Frequently Asked Questions

At JBTG We consider the benefits and risks of bariatric surgery

There are many benefits to having Roux-en-Y gastric bypass or gastric sleeve surgery. Of course, any surgery has risks, and it’s important you understand them before deciding to proceed. Your bariatric surgeon will explain the risks associated with both procedures.

Gastric sleeve cannot be reversed because a portion of the stomach is removed. Roux-en-Y gastric bypass can be reversed or converted to gastric sleeve if the need arises due to complications.

No. Weight loss surgery is very safe and decreases the chance of dying from obesity. In fact, weight loss surgery is safer than removing the gallbladder or having a knee replacement.

A recent study of 209,116 patients found the risk of death from weight loss surgery was 0.16%, or approximately 1 in 600. (4) This rate is considerably less than most other surgeries, including gallbladder and hip replacement surgery. Large studies find that the risk of death from any cause is considerably less for patients after weight loss surgery than for those who have severe obesity and have never had the surgery. Patients who have weight loss surgery have a reduction in their risk of death by 40%. Death related to diabetes is reduced by more than 90% and from heart disease by more than 50% for patients after weight loss surgery. (3) The benefits of weight loss surgery far outweigh the risks. As with any serious surgical operation, the decision to have weight loss surgery should be discussed with your surgeon, family members, and loved ones.

Both complications and unsatisfactory outcomes may occur following cosmetic or bariatric surgery, both here in NZ and overseas. If a complication occurs, Accident Compensation Corporation (ACC) in New Zealand will cover patients for treatment injury for care provided in an overseas location by registered medical practitioners recognised as such by ACC.

While medical tourism for cosmetic surgery and other types of elective treatment is becoming increasingly popular, it's still considered risky business to travel insurers. Travel insurance is designed to cover unexpected events, not planned events where the risk is very high. Therefore, elective surgery is not covered, and nor is any claim which is connected to elective surgery.

You're still eligible for all the other benefits of travel insurance – such as cancellation and delay cover, baggage loss or theft and family emergencies - but if you have complications from elective surgery and are not fit to fly home, we will not be able to cover you. This also extends to any overseas medical emergency expenses which arise as a result of the elective surgery. Examples include requiring hospitalisation due to an infection, or if you need to go to the doctor for a follow-up after your surgery.

Once you book a nutrition plan will be sent from a nutritionist to  you via email and it is important that you follow the pre- op diet. During your hospital stay, at our hospital in Mexico, the dietitian will go through your follow up diet.

Immediately after surgery, you will follow a liquid diet. Liquids containing sugar, carbonation (fizzy) and caffeine must be avoided. You will first add protein-based liquids to your diet, followed by pureed foods, and finally foods with texture. The post-operative diet is a progressive diet and you will be back to eating a regular healthy diet by week 9.

It is important to eat nutritious foods following surgery to help heal your incision and for your overall health. Your dietitian will recommend vitamin and mineral supplements, and guide you on protein intake.

Losing weight before surgery will lower the risk of complications and make weight-loss surgery safer. The main purpose of losing weight before weight-loss surgery is to reduce body fat in the abdominal region, especially in and around the liver.

The preparation period before surgery provides time for you to practice healthier eating habits and mentally adjust to a different lifestyle. Bariatric surgery involves physical, mental, and emotional changes to be successful in the long term.

4-6 weeks before your surgery, you are required to follow a liquid meal replacement diet (optifast). The purpose of this diet is to reduce the size of the liver to make surgery safer. This diet includes protein shakes, several “approved” snacks (e.g., sugar-free pudding, yogurt, and sugar-free gelatin), and plenty of clear liquids (water, broth, sugar-free jello and popsicles which you can buy form The warehouse, etc.). Your Mexican dietitian will send you the details of this diet once your surgery is scheduled.

One in ten patients who have had bariatric surgery will later need to have their gallbladder removed due to gallstones. The main causes of gallstones are rapid weight loss and changes in bile acid circulation after bariatric surgery.

the gallbladder does not serve a vital purpose and can be removed easily without long-term postoperative concerns, in Mexico our surgeon can remove your gall bladder for $700USD ($1110NZ at todays ROE)  compared to between $3000-$6500NZ here in NZ

Obesity (over a BMI of 30) raises the risk of developing hernias in the abdominal wall. Being overweight puts more strain and pressure on your abdominal muscles, making them weaker and more vulnerable to hernia development. Approxiamtely 80% of my past clients the surgeon has discovered and repaired a hernia. The cost of the hernia repair is $650 USD ($1036NZ) compared to $3750NZD her in NZ

It’s natural to want to return to the comforts of home as soon as possible, but the body takes time to heal. Some bariatric patients can return home by plane as soon as 48 hours post-op depending on their chosen procedure, the flight duration, and their surgeon’s recommendations, but keeping in mind flying to Aotearoa can be over 15 hours it is suggested to wait 5 days before flying home.

