Download NOV-2014-Dr-Chung-Part-1

Guide to Health & Nutrition
With Bariatric Surgery
Part 1
Bariatric Surgery
Gastric Bypass / Sleeve Gastrectomy
Obesity Surgery Center of Louisiana
Dr. Keith Chung
4150 Nelson Road, Suite B6
Lake Charles, LA 70605
337-433-1303
www.obesitysurgeryla.com
Chapter 1
Preparing for Surgery
Expectations & Timeline for Weight Loss Surgery
The following is information that is important to your health and the success of your
weight loss. Following the information in this booklet is recommended to assist you in
successful healthy weight loss following bariatric surgery.
Prior to Surgery:
 Stop drinking and do not plan to resume consuming carbonated
beverages/sodas/pop.
 If you smoke or use tobacco products you must have stopped at least 3 months
prior to surgery and DO NOT plan to resume after surgery!!!!!
o Including electronic devices and vapors.
 If you resume using tobacco products you WILL HAVE COMPLICATIONS.
o Complications can lead to stomach ulcers, gastric leak or even death!
 Patients who continue tobacco use may be dismissed as patients of this practice.
 We encourage you to attend the monthly Bariatric Support Group meeting held at
Lake Area Medical Center the second Thursday of the month at 6 PM (more
information call 337-475-4075).
 Complete nutrition visits and evaluation per insurance requirements &/or per Dr.
Chung’s recommendation.
2 Weeks Prior to Surgery:
 Stop talking all diet medications (prescription and over the counter)
 Stop taking all herbal supplements.
 Attend Bariatric Nutrition Class at Lake Area Medical Center
o RSVP: 337-475-4075 to register.
o Attendance to this class occurs 2 weeks prior to surgery or within the first
3 weeks after surgery.
1 Week Prior to Surgery:
 Stop taking all blood thinners or anticoagulants.
o These include aspirin, Plavix, Coumadin, Vitamin E, St. John’s Wart, Gingko
Biloba, Garlic, etc.
 Stop taking birth control pills and hormone replacement therapy.
 Stop taking all Aspirin, Ibuprofen and non-steroidal anti-inflammatory
medications (NSAIDs).
o Anti-inflammatory medication that is allowed: Celebrex.
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Please check labels to be sure if medications contain aspirin, ibuprofen or
NSAIDs.
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Examples:
Mobic (Meloxicam)
BC Powder
Talwin
Doans
Dristan
Norgesic
Tramadol (Ultram)
Alka-Seltzer
Anacin
Bufferin
Alka-Seltzer
Ecotrin
Midol
Bayer
Aleve
Etodolac
Naprosyn
Indocin
Percodan
Anaprox
Advil
Arthrotec
Motrin
Indomethacin
5 Days Prior to Surgery
 Start a liquid diet.
 A shopping list will be given to you that will include good items to have available.
 Rule of Thumb during this time period: you can have it if it can fit through a
straw. ***If you have to chew it, then do not eat it!***
 Patients with Diabetes:
o Important that you monitor you blood sugar level while on this diet.
 Blood sugars tend to drop significantly on the liquid diet.
 You may need to decrease your diabetes medications while on this
diet.
 Recommended you consult/call your physician who prescribes your
diabetes medication to adjust the dosages prior to starting diet.
o You may need to test your blood sugar levels more often.
Day Prior to Surgery
 If you are having an EGD, nothing to eat or drink after 12 Midnight on this
morning. Only take scheduled blood pressure and thyroid medication with a small
sip of water this morning.
 If you are not having an EGD – please continue your liquid diet on this day.
 Report to Dr. Chung’s office at appointment time to sign consents.
o Bring with you COMPLETED PRE-OP TEST, ANESTHESIA FORM, and
AGREEMENT.
 Once you have finished at Dr. Chung’s office- ->Proceed to Lake Area Medical
Center at scheduled time.
 Bring your medication bottles or a list of medications with dosages and frequency
taken.
 Meet with pre-op nurse for pre-op testing:
o Labs
o Chest X-ray
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o EKG
For those having an EGD, Dr. Chung will be in before noon to perform the EGD.
o A scope is passed through the mouth and used to visualize this esophagus
and stomach.
o You will be sedated for this procedure and someone will have to be available
to drive you home.
