You Just Had Your Surgery NOW WHAT? Post-op Information

You Just Had Your Surgery NOW WHAT? Post-op Information

You just had your surgery, now what?

 

You elected to have bariatric surgery, which is first and foremost developed to cause weight loss, but also to avoid any medical issues that come with obesity and high BMI.  This surgery will limit the amount of food you are able to eat.  You will have 50-70% of your stomach removed, which all depends on the size of your stomach.  Your new stomach will now be the shape of a tube or banana.

The success of your surgery will depend on you and the choices you make in regards to healthy food intake and your physical fitness.  This diet should be followed if you intend to achieve the maximum amount of weight loss the surgery can offer you.  It will also help to prevent any nutritional deficiencies and complications that can arise.

 

RECOMMENDED GUIDELINES:

1.  Eat three meals a day with limited snacking in between meals.  This is a restrictive procedure, which means if you are not limiting what you intake, it may not give you the results you want.  Unhealthy snacking in between meals with things such as, but not limited to: Pretzels, crackers, cookies, sweets, etc.  or in general just eating frequently may prevent your weight loss or cause weight gain due to excess in calories that you should not be ingesting.

2.  Eat slowly and chew your food until it is in LIQUID FORM.  If you do not do this, it can cause pain, nausea, vomiting, heartburn, and irritate your new stomach.  THIS IS IMPERATIVE.  It is also recommended to cut your food into small pieces before eating to ensure that you can chew it up properly.  Wait one minute in between bites, and allow at least 30 minutes per 1 meal.

3.  AVOID CONCENTRATED SUGAR.  Keep sugar out of the first 3 ingredients on the food label.  The number of sugar grams on the label includes both added and natural sugars; therefore, it is essential to read the ingredients to find out what type of sugar the food contains.  It is recommended that you keep the sugars down to 15 grams or less per serving to help you limit “empty” calories in your diet.  AVOID sugar, dextrose, high fructose corn syrup, corn syrup, glucose, sucrose, molasses, and honey, especially if they are one of the first 3 ingredients on the nutrition label.  Artificial sweeteners such as NutraSweet/Equal, Saccharin/Sweet’n Low, and Sucrose/Splenda are acceptable to use.

4.  LIMIT HIGH-FAT FOODS.  Low fat is 3 grams or less per serving on a food label.  Some foods that are high in fat are potato chips, fried foods, fast food, bacon, sausage, hot dogs, bologna, pepperoni, cream soups, alfredo sauce, donuts, cakes, cookies, and pastries.

5.  Stop eating when you feel comfortably satisfied.  If you overeat, it can cause nausea, pain, and vomiting.  It can also cause your stomach to stretch.  It takes 6-9 months for your new stomach to stabilize.

6.  Drink plenty of fluids to avoid dehydration.  It is recommended to drink 64-86 fluid ounces, which is 8 cups of liquid per day.
- Take frequent small sips of your beverage throughout the day, NO GLUPING!
- Avoid carbonated drinks containing sugar, caffeine, and alcohol.
- Choose sugar-free non-carbonated drinks such as crystal light, fruit 20, diet Snapple, propel fitness water, light minute maid, diet ice tea, etc.
- Limit fat-free milk to less than 16 ounces per day.  Limit your intake of 100% real fruit juice to less than 8 ounces per day, attempt to dilute it with water.

 

TIPS:

-Wean yourself off carbonated and caffeinated beverages before surgery to help prevent withdrawals.
-Choose drinks with 10 calories or less per serving.
-If you are having issues with tolerating plain water, add sugar-free flavoring such as True lemon, lemon, or orange slice, etc.
-INCREASE YOUR FLUID INTAKE IF You have dark urine, headaches, lethargy, or a white coating on the tongue.

7.  AVOID eating and drinking at the same time.  Do not drink along with your meal.  Eat your meal, and then wait at least 30 minutes after your meal to resume drinking.

8.  When eating, protein should be consumed first, then your vegetables and fruits, and THEN whole grains.

9.  EXERCISE!
- Try to exercise for 30 minutes per day
- Exercise will help you maintain long term weight loss
- When starting out, you can even exercise for 5 minutes at a time, then begin increasing your time as you can tolerate.
- The first 4 weeks exercise should be limited to walking after 4 weeks try introducing strength exercise
- If you have never exercised before please consult your physician first.

