Download ECU Bariatric Surgery

ECU Bariatric Surgery Instructions
MEDICATIONS
AFTER WEIGHT LOSS SURGERY
GENERAL
All medications must crushed, chewed or in liquid form for 1 year after gastric bypass. Medications that are
labeled SR (sustained release), XR (extended release) or the like cannot be crushed, so you will have to find an
alternative. You should discuss this requirement with your pharmacist and the physician(s) who prescribes your
medication(s) well in advance of your surgery date.
You may mix your crushed or liquid medications with water, Crystal Light or food items such as yogurt in order
to make them more tasteful.
After the 1 year mark, you may take small pills whole but should continue to crush larger ones.
Tylenol or any Acetaminophen product is the only acceptable pain reliever to may take following weight
loss surgery.
DIABETIC MEDICATIONS (GASTRIC BYPASS ONLY)
Most people with diabetes will not require any of their diabetic medications following surgery. If you didn’t
receive any insulin or other diabetic medication while you were in the hospital, you don’t need any medication
when you go home. If you were receiving insulin (usually Lantus) and/or Glucophage (liquid) on the day of
discharge, you should have received prescriptions for these medications and instructions on their use.
ALL people with diabetes who have a glucometer should monitor their blood sugar levels after surgery until their
first clinic visit with the surgeon. If your blood sugar in consistently above 160 before meals, call the gastric
bypass office.
OTHER MEDICATIONS
Medications for other conditions (high blood pressure, depression, etc.) should be resumed as soon as you leave
the hospital. You should plan to see your primary care doctor or prescribing physician(s) within 1 month after
surgery to review your medications and evaluate the need for their continued use. We recommend making that
appointment before your surgery.
VITAMIN SUPPLEMENTS
You should take the following supplements starting as soon as you leave the hospital:
Chewable Multivitamins (Flintstones, Bugs Bunny, etc.)
Calcium Citrate or TUMS
Vitamin D
Vitamin B12
Iron Sulfate Elixir (All women under 50)
Take 2 every day
Take 1000 mg every day
Take 800 IU every day
Take 250 mcg every day
Take 325 mg every day
The calcium and vitamin D may be taken as one product like OsCal 500 + Extra D, Caltrate 600 + D Plus, etc.
You may have you primary care physician prescribe a monthly vitamin B12 injection instead of taking a daily
dose.
**Take your Iron at least 2 hours before or after taking your Calcium.**
IT is ESSENTIAL that you take your multiple vitamins EVERY DAY for LIFE!!
MEDICATIONS YOU SHOULD NOT TAKE WITHOUT YOUR SURGEON’S PERMISSION
- NSAIDs including Ibuprofen, Motrin, Naprosyn, Naproxen, Aleve, Indomethacin.
- Aspirin and aspirin containing products including Excedrin, Goody’s Powder and BC Powder.
- Oral and IV steroids
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ECU Bariatric Surgery Instructions
PRE-OP DIET & EXERCISE PROTOCOL
INTIAL VISIT
PATIENT GROUP
COUNSELING
BMI <60 and weight < 350 lbs.
1. No weight gain, encourage 5-15 lb weight loss
2. Weight gain – will not proceed with OR scheduling
3. Encourage exercise program
4. Encourage dietary modification (no carbonated sugar
sweetened beverages, no fried food, smaller
portion sizes eating 6 smaller meals a day, etc.)
5. Start multivitamin, calcium, Vitamin D & B12, and
iron
BMI >60 and weight > 350 lbs.
1. Require 8-10% Estimated Weight Loss or at least 25
lbs. prior to insurance approval
2. Require exercise program by next visit
3. Require dietary modification (no carbonated sugar
sweetened beverages, no fried food, smaller
portion sizes eating 6 smaller meals a day, etc.)
by next visit
4. Start multivitamin, calcium, Vitamin D & B12, and
iron
DECISION VISIT
PATIENT GROUP
COUNSELING
BMI <60 and weight < 350 lbs.
1. OPTIFAST® Diet for 2 weeks before OR date
2. Encourage 10-20 lb. weight loss
3. Weight gain – Cancellation of surgery
BMI >60 and weight > 350 lbs.