After your pre-operative testing at the hospital, resume your liquid diet.
o NO cottage cheese or egg beaters today.
o NOTHING TO EAT OR DRINK after midnight tonight.
It is a good idea to pack an overnight bag for your hospital stay.
o Possible items include: CPAP machine (if have sleep apnea), robe, slippers,
loose night gown or easily removable shirt and pants that are comfortable,
toothbrush, toothpaste, hair brush, shampoo, conditioner, lip balm, etc.
Morning of Surgery
 No make-up or perfume.
 Remove all jewelry, finger nail polish and false nails.
 Nothing to eat or drink.
 Do not take medications unless instructed to do so (usually hypertension and
thyroid medications are taken with a small sip of water).
 Arrive at the time instructed to you by your pre-operative nurse.
 Someone must drive you to the hospital.
What to expect while in the Hospital
 A family member or friend may stay with you overnight; however nursing staff
will be rounding on you often.
 Expect some pain after surgery. Pain medication will be available after surgery,
you must notify the nurse when you are in pain and she will dispense the pain
medication.
 Nausea medication is also available if necessary.
 Vital signs will be monitored every 4 hours. This can be aggravating but is
necessary.
 You will be provided an incentive spirometer during your stay.
o Your nurse will show you how to use the incentive spirometer to expand
your lungs to prevent pneumonia.
o Continue to use incentive spirometer (inspire [take a deep breath in]) a few
times every hour while awake during your hospital stay.
 Four hours after arrival to your room you will be assisted by the nursing staff to
get up and walk.
o DO NOT get out of bed without assistance of the staff.
 You will still be under the effects of medication and could easily fall.
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You may not feel like getting out of bed but it is necessary to
decrease your risk of blood clots and to start passing gas.
o Dr. Chung inflates your abdomen with carbon dioxide to be able to visualize
the operative field.
 This gas can cause you abdominal pain, pressure and back pain.
o Walking, deep breathing and sitting up in bed will help with pain relief.
 Frequent short walks during the day can be beneficial in your
recovery.
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Day of Discharge from the Hospital
 Someone must drive you home from the hospital.
o You have been on pain medication and will not be able to drive yourself.
 Dr. Chung will prescribe pain medication to be taken after surgery. The
medication is usually taken as needed every 4-6 hours for the first few days
after surgery. If the medication is too strong you may take extra-strength
Tylenol instead. Take the Tylenol as directed on the bottle. Dr. Chung does not
usually refill pain medication. If you do not live in the state of Louisiana, you
must have your medication filled before leaving the state.
 Plan on having someone stay with you for the first 24-48 hours after discharge.
 Dr. Chung will instruct you on medications to continue after surgery.
o Do not stop thyroid medication or anti-depressant medications without
approval from the prescribing physician.
o If you have hypertension, please monitor your blood pressure readings and
if they are abnormally low or high please notify us.
o Patients with diabetes, please continue to closely monitor/check your blood
sugars. Please let us know if they are abnormally low or high.
 Notify your primary care physician of your weight loss procedure and keep them
active in your care.
 The physician who originally prescribed these medications (high blood pressure
and or diabetes medication) needs to be made aware that you have had the
procedure and will guide you on how to adjust the medication.
 FEVER: a low grade temperature (under 101.0) is normal. This is usually due to
atelectasis from your surgery.
o Atelectasis is caused by the anesthesia from your surgery making your lung
capacity a little less than normal.
o As a result, you are not circulating enough blood through our body which
will cause a slight increase in temperature.
o To ease this, you should do the following breathing exercises:
 Take 8-10 deep breaths and hold as long as you can before exhaling.
 Continue to do this until your fever subsides. Usually 2-3 hours.
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VERY IMPORTANT: If you have excessive bleeding, excessive pain, or sudden
spike in temperature or heart rate call the office immediately at 337-433-1303.
The nurse in the hospital should instruct you on dressing changes.
o Please leave the little white pieces of tape called steri strips on your
incisions until Dr. Chung instructs you to remove them.
o Change your dressing around your JP drain daily or as needed.
o You may notice some drainage around your drain, this is normal.
