ORBERA PATIENT INSTRUCTIONS

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Lillian Parrish
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ORBERA PATIENT INSTRUCTIONS MY PROCEDURE INFORMATION: Prcedure Date: Prcedure Time: Arrival Time: WAKEMED NORTH FAMILY HEALTH AND WOMEN S HOSPITAL 10000 FALLS OF NEUSE ROAD, RALEIGH, NC 27614 PLEASE

1 ORBERA PATIENT INSTRUCTIONS MY PROCEDURE INFORMATION: Prcedure Date: Prcedure Time: Arrival Time: WAKEMED NORTH FAMILY HEALTH AND WOMEN S HOSPITAL FALLS OF NEUSE ROAD, RALEIGH, NC PLEASE OBTAIN THE FOLLOWING MEDICATIONS (PRESCIPTIONS PROVIDED) Prilsec (meprazle) 40mg - 1 mnth supply with 5 refills Zfran (ndansetrn) 8mg 30 pills with 1 refill Emend (aprepitant) 80mg 2 pills with 1 refill Levsin (hyscyamine) 0.125mg 30 pills with 1 refill Cmpare prices at GdRx.cm, particularly fr Emend, which can be expensive depending n insurance cverage ONE WEEK PRIOR TO YOUR PROCEDURE: START: Omeprazle (Prilsec) 40mg ONCE DAILY (30 minutes befre breakfast). Yu will cntinue t take this medicatin fr the next 6 mnths, r until the balln is remved. STOP: Anti-inflammatry drugs (NSAIDS) such as ibuprfen, Advil, Mtrin, Aleve, Aspirin Tylenl may be used freely, including the day f prcedure. THE NIGHT BEFORE YOUR PROCEDURE: 7:00PM: DRINK 32 OUNCES f GATORADE OR PEDIALYTE. This will prvide electrlytes and energy fr yur weight lss prcedure. Yu shuld have NOTHING TO EAT OR DRINK after the Gatrade r Pedialyte. That is a full 12 HOURS withut fd r drink befre yur prcedure. PROCEDURE DAY: TAKE 1 DOSE OF EMEND (80mg) 3 HOURS befre yur prcedure. This will help t reduce nausea.

2 Please take any mrning bld pressure r heart medicatins with small sips f water. Otherwise, yu are t have abslutely NOTHING TO EAT OR DRINK the day f yur prcedure. If yu are n insulin r ral diabetes medicatins, please cnsult with yur physician t discuss adjusting these medicatins. Typically, we recmmend NOT taking yur diabetes medicatins the mrning f the prcedure, as yu will be fasting. Please arrive 2 HOURS prir t yur prcedure time. Check in at the Cncierge Desk at the main entrance f WakeMed Nrth hspital. Yu will be taken t the same day surgery suite. A licensed drive (18 and lder) MUST accmpany yu and remain during yur visit. Plan n spending 3 hurs at the hspital. D n bring jewelry r valuables. Wear cmfrtable clthing. D nt wear cntact lenses. AFTER YOUR PROCEDURE: Yu may resume nrmal activity as sn as yu feel ready. Plan t take 2-3 days ff wrk after the prcedure. Cntinue taking Prilsec 40mg nce daily Take Zfran 8mg every 6 hurs fr the first 24 hurs, even if yu are nt nauseated. After the first 24 hurs, yu may use it as needed fr nausea every 6 hurs. Take Emend 80mg n the mrning after yur prcedure. This will help treat any nausea. Tylenl (acetaminphen) may be used fr any discmfrt. Levsin (hyscyamine) may be used fr any cramping. Peppermint tea is als helpful fr cramping. T minimize nausea: Drink slwly, taking small sips. Wait between sips fr a minute r tw. D nt drink mre than ½ cup at a time Lying n yur left side can help t alleviate nausea CONTACT us if yu are unable t maintain sufficient fluid intake, if yu are feeling dehydrated, r yu have significant nausea and vmiting despite the abve measures. DAY 1-3: FOLLOW A CLEAR LIQUID DIET Drink 64 z (8 cups) f clear fluids each day. Start slwly sipping n clear liquids. Examples: water, lw-sugar sprts drinks, decaf tea, chicken brth, Jell-, sugar-free ppsicles Avid beverages cntaining carbnatin, caffeine, sugar, and alchl. Carbnatin may cause abdminal discmfrt. Caffeine may irritate the stmach. Caffeine and alchl can cntribute t dehydratin. Practice sipping beverages slwly. Drinking t quickly, gulping, and/r drinking t sn may cause discmfrt.