It is important that you take measures to Prevent Blood Clots also known as deep vein thrombosis (DVT), are the biggest risk of flying after bariatric surgery. They form when sitting in confined or cramped spaces for long stretches of time. Bariatric patients can take several steps to reduce the risk of blood clots, including:

• Wearing compression socks
• Paying for an extra comfort seat with extra leg room to perform some leg exercises (price depends on airline we use at the time of booking the tour)
• Walking around the cabin every 1-2 hours
• Taking any prescribed blood thinner on schedule (these are the Eliquis (apixaban)which we purchase in Mexico at the pharmacy it is a prescription anticoagulant, or blood thinner, used to lower the risk of blood clots, you may also ask your local GP for a prescription before you leave NZ, however many GP’s will suggest you that these are prescribed in the country of the surgery to ensure it does not interfere with the other medication you will be taking for your bariatric surgery.

Depending on which procedure you have, you may lose 59 to 72% of excess weight in the first 12 to 14 months after surgery.

Following bariatric surgery, you may experience pain in the incision site. This should resolve over time. Your bariatric surgeon will examine you and prescribe a limited amount of pain medications.

You will most likely feel nauseas for 2-3 days ,  Anaesthesia and surgery itself may cause the nausea. It's important to remember that this is one of the "normal" side effects of having bariatric surgery and this can usually can be treated with medications called antiemetics

If you have minimally invasive gastric sleeve or laparoscopic Roux-en-Y gastric bypass, you can expect to return to work in about 1-2 weeks. If you have a physically strenuous job, you may talk with your employer about working half-days or taking on some lighter work until you recover.

You may have low energy for a while. Post surgery,  I personally get B12 shots from my pharmacist here in NZ.

After surgery, you will take a multivitamin, B12, with iron and calcium every day.  Again, the nutritionist will make suggestion when she visits you in your room for a one-on-one meeting.

Weight-loss surgery is just one part of your weight-loss plan. The path to success depends on you. Even before surgery, begin to adjust your eating patterns and lifestyle:

Drink calorie-free beverages. Avoid soda altogether, including diet soda.

Eat fewer fried foods, added fats like butter, and high-fat foods.

Incorporate fruits and vegetables.

Pay attention to your eating habits and patterns. If you eat in response to boredom, find another activity to divert your attention.

Chew food completely, and eat meals slowly.

Remember the 'Rule of 20' –– chew for 20 times before you swallow – put your knife and fork down and count to 20 before taking your next mouthful – eat 20 mouthfuls over 20 minutes – and then stop. Discard any remaining food on your plate.

We recommend that you take your vitamin and mineral supplements for the rest of your life. You will need to get your blood checked several times within the first year after surgery, and once a year thereafter. This is done to ensure you are absorbing your vitamins and minerals adequately.

YES, You should discontinue the use of  any NSAID Nonsteroidal anti-inflammatory drugs, eg aspirin Walfarin Naprosyn, Relafen Nurofen, Diclofenac (Voltaran), Ibuprofen (Advil, Motrin), Ketorolac (Toradol); Etodolac (Lodine), Indomethacin (Indocin); Meloxicam (Mobic) and Naproxen (Aleve, Naprosyn, Anaprox); Nabumetone (Relafen); - Oxaprozin (Daypro); and 10 days- Piroxicam (Feldene).and also  vitamin E, fish oils, for a least two weeks before your surgery.

NSAIDs are more than just pain relievers. They also help reduce inflammation and lower fevers. They prevent blood from clotting, which is good in some cases but not so beneficial when having surgery as this could increase your risk of bleeding.

Do not stop your necessary medication that is not a blood thinner, for example anti-depressant, or blood pressure tablets

Blood pressure medication is vital to your health and wellness before, during, and after surgery. In most cases, you should continue taking your blood pressure medications in the days leading up to surgery.

Certain medications work differently to control your blood pressure, so you should discuss your medications with our team before surgery.

It's more dangerous to stop taking your medications in the days leading up to surgery. If you suddenly stop taking most blood pressure medications, it can cause your blood pressure to rise substantially during your procedure, putting you at risk for heart attack and stroke.

As long as you take your appropriate vitamins, it is rare to have health problems from vitamin deficiency.