Continue drinking sugar free grape Kool-Aid several times per day until your JP
drain is removed.
Monitor your JP drain for signs of purple fluid (grape Kool-Aid) and notify the
office immediately if you suspect it.
Empty your drain as needed and remember to compress it to form suction after
emptying.
Schedule an appointment with the office for 6 days from date of surgery.
ACTIVITY-take it easy for the first week. Walk often but avoid strenuous
activity and heavy lifting. No heavy lifting (over 10 lbs) for 6 weeks.
You may take showers but no tub baths or swimming until incisions healed.
6 Days After Surgery
 Follow-up appointment in office. JP drain will be removed.
 Patients with diabetes need to bring in a log of blood sugar readings.
2 Weeks After Surgery
 Start taking a complete multi-vitamin and calcium citrate supplement (1500 mg
per day).
 Multivitamins must be labeled as a complete multivitamin.
 Please do not substitute vitamins with herbal supplements or drinks.
 Calcium can be supplemented with Caltrate, Tums or Viactiv.
 Dr. Chung offers Bariatric Advantage products for vitamin, calcium and protein
supplementation.
 Plan to attend monthly Bariatric Support Groups at Lake Area Medical Center on
the second Thursday of the month at 6 PM (more information call 475-4760).
 Attend Bariatric Nutrition Class at Lake Area Medical Center
o RSVP: 337-475-4075 to register.
o Attendance to this class must be completed before the 3 week post-op
visit with Dr. Chung.
3 Weeks After Surgery
 Follow-up appointment in office.
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3 Months, 6 Months, 1 Year, 1 ½ Years and 2 Years After Surgery
 You will receive a lab slip in the mail.
 Have labs drawn at any local lab and they will fax results to our office (433-4644
fax).
o Please follow-up with Dr. Chung’s office about 2 weeks after having blood
work to ensure that his office did receive the lab paperwork.
 Once we received the results we will contact you for a follow-up appointment. (It
may take up to two weeks for us to get all the results).
 Please log a diet and liquid intake journal prior to this appointment. Usually a few
days preceding the blood work. This diet journal is very important to help keep
diet on track!
2 Years After Surgery:
 Our office will always be open to you.
 Please call our office with any questions or concerns.
 Please keep our office up to date with any address and phone number changes.
 Come by the office so we can see how good you look and if you want to check your
weight.
 At this time yearly lab work is usually turned over to your primary care physician.
 If you have any gastrointestinal problems please keep Dr. Chung informed – he is
most familiar with your new anatomy.
Labs that are checked include:
CBC
CMP
LIPID PROFILE
HgA1C
B-12
TIBC
TSH
THIAMINE
VIT D 25-Hydroxy
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Chapter 2
Patients with Diabetes
1) While you are following the liquid diet 5 days prior to surgery, make sure you have
enough blood glucose test strips to check blood sugar more often.
a. More prone to hypoglycemia (low blood glucose)
2) In the hospital the nursing staff will monitor your blood sugar and if needed will
treat any abnormalities.
3) Continue to monitor your blood sugar after discharge from the hospital.
4) Bring a log of readings to follow-up appointments.
5) Please follow up with your primary care physician who follows your diabetes to
have medications adjusted accordingly.
6) Some patients are able to stop taking their medications completely, immediately
following surgery while others have to have their medication dose gradually
decreased.
Signs of LOW BLOOD SUGAR (Less than 70 mg/dL):
Sweating
Nervousness, shakiness and weakness
Extreme hunger and slight nausea
Dizziness and headache
Blurred vision
A fast heartbeat and feeling anxious
Follow treatment for hypoglycemia per your provider’s recommendation.
Signs of HIGH BLOOD SUGAR:
High blood glucose
High levels of sugar in urine
Frequent urination
Increased thirst
Dry mouth
Breath smells fruity
Nausea and vomiting
Shortness of breath
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Chapter 2
Patients with Hypertension
1) In the hospital the nursing staff will monitor your vital signs including blood
pressure every 4 hours throughout both day and night. This can be aggravating
but it is necessary.
2) Continue to monitor your blood pressure once you have been discharged from the
hospital.