3 When yu return hme after yur prcedure, it may seem difficult t get fluids in at first. Aim fr 1-2 unces every 15 minutes at first. DAY 3-14: FULL LIQUIDS Cntinue t drink plenty f clear liquids and water (gal: 64 unces per day) Slwly add full liquids, starting with small sips Examples f full liquids: Any clear liquids Skim milk r lw-calrie sy milk Prtein shakes (we recmmend Premier Prtein) Meal replacement shakes Vegetable sup withut chunks f vegetables (strained) Lw fat ygurt r cttage cheese Weak r decaf cffee Start taking a daily multivitamin Aim fr GRAMS f prtein per day Sample Full Liquid Meal Plan 7:00am: 8 z fluid such as decaffeinated cffee r water 8:00am: 2 tbsp semi-liquid such as fat free plain Greek ygurt 8:30am: 8 z fluid such as sugar-free fruit flavred beverage 9:00am: 2 tbsp semi-liquid such as sugar-free pudding 10:00am: 8-12 z prtein supplement / shake 12:00pm: 2 tbsp semi-liquid such as sugar-free gelatin 1:00pm: 8 z fluid such as water with lemn 2:00pm: 8-12 z prtein supplement / shake 4:00pm: 8 z fluid such as decaffeinated sugar-free iced tea 6:00pm: 2 tbsp fat-free cttage cheese 8:00pm: 8-12 z prtein supplement made with 1% r skim milk WEEK 3: PUREED FOOD DIET If yu are tlerating full liquids withut difficulty, yu may advance t pureed fds. Cntinue t drink 64 unces f liquid each day. Cntinue a daily multivitamin and aim fr 60g-80 f prtein each day. Eat prtein fds first, fllwed by vegetables, fruits, then grains. Examples f PUREED FOODS Fd Chse Avid

4 Prtein 2 Tbsp (1z) prvides 6-7 grams f prtein Blended: Lean Beef, Prk, Pultry, Fish, Shrimp, Lbster, Crab, Imitatin Crab/Lbster, Tuna fish in water 1 Egg (scrambled), egg substitute 2 Tbsp (1z) prvides 3-4 grams prtein Cttage and Rictta Cheese (fat-free, skim milk r 1%) Greek ygurt (fat-free, plain, withut seeds r chunks) Tfu (sft) Cheese, fat-free r lw fat (1 slice r 1 z) Milk, 1% r skim (8 z prvides 8 grams f prtein) High fat meats Prteins cked in il, fat and butter Peanut butter and ther Nut butters Cheese r ygurt made frm whle milk Whle r 2% Milk Tip: Prduce Add Prtein Pwder Grains and Starches Tip: Add Prtein Pwder Tip: Sups Add Prtein Pwder Beverages Miscellaneus Vegetables Sft, tender varieties, cked and blended r mashed with a frk Fruits Mashed banana, N sugar added applesauce, blended canned peaches r pears in 100% juice, blended fresh fruit withut seeds r skins and baby fd fruit Ht cereal (atmeal, grits, cream f wheat) Mashed white r sweet ptates Blended/mashed beans (refried beans, hummus) Brth, builln Blended: Vegetable sup, Reduced fat cream sup, Bean sup r Egg drp sup Water Decaffeinated, nn-carbnated beverages with less than 10 calries per 8 z serving such as cffee, tea, Crystal Light, Mi, Prpel Zer, Fruit 2O, Vitamin Water Zer, True Lemn/Lime/Orange Light ygurt, sugar-free gelatin, sugar-free ppsicles, sugar-free pudding and custard, sugar- free/lw fat ice cream and sherbet, light r lw fat maynnaise Raw Salad; Tugh varieties with fibrus stalks; seeds, skins r hulls; Cked in butter r il Fruit in heavy r light syrup Pasta and ndles Rice Bread and bread prducts All additinal starchy fds nt listed in the chse categry Grains prepared with added butter r il Rich, high fat cream sups r sups with chunks r ndles All sda / carbnated drinks Caffeinated cffee/ tea Chclate milk 2% r whle milk All thers

