My name is Michael Martinez. I’m a bariatric or foregut surgeon at the Advanced Weight Loss Center at Texas Digestive specialist. Today, I’m joined by my physician assistant and first surgical assistant and brother, Matthew Martinez. And together, we’re going to be reviewing some of the most frequently asked questions by our patients.

So our first question, what kind of training did you receive?

So in order to do general surgery of any type, you have to go through college typically and medical school training. After medical school, you are now a physician, but now you have to pick a specialty. And for me, I chose general surgery and then ended up specializing within general surgery for bariatric and what we call foregut surgery.

So I went on to do general surgery training. That’s the residency training that some people know about after medical school. That’s a five year program of training, specifically on surgery, but various types of surgery. Then I chose to focus on what we call bariatric surgery, which is essentially surgery to help people improve their health by losing weight. So now we kind of refer to that as metabolic and bariatric surgery because we know of all the metabolic benefits to patients to improve things like diabetes and other other issues.

So I went on to get fellowship training, specialty training after general surgery in bariatric and metabolic surgery and foregut surgery. Foregut is just a fancy way of saying the upper part of the intestinal tract. So when we think of someone like a colorectal surgeon, they deal with the high and get the lower part of the the digestive tract.

And for us in our practice, we focus on the upper part of that digestive tract.

What surgeries do we perform and how do we perform them? Laparoscopically, robotically, and what’s the difference?

So again, our specialty tends to focus primarily on weight loss type surgeries to help patients improve their health or other issues of the upper digestive tract. So we deal with issues and diseases of the esophagus. Sometimes that can be benign disease. We deal with stomach cancers, for instance. We deal with cancers or tumors in the small intestine. So these are the areas of the anatomy that we work on and the different types of diseases that we deal with.

With regard to your question about robotic versus laparoscopic or even another kind of surgery called open surgery. We prefer to do most of our cases robotically. And the real difference here is robotic and laparoscopic surgery. Both use small incisions. The incisions are about the size of a fingernail, roughly. We use a camera inside the belly that helps us visualize things.

And even though our instruments are going into these small incisions, our hands never have to go inside the patient. So we avoid a big cut, and that allows the patients to recover much quicker and allows the patients to have less discomfort and pain afterwards, less risk of things like wound infections or hernias down the road. But now the difference between robotic and laparoscopic is a little more nuanced.

They both use cameras, the multiple small incisions. However, with the robotic machine, we have better visualization. We are in control of the instruments. The whole time. Some people have this misperception that the robot, when you say that word, it’s like something else. The machine itself is doing the surgery, but in reality it’s the same types of instruments. We’re in control of the instruments the entire time, but it allows us to work under lower pressures in the abdomen.

We don’t need the abdomen as inflated, and that allows the patients to be much more comfortable when they wake up. We get better visualization. We get finer ability to move in very tight spaces. So sometimes we can do things that are a little more complex. So our preference is robotic surgery. When the facilities or the hospitals have those resources available.

Another common question that our patients ask is what does recovery look like after surgery? Can you explain a little bit of that process?

So just like you alluded to, because we’re not opening up the belly, patients get are able to recover much quicker. So generally our patients stay in the hospital overnight. So one night in the hospital, back to most normal activities within 3 to 5 days, sometimes up to a week and then back to work most often within two weeks to a month.

No heavy lifting, no high impact activity, no deep binding for a month, but otherwise back to normal, back to most normal things within a few days to a week.

Another common question that we have, which you somewhat answered there is specifically about when they can go back to work after their surgical procedure.

So every job is different. If your job is heavy lifting, climbing ladders, doing things that require you to carry lots of things, it would be more like a month before you get to go back to work. If your job doesn’t require you to do any heavy lifting, then it’s more like a couple of weeks, a week to two weeks even if needed.

If somebody says, I really want to get to exercising, I used to do strenuous exercise. Can I start lifting weights in a month if I can go back to work and having work like that. Can I start running? Can I start doing these kinds of physical activities at a month? What’s typically our rule about that?

So basically the answer is yes. We’d always have patients start slow, start low. So I wouldn’t expect you to start your marathon training or heavy, heavy lifting right out of the month. But you are allowed to do anything that you can tolerate doing with a lot of pain or discomfort. So if I want bariatric surgery, how long do I have to wait?

So this is probably one of the most common questions we get, especially when we do our seminars, our live seminars, where we give patients information about the process for bariatric surgery.  The length of time that you have to wait from first visit to surgery is variable, depending on your individual insurance. This is what makes it such a hard question to answer.