Weight loss surgery can lead to reduced amounts of vitamins and minerals because people eat less and may absorb less in the intestines. Weight loss surgeries have different effects on vitamins and minerals based on how much change in absorption they cause. Deficiencies in vitamins, minerals, and protein can negatively affect health causing:

• fatigue (feeling tired)
• anemia (low levels of red blood cells that carry oxygen through your body)
• bone and muscle loss
• impaired night vision
• low immunity (your body’s ability to stay healthy)
• loss of nerve function (can affect your senses such as touch, taste, and smell)
• mental function deficits (changes how clearly you think)

Fortunately, nutrient deficiencies following surgery can be easily avoided with a good diet and the use of supplements including vitamins, minerals, and sometimes protein supplements. Before and after surgery, patients are advised of the appropriate diet and vitamin supplement needed. Health problems due to deficiencies usually occur in patients who do not regularly follow-up with blood test to monitor healthy vitamin and mineral levels.

Dumping syndrome is an unpleasant side effect where food passes rapidly into the small intestine. Symptoms include:

• Cramping
• Sweating
• Flushed appearance
• Dizziness
• Weakness
• Headache
• Diarrhea

To prevent dumping syndrome, follow your dietitian’s recommended dietary guidelines and avoid the following:

• Sweets
• Fried, fatty or greasy food
• Eating too much at one sitting
• Drinking fluids with your meals

You will eat in a regular pattern of three meals per day, with snacks in-between meals that are low in calories. Since you will have a small stomach pouch, you should eat about half a cup of food at each meal. Focus on proteins first, followed by vegetables and fruits. Water and non-calorie-containing liquids are the beverages of choice. Avoid carbonated beverages altogether. Do not drink liquid with your meals. This can make your pouch empty more quickly and make you feel hungry too soon.

This is one of the most popular questions I get asked! It is not recommended to drink alcohol following bariatric surgery for a year. You will be more sensitive to the effects of alcohol post-surgery. Your body is swiftly losing weight, so it will naturally process alcohol differently than it did before.

Bariatric surgery limits the amount of food intake – with less food in your stomach to process through, alcohol will hit you harder.

My rule is moderation- The best way to monitor this is to increase self-awareness regarding your alcohol consumption – note how you feel after small amounts and regularly check in with yourself. Make sure to take breaks often and monitor how your body is reacting. This is a good practice for anyone having a few drinks, but especially important for those who have had weight loss surgery!

We strongly recommend you quit smoking before your procedure, and do not start again after your procedure. Smoking is contraindicated (meaning we advise against it) to weight-loss surgery. The World Health Organisation suggests that Tobacco smokers are at significantly higher risk than non-smokers for post-surgical complications including impaired heart and lung functions, infections and delayed or impaired wound healing.

My clients always ask me questions about exercise. They want to know if and when they can exercise after bariatric surgery, and what kinds of exercise are safe. I reassure them that they most certainly can, and should, exercise once they have weight-loss surgery. After all, people have bariatric surgery to enjoy better health. And exercise — along with a healthy diet — is a necessary complement to surgery.

It’s common to be sore and uncomfortable immediately after surgery. But a little movement, like 5 to 10 minutes of walking a few times a day, can help put you on the road to recovery and is recommended by our surgeons.

After 2-4 weeks start a maintenance exercise regimen with the long-term goal of 30 minutes of moderate aerobic exercise each day. From there, you can slowly increase your physical activity as you heal. It’s generally safe to start exercising up to your pain threshold 2 weeks after a laparoscopic surgery (where the surgeon makes several small cuts). However our surgeon does ask you to avoid heavy lifting in excess of 5-7kgs for the first month after surgery.

We strongly caution against becoming pregnant for 12 to 18 months after surgery. You may become more fertile as you lose weight, so a reliable birth control method should be used during this time It’s important that you monitor your pregnancy throughout, and take the proper amount of vitamins and minerals.

Temporary hair thinning can occur in the months after Roux-en-Y gastric bypass surgery, as you rapidly lose weight. If you do lose hair, it should re-grow when your weight stabilises. Avoid hair treatments and maintain recommended protein intake during this time. Biotin and zinc supplements may also help. Prior to my surgery I swapped to Nioxin shampoo and conditioner which is effective on thinning hair. I also had Hot fusion extensions put in. Heat seals keratin bonds to your natural hair for a totally undetectable, safe length and body. Needless to say these need to be “moved up” every 4-6 weeks.

If you do have plastic surgery, it’s best to wait until your weight has stabilised usually after one year. The cosmetic surgery tour I take to Thailand essentially due to the fact that the 14 days post-surgery in Thailand, there is so much you can do, shopping, walking along the beach, markets, etc, the hospital I have used in Thailand for nearly 15 years where all surgery is performed by one of 7 senior PLASTIC surgeons, who has had 6 additional years training over and above a cosmetic surgeon.

