Life After Surgery
Clinical studies of laparoscopic (minimally invasive) bariatric surgery patients found that they felt better, spent more time doing recreational and physical activities, benefited from enhanced productivity and economic opportunities, and had more self-confidence than they did prior to surgery.
After the surgery patient should follow
- Strict diet regimen,
- Regular Exercise,
- Daily Medications to be taken,
- Regular follow up with the bariatric surgical team.
The basic rules are simple and easy to follow:
- Immediately after surgery, you will begin the diet guidelines provided to you prior to surgery. You will need to follow these guidelines closely. You will begin with a liquid diet, move to semi-solid foods and later, solids foods will be added and tolerated without risk to the surgical procedure performed. Allowing time for proper healing of your new stomach pouch is necessary and important.
- Never eat between meals.
- Drink 8-10 glasses 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 30 minutes (one-mile brisk walk, bike ride, stair climbing, etc.) Weight/resistance exercise can be added 3-4 days per week, as instructed by your doctor.
Both men and women generally respond well to this surgery. In general, men lose weight slightly faster than women do.
It is probably a good idea to have someone to help out for at least 1 week.
This is quite variable, if your job involves strenuous physical activity especially heavy lifting, we suggest 6 – 8 weeks, whereas if your job is very sedentary then you might return to work as early as 3 to 4 weeks 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.
The Roux-en-Y gastric bypass has the potential for “dumping syndrome.” If you eat high-fat foods or concentrated sugars, such as sweets, desserts or deep-fried foods, the concentrated sugar or fat rapidly dumps into the small intestine. The body’s response is to try to dilute these sugars and fats by pouring a large amount of fluid into the bowel. Insulin often is rapidly released, as well. The combination of the extra fluid and insulin create a feeling of light-headedness, clammy skin, fast heartbeat, nausea and a sense of needing to vomit or pass gas. Some people will feel abdominal cramping and these symptoms often are frequently followed by diarrhea. Avoiding these foods will prevent dumping.
Snacking can sabotage your weight control efforts. Snacking, nibbling or grazing on foods, especially high-calorie and high-fat foods, can add hundreds of calories a day to your intake while defeating the restrictive effect of your operation. Most snacking is done out of impulse rather than true hunger. Snacking will slow your weight loss and can lead to regaining some of your lost weight. Snacking also is a habit which is easier to avoid than to stop once started.
When you are losing weight, there is a heavy load of 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 will fill your stomach and help to prolong and intensify your sense of satisfaction with food. If you feel a desire to eat between meals, it is probably because you did not drink enough water in the hour before.
Many patients find carbonated beverages uncomfortable from the gas they produce, which also could cause some expansion of the stomach pouch. We ask that patients refrain from drinking all carbonated beverages after surgery to avoid this risk. In addition, these drinks often are high in sodium and have no nutritional value, so we recommend not drinking any of them, including those that are calorie-free.
Alcohol causes stomach irritation and can cause liver disease. During rapid periods of weight loss, the liver becomes especially vulnerable to toxins such as alcohol. You also may find that you become intoxicated more quickly and with less alcohol than you did before surgery. Researchers think this may be due to the way the body metabolizes alcohol. You may become more vulnerable to increases in drinking or drugs following weight loss surgery. There are many possible reasons for this. One reason may be a phenomenon known as addiction swapping, meaning that alcohol or drugs replace the food addiction now that you can no longer eat as much. Alcoholic beverages also are high in empty calories and may cause “dumping syndrome.” For these reasons, we recommend no alcohol for life long. Because of the potential for addiction, it is important that you be aware of the risks, signs and symptoms of alcohol abuse after surgery.
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 tissue. Smoking may also increase risks of developing ulcers.
Regular exercise and physical activity are essential for long-term weight loss and prevention of weight regain. Visits with an exercise physiologist before and after bariatric surgery will assist in developing a personalized fitness plan tailored to your individual needs and abilities. The benefits of exercise are many:
- helps you lose weight and keep it off
- helps your skin bounce back
- maintains and builds muscle
- keeps bone tissue dense and strong
- increases your strength, endurance, balance and metabolism
- boosts energy and mood
Patients who exercise regularly after surgery find that they lose weight more quickly and their exercise capacity improves dramatically. Muscle loss is something that can happen after bariatric surgery and something you want to prevent. 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. To prevent your body from using muscle mass for energy, you must work your muscles regularly.