10.  PROTEIN: you should be consuming 60-80 grams of protein per day, combining food and or supplements.

 

Consult pompeiisurgical.com post-op diet for food charts:
1. The protein content of meats, poultry, and fish
2. Milk and dairy
3. Legumes and nuts

 

PROTEIN MEAL SUPPLEMENTS
-examples of supplements you can use


1.  Drinks made with WHEY PROTEIN ISOLATE, this absorbs well vs. Whey protein concentrate which has lactose, or milk sugar
2.  Strive for protein with at least 20 grams of protein per serving.  Mix with skim or 1% milk for an additional 8 grams of protein per serving.  Aim for a product with less than 3 grams of sugar per serving.
3.  Avoid and or limit protein collagen-based products (incomplete form of protein that is missing tryptophan, an essential building block of protein)
EXAMPLES: 
Ready to drink- Atkins, E.A.S Myoplex Carb Sense, Zero Carb Isopure.
Powders: Designer, Unjury, Nectar, Premier Protein. 
*Unjury, and Premier Protein are a couple of our Patients favorites.

11. Vitamin and Mineral Supplements.  You will be required after surgery to take a supplement for the rest of your life to prevent deficiencies.

Multivitamin: Two chewable or liquid multivitamins with minerals per day.  Take with food.
Calcium: 1500 mg of calcium citrate per day.  Take 1 chewable 3 times daily.  Maximum of 600 mg at one time.  It MUST contain Vitamin D (at least 200 IU)

SAMPLE Table for Taking Your Supplements 
Breakfast — Multivitamin (NOT with dairy) Lunch — 500-600 mg Calcium
Snack — 500-600 mg Calcium
Calcium Dinner — 500-600 mg Calcium 

 

Resource the Diet Allowable Foods and Meal Plans on pompeiisurgical.com
Liquid Diet: Week 1
Sample Full Liquid Meal Plan (1st Week Post-op

Liquid Diet: Week 2
Sample Full Liquid Meal Plan (2nd Week Post-Op)

Pureed Food Diet: Weeks 3-4
Pureed Diet Instructions
Instructions for Pureeing Foods
Food Choices
Sample Pureed Menu (3rd and 4th week)

Soft Foods Diet: Weeks 5-6
Food Choices
Avoid List
Sample Soft Menu

After 2 weeks of the soft food diet, you will be able to introduce new food choices slowly.  It’s essential to be patient with the diet to get your stomach acclimated.  Keep food records or your intolerance and intake because some things can change after surgery.  Remember that food intolerance is highly individualized.  Take your time at meals and make sure to chew your food well to increase your tolerance to these food choices.  Over time your tolerance will increase to tolerate textures and a wider variety of foods.  Your diet needs to remain low-fat, low calorie, low carb, sugar-free, and portion controlled for the rest of your life.  YOU MUST MAKE THIS COMMITMENT IN ORDER TO MAINTAIN THE WEIGHT LOSS.

 

POSSIBLE NUTRITION PROBLEMS THAT MAY OCCUR:
HAIR LOSS:
Due to rapid weight loss, you can experience hair loss.  The typical onset is about 3-6 months after surgery.  The good news is that usually its just overall thinning, not noticeable.  Biotin may be taken that may help and will ensure that your fluid protein, iron, and zinc levels or intake are good.

NAUSEA OF VOMITING:
This is usually due to eating too quickly or drinking too quickly.  The onset can be caused by lying down too quickly after a meal.  This increases your risk of feeling sick but also increases your chance of heartburn.   Nausea and Vomiting are a prevalent side effect of bariatric surgery.  Your body is going through an adjustment period and is getting used to the changes.  If concerned contact your surgeons' office.

GERD: The onset of this usually occurs twice a week after surgery.  Continue to use your nexus/Maalox/Mylanta.  This over the counter medication can be very useful due to your combination of dietary changes and medications.

BAD TASTE IN MOUTH: This is very common after surgery and should go away very quickly in the weeks after surgery.

DECREASED APPETITE AND TASTE CHANGES: It is very common to not feel hungry after bariatric surgery and to have different taste sensations.  You will need to commit to ensuring you are getting the proper nutrients even with decreased appetite, and to take care of yourself and well being.  If you do not, you can experience complications.

INCREASED GAS: One of the most common side effects mentioned.  This onset is usually directly after surgery and can last for the first few weeks.  It can be a sign of lactose intolerance as well.  If you have gas pains at home, try Gas X and Devrom.

EXCESS SKIN: With rapid weight loss, there is usually excess skin.  A lot of our patients refer to it as a badge of honor, but you can also get it removed later down the line.  The level of your excess skin will depend on how much you lose, genetics, age, and gender.  Weight training can also help minimize the appearance of loose skin.

PREGNANCY: Pregnancy after the first 18 months after surgery should be avoided.  It can cause complications and deficiencies for you and baby and can result in birth defects.  Rapid weight loss can increase fertility so be very careful.