1. OPTIFAST® Diet for 4 weeks before OR date
2. Require additional 8-10% Estimated Weight Loss
prior to surgery date
3. <8-10% Estimated Weight Loss - Cancellation of
surgery
PRE-OP DIET
OPTIFAST® 800 MEAL REPLACEMENTS
MEAL
BREAKFAST
LUNCH
AFTERNOON SNACK
DINNER
EVENING SNACK
PRODUCT
Formula
Formula or Soup
Formula
Formula or Soup
Formula
TOTAL
CALORIES
160
160
160
160
160
800
PROTEIN (g)
14
14
14
14
14
70
In addition to your five replacement meals a day, you may drink an unlimited amount of water or any zero calorie,
non carbonated beverage like Crystal Light or Diet Lipton Iced Tea.
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ECU Bariatric Surgery Instructions
POST-OP DIET PROGRESSION
0 TO 3 MONTHS
¼ cup maximum per meal
100% Protein
Your pouch is extremely small, about the size of a plum. Your diet for the next year will be mostly food
containing high levels of protein. You should always eat your PROTEIN FIRST. You probably will not
have room for any other food and you may not be able to finish the entire ¼ cup. Don’t worry. We will
add other foods (including fruits, vegetables, etc.) later. Make sure that you eat your protein.
You should be drinking at least 64 oz. (1 liter) of water or other zero-calorie liquid per day. In order to
do this, you should sip throughout the day and carry your water bottle everywhere, including to your
clinic appointments. You will need to drink lots of fluid, but just not during your meals.
WEEKS 1 AND 2 POST-OP
Level 1 Diet
Goal 24 g protein/day (8oz. OptiSource)
WEEK 3
Discontinue Level 1 Diet (OptiSource)
Start Level 2 Diet (soft foods-see list)
Goal 20-30g protein/day
WEEK 4
Add Level 3 Diet (add fish/seafood)
Continue Level 2 Diet – soft foods
Goal 20-30g protein/day
WEEK 5
Add Level 4 Diet (add chicken/poultry)
Anything from Levels 2-4
Goal 30-40g protein/day
WEEK 6
Add Level 5 Diet (Beef/pork)
Anything from Levels 2-5
Goal 30-40g protein/day
3 TO 6 MONTHS
½ cup maximum per meal
90% protein
Goal 40-50g protein/day
You should be well adjusted to eating with your new stomach. Continue to experiment with different
protein-rich foods and cooking methods. Keep your portions small!
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ECU Bariatric Surgery Instructions
POST-OP DIET PROGRESSION CONT’D.
6 TO 9 MONTHS
¾ cup maximum per meal
80% protein
Goal 50-60g protein/day
Your pouch has dilated somewhat. You will probably notice that you can eat more than you could for
the first few months after surgery. Continue to eat your protein first, but you can add a small amount
(1/4 cup or less) of fruit, vegetable or carbohydrate (starch) AFTER you finish your protein (1/2 cup or
less) if you have room. You will need to keep your portions small or you will dilate your pouch and
overcome part of the gastric bypass.
9 TO 12 MONTHS
1 cup maximum per meal
70% protein
AFTER 1 YEAR
Continue to eat your protein first. You will still need to keep your portions small, at around a cup of
food. You may add small amounts of diet carbonated beverages, if you cannot completely give them
up. Remember – the carbonation may dilate your pouch and reduce your total weight loss.
TIPS FOR YOUR DIET
Do not drink anything 30 minutes before or after your meals.
Take very small bites of food. Put your utensil down, chew thoroughly and swallow before taking
another small bite.
Take at least 30 minutes to eat a small meal.
You may use small amounts of condiments with your food. Even small amounts of some condiments
(ketchup, barbecue sauce, etc.) may cause you to have dumping symptoms because of the sugar they
contain. Try diluting them 50/50 with water.
FOODS TO AVOID
Soups, especially cream soups (unless instructed by your surgeon)
Protein supplements/drinks (unless instructed by your surgeon)
Anything sweetened with real sugar or sugar substance (honey, corn syrup, etc.)
Gravy
Cream sauces (alfredo, hollandaise, béarnaise)
Fried food
Fast food
Junk food
Alcohol
If you need help with your new diet, you may benefit from a consultation with a registered dietitian
experienced with weight loss surgery patients. Contact the dietitians at the ECU Family Medicine
(744-4611) or at the ViQuest Wellness Center – Greenville (847-5590). There will be a charge for
these visits but they are very helpful.