All surgeons are on the Thailand board of plastic surgeons. This is a huge hospital (not a clinic) it is used by the United Arab Emirates, UK, Europe, Australia and USA for all surgeries from orthopaedic, critical care, dentistry, internal medicine - endocrinology & metabolism, ophthalmology (Eyes), internal medical (lungs, infectious disease & tropical, pulmonary disease) .

The Hospital is located close to the beach on the Thai gulf in a busy seaside city with lots of multi storied shopping malls, night markets and lots of attractions and activities to visit (I tend to describe it as Surfers Paradise on steroids!). It is a part of the Bangkok Hospital Group, which is the largest hospital operator in Thailand. Each facility offers specialised medical treatment, staffed with multi-disciplinary teams of highly-trained specialists. Bangkok Hospital Pattaya has a high reputation for specialised services in cosmetic surgery and has been accredited by the Joint Commission International (JCI). We are talking a large hospital not a clinic. maternity, cardiology with a state-of-the art dentistry floor with dental cosmetic and implant centre, A&E and intensive care unit, plus many more departments too numerous to list.

See:

www.bumstumsandgums.co.nz

t’s possible. Weight-loss surgery is a tool designed to help you lose weight, but it’s just one part of your larger program. Following your dietary recommendations and exercising regularly are also important to your overall result. Be sure to take advantage of the resources the JBTG  has available to you, including the eBook that has been created with you in mind, links to offer online counselling, dieticians , nutritionists,  life style counsellors, life coaches.

Revisional surgery may be an option if it is medically advisable, but not recommended for everyone. The risks are greater than the first time the procedure was performed

Lap Band to Gastric Sleeve Surgery is recommended for patients who have experienced complications after the initial surgery (lap band), have achieved insufficient weight loss or regained 40% of the weight they have lost with their lap band surgery.

Our surgeon’s objective is to help you achieve your weight-loss goals in the healthiest way possible. Bariatric surgery requires a lifelong commitment to following dietary guidelines, a vitamin and mineral supplement regime and lifestyle changes.

At the request of Dr Camelo, routine laboratories are required with your general practitioner one month before your surgery date (you must send the results where your haemoglobin levels can be checked) all in order to ensure that everything is in order for the surgery. That required a) copy of blood test b)copy of your ECG

If you take medication, when you fill in the form to ensure you are a candidate, please send us the names of your medications to be checked.

Our surgeon does prefer a letter of consent from your GP, just acknowledging that you are wanting bariatric surgery. if you have a doctor that does not sanction this, it’s not the end of the world we would just ask that you go on a strict post bariatric surgery diet for 6 weeks

Going overseas for the surgery cost a third of what it costs privately in New Zealand,– somewhere between $13,000 and $15,000, including surgery, airfares, hotels , transfers and excursions.

Gastric Sleeve $4499 USD  (approximately

Gastric bypass $5800USD

Gastric bypass with repair of internal scar tissue from earlier surgeries, eg,  caesarean  $5900

ADDITIONAL  EXPENSES:

Please also note:

After surgery if you require additional pain and anti-nausea meds over and above what is regularly supplied in the package except to pay an extra $100-$200USD ($159NZ-$318NZ) (depends on how much pain relief you have over and above the package, also we can supply anti-coagulants  that Pam buys from the pharmacy as they are cheaper there than the hospital)at:

• Anticoagulants $50USD
• Omeprazole $20USD (for 2 pottles)

Please note all the above to be paid direct to the hospital in US dollars which can be order online and pick up form the airport

Most banks now do not do currency exchange (check you bank) however, you can order online via https://www.travelex.co.nz/ and pick up at the counter at Auckland airport, either by gate 5 or at the bottom and the top of the escalators.

Yes, you can withdraw money in the USA with EFTPOS, but they charge you $10 for each transaction and not always at the best rate of exchange. I do not suggest using EFTPOS in Mexico because it gives you your money in Pesos.

If you're planning to spend money overseas, using a travel money card, credit card or bank-issued debit card have been the most popular methods.

With every transaction using these cards, cardholders have been hit with foreign currency conversion fees, ATM withdrawal fees and/or a bunch of other fees. (as mentioned above)

The Wise debit card has shaken things up by offering never-seen-before features - rock bottom overseas currency conversion fees, free ATM withdrawals (up to NZ$350/month), an app to track and manage your money, and even foreign bank account setup.

The Wise debit card is easy to sign up to and packed with features. I see it as very similar to a travel money card, that the banks used to offer, but cheaper in seemingly every sense.