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. The body 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 break down your unused muscle and you will lose muscle mass and strength. Daily aerobic exercise for 30 minutes will communicate to your body that you want to use your muscles and force it to burn the fat instead.
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.
Sit-ups & weight lifting are ok after about 6 weeks. No abdominal exercises for a minimum of 3 months.
Swimming or water exercise is ok after 6 weeks.
Many people heavy enough to meet the criteria for weight loss surgery have stretched their skin beyond the point from which is can “snap back.” Some patients will choose to have plastic surgery to remove loose or excess skin after they have lost their excess weight
Exercise is good in so many other ways that a regular exercise program is recommended.
Patients can return to normal sexual intimacy when wound healing and discomfort permit. Many patients experience a drop in desire for about 6 weeks.
Yes, you can, but it is recommended you wait at least 18 to 24 months after your surgery due to the possibility of nutrient deficiencies during the weight loss period. You will also need time to adjust physically and emotionally to your weight loss before becoming pregnant. It is important to practice effective contraception other than birth control pills during the weight loss period to avoid getting pregnant. With appropriate nutrition and vitamin/mineral supplementation, weight loss surgery does not cause growth or developmental problems for the fetus. In fact, studies find that women who have had weight loss surgery have improved pregnancy and infant outcomes compared to women who have severe obesity and have not had weight loss surgery.
Your doctor will determine whether medications for blood pressure, diabetes, etc., can be stopped when the conditions for which they are taken improve or resolves after weight loss surgery. For meds 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.
Vitamin and mineral supplements are critical to long-term success. You will need to take a multivitamin with 18 mg of iron twice a day, 1500 mg of calcium citrate per day divided into three doses and 1,000 mcg of vitamin B12 daily. If you do not take supplements as recommended, it is likely you will develop deficiencies, which can lead to problems such as anemia, osteoporosis, low protein levels and other specific vitamin deficiencies. It will be important to have lab work done annually to monitor your levels of these vitamins and minerals. Our bariatricians will order these labs when they see you for your yearly appointment.
Hair loss is common after many times of physical stress. The stress of abdominal surgery can certainly contribute to hair loss. The amount of hair loss will vary between individuals. This hair loss cannot be prevented, but it is definitely a temporary effect. Nutritional deficiencies such as inadequate protein, iron and zinc consumption can also contribute to hair loss. In the early weeks following surgery, it is difficult to take in all the necessary nutrients in adequate amounts. It is important to take a vitamin/mineral supplement regularly to help preserve body stores of critical nutrients. Protein intake will be reduced during the early weeks following surgery. You will gradually be increasing the amount of protein in your diet to reach a target of 60 grams/day by about 6 weeks following surgery. If you are having difficulty getting this amount of protein into your diet, you can ask for recommendations for a liquid protein supplement. New hair growth is usually seen within 6-8 weeks after surgery and after correction of any nutritional deficiencies.
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.
We sometimes consider the first 6 months to a year the honeymoon period. The reason is people tend to be very focused on what they are doing and follow the rules; however they do not always embrace the changes that they have made for a lifetime. They can find themselves falling back into old habits. Eating healthy, learning to listen to your body, taking responsibility for your choices and regular exercise is a lifelong commitment. You can think of the surgery as a tool to assist you in these lifelong changes for healthy life long success.
When a person decides to have gastric bypass surgery they are making a decision that will affect their lives and those around them. Patients find their personalities do change and their desire to do different activities increases. This changes different family and friendship dynamics. As much as you need to adjust to the significant emotional changes you are going through, so do your loved ones. Communication is a key component to prevent problems in relationships. Some people find the problems always existed, however, before surgery they did not feel confident enough to do anything and now they are confident enough to deal with it. When dealing with your friends and family try to understand where they are coming from and discuss your concerns and acknowledge their support. Often they can feel left out or ignored.
Attend a support group. Support groups provide a comfortable way to learn about bariatric surgery and life after the surgery. You will meet patients who have had weight loss surgery, so you can hear first hand opinion about what the experience is like and what your loved one can expect. Studies have showed that there was better weight loss in people who attend the support group meeting compared to those who don’t attend the meeting.