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- What do I need to do to be successful after surgery?
- How often will I be seen after surgery?
- How often are your support groups?
- Do I meet with a nutritionist before and after
surgery?
- What are the nutritional issues with weight loss
surgery?
- Will I get a copy of suggested eating patterns
and food choices after surgery?
- How much can I eat after my operation?
- What are the best choices of protein?
- How can I be sure I am eating enough protein?
- How long will I be restricted from eating solid
foods after surgery?
- Will I be able to eat "spicy" foods or seasoned
foods?
- Will I be allowed to drink alcohol?
- What vitamins will I need to take after surgery?
- Is it important to take calcium, iron, and trace
elements?
- How much water should I be drinking after my surgery?
- Why do I need to drink so much fluid?
- Is there a problem with consuming milk products?
- Why can't I snack between meals?
- Is there any restriction of salt intake?
- Why can't I eat red meat after surgery?
- What's so important about exercise?
- What is the right amount of exercise after weight
loss surgery?
- What is Dumping Syndrome?
- How can I know that I won't just keep losing weight
until I waste away to nothing?
- Will I be miserably hungry after weight loss surgery
since I'm not eating much?
- What if I am really hungry?
- What if I'm not hungry after surgery?
- Will I have excess skin?
- What can I do to prevent lots of excess skin?
- Will I have to change my medications?
- Is there any difficulty in taking medications?
- Will I lose hair after surgery? How can I prevent
it?
- Can I get pregnant after weight loss surgery?
- Will I be able to take oral contraception after
surgery?
- Is sexual activity restricted?
- What do I need to do to be successful after
surgery?
The basic rules are simple and easy to follow:
- During your hospitalization, the nursing staff will review
with you your special dietary guidelines. You will need to
follow these guidelines closely. Allowing time for proper
healing of your new stomach pouch is necessary and important.
- When you are able to eat solids, eat 3 meals at a ½ cup
portion size per day, no more. Protein in the form of lean
meats (chicken, turkey, and 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 or snack between meals. Do not drink sugary,
carbonated, caffeinated or alcoholic beverages. This includes
diet soda.
- " Drink 48-64 oz or more of water each day. Water must be
consumed slowly, 1 oz per 10 minutes, due to the restrictive
effect of the operation. Liquids should be separated from
solid meals by at least 30 minutes before and after.
- Take your vitamins daily as instructed prior to your operation.
- Exercise aerobically every day for at least 20-30 minutes
(one-mile brisk walk, bike riding, stair climbing, etc.).
Weight/resistance exercise can be added 3-4 days per week,
once you are 4 weeks out from your operation.
- How often will I be seen after surgery?
We pride ourselves on providing long term post-operative care
for our patients. After your surgery, you will be seen at 2 weeks,
1 month, 3 months, 6 months, 12 months, 18 months, 24 months, and then
on an annual basis for the first 5 years for gastric bypass and
sleeve gastrectomy patients. Adjustable gastric banding patients
are seen at 6-week intervals for the first 12 to 18 months after
surgery in order to adjust the band. You may be seen more often
if you are experiencing difficulties.
- How often are your support groups?
Support groups are held once a month. For now they are held on
first the Thursday of the month. Please click on the "Seminar
schedule" tab on the left of your screen to see the upcoming dates.
- Do I meet with a nutritionist before and
after surgery?
Dr. Raja requires patients to consult with our nutrition and exercise
counselor before surgery. Counseling after surgery takes place
at each of your regularly scheduled visits.
- What are the nutritional issues with weight
loss surgery?
Failure to follow the guidelines provided to you can lead to dietary
consequences. If you do not consume 60-80 grams of protein per
day this can lead to protein malnutrition. Failure to take your
daily vitamin supplements can lead to various vitamin/mineral
deficiencies.
- Will I get a copy of suggested eating patterns
and food choices after surgery?
We will provide patients with materials that clearly outline the
expectations regarding diet and compliance to guidelines for the
best outcome based on your surgical procedure. After surgery,
health and weight loss are highly dependent on patient compliance
with these guidelines. You must do your part by restricting high-calorie
foods, by avoiding sugar, snacks and fats, and by strictly following
the guidelines set by Dr. Raja.
- How much can I eat after my operation?
Dr. Raja recommends eating 3 meals a day at a ½ cup portion with
an emphasis on protein.
- What are the best choices of protein?
Eggs, low-fat cheese, low-fat cottage cheese, tofu, fish, other
seafood, chicken, and turkey are good sources of protein.
- How can I be sure I am eating enough protein?
60 to 80 grams of protein a day are the general recommendations.
- How long will I be restricted from eating
solid foods after surgery?
Dr. Raja recommends a period of 2-4 eeks or more without solid
foods after surgery. A liquid diet, followed by a pureed diet,
then a soft food diet is recommended for a period of time until
adequate healing has occurred. Our nutrition and exercise counselor
will provide you with specific dietary guidelines for the best
post-surgical outcome.
- Will I be able to eat "spicy" foods or seasoned
foods?
Most patients are able to enjoy spices after they are on a regular
diet.
- Will I be allowed to drink alcohol?
You will find that even small amounts of alcohol will affect you
quickly after gastric bypass surgery. It is suggested that you
drink no alcohol for the first 3 months after surgery. Thereafter
you may have a glass of wine or a small cocktail occasionally.
- What vitamins will I need to take after
surgery?
Yes, Dr. Raja recommends daily multivitamin supplements for the
rest of your life. You may click on the Vitamins and Nutritional
Supplement eStore button on the left to see Dr. Raja's recommendations.
