Returning to Work after Weight Loss Surgery
Some return to work on a part time basis in as little as two weeks after surgery, most return to work after three weeks. If you do a lot of lifting and cannot get a light duty status you may need to be out of work for as long as six weeks after surgery. Your workplace probably has forms for your surgeon to fill out for you to return to work.
There is a lot on those forms for you to fill out and it is always helpful to do that—for example, your name, your address, the date you had your surgery. One time a patient faxed us five pages of these government-issued blank forms. The patient didn’t fill out his name or any information, nor did his fax have a return number on it. The patient became irate that we had not filled them out until he realized that we had no idea who had faxed them to us. Please fill out as much as possible before your surgeon’s office staff sees them. Also, ask for an extra copy—things do get lost.
Driving after Weight Loss Surgery
—No, you cannot drive home from the hospital
There are a few simple rules about when you can drive. First, if you are taking narcotics, pain pills such as Vicodin, Percocet, Davocet, you should not drive a car. If you drive under the influence of these drugs you can be arrested, put in jail, have your license suspended, and may injure yourself or someone else. Second, you shouldn’t drive until your reaction time has returned to normal. Have you ever been driving along and suddenly notice the person in front of you has stopped? You have to slam on your brakes and just avoid rear-ending them. Well, imagine if your reaction time is one second off—instead of just "missing" the car in front of you, you now have your engine in your lap. If the thought of slamming on your brakes makes your incision hurt, then you shouldn’t be driving. Some surgeons want patients to wait two or three weeks, but there are clearly some patients who should wait even longer. I had knee surgery in 1989, and my friends tell me it is still too early for me to drive.
What about bathing, swimming, Jacuzzi???
These are best left up to the surgeon. Most surgeons want patients to wait for three weeks before baptism.
When to Call Your Surgeon
Call your surgeon when any of following the happens:
- Pus comes out of the wound
- The wound becomes progressively more red
- Red streaking from the wound
- The wound becomes unusually tender
- Your temperature is greater than 101
- You have yellow or green FOUL smelling drainage
Some clear yellow drainage is normal from your wound. This liquid is generally liquefied fat cells that were destroyed when we made our grand entrance into your body.
Things you can and can’t do to the wound
- It is okay to allow soap and water to run over the wound
- Do not use Neosporin® or other ointments on the wound
- Do not bathe or swim for three weeks
- If you are outside in the sun, the wound will burn easily, so keep it covered
- After several weeks it is okay to use sun block on the wound
If you have a wound infection your doctor, or a nurse, will give you instructions about how to take care of the wound. Generally, the wound is packed with saltwater soaked gauze and this dressing is changed a couple of times a day. Antibiotics are prescribed, and typically, these are Keflex® or Augmentin® (unless you have an allergy). An infection usually comes from bacteria that live on your skin. It is rare that it will come from a dirty instrument in the operating room or some other source. This is why it is important to keep your wound clean.
If your wound has been opened to allow the pus to drain, it is still advisable to wash your wound out with soap and water—it won’t hurt the wound and is the best thing for it. Once the wound infection has passed, and the wound looks healthy the skin may be re-closed with suture, or the surgeon may wait until the wound closes itself. Sometimes these wound infections can take weeks to take care of, so be patient. This does not mean that you will need to be on antibiotics for all this time. If the surrounding skin doesn’t show red streaking, chances are the surgeon will take you off the antibiotics.
Packing a wound
Your surgeon will have you "pack" the wound with some saline soaked gauze. Please do not stuff this in the wound—the idea is for the wound edges to remain moist. If you stuff gauze into the wound, it will take longer for the wound to close. Over time, this wound will start "contracting" and closing itself, and after a few months, no one will notice a difference. But, if you stuff the wound with the gauze, instead of layer it, it will take the wound a lot longer to close. So, be gentle.
