life after surgery
What do I need to do to be successful after surgery?
The basic rules are simple and easy to follow:
- Following surgery, refer to special dietary guidelines already given to you by are nutritional specialist. You will need to follow these guidelines closely. Many surgeons begin patients with liquid diets, moving to semi-solid foods and later, sometimes weeks or months later, solid foods can be tolerated without risk to the surgical procedure performed. Allowing time for proper healing of your new stomach pouch is necessary and important.
- When able to eat solids, eat 2-3 meals per day, no more. Protein in the form of lean meats (chicken, turkey, fish) and other low-fat sources should be eaten first. These should comprise at least half the volume of the meal eaten. Foods should be cooked without fat and seasoned to taste. Avoid sauces, gravies, butter, margarine, mayonnaise and junk foods.
- Never eat between meals. Do not drink flavored beverages, even diet soda, between meals.
- Drink 2-3 quarts or more of water each day. Water must be consumed slowly, 1-2 mouthfuls at a time, due to the restrictive effect of the operation.
- Exercise aerobically every day for at least 20 minutes (one-mile brisk walk, bike riding, stair climbing, etc.). Weight/resistance exercise can be added 3-4 days per week, as instructed by your doctor.
What's so important about exercise?
When you have a weight loss surgery procedure, you lose weight because
the amount of food energy (calories) you are able to eat is much less
than your body needs to operate. It has to make up the difference by
burning reserves or unused tissues. Your body will tend to burn any
unused muscle before it begins to burn the fat it has saved up. If you
do not exercise daily, your body will consume your unused muscle, and
you will lose muscle mass and strength. Daily aerobic exercise for 20
minutes will communicate to your body that you want to use your muscles
and force it to burn the fat instead.
What is the right amount of exercise after weight loss surgery?
Many patients are hesitant about exercising after surgery, but exercise
is an essential component of success after surgery. Exercise actually
begins on the afternoon of surgery - the patient must be out of bed and
walking. The goal is to walk further on the next day, and
progressively further every day after that, including the first few
weeks at home. Patients are often released from medical restrictions and
encouraged to begin exercising about two weeks after surgery, limited
only by the level of wound discomfort. The type of exercise is dictated
by the patient's overall condition. Some patients who have severe knee
problems can't walk well, but may be able to swim or bicycle. Many
patients begin with low stress forms of exercise and are encouraged to
progress to more vigorous activity when they are able. Always be sure to
have your physician approval for appropriate levels of exercise.
Can I get pregnant after weight loss surgery?
It is strongly recommended that women wait at least one year after the
surgery before a pregnancy. Approximately one year post-operatively,
your body will be fairly stable (from a weight and nutrition
standpoint) and you should be able to carry a normally nourished fetus.
You should consult your surgeon as you plan for pregnancy.
What if I have had a previous weight loss surgical procedure and I'm now having problems?
Contact your original surgeon - he or she is most familiar with your
medical history and can make recommendations based on knowledge of your
surgical procedure and body.
What happens to the lower part of the stomach that is bypassed?
In some surgical procedures, the stomach is left in place with intact
blood supply. In some cases it may shrink a bit and its lining (the
mucosa) may atrophy, but for the most part it remains unchanged. The
lower stomach still contributes to the function of the intestines even
though it does not receive or process food - it makes intrinsic factor,
necessary to absorb Vitamin B12 and contributes to hormone balance and
motility of the intestines in ways that are not entirely known. In the
BPD procedures, some portion of the stomach is completely removed.
How big will my stomach pouch really be in the long run?
This can vary by surgical procedure and surgeon. In the Roux-en-Y
gastric bypass, the stomach pouch is created at one ounce or less in
size (15-20cc). In the first few months it is rather stiff due to
natural surgical inflammation. About 6-12 months after surgery, the
stomach pouch can expand and will become more expandable as swelling
subsides. Many patients end up with a meal capacity of 3-7 ounces.
What will the staples do inside my abdomen? Is it okay in the future
to have an MRI test? Will I set off metal detectors in airports?
The staples used on the stomach and the intestines are very tiny in
comparison to the staples you will have in your skin or staples you use
in the office. Each staple is a tiny piece of stainless steel or
titanium so small it is hard to see other than as a tiny bright spot.
Because the metals used (titanium or stainless steel) are inert in the
body, most people are not allergic to staples and they usually do not
cause any problems in the long run. The staple materials are also
non-magnetic, which means that they will not be affected by MRI. The
staples will not set off airport metal detectors.
What if I'm not hungry after surgery?
It's normal not to have an appetite for the first month or two after
weight loss surgery. If you are able to consume liquids reasonably
well, there is a level of confidence that your appetite will increase
with time.
Is there any difficulty in taking medications?
Most pills or capsules are small enough to pass through the new stomach
pouch. Initially, your doctor may suggest that medications be taken in
liquid form or crushed.
Is there a difference in the outcome of surgery between men and women?
Both men and women generally respond well to this surgery. In general, men lose weight slightly faster than women do.