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ECU Bariatric Surgery Instructions
SAMPLE MENUS
LEVEL 2
Breakfast
¼ cup scrambled egg substitute
Snack
2 Tablespoons of reduced fat Peanut Butter
Lunch
¼ cup non fat or low fat Yogurt
Dinner
¼ cup reduced fat Cottage Cheese
7.5g
8.0g
3.25g
7.0g
25.75g of protein
LEVEL 3
Breakfast
1/8 cup scrambled egg substitute
1/8 cup non fat or low fat yogurt
Snack
14 Peanuts
Lunch
¼ cup tuna salad made with light or no fat mayo
Dinner
4 Large Shrimp or 1/8 cup Broiled fish
2 tablespoons low fat cheese
3.75g
1.67g
3.66g
8.22g
5.77g
7.36g
30.43g of protein
LEVEL 4
Breakfast
¼ cup reduced fat Cottage Cheese
Snack
7.0g
2 tablespoons low fat cheese
7.36g
Lunch
¼ cup Broiled fish
Dinner
11.0g
1/8 cup Roasted Turkey
1/8 cup Great Northern white beans
5.12g
2.38g
32.86g of protein
LEVEL 5
Breakfast
¼ cup non fat or low fat Yogurt
Snack
2 Tablespoons of reduced fat Peanut Butter
Lunch
¼ cup Broiled Chicken
Dinner
¼ cup lean ground beef
3.25g
8.0g
14.05g
11.02g
36.32g of protein
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ECU Bariatric Surgery Instructions
RECOMMENDED FOODS
LEVEL 1
protein(g)
cal
carb(g)
24
200
12
7.0
7.53
6.76
6.29
6.27
3.25
4.01
3.85
6.90
7.36
7.63
5.5175
2.065
2.745
¼ cup
¼ cup
1
1
1
¼ cup
1 TBSP
1 TBSP
1 oz.
1 oz.
1 oz.
¼ cup
¼ cup
¼ cup
0.1025
0.86
0.9
1.52
1.11
¼ cup
¼ cup
¼ cup
¼ cup
4
Beans, black
Beans, kidney
Beans, navy
Beans, pinto
Beans, great northern
Beans, white
Beans, lima
Lentils
3.81
3.6
3.745
3.85
3.685
4.755
2.97
4.475
¼ cup
¼ cup
¼ cup
¼ cup
¼ cup
¼ cup
¼ cup
¼
Fish, cod
Fish, haddock
Fish, salmon
Fish, flounder
Fish, swordfish
Fish, tuna steak
Fish, tuna, canned
Fish, tuna salad
19.51
20.60
23.21
20.54
21.58
25.47
21.68
8.22
3 oz. (85g)
3 oz.
3 oz.
3 oz.
3 oz.
3 oz.
3 oz.
¼ cup
Optisource HP Drink
LEVEL 2
Cottage cheese, low fat (1%)
Egg substitute
Egg, scrambled
Egg, boiled
Egg, poached
Yogurt, skim or non fat
Peanut butter, smooth, reduced fat
Peanut butter, chunky, reduced fat
Cheese, low fat cheddar
Cheese, part skim mozzarella
Cheese, swiss
Couscous, dry
Milk, skim
Soy milk
FOR COMPARSION ONLY
Applesauce, unsweetened
Grits
Cream of wheat cereal
Oatmeal, plain
Crackers, saltines
LEVEL 3
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8 oz.
ECU Bariatric Surgery Instructions
RECOMMENDED FOODS CONT’D.
Nuts, cashew
Nuts, mixed
Nuts, pecans
Nuts, peanuts
4.6
4.825
2.6
7.33
1 oz. (18 nuts)
1 oz.
1 oz. (20 halves)
1 oz. (28 nuts)
Seafood, clam, canned
Seafood, oyster
Seafood, scallop
Shrimp
Shrimp
21.72
7.45
2.80
17.3
9.89
3 oz.
3 oz.
1 large
3 oz. (12 large or 7 XL)
¼ cup (4 XL)
Quinoa
5.55
¼ cup
Chicken, breast
Chicken, breast
26.68
28.1
½ breast
3 oz.
Turkey, roast
Turkey, roast
10.2625
24.56
¼ cup
3 oz.
Pork, ham, extra lean
Pork, ham, lean
Pork, chop
Pork, loin
Pork, sausage
Pork, sausage
9.8
21.29
25.66
24.41
5.25
5.05
2 slices (56.7g)
3 oz.
3 oz.
3 oz.
1 patty
2 links
Beef, roast
Beef, ground, 85% lean
Beef, top sirloin
Beef, frankfurter
Steak, ribeye
24.0
22.04
24.0
5.06
12
3 oz.
3 oz.
3 oz.
1
¼ cup (1.5 oz.)
Veal, leg
Veal, rib
30.74
20.37
3 oz.
3 oz.
Lamb, shoulder
30.21
3 oz.
LEVEL 4
LEVEL 5
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