Some surgeons use other materials to soak the wound. Some use a weak bleach or iodine solution, acetic acid, or one of a number of other solutions. The important principles are to pack the wound lightly, change the dressing twice a day (unless otherwise instructed) and take a shower. Likewise, there are a number of other products that surgeons can use, such as the wound vac, various forms of gels, or even material from algae (Sorbsan®). These all come with special instructions, and probably will come with a home health nurse to help you manage all of this material. Fear not, if you eat well and consume adequate protein, your wound will close nicely, and look just fine.
Wound infections are common and happen about five percent of the time. These infections can be small and easy to manage, or your entire wound might be opened up and allowed to close on its own. If your wound is left to close on its own, a binder sometimes helps. The forces on most wounds are from side to side, tending to keep the wound open longer. Check with your surgeon—he or she may have other ideas.
Closure of a wound
Sometimes a surgeon will take you back to the operating room to close the wound. This only happens after the wound is very well healed and has a nice red bit of "granulation" tissue in it. Sometimes a surgeon will allow the wound to slowly close by itself—that your surgeon’s decision.
What suture did they use?
There are a lot of ways for a surgeon to close the skin, and a lot of tools. There are advantages and disadvantages to all of them. Skin staples are the least painful, and lead to a good cosmetic result, although a number of patients don’t like them too well. Most surgeons use a dissolving suture and then place steri-strip tapes over the wound. These steri-strips are a wound closure device—some of them are as strong as suture. Still other surgeons use Demabond®, which is superglue for the skin. There is no right or wrong way to close a wound, but there are a lot of opinions. One friend of mine said that in her part of the country, surgeons don’t use staples because patients think they are not cosmetically appropriate. Wherever you live, and however your wound is closed it probably will affect how the wound looks later on.
Why do I have this big ugly scar?
Different people scar differently. Some people develop thick ugly scars, which are called keloids, and sometimes those scars have to be revised or removed— typically, this happens to people who have a lot of pigment in their skin.
The scar will look its worst about six months to a year after surgery. There are several reasons for this. Your body is constantly remodeling itself—worse than a Beverly Hills househusband. As time goes on, your scar will shrink and it will begin to look better. After a couple of years the scar will pretty much look the way it will always look.
Scars respond to motion and forces. For example, scars on joints tend to be thicker because the joint is always moving (very seldom will you find a pretty scar on a knee). In patients with large abdomens, the scars can be very thick because the force of the abdomen is from side to side, and if you have a scar in the middle (up and down) it will tend to become thick. Here is where plastic surgeons always look good—after we Bariatric surgeons do the great job of rearranging guts, and the patient loses the weight, the plastic surgeons do their tuck and nip and patients have smaller scars—perhaps I went in the wrong field here. Another reason some weight loss surgeons like their patients to wear a binder for several weeks after the surgery is that it decreases the forces on the incision.
Someone always wants to sell you something to make your scar look better. It might be vitamin E based, aloe Vera based, or some entirely new brew from their cauldron. There is no evidence that any of this stuff works terribly well. But the rules for your scar are simple—don’t put anything on it the first few weeks. Always keep it out of the sun, certainly for the first couple of years, and don’t ever be afraid of soap and water. Wound infection or not, soap and water will not hurt you—honest.
—Over the counter: what can I take when I get a cold, or the flu?
There are a few simple rules with weight loss surgery, and one of them is to learn about your body and the medicines you put into it. If you have a cold, or the flu, and want to take something remember: it will take about a week to get over it, if you take nothing it will take seven days. Tylenol is ok to take, but it is also found in many other cold and flu medications, so be careful to read the label of every medicine you might take, and do not exceed the maximum daily dose of Tylenol (acetaminophen). Many cold and flu remedies are time-released, and if you have had a bypass surgery, you may not absorb a portion of that time-released medicine, so it will be wasted (Contact tablets, for example, will not work well with patients who had a duodenal switch). Some surgeons do not want their patients to take non-steroidal anti-inflammatory medications, such as Motrin or Aspirin, and you should have a list of these if that is the rule.
Again, know what you are taking and why – and avoid time-released medications if you have had a distal bypass, and if you have had a proximal bypass you should be monitored carefully by your primary care doctor to make certain that you are getting a therapeutic effect.