3) Follow-up with your primary care physician to have medications adjusted.
4) Regularly monitoring your blood pressure is STRONGLY RECOMMENDED.
Signs of LOW BLOOD PRESSURE
Dizziness
Weakness
Light-headed
Chest pain
Signs of HIGH BLOOD PRESSURE
Headache
Dizziness
Blurred vision
Nausea
Some individuals will have NO SYMPTOMS
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Chapter 3
Welcome to Your New Way of Eating
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HEALING:
o Your new stomach will take six to eight weeks to heal. To allow your stomach
to heal properly, without stretching, you will have to slowly progress your diet
from a liquid diet, thicker liquids, soft stage diet then to solids. It is
important that you follow these stages to ensure proper healing.
SUPPORT:
o Monthly support group is held by Dr. Chung and hospital staff at Lake Area
Medical Center. Support group is usually held at 6 PM on the second Thursday
of the month. More information, contact the hospital Bariatric Coordinator
337-475-4760.
o Newsletters are usually written quarterly and can be downloaded at
www.obesitysurgeryLA.com .
o Another helpful website is www.obesityhelp.com . This website offers a chat
forum and information from bariatric surgery patients across the country.
CHANGE IN DIETARY NEEDS
o Your meal plan will be high in protein, which is essential for optimal healing and
weight loss. Your diet will ALWAYS be low in fat and concentrated sweets.
You will be on a liquid diet for about two weeks before advancing to pureed,
soft solid foods and finally to soft, moist whole foods. At your follow up
visits, you will be evaluated for your readiness to advance to the next stage of
your diet.
TAKE TIME TO EAT
o Your meals should last at least 20-30 minutes. Foods should be at a liquid
consistency in your mouth before you swallow.
o Chew foods completely.
o Liquids should be sipped slowly, between meals only, so you will still have room
in your stomach for meals and so that you do not wash your food out of your
pouch during meals. This prevents you from overeating.
FINDING WHAT YOU CAN EAT
o If you are experiencing any cramps, gas or diarrhea in your initial stages, you
may have developed intolerance to lactose, the sugar found in milk. If this
occurs, changing your diet to a lactose-free diet will usually reduce these
symptoms. Please be aware of your symptoms and write down any foods that
irritate your body so that we can find out the causes and make necessary
changes.
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IT’S A BUILDING PROCESS
o This will be a progressive diet and each stage will add more foods for you to
include in your diet. When advancing, it is important to try ONE new food at a
time so that if you do have a difficult time tolerating it, we will know exactly
which food cause the trouble.
DON’T FORGET TO EAT
o Patients often report that they do not feel hungry or have a loss of appetite
after surgery. In turn, this often causes patients to skip meals, depriving
themselves of their nutritional needs. Many also believe that skipping meals
will speed their weight loss. This is not true, nor is it healthy. You should eat
a minimum of three small meals per day. It is acceptable to be unable to
finish the food that is recommended. Do not force yourself to finish food
with in a specific period of time. Stop eating as soon as you feel full. If
necessary, put away the food that you didn’t finish and eat it later. Keep a
food diary or record to facilitate your meal timings and help keep track of
what you need to finish by the end of the day. Most often your three meals
may turn into 4-6 small meals. Feelings of hunger and fullness take time for
your mind and body to recognize. Bring these records with you to your follow
up consultations.
IT WILL GET EASIER
o Five to six weeks (Stage 5) following your surgery, you will advance to the final
stage, which is solid food that is low in fat and low in sugar. This is the time
to introduce different food groups into your diet. Your diet will incorporate a
wide variety of foods from the different food groups; however your portions
will be less/smaller.
o Food groups include: protein/meat and meat substitute sources, vegetables,
fruits, whole grains, and healthy fats.
o Within these groups focus on low-fat, low sugar foods (no concentrated
sweets) to minimize stomach upset and to promote further weight loss. If you
eat foods high in fat and sugar, you may experience dumping syndrome which
causes dizziness, sweating, diarrhea, nausea and cramps.
YOU ARE CHANGED FOREVER
o Over time, you will be able to tolerate and eat more foods. To help with
weight maintenance and a healthy eating lifestyle, it is important to keep this
in mind. This is a drastic change that may affect all areas of your life.
