Audio_Postop_Fp_2

POSTOPERATIVE VISIT

HISTORY: This is a 54-year-old woman who had gastric bypass surgery for the treatment of her extreme obesity. Her operation was complicated by a staple line disruption due to a misfiring of the linear stapler, which was repaired by hand and further stapling without subsequent problem. She spent 5 days in the hospital postoperatively, had bleeding postoperatively that required a transfusion, and resulted in some bruising of her flank. In the last 3 weeks, she has felt better and is now feeling well. She has no nausea or vomiting. She is drinking well. No dumping. A mild amount of bloating. She is walking for exercise and has even traveled to Chicago. Her energy level is fair.

PHYSICAL EXAMINATION: Her weight is 185 pounds. She has lost 13 pounds since surgery. Temperature 36.5, pulse 84, respirations 16, blood pressure 120/78. BMI 37.3. She appears absolutely well. The abdomen is soft, flat and nontender. There is some bruising of the left flank that is persistent, although much of her bruising that I saw 2 weeks ago has gone away.

I removed her staples today.

PLAN: The patient can now go to a stage 3 diet, and I instructed her how to do this. She already has good early satiety. She is taking her vitamins. I instructed her to increase her exercise. She is already driving, and she should come back and see us in 3 months.