 

CHECKLIST AFTER YOUR GASTRIC SLEEVE SURGERY 
        ●  60-80 grams of protein a day 

        ●  No more than 45 grams of sugar a day 

        ●  Try to keep fat to under 9 grams a day 

        ●  By week 5 you should be having a calorie intake between 800-1200 a day depending 
on your daily activity 

        ●  Eat protein first at all meals 

        ●  Eat slowly and chew well 

        ●  Meals should take 30-45 minutes 

        ●  Avoid snacking on high-calorie foods in between meals 

        ●  64-86 oz. of fluid a day (more if your urine is dark or you’re dizzy) 

        ●  Beverages less than 10 calories per serving 

        ●  Vitamin/mineral supplementation taken for life this may decrease, an amount 
suggested by your Primary Care Physician based on blood workups for vitamin levels. These should be done at
3 Months
6 Months 
9 Months
1 Year
Once a year after the first year 

        ●  Multivitamin (one a day, with food; not with calcium or dairy) 

        ●  Calcium citrate 1500-2000 mg a day...in divided doses (at least 3 times a day) and no 
more than 600 mg at one time, and apart from multivitamin and iron 

        ●  Exercise Aim for at least 30 minutes on most days of the week...5 minutes at a time, 
and gradually build up, as tolerated 

        ●  Incorporate light weights (about 2 months after surgery, and/or as your surgeon 
recommends) 

        ●  Consider stretching and the importance of a stress management program in your 
regimen 


DIETITIAN VISITS: 
2-4 weeks post-op
3 months post-op
6 months post-op
1-year post-op
Once a year after the first year 
NOTE: You may need to see your dietitian more often than above if you are having any nutrition problems and/or if your doctor feels you need to be seen for any reason. 
Keep food records. 
This will help you to monitor your intake and tolerance to foods. Look for patterns of foods tolerated well and foods that are not tolerated. The records will also be helpful for your dietitian to provide suggestions for better tolerance or nutrient balance. 
Record: 
        ●  Time Type of food (ex: baked chicken without skin) 

        ●  The amount consumed (ex: 2 ounces chicken breast) 

        ●  How your food was prepared (ex: baked with broth). Be sure to include any butter, 
oil, grease, or margarine that was added to the food. 
Please remember to bring these records with you for the dietitian to review. 


 

You can visit pompeiisurgical.com on the post-op diet information for *Pureed Food Recipes 

 

Instructions for Post-Op Medications Cefalexina (Antibiotic) 
Preparation: Add water (Bottled, Purified) to the RED Arrow. Shake well. If after shaking mixture level is below Red Arrow add more water. DO NOT USE Tap Water. 
Once mixed medication can be stored at room temperature for seven (7) days, Take 5 ml every 12 hours for 3 days. 
Ketorolaco (Pain Medication) 
Take one (1) pill every six (6) hours as needed. 
Riopan (Antacid Liquid) Take first-week Post-Op 
Take 5 ml (1 teaspoon) three times daily for one week. 
Omeprazole (Antacid Capsule) Take second-week Post-Op 
1 capsule (20 mg) Every 12 hours for 7 days 
*If you have heartburn after 2 weeks, take Nexium 20 mg in the morning & 20 mg at night for 2-4 weeks until it is controlled, then reduce to 10 mg in the morning / 10 mg at night for 2-4 weeks. Follow up with your primary care provider. 
Wound Care 
Your incisions should need minimal care. 
Since nylon sutures were used, they will have to be removed, usually around the twelfth (12) to fourteenth (14) day after surgery. This should not cause any pain. Please email pictures of your incisions before removing your sutures to 
Adrian Escandon at aescandon77@gmail.com 
It is essential to keep it clean and dry to promote faster healing. Unless otherwise prescribed, you should shower, wash with soap, rinse, and dry thoroughly. If the wound is oozing or catching on clothing, you may cover it with a very light dressing, but otherwise leaving the wound open to air whenever possible may help prevent suture infection. Absolutely do not pick at the incisions, stitches, or scabs. You will get an infection. 
Once all your incisions have closed, it is usually safe for your incision to get completely wet. Your incisions should be closed within three to four weeks. As you feel stronger, you may enjoy a swim or a soak in the tub. 
Despite the most exceptional care, any wound can become infected. If your wound becomes reddened, swollen, leaks pus, has red streaks, has yellow/green purulent or odorous drainage, feels increasingly sore or you have a fever above 100.5T, you must notify your surgeon right away. These may be signs of an infection. 
Do not use any antibiotic ointment or another occlusive ointment on your incision, unless your medical team has instructed you to do so. 

Also, visit pompeiisurgical.com for laboratory tests that Dr. Q recommends you have at 6 months and 12 months after your VSG.

This is a brief overview of the instructions from pompeiisurgical.com just to get your feet wet.  Please refer to the original document for thorough information after surgery.