Preparation
Increase the chances of success by following these guidelines:
- We recommend that patients attend at least three support group meetings before surgery and keep attending support group meetings for at least six to 12 months after surgery.
- Read the information material. Please read as much as possible about weight loss surgery to prepare yourself for the operation. Make sure you read the material given to you or recommended to you by your surgeon.
- Exercise. Start exercising on a regular basis. Your exercise could be as mild as water aerobics, daily walks or any other aerobic workout. It is important to start gradually and build up to at least 30 minutes of regular exercise every day. We recommend that our patients buy a pedometer to count the number of steps daily. Check your pedometer before going to bed and keep track of your daily steps. This is a very good way to motivate yourself to walk more.
- Stop smoking. You cannot have this surgery until you have been off cigarettes/cigars for one month. Smoking is probably more dangerous to your health than obesity. Smoking paralyzes the lining of your air passages. It hinders good working of your lungs and heart. After weight loss surgery, smoking also increases the risk of development of ulcers in the new stomach pouch.
- Do not have weight loss surgery while you have any other acute medical problem. If you are getting a cold or have a sore throat, ear infection, kidney or bladder infection, open wound or sore, call your doctor. It may be safer to reschedule your surgery.
- Begin taking two showers a day a few days before you enter the hospital. Use a good soap. Wash very well from your breasts to below your waist. Make sure you clean between any folds of skin.
- Stop taking all herbal products or natural medicines (e.g., St. John's wort, ginko, biloba, ginsung, garlic and even Vitamin E) for at least one week before surgery. Some of these "natural medicines" can increase the risk of bleeding during and after surgery.
- Stop blood thinning medications. If you take any blood thinning medicine, such as warfarin, coumaden, aspirin or aspirin-like medications called NSAIDs (Ibuprofen, Motrin, Advil and Naproxen), you should stop taking those before surgery and talk to your doctor about it.
- Stop birth control pills for a month before surgery. Birth control pills increase the risk of blood clots in the veins of your legs and pelvis. Patients undergoing weight reduction surgery are at a higher risk of making these blood clots. Stopping birth control pills will decrease the risk of blood clots. You should switch to a barrier method of birth control for a month before surgery and continue this method of birth control for at least 18 months after surgery.
- Avoid "Last Supper Syndrome." Some patients start going out to eat before weight loss surgery and start eating all their favorite foods and desserts before surgery. They are afraid that they will never be able to eat these foods. As a result, they put on more weight while they are getting ready for surgery. This makes the surgery technically more challenging and increases the amount of weight they have to lose. In fact, most people are able to eat and drink almost everything they ate before surgery. But it takes some time to get to that stage, and they can only eat in small amounts, which is good for them anyway.
- Follow a liquid diet for 24 hours before surgery and do not eat or drink anything after midnight the night before surgery. You may also need to take a bowel prep. Our office will give you exact instructions if you need them.
- You may want to visit the surgical floor before you have surgery. You can see the unit, meet the nurses, learn about your care and ask questions. Please ask about scheduling this visit. You may want to write down questions to ask the doctors or nurses when you see them.
- An anesthesiologist will talk with you about anesthesia to put you to sleep during surgery. He or she will put an endotracheal tube in your windpipe (trachea) through your mouth or nose. Your throat will be numbed with a spray. The anesthesiologist moves air in and out of your lungs through this tube while you are asleep during surgery.
Starting Liquid and Food after Weight Loss Surgery
Before surgery: Liquid diet for 24 hours the day before surgery and from midnight before your surgery to after surgery. An IV will give you liquid. You may also need bowel prep to clean your bowels. Our staff will let you know if you need it.
The day after your surgery, you will undergo a "leak test". If the test looks good, you will be able to start drinking a bariatric clear liquid diet. Your schedule of drinking and eating is likely to be:
First or second day after surgery: Bariatric clear liquids (sugar-free jello, dilute juice, broth), ice chips and water in 30 cc medicine cups.
Second or third day after surgery: Bariatric full liquids (skim milk, low-fat yogurt, low-fat pudding, low-fat cottage cheese, other foods and liquids that do not need chewing).Take it slowly. You do not have to eat all you are given. Remember, your new stomach is only 1 to 2 tablespoons big. The opening into the intestine is only the size of a dime. At first, about one-quarter cup of food or less is the most your stomach can hold at one time.
Such liquid food will not stretch your small stomach and will pass through the small opening easily without blocking it. You may find that you need to spread your food or fluids out over the hour when you get to three or four ounces in an hour.
Avoid liquids with a lot of simple sugars and carbonation. Instead drink water or flavored, diet non- carbonated liquids like diet Snapple, crystallite, propel, etc. Begin taking daily vitamins. We recommend Optisource multivitamin (one tablet four ttimes a day). Optisource will also provide extra iron, calcium and B-12. If you do not like their taste, you may take two chewable multivitamins with iron or one prenatal vitamin. Begin taking a calcium supplement, such as three to five Tums per day or other pills to equal 1,000 milligrams of calcium.
Patients stay on a full liquid diet for two weeks after gastric bypass and three weeks after lap-band. It is very important to drink at least 2 liters (64 ounces) of liquids per day and supplement your diet with a protein powder or protein shake at this time. Your goal is 60 to 70 grams of proteins per day. In the beginning, it is very difficult to achieve this goal. Thierty to 40 grams of proteins per day are an acceptable goal for the first few weeks. Do not take a protein supplement with a lot of fat calories. You can take designer protein powder mixed in 8 ounces of water or skim milk two to three times a day. Some patients like to drink Boost High Protein at this stage. If you choose Boost High Protein, you should dilute it with skim milk in a 1:1 ratio. As a rule, any liquid that has more than 20 grams of sugar per serving should be diluted to avoid Dumping Syndrome symptoms after gastric bypass surgery. Dumping symptoms are not seen in patients after lap-band surgery. Another option is to drink Low-Carb Carnation Instant Breakfast. Keep in mind that Boost High Protein and Low-Carb Carnation Instant Breakfast are high in calories compared to designer protein shakes.
When you eat solid food, it is very important to chew your food very well. Place your knife and fork on the table after every bite and concentrate on chewing. Do not watch TV and do not talk to anyone during eating for the first few weeks because you could inadvertently swallow a bite without chewing. If that happens, it will cause a lot of discomfort and pain.
Stop eating immediately when you feel full.
Most patients suffer from a change in their taste after surgery. Many foods that tasted good before surgery do not taste good any more and vice versa. It is partly related to the breakdown of fats (ketoacids) and their release into the breath. Mouthwashes or low-sugar mints are very helpful.
About 15 percent to 20 percent of patients suffer from nausea and retching in the first few weeks after gastric bypass surgery. It is most noticeable between the fourth and 12th weeks after surgery. Nausea is usually more common and more severe after gastric bypass surgery than lap-band. When you feel nauseous or have dry heaves, go back to the previous stage of food. If you are on the semisolid food stage, go to puree food. If you are at puree food, go to liquids for 24 to 48 hours. Also, try hot or cold liquids. If these measures don't help, call your doctor. You may need a medication for nausea or may even need admission in the hospital to give you intravenous fluids. It is very common to be able to eat a certain food one day and not be able to eat the same food another day. This stage can be very annoying, but it will pass.
Even though nausea is less common after lap-band, it is extremely important to avoid severe nausea, retching and dry heaving for the first three weeks after lap-band to minimize the possibility of band slippage. We usually advise patients to take scheduled nausea medication for the first three weeks and avoid all kinds of solid foods during that period.
You will receive more detailed information from our dietitian. Please follow those instructions closely.