There is a one-off $30 charge to issue the Wise debit card - this covers postage and account setup. After you pay the fee, there is no further ongoing charge (i.e. when the card renews). Despite the upfront fee, I consider the ongoing savings to be considerable, especially when compared to a travel money card.

Right now, most banks charge between 2% and 2.8% of your purchase price in 'overseas currency conversion' fees when using a debit card. This means if you spend NZ$100 overseas, your bank charges you $2.10 to $2.80 on top of that. It is these fees that soon add up.

The Wise debit card offers a much better deal. You'll pay between 0.35% and 2.85% in overseas currency conversion fees. For popular currencies such as AUD, GBP, USD and EUR, you'll pay around 0.35%. Additionally, you can withdraw up to NZ$350 free every 30 days from ATMs around the world free of charge.

​The Wise debit card is available to all New Zealand customers. It also offers a free New Zealand bank account number. You can also open up accounts in other currencies (USD, AUD, GBP, EUR etc) to store money if you want to lock in an exchange rate. Please note the actual card can take up to 14 days to get in the mail, so organise this early.

Check out https://wise.com/invite/u/jacquelineb1172  I think all my clients on my most recent trips have used it in ATM’s and also in shops both in Thailand and USA.

Can I also suggest you download not only the Wise app, but also the UBER  App and also WhatsApp,  if you fancy a trip out to Walmart super centre Uber will take you there for around $30USD.

The good news is that most Kiwi citizens do not need a visa to travel to the US—most can travel on the Visa Waiver Program. They just need an ESTA. And lots of other New Zealand based applicants can apply for a visa without needing an interview. This ESTA allows crossing over to Mexico (and back)

Note that under U.S. law (22 C.F.R. 41.103) you must electronically sign and submit your own application . Even if someone else helped you complete the application, you (the applicant) must click the “Sign Application” button, or your application may not be accepted. Make sure you go to the official site, as there are many third party agencies that charge more

Go to the official website. https://esta.cbp.dhs.gov/

The Electronic System for Travel Authorization (ESTATM) is an automated system that assists in determining eligibility to travel to the United States under the Visa Waiver Program (VWP), and whether such travel poses any law enforcement or security risk.

visa Waiver Program  

official site: https://esta.cbp.dhs.gov/

Overview

The Visa Waiver Program (VWP) enables most citizens or nationals of participating countries (NZ IS INCLUDED) to travel to the United States for tourism or business for stays of 90 days or less without obtaining a visa.

Travelers must have a valid Electronic System for Travel Authorization (ESTA) approval prior to travel and meet all requirements explained below. If you prefer to have a visa in your passport, you may still apply for a visitor (B) visa.

ESTA applications may be submitted at any time prior to travel, though it is recommended that travellers apply as soon as they begin preparing travel plans or prior to purchasing airline tickets

When you are admitted to the United States under the VWP, you may take a short trip to Mexico, and be readmitted to the United States under the VWP for the remainder of the original 90 days granted upon your initial arrival in the United States. So when asked if going to any other countries you can tick NO.

The standard processing for an ESTA will cost USD $21. Keep in mind that the ESTA is Not a visa but rather an automated system that determines if a visitor is eligible under the Visa Waiver Program

How long does it take to be approved: 72 hours and is valid for 2 years

It's important to note that having a criminal record does not automatically bar you from travelling to the USA. Anybody travelling to the US for less than 90 days will be able to travel under the Visa Waiver Programme (VWP). If you have minor offences (traffic offence) these are okay and your NZ record is cleared after 7 years unless you have drug convictions or have spent time in prison.

For more information click here: https://estatousa.com/applying-for-esta-with-criminal-record/)

You will be asked for the following details:

• Passport Information.
• Your Birth Date, Birth Place, and Country of Birth.
• Any Other Citizenships.
• Names of your parents.
• Your Contact Information.
• Work Specifics.
• Travel Details.
• Details on Emergency Contacts.
• They will ask if any criminal record, if you have had minor offences (such as DIC) these are cleared from your record after 7 years

So firstly go to the official website

Go to the official website. https://esta.cbp.dhs.gov/

1. Access a new form for an individual request;
2. Validate access to the form.
3. Accept waivers and general conditions.

Fill in the applicant's data. It is necessary to inform:

• Last name and first name ;
• Date and place of birth ;
• Passport number and validity dates;
• Information on the applicant’s citizenship and nationality.

4. Address in USA and phone number (which I will supply you with)
5. Enter travel information.
6. Respond to eligibility questions.
7. PRINT IT OUT AND KEEP WITH YOUR PASSPORT (if you lose it don’t panic as it will be on the database but I like to have a copy with me)