You may start to feel anxious about comments that are made to you about your
weight loss, “feeling fat” in spite of weight loss, dealing with social situations
and experiencing new emotions. Remember that you are never alone in this
process. It is important to keep yourself involved in support groups, talk to
any member of the team and be open with family and friend.
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Chapter 4
THE LIQUID STAGE
 Immediately following your surgery, you will be placed on clear liquids for the day
of surgery until you go home.
 Starting the next day, you will gradually be able to add other liquids.
 You must remain on the liquid stage (liquid to very thin soupy foods) for two full
weeks. We need to have virtually NO pressure on the staple line of your stomach.
 WHY???
o Remember during your surgery, 2/3 of your stomach is removed.
o The stomach will be closed using three rows of staples and reinforced with
sutures (stitches).
o While this technique will make the closure very strong, remember that we
are using a device. Devices occasionally fail.
o If one staple in the row of three fails, it will put that area at risk for a
leak.
o Thus we do not want you to put any pressure on the staple line until your
tissue has time to grow in through the staple line.
o This occurs at 7-10 days following surgery.
o Liquids will not put any pressure on the staple line, thus for your safety, it
is vital that you remain on liquids ONLY!
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THE SOLID STAGE
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Your solid stage will start two weeks after surgery.
You can add one new item with each meal, as outlined on the next page.
Be sure to chew well and take a few moments between each bite to allow for
settling.
Stop eating when you feel full.
Do not attempt to eat after feeling full, or you could cause yourself to vomit and
this could cause irritation of the esophagus.
Do not drink with your meals. Stop drinking 30 minutes before eating and wait 30
minutes after to drink. You can cause your weight loss to slow if you drink with
your meals. When you drink liquids with solids, it will wash the food out of the
pouch. You will not have sufficient time to get the “full” feeling that is the key to
success.
Try to choose high protein, solid foods like meats and green veggies. These will
cause you to be full faster and stay full longer.
STAY AWAY FROM LIQUID CALORIES!!!!!!
You can take in just as many calories per day as you did prior to surgery if you
drink HIGH CALORIE LIQUIDS such as regular sodas, shakes, malts, energy
drinks, or high sugar fruit juices.
Watch you fluid calorie intake. Your body is in starvation mode after surgery and
will hold on to every empty calorie you feed it.
AVOID the following:
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AVOID Sports drinks (Powerade, Gatorade)
AVOID Coffee specialty drinks/’dessert coffees’
AVOID Energy drinks (Monster, Redbull, etc.)
AVOID Fruit Juice (Apple, grape, orange, cranberry, coconut, pineapple, etc.)
AVOID Commercial liquid supplements that do not meet the nutritional criteria of at least 20
grams of protein AND less than 6 grams of carbohydrate PER SERVING! (Ensure, Boost)
AVOID Commercially made smoothies (smoothie King). **Hint: if you did not make it – don’t drink
it**
AVOID Milkshakes
AVOID Carbonated ‘regular’ sodas
AVOID 1%, 2% or Whole Milk
AVOID Snow cones
AVOID V-8 Splash (any with fruit juice)
AVOID Alcohol (beer, wine spirits)
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Chapter 5
Frequently Asked Dietary Questions
1. Why have I been requested to lose weight prior to surgery?
We require weight loss so that the size of your liver can decrease, increasing the changes of
your surgery being done laproscopically. Losing weight prior to surgery may decrease the
risk of complications around the time of surgery, may allow a smaller incision and may speed
recovery after surgery. Secondly, a commitment to try to lose the weight in order to help
with the surgery shows a commitment on your part and ensures that you will be compliant
with our dietary plan both before and after surgery, which is the key to success.
2. How big will my stomach be after the surgery?
Sleeve: Approximately 2/3 of your stomach is removed and your new stomach is
approximately 2-3 ounces immediately after surgery.
Gastric Bypass: Approximately 1-2 ounces immediately after surgery. About the size of an
egg.