Will I be asked to stop smoking?
Patients are encouraged to stop smoking at least one month before surgery.
If I continue to smoke, what happens?
Smoking increases the risk of lung problems after surgery, can reduce
the rate of healing, increases the rates of infection, and interferes
with blood supply to the healing tissues.
How can I know that I won't just keep losing weight until I waste away to nothing?
Patients may begin to wonder about this early after the surgery when
they are losing 20-40 pounds per month, or maybe when they've lost more
than 100 pounds and they're still losing weight. Two things happen to
allow weight to stabilize. First, a patient's ongoing metabolic needs
(calories burned) decrease as the body sheds excess pounds. Second,
there is a natural progressive increase in calorie and nutrient intake
over the months following weight loss surgery. The stomach pouch and
attached small intestine learn to work together better, and there is
some expansion in pouch size over a period of months. The bottom line is
that, in the absence of a surgical complication, patients are very
unlikely to lose weight to the point of malnutrition.
What can I do to prevent lots of excess hanging skin?
Many people heavy enough to meet the surgical criteria for weight loss
surgery have stretched their skin beyond the point from which it can
"snap back." Some patients will choose to have plastic surgery to
remove loose or excess skin after they have lost their excess weight.
Insurance generally does not pay for this type of surgery (often seen as
elective surgery). However, some do pay for certain types of surgery
to remove excess skin when complications arise from these excess skin
folds. Ask your surgeon about your need for a skin removal procedure.
Will exercise help with excess hanging skin?
Exercise is good in so many other ways that a regular exercise program
is recommended. Unfortunately, most patients may still be left with
large flaps of loose skin.
Will I be miserably hungry after weight loss surgery since I'm not eating much?
Most patients say no. In fact, for the first 4-6 weeks patients have
almost no appetite. Over the next several months the appetite returns,
but it tends not to be a ravenous "eat everything in the cupboard" type
of hunger.
What if I am really hungry?
This is usually caused by the types of food you may be consuming,
especially starches (rice, pasta, potatoes). Be absolutely sure not to
drink liquid with food since liquid washes food out of the pouch.
Will I have to change my medications?
Your doctor will determine whether medications for blood pressure,
diabetes, etc., can be stopped when the conditions for which they are
taken improve or resolve after weight loss surgery. For med's that need
to be continued, the vast majority can be swallowed, absorbed and work
the same as before weight loss surgery. Usually no change in dose is
required. Two classes of medications that should be used only in
consultation with your surgeon are diuretics (fluid pills) and NSAID's
(most over-the-counter pain medicines). NSAID's (ibuprofen, naproxen,
etc.) may create ulcers in the small pouch or the attached bowel. Most
diuretic medicines make the kidneys lose potassium. With the
dramatically reduced intake experienced by most weight loss surgery
patients, they are not able to take in enough potassium from food to
compensate. When potassium levels get too low, it can lead to fatal
heart problems.
What is a hernia and what is the probability of an abdominal hernia after surgery?
A hernia is a weakness in the muscle wall through which an organ
(usually small bowel) can advance. Approximately 20% of patients develop
a hernia. Most of these patients require a repair of the herniated
tissue. The use of a reinforcing mesh to support the repair is common.
Is blood transfusion required?
Infrequently: If needed, it is usually given after surgery to promote healing.
What is phlebitis and is it preventable?
Undesired blood clotting in veins, especially of the calf and pelvis.
It is not completely preventable, but preventive measures will be
taken, including:
- Early ambulation
- Special stockings
- Blood thinners
- Pulsatile boots
Will I lose hair after surgery? How can I prevent it?
Many patients experience some hair loss or thinning after surgery. This
usually occurs between the fourth and the eighth month after surgery.
Consistent intake of protein at mealtime is the most important
prevention method. Also recommended are a daily zinc supplement and a
good daily volume of fluid intake.
Does hair growth recover?
Most patients experience natural hair regrowth after the initial period of loss.
What are adhesions and do they form after this surgery?
Adhesions are scar tissues formed inside the abdomen after surgery or
injury. Adhesions can form with any surgery in the abdomen. For most
patients, these are not extensive enough to cause problems.
What is the "Candida Syndrome?"
Some patients have a type of yeast present on the surface of their
skin, intestine or vagina at the time of surgery. This leads to
overgrowth in certain circumstances. A whitish coating may occur on the
tongue or throat. This syndrome is associated with a frothy mucous,
nausea, difficulty swallowing, sore throat, loss of taste and appetite,
and occasionally abdominal bloating and diarrhea.
What causes it to appear?
It is promoted by the use of most antibiotics and some other
medications, by stress, by reduced immune response, and by diabetes.
Can it be cured?
There are several effective medications now available for treating the overgrowth of Candida.
What is sleep apnea (SA)?
It is the interruption of the normal sleep pattern associated with
repeated delays in breathing. Sleep apnea often shows rapid improvement
after surgery. In most patients, there is a complete resolution of
symptoms by six months following surgery.