5 T make a simple puree: cut fd int small pieces and place in a blender r fd prcessr. Add liquid (water, apple juice, chicken brth) t cver the blades. Blend t an apple sauce cnsistency. Strain ut any lumps, seeds, r pieces f fd. WEEK 4: SOFT FOOD DIET If yu are tlerating pureed fds, yu may nw advance t sft (nn-pureed) fds Chew yur fd thrughly. Start with smaller bites. Cut fd int tiny pieces. Chew each bite apprximately 20 times r until liquid. Eat slwly, and stp if yu feel any discmfrt Eat prtein fds first, fllwed by vegetables, fruits, then grains. Cntinue t drink 64 z fluid each day (including prtein drinks) sipped between meals. All fds must be sft r cked t a sft cnsistency. Chew all fds well. Try new fds ne at a time t make sure yu can tlerate it. See next page fr sample sft fds. Examples f SOFT FOODS Fd Chse Avid

6 Prtein 1 z prvides 6-7 grams f prtein Grund r finely chpped: Lean Beef, Prk, Pultry, Fish, Shrimp, Lbster, Crab, Tuna in water Lean deli meats Egg and egg substitute High fat meats Tugh, dry meats Prteins cked in il, fat and butter Peanut butter and ther nut butters Cheese r ygurt made frm whle milk Whle r 2% Milk 2 Tbsp prvides 3-4 grams prtein Cttage/Rictta Cheese (fat-free, skim milk, 1%) Greek ygurt (fat-free, plain, light r 100 calrie) Tfu (sft) Cheese, fat-free r lw fat (1 slice r 1 z) Milk, 1% r skim (8 z prvides 8 grams f prtein) Prduce Grains and Starches Sups Beverages Vegetables: Tender varieties, cked until sft Fruits: Meln, Banana, N Sugar Added Applesauce, canned peaches and pears in 100% juice and ther sft fruit withut seeds, skins r hulls Ht cereal (atmeal, grits, cream f wheat) Mashed white r sweet ptates Beans, hummus Tast, crackers withut seeds, hard pretzels Rice, pasta and ndles (wait until week 7,8) Brth, builln, reduced fat cream sups Egg drp sup Water Decaffeinated, nn-carbnated beverages with less than 10 calries per 8 z serving such as cffee, tea, Crystal Light, Mi, Prpel Zer, Fruit 2O, Vitamin Water Zer,True Lemn/Lime/Orange Miscellaneus Light ygurt, sugar-free gelatin, sugar-free ppsicles, sugar-free pudding and custard, sugar- free/lw fat ice cream and sherbet, light r lw fat maynnaise Sample Sft Diet Plan: 7:00 am 8 z fluid such as decaffeinated cffee Raw salad; tugh vegetables. Seeds, skins r hulls (peas, crn); Cked in butter r il Fruit in heavy r light syrup Sft bread, Bagels All additinal starchy fds nt listed in the chse categry Grains prepared with added butter r il Rich, high fat cream sups All sda and carbnated drinks Caffeinated cffee/ tea Chclate milk 2% r whle milk All thers 8:00 am 2 z prtein fd such as an melet (1 scrambled egg with 1 slice light cheese and 1-2 tbsp cked vegetables)