We’ll start off with a patient who has no insurance whatsoever. They are either paying out of pocket or their insurance has no time restrictions. In that situation the number of appointments that we have that are standard to get you prepared for surgery. They include things like endoscopy to look at the anatomy. They include things like getting lab draws, psychiatric and dietician evaluations, all these kinds of things that are standard of care in order to give you the safest, best chance at a good outcome.

Those appointments typically can be done within about 2 to 4 weeks, give or take. And assuming that no results come back, that make us have to postpone your surgery. We’re talking about surgery from first visit to the surgery time itself being somewhere around 4 to 6 weeks. That’s at the absolute earliest. No setbacks. Now, some insurances require arbitrary timeframes and they may be something like three months or six months or even up to 12 months of monthly dietary visits or other qualifications that they would ask you to meet before you’re qualified for surgery.

And in those situations, our hands are tied in order for you to utilize the insurance to help pay for the procedures, you’re going to have to do exactly what they ask. So those patients will have a longer process, not for medical reasons, but for the logistics of dealing with the insurance company. Next question. That is very common for our patients.

They often want to know, do they have to take vitamins after surgery?

So the answer is yes. We recommend they take vitamins. Don’t think of vitamins as medication. Think of them as supplements, things like vitamin D or iron. Vitamin A, it is not medication. In fact, with our surgeries, most patients get off of their medications. So high blood pressure medications, diabetes medications, doses get lowered or they come off of medicines altogether eventually.

Will my eating habits have to change after surgery?

That’s a great question. And the on the surface, obvious answer is yes, you’re going to have to change some of your eating habits in order to have long term success. But this is where we really take the time when a patient comes in and ask a question like this to explain what is the whole point of surgery?

What is the philosophy behind this? Surgery essentially is changing the anatomy to create a tool inside of you that’s going to amplify and maximize your efforts for weight loss. It depends on you eating well. It depends on you exercising. It depends on you leading a healthier lifestyle. If you don’t change your eating habits and go through one of the surgeries and you’re still eating fast food and other things like that, it is possible that you will lose weight, but you will not necessarily become healthy as you’re losing that weight.

Just eating less because the surgery doesn’t allow you to eat as much as you used to is not sufficient for healthy, sustained long term weight loss. What we try to do is build the right kind of habits, which include changes to the eating habits. And mostly that’s about food choices. The one big kind of technical thing that patients have to understand as well as that with a smaller stomach, which most of our surgeries are going to include a smaller stomach as part of the procedure, you cannot really eat and drink at the same time the way you did before surgery.

And the example I tell patients is usually a typical day for a non-surgical patient. Pre-surgery patient is they eat breakfast and they drink their coffee or the orange juice. They eat lunch and they drink their water, their soda, their tea, whatever. They eat dinner and they’re having something to drink at that point in time. And they typically hydrate when they’re eating right after surgery. With a stomach pouch being smaller in order for you to eat enough protein, eat enough of the vegetables, eat enough of the fruits, you typically get to focus on eating.

And then after you’re done eating, 15, 20 minutes later, 30 minutes later, you start drinking and you’ll drink between meals and kind of hydrate. That’s really kind of the only change that you have to make. No foods are completely off limits. It doesn’t mean you can never taste something that’s really delicious or a piece of cake on your birthday or other things like that.

But we want you to make better food choices more consistently, and that, along with increased activity, the vitamins and the tool of surgery inside your body can allow you to have fantastic lifetime results. Another common question our patients ask is do they have to go on any kind of special diet before surgery?

So they do, depending on the kind of surgery, determines the kind of diet or the length of time of the diet. So for our bariatric patients, gastric bypass and sleeve gastrectomy patients, it’s two weeks prior to surgery that they start a liquid diet. Clear liquids two days before other foregut surgeries. It can be anywhere from a week to five days to just two or three days.

But the answer is yes. You have to go on a special diet prior to surgery.

For the weight loss patients. That liquid diet, that’s two weeks. Is there anything special about the liquids or are they just drink whatever liquids they want just to stay hydrated?

So healthy liquids, low sugar liquids, it needs to be things like protein shakes, make sure it’s water, things like Powerade or Gatorade, Zero things that are low sugar. Can’t be things like Kool-Aid. It has to be healthy things. What happens if insurance doesn’t cover this surgery?

We take all major insurances. And if by any chance their insurance doesn’t have weight loss surgery benefits or they don’t meet criteria but are still medically appropriate to have surgery, we have financing available as well.