3. Will I ever be able to eat normal foods again?
You will be able to eat foods that are lean high protein foods, low in fat and low in sugar
following the 5 week period after surgery. The biggest difference will be the drastic change
in meal size and the composition of foods (lower fat and lower sugar). After eating a few
ounces, you will feel very full. Although you will have to avoid sugars and limit fats in your
diet, you can otherwise eat a small amount of your favorite foods and even dine out.
4. Why is protein so important in my diet after surgery?
After bariatric surgery, we focus on protein. Protein is essential in healing, maintaining
muscle tissue and organ function.
5. Why is it important for me to drink fluids after surgery?
It is important to maintain about 48-64 ounces to maintain appropriate body levels of fluid
and to replace loss due to weight loss. Dehydration can make you feel very sick.
6. Are there any nutritional supplements that I will have to take after this surgery?
Due to limited capacity of your stomach and the way your pouch is connected to your
intestine, it is difficult to get adequate amounts of some nutrients in your diet. For those
reasons, you will have to take a complete multivitamin and a calcium supplement every day for
the rest of your life.
7. After the surgery, how will I take the medications I am currently on?
Pills or capsules can be taken as before. Oral tablets that are fairly large must be broken or
crushed or alternative medications can be chosen. Speak to your surgeon regarding this.
8. Why can I not eat any foods with a lot of fat and sugar after surgery?
One incident of eating these foods will answer this question for you! Sugar and fats are
usually not tolerated well and may cause severe symptoms such as pain, nausea, heart racing,
vomiting, cramps and diarrhea. This is called Dumping Syndrome. Also, they are not very
nutritious and since you can only eat a limited amount, you should save room for more
nutritious choices.
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9. When can I drive?
After the first visit back to the clinic, if you are no longer taking narcotics/pain medication
and feel comfortable to move.
10. When can I go back to work?
As soon as you feel fit. 2-3 weeks for most desk jobs and 6 weeks for manual labor jobs.
11. When can I start exercising?
Start walking immediately! You can start doing more strenuous exercising such as aerobics
approximately 6 weeks following surgery. Avoid full sit-ups until about 6 months following
surgery. Listen to your body. You will know when you are ready.
12. Why am I losing so much hair?
Sometimes after surgery patients will complain of hair loss. It is related to not getting
enough protein or vitamins in your diet and for many, it is the body’s response to rapid
weight loss. You will not go bald. Your hair loss is usually not permanent and will grow back.
You may take hair loss supplements such as AG Pro or Bariatric Advantage offers a hair care
kit & Biotin.
13. What should I do if I am having constipation?
You may need to increase your fiber and fluid intake. Food records will help you quantify
what you are currently consuming. If increasing fiber doesn’t help, try Metamucil, milk of
magnesia or diluted prune juice (dilute ½ juice with ½ water). After surgery expect to not
have bowel movements every day. You are eating much less and have been on a liquid diet for
several days so you may not be constipated. It may take several days before you have a
bowel movement.
14. What do I do if I have gas and bloating or diarrhea?
For the first week after surgery, it is normal to feel some cramping and diarrhea. However,
later on some patients may experience these symptoms due to a sugar found in milk products
called lactose. If you are intolerant to lactose, it will cause gas, bloating and diarrhea.
Symptoms should resolve by switching to lactose free products. You may take Mylicon or
Gas X for gas relief. Some patients experience diarrhea while adjusting to their new
stomach and diet – this usually only last for a few days. If the diarrhea persists you may
take over the counter Imodium.
15. What do I do if I am feeling nauseous?
Be aware of your eating behavior. Perhaps you are eating too much, to fast or eating foods
high in sugar. Discuss this with your doctor if it continues. It is very important to keep
food records for the first few months to identify problem foods or amounts of food and
fluids.
16. Why do people often vomit after surgery?
Vomiting is not an uncommon occurrence; however, it can be controlled. If you are vomiting,
there are some things you should be looking for. Are you eating your foods too quickly? Is
the food too dry? Make sure meats are moist. If you are still having problems with meats,
even if moist, leave them out of your diet and try them again in a few weeks. Drink fluids
separately! Do not eat and drink at the same time. Liquids will fill you up and may cause
distress, making you feel like you need to vomit.
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17. What could cause me to feel tightness in the middle of my chest while I am eating or
right after I eat?