- Is it important to take calcium, iron, and
trace elements?
All gastric bypass patients require these supplements. We will
do blood test for your body's reserves and make recommendations
based on your own need.
- How much water should I be drinking after
my surgery?
You should drink between 48-64oz of fluid each day.
- Why do I need to drink so much fluid?
When you are losing weight, there are many waste products to eliminate,
mostly in the urine. Some of these substances tend to form crystals,
which can cause kidney stones. A high water intake protects you
and helps your body to rid itself of waste products efficiently,
promoting better weight loss. Water also fills your stomach and
helps to prolong and intensify your sense of satisfaction with
food. If you feel a desire to eat between meals, it may be because
you did not drink enough water in the hour before.
- Is there a problem with consuming milk products?
Milk contains sugar known as lactose, which is not well digested
by many individuals. This sugar passes through undigested until
bacteria in the lower bowel digest it, producing irritating byproducts
as well as gas. Depending on an individuals tolerance, some people
find even the smallest amount of milk can cause cramps, gas and
diarrhea.
- 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 will lead to weight regain.
- Is there any restriction of salt intake?
No, your salt intake will be unchanged unless otherwise instructed
by your primary care physician. Salt should always be consumed
in moderation.
- Why can't I eat red meat after surgery?
Red meat can be eaten after surgery, but you will need to be very
careful. Dr. Raja recommends that you avoid red meat for the first
several months. Red meats contain large amounts of meat fibers
that hold it together, preventing you from separating it into
small parts when you chew. The gristle can plug the outlet of
your stomach pouch and prevent anything from passing through,
which becomes very uncomfortable.
- 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 function. It has to make
up the difference by burning reserves or unused tissues. Your
body will tend to burn any unused muscle and 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 20-30 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
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 2 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 may not 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. Dr. Raja feels that after
weight loss surgery patients should exercise 20-30 minutes per
day, 6 days per week.
- What is Dumping Syndrome?
Eating sugars or other foods containing many small particles when
you have an empty stomach can cause dumping syndrome in patients
who have had a gastric bypass. Your body handles these small particles
by diluting them with water, which reduces blood volume and causes
a shock-like state. Sugar may also induce insulin shock due to
the altered physiology of your intestinal tract. The result is
a very unpleasant feeling: you break out in a cold clammy sweat,
turn pale, feel "butterflies" in your stomach, and have a pounding
pulse. Cramps and diarrhea may follow. This state can last for
30-60 minutes and can be quite uncomfortable; you may have to
lie down until it goes away. This syndrome can be avoided by not
eating the foods that are high in sugar, especially on an empty
stomach.
- 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 15-20 pounds per month, or maybe when they've
lost more than 100 pounds and they're still losing weight. Two
things 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 the 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.
- 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 type of hunger.
- What if I am really hungry?
The types of food you may be consuming may cause excessive hunger.
Meals high in starches such as rice, pasta, and potatoes can leave
you feeling hungry soon after a meal. Well-balanced meals that
contain high amounts of protein lead to a feeling a fullness that
is maintained longer. Be sure not to drink liquid with food since
liquid washes food out of the pouch.
- What if I'm not hungry after surgery?
It's common not to have an appetite for the first month or 2 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.
- Will I have excess skin?
Many people heavy enough to meet the criteria for weight loss
surgery have stretched their skin beyond the point from which
it can shrink 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 as it is often seen as an elective surgery. However,
some do pay for certain types of surgery to remove excess skin
when complications arise from these excess skin folds.
- What can I do to prevent lots of excess
skin?
A regular exercise program is an essential part of the after surgery
regiment. Good nutrition, good hydration and a regular exercise
regiment will help with minimizing excess skin. Unfortunately,
many patients may still be left with large flaps of loose skin.
It is important to realize that excess skin does not contribute
to poor health in the manner that excess fat does i.e. diabetes,
high blood pressure, high cholesterol etc.
- Will I have to change my medications?
Dr. Raja 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 meds
that need to be continued, the vast majority can be taken, 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 Dr. Raja are diuretics and NSAIDs,
which include most over-the-counter pain medicines with exception
of Tylenol. NSAIDs such as ibuprofen and naproxen 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 unable to take in enough potassium from food to compensate.
When potassium levels get too low, it can lead to fatal heart
problems.
- Is there any difficulty in taking medications?
Dr. Raja recommends that medications be taken in crushed, chewed
or liquid form for first six months after surgery. After six months
pills or capsules that are smaller than eraser on a #2 pencil
may be taken whole. Pills larger than that size should be cut
into that size.
- 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 4th and the 8th month after surgery.
Consistent intake of protein at mealtime is the most important
prevention method. Also recommended are a daily B and zinc supplement
and at least 48-64 oz of fluid intake. Most patients experience
natural hair re-growth after the initial period of loss.
- Can I get pregnant after weight loss surgery?
It is strongly recommended that women wait about 2 years after
weight loss surgery before a pregnancy. At this time, your body
will be fairly stable, from a weight and nutrition standpoint,
and you should be able to carry a healthy nourished fetus. You
should notify your obstetrician of your prior weight loss surgery
as you plan for pregnancy.
- Will I be able to take oral contraception
after surgery?
Most patients have no difficulty in taking these pills. Dr. Raja
recommends taking all medications in a crushed, chewable, or liquid
form for the first 6 months after surgery.
- Is sexual activity restricted?
Patients can return to normal sexual intimacy when wound healing
and discomfort permit. Many patients experience a drop in desire
for about 2-4 weeks.
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