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This cultivates a somewhat standardized approach to surgery and provides expertise available 365 days a year. "Morbidly obese patients allow for very small margins of error because their systems are already working overtime," Dr. Kaul explains. "Each surgeon in our department essentially performs every surgery the same way, and because we collectively have per- formed more than 5,000 bariatric surgeries, we can tell which patients are at risk for specific complications and prevent them." The Long Journey After While surgical excellence is a point of pride among bariatric surgeons at Putnam Hospital Center, optimal weight loss and resolution of comorbidities largely depend on postsurgical dedication of the patient and the team of providers. Immediately after surgery, patients start on a diet of JELL-O, Italian ice and broth. For two weeks, their diet is mostly liquid, the bulk of nutritional content supplied by protein shakes. After a two-week checkup, bariatric surgeons recommend replacing one protein shake with a soft protein meal per day and then encourage more as tolerated. Six weeks after surgery, patients participate in a nutrition class, led by Health Quest dietitians, who also see patients every three months to monitor vitamin levels and ensure proper nutritional maintenance. Patients meet with their surgeons every two to three months for the first year after surgery and then one to two times per year if everything goes well. To encourage sustained success, the Health Quest support network that welcomed patients before surgery plays an integral role in shepherding patients through the postsurgical journey. "Weight loss is a lifelong process," Dr. Kaul says. "We emphasize that surgery is only part of the process and complement our surgical capa- bilities with a team of dedicated, passionate providers who care for each patient." During preoperative counseling, dietitians and psychologists prepare patients for life after surgery, which can be challenging as they adjust to a new lifestyle. "Morbid obesity doesn't spare patients from temptation they may want to relapse into, even after surgery," Dr. Maffei says. "Our support groups are critical to helping patients move through the tough times. There, they can talk about any challenges they face — if they gained a few pounds, they can talk to their peers who have overcome the same obstacles." But it's not all about the trials. During support group meetings helmed by Health Quest dietitians, patients exchange informa- tion about what healthy foods they enjoy and what exercises work for them as they reshape their lives. For more information about bariatric surger y at Putnam Hospital Center and Health Quest's expansive support network, visit www.health-quest.org. ■ (L-R) Cheryl Madonna, bariatric coordinator; Margaret Sheehan, Director of Surgical Services; Dominick Buono, surgical technician; Ed Krauss, robotic team leader; Krystyna Kuchtar, operating room nurse; and Daryl Joy Esposito, operating room nurse, inside a state-of-the-art operating suite at Putnam Hospital Center. COV ER FE AT UR E 1 0 | Mid Hudson MD NEWS ■ M D N E W S . CO M