You may be overeating or eating too fast. Time yourself when you sit down to eat a meal.
Remember if may initially take 10 minutes to consume 1 ounce of food. Keep food records of
amounts and time you start and finish.
18. Why can’t I snack between meals?
Snacking, nibbling or grazing on foods, usually high-calorie and high-fat foods, can add
hundreds of calories a day to your intake, defeating the restrictive effect of your operation.
Snacking will slow down your weight loss and can lead to regain of weight.
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Chapter 6
Special Considerations
Bariatric surgery creates dramatic changes in the size and shape of the stomach. It
may take a while to get used to these changes. Patients report a wide variety of
complications after surgery. Some of these changes will go away with time, while others
can be lessened with adjustment of the diet.
1. Nausea and Vomiting
These are the most common complications that will occur in the first few months
after surgery. They may occur after eating too fast, drinking liquids while you eat,
not chewing enough or eating more than your new stomach can hold. It is absolutely
necessary that you learn to eat very slowly and chew foods thoroughly. Nausea and
vomiting can also be triggered after trying a new food again. This is why it is
important to only try one new food at a time. Notify your physician if frequent
vomiting persists despite change in eating habits.
2. Dehydration
Loss of body fluids or dehydration is also an important concern, especially if vomiting
or diarrhea is frequent. Prevent dehydration by drinking water or low-calorie
beverages between meals. Signs of dehydration can include: fatigue, lack of energy,
dry mouth, chapped lips, dark urine, and headaches.
3. Dumping Syndrome
Not as common with the Vertical Sleeve Gastrectomy as with the Gastric Bypass. But
some sleeve patients do develop Dumping Syndrome. This condition occurs when food
passes too quickly from the stomach into the small intestine. Symptoms include a
combination of nausea, uncomfortable fullness, cramping, diarrhea, weakness, sweating
and fast heart rate. Eating very sweet or surgery foods can provoke dumping. Reduce
intake of sweets and notify physician if symptoms persist.
4. Food Intolerances
Many patients experience food intolerances, especially to red meat, milk and high
fiber foods. Since food intolerance varies with the individual, meeting with a
registered dietitian may be needed.
5. Overeating
Almost all people who require a vertical sleeve gastrectomy have had problems with
overeating. The causes for this are complex involving genetics, emotions, upbringing
and even the functions of the brain. None of this will change after surgery, but the
size of your stomach will change. You must train yourself to eat only the amount
allowed by your new stomach. Eating more than 2-3 ounces at a time can cause
vomiting, expansion of the pouch, weight gain and even rupture of the stomach.
Education, group support and simply being aware of your behaviors can help to prevent
overeating and are just as important as diet to the success of the operation.
6. Menstruation
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After surgery some female patients notice that their menstrual cycle becomes
irregular for the first month or two. Some patients may have two periods in one month
or bleeding during the first period after surgery that is prolonged. This is normal after
surgery. If excessive bleeding persists or patient shows signs of anemia, please
contact the office.
Strategies for Eating Right
How you go about eating is just as important as what you eat!!! Remember:
1. The new stomach can hold 2-3 oz at a time.
2. Eat 3 to 4 small meals per day.
3. Chew food 20-25 times prior to swallowing. (Chew, chew, chew, chew)
4. At least 60 grams of protein per day.
5. Less than 20 grams of fat per day.
6. Eat protein first!
7. No fluids 30 minutes before or after a meal, or with meals.
8. Drink about 50-64 ounces of water per day. Sip, sip, sip – Do NOT Gulp.
9. Limit snacking between meals.
10. Sit while eating.
11. Take your multivitamins as directed, daily.
12. Bake, broil or BBQ. Do NOT fry.
13. Read nutrition food labels.
14. Use non-fat dressings, spreads and condiments.
15. Avoid sweets and sugary foods.
16. Recommended to AVOID alcoholic beverages, but if you do drink – limit alcoholic
beverage intake. If you drink alcohol, choose light or low-calorie beverages. Use
caution when drinking, as your new stomach and body size will respond differently
to alcohol.
17. Avoid high calorie beverages including: Coke, Dr. Pepper, Root Beer, Sprite,
commercial shakes and malts, smoothies, snow cones.
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