Bariatric Surgery History

How long ago did you have bariatric surgery?

0-1 month

1-3 months

3-6 months

6-12 months

12-24 months

24-36 months

What type of surgery did you have?

Sleeve Gastrectomy

Roux-en-Y Gastric Bypass

One Anastomosis Gastric Bypass

DIABETES MELLITUS:

Did you have pre-diabetes?

Yes

No

Did you have Type 2 Diabetes Mellitus?

Yes

No

What was the treatment for your diabetes?

Diet/Exercise

Non-insulin medication (single)

Non-insulin medication (multiples)

Insulin

What treatment are you on now?

No Diabetes

Diet/Exercise

Non-insulin medication (single)

Non-insulin medication (multiple)

Insulin

ANTIDEPRESSANT USE:

Were you on antidepressants prior to surgery?

Yes

No

Have you continued to use antidepressants after surgery?

Yes

No

Is your dose:

The same

Increased

Decreased

Changed medication

Are you experiencing any unexplained long-term or recurrent abdominal pain lasting for more than 3 months?

Yes

No

Do you experience diarrhoea, abdominal cramps, bloating and/or nausea within a few hours after consuming dairy?

Yes

No

Have you developed a new intolerance to lactose after bariatric surgery?

Yes

No

Do you experience unpleasant symptoms after eating gluten-containing foods such as abdominal pain, bloating, fatigue, brain fog, diarrhoea or constipation?

Yes

No

Have you developed a new intolerance to gluten after bariatric surgery?

Yes

No

Are you currently taking Creon or Panzytrat (medications use to treat pancreatic insufficiency)?

Yes

No

Do you experience episodes of urinating more frequently, pain or stinging when peeing, cloudy or foul smelling urine?

Yes

No

Is this new or worse since bariatric surgery?

Yes

No

Have you had a cholecystectomy (removal of gallbladder) since bariatric surgery?

Yes

No

Alcohol (use since surgery)

How often do you have a drink containing alcohol?

Never

Daily

2 to 3 times a week

Weekly

Monthly

How many drinks containing alcohol do you have on a typical day when you are drinking?

1 or 2

3 or 4

5 or more

N/A

Have you felt the need to cut down on your drinking?

Yes

No

Have people annoyed you by criticising your drinking?

Yes

No

Have you ever felt bad or guilty about your drinking?

Yes

No

Do you feel heightened effects of alcohol when drinking?

Yes

No

Do you feel like you ‘recover’ from the effects of alcohol more quickly since surgery?

Yes

No