7 9:00 am 8 z fluid such as water with an range wedge 10:00am 8-12 unces prtein supplement 1:00 pm 1-2 z prtein fd such as tuna with lw fat maynnaise 2 saltine crackers 2-4 z canned/ diced pears in 100% Juice 2:00 pm 8 z fluid such as water with lemn 3:30 pm 8-12 z prtein supplement 5:00 pm 8 z fluid such as decaffeinated sugar-free iced tea 6:00 pm 1 ½ -2 z prtein fd such as chpped chicken breast (mist, tender) 2 tbsp cked green beans 1-2 tbsp mashed ptates with 1 tbsp fat-free gravy 7:30 pm 8 z fluid such as a sugar-free flavred water 8:00 pm 1/2 cup meln WEEK 5+ (MAINTENANCE): LOW FAT, LOW CARBOHYDRATE DIET At this pint, yu will transitin t the final stage f yur diet Yu will wrk with yur dietician t craft the ideal diet fr yu Cntinue a daily multivitamin and aim fr 60g-80g f prtein intake each day Cntinue t drink 64 unces f water each day, aviding fluids during meals and within 30 minutes after meals. Begin t add raw vegetables such as lettuce and carrts but cntinue t avid fds with tugh skins and large seeds. Take yur time at meals and chew very well t help increase yur tlerance t these fds. Drink a glass f water 30 minutes befre each meal. Refrain frm drinking during meals. Eat lean prteins, such as grilled chicken breast r salmn, steamed tilapia, r lean steak REGULAR DIET: Suggested Daily Intake Based n Fd Grups Fd Grup Fd Chices Serving Number f Grams Grams Size Servings Prtein Carb Meat, Pultry, Fish, Eggs Examples: lean beef, prk, ham, veal, chicken, turkey, fish, tuna fish, crab, shrimp, lbster, scallps, mussels, Canadian bacn, eggs, egg whites, firm tfu 1 z ¼ cup Vegetables Examples: carrts, green beans, tmates, spinach and ther greens, zucchini, yellw squash, beets, nins, ½ cup

8 Fruits Grain, Starchy Vegetables Dairy Fats/Oils Ttal peppers, brccli, cauliflwer, asparagus, cabbage, eggplant Examples: apples, applesauce, plums, pears, peaches, nectarines, grapes, tangerines, cherries, berries, bananas Examples: rice, ptates, sweet ptates, ndles, pasta, bread, crackers, pretzels, cereals, peas, crn, beans, chick peas, lentils, sybeans Examples: skim/1% milk, Light ygurt, Greek style ygurt, cttage/rictta cheese, lw fat/fat free cheese, lw fat sy milk Butter, margarine, maynnaise, salad dressing ½ cup ½ cup z ½ cup 1 Tbsp Sample Regular Diet Plan: Befre Breakfast: 8 z water Breakfast: 1 egg scrambed with 1 slice f fat free cheese ½ slice whle grain tast ½ banana 30 mins after breakfast: 8-16 z sugar-free flavred beverage Mid-mrning snack: ½ cup slice apple + 1 unce lw-fat string cheese 30 mins after snack: 16 z water r ther apprved beverage, sipped thrughut the mrning Lunch: ½ cup tuna in water, 1 Tbsp lw fat may, n 1 slice whle grain bread 3 slices fresh tmat and ½ cup lettuce ½ cup fresh cantelupe 30 mins after lunch: 8 z decaf sugar-free iced tea Mid-Afternn Snack: ½ cup plain, lw-fat Greek ygurt with ½ cup berries 30 mins after snack: 16 z water r ther apprved beverage, sipped thrugh the afternn Dinner: 2-4 z baked fish ½ cup steamed brccli with lemn ½ cup baked sweet ptat with 1tsp lw fat margarine/butter Evening Snack: 8 z skim r 1% milk r sy milk

ENDOSCOPIC SLEEVE (ESG) PATIENT INSTRUCTIONS

ENDOSCOPIC SLEEVE (ESG) PATIENT INSTRUCTIONS MY PROCEDURE INFORMATION: Prcedure Date: Prcedure Time: Arrival Time: My Dctr: Christpher McGwan, MD WAKEMED CARY 1900 Kildaire Farm Rd, Cary, NC 27518 PLEASE