the week before your scheduled surgery, please contact your regular doctor for treatment. Also notify Dr. Teixeira’s or Dr. McGinty’s office. ä It will be determined whether your procedure should be rescheduled.

13. A Call to Confirm ä On the day before surgery patients are asked to call the Ambulatory Surgery Unit (ASU) between the hours of 5:30 and 7:30 p.m. to confirm the time of your arrival for surgery. ä If your procedure is scheduled for a Monday you are asked to call the Friday before your surgery.

14. A Call to Confirm (cont’d) ä We will attempt to contact you. However, we have found that we may not able to reach patients at their home telephone number the evening prior to surgery. ä Please call St. Luke’s Hospital ASU at (212)523-3371.

15. What to Bring the Day of Surgery ä Presurgical forms and insurance information (bring every time you come to the hospital) ä List of medications and allergies

16. What to Bring the Day of Surgery (cont’d) ä Advance Directives which specify your wishes regarding healthcare treatments in the event of a situation in which you are not able to make these decisions for yourself. ä Overnight bag containing a few personal items.

17. Checking In ä ARRIVE ON TIME ä Go directly to the Ambulatory Surgery Unit on the third floor of the Babcock Building.

18. Canceling Procedure ä If you find it necessary to cancel your surgery, please call Dr. Teixeira’s or Dr. McGinty’s office as soon as possible.

19. Personal Items ä On the day of surgery do not wear contact lenses or body jewelry. ä You may wear eyeglasses, hearing aids or dentures. However, these must be removed prior to the surgery. Please bring your containers in which you store these items. ä Do NOT bring any valuables or jewelry.

20. Clothing ä Before surgery, you will be given a hospital gown and robe to wear. ä You will have a hospital ID bracelet put on your wrist.

21. Anesthesia ä The anesthesiologist will meet with you prior to your surgery to discuss your anesthesia and answer any questions you may have.

22. Anesthesia (cont’d) ä If you have had any experiences in the past with anesthesia, please inform the anesthesiologist. ä It is important that they have as much information as possible to provide the best anesthesia care to you.

23. General Anesthesia ä Uses medicines to put you to sleep and to keep you asleep during the surgery ä Also involves medicines to relax your muscles ä Uses techniques to support your breathing

24. Pain Management ä Always tell your doctor, nurse or other staff member when you are having pain. ä Don’t be afraid to ask for pain medicine.

25. Pain Management (cont’d) ä You will be asked questions about the pain you may be experiencing including: ä intensity (how strong) ä location ä type (throbbing, burning, aching)

26. Pain Management (cont’d) ä You will be asked to rate the severity of pain using a pain scale (0 = no pain to 10 = worst pain). ä There is no right or wrong answer. ä Just rate your pain as best you can to give us an idea of how close we are to making you comfortable.

27. Pain Management (cont’d) ä The pain scale is used to evaluate your pain and also to evaluate the effectiveness of pain medicine and treatments. ä We will ask you often about your pain. ä Your answers will help us follow your pain to see how effectively we are managing your pain.

28. Pain Management (cont’d) ä Managing pain is an important aspect of getting well after your surgery. ä Patients who have their pain well controlled generally tend to recover better and faster.

29. Patient Controlled Analgesia (PCA) ä A PCA pump is a machine that contains pain medicine. The pump delivers the medication through your IV tubing. ä The pump has a button that you can push to give yourself a dose of pain medicine when you need it.

32. PCA (cont’d) ä Once you push the button wait 5 or 10 minutes to give the medicine a chance to work. ä After the 5 or 10 minutes, if you are still having pain, push the button again. ä We want you to be comfortable. We don’t want your pain to be more than a 3 or 4 on the pain scale.

33. PCA (cont’d) ä If you are not sure if enough time has passed to push the button again, go ahead and push it. ä The pump is set with a limit so you will not be able to give yourself medicine too often or give yourself too much medicine.

34. Methods to Assist with Pain Relief ä Relaxation techniques ä Hot or cold packs ä Rest ä Deep breathing exercises ä Proper positioning ä Distraction techniques such as music, TV or visitors

35. Facts about Pain Management ä Let health care providers know about your allergies, previous experience with pain medicine, other medicines you take and your health history. ä Tell staff how strong your pain is and what makes it better or worse.

36. More Facts - Pain Management ä Ask for pain medicine when you need it or before doing an activity that may cause pain, like getting out of bed. Don’t wait until the pain is too strong! ä Give the pain medication time to work. Ask when you can expect to feel some relief.

37. More Facts - Pain Management ä Use rest, deep breathing and other non-drug treatments to help your pain. These will work with your pain medicine to control your pain. ä Tell the staff how you are feeling. Let them know how effective the treatment is and if you are experiencing any side effects from the medication.

38. Post Anesthesia Care Unit (PACU) ä You will be connected to equipment to monitor your heart rate, breathing and blood pressure. ä You may receive oxygen through a mask placed on your face. It is common to receive oxygen for a little while after surgery. It will likely be removed before you leave the PACU.

39. Discharge to Step down Unit ä When awake from the anesthesia ä Pain from surgery is controlled ä Breathing, heart rate and blood pressure are stable ä Cleared for discharge by anesthesiologist

40. Incentive Spirometry, Coughing and Deep Breathing Exercises ä Incentive spirometry - perform 10 to 20 times every hour ä Coughing and deep breathing exercises - perform several times every hour ä Helps clear your lungs and prevent pneumonia

41. Out of Bed ä The first time you get out of bed the nurse will be there to assist you. ä Do NOT get out of bed by yourself the first time. ä Plan to get out of bed the evening of surgery or by the next morning.

42. Out of Bed (cont’d) ä Getting out of bed and moving around helps prevent many of the potential problems that may occur after surgery and anesthesia like pneumonia, blood clots and skin sores. ä It is the best thing you can do to help yourself recover.