Tips & Reminders: exercise

1. Walking is always okay.
   
2. For the first 6 weeks after surgery no lifting greater than 10 lbs.
   
3. Check with your doctor about when, what type, and how much exercise is appropriate for you.
   

   --Regular and water aerobics can be started at 4 weeks
   

   --Weight lifting and abdominal exercises can be started at 6 weeks
   

4. Exercise will help you lose weight and maintain lean muscle tissue.
   

   
    

Tips & Reminders: vitamins/minerals

1. Protein. Remember your ultimate goal of 60-70 grams for females or more per day (or 70-80 grams for males). Adequate protein is essential to avoid loss of your lean body mass (muscle), hair, and to promote healing. Also, the lack of protein can cause fatigue.
   
2. Take a children's multivitamin/mineral supplement with iron two tablets daily beginning with Stage 2 (full liquid diet). Do not take your multivitamin with iron, concurrently with dairy products, Calcium, Vitamin D, Coffee or Tea as the items hamper absorption.
   
3. Supplement 1500 mg of chewable calcium daily, but don't take your whole daily dose at once. Split it into at least 3 doses (calcium citrate (Citracal) is preferred.
   
4. Pills. Ask your doctor about any medications you must take. If they are large, they may need to be crushed (and mixed with pudding or applesauce) or broken into smaller pieces.
   

Tips & Reminders: Fluids

1. It may be a "full time job" to keep up with your fluid needs. Plan to carry around a big bottle full of water or sugar free beverage.
   
2. Your urine should be clear and frequent.
   
3. Drink fluids between meals only. Keep meals dry. Do not drink with meals. Drinking fluids at meal has the same effect as eating large amounts of foods. It may cause dumping syndrome.
   
4. Avoid the use of straws as the air swallowed with eventually stretch your pouch.
   
5. Avoid sugary foods and drinks. They can lead to "dumping syndrome" (a condition characterized by abdominal cramps, diarrhea, sweating and dizziness shortly after consuming concentrated sweets) and provide extra empty calories.
   
6. You should really try to avoid alcoholic beverages, including beer, wine, and liquor. Alcohol affects your liver very quickly and can lead to serious liver damage if taken in excess. Alcoholic beverages can cause weight gain and result in poor nutrition since they are very high in calories and low in nutrients.
   

 

(Information from WHMC Gastric Bypass Nutritional Guidelines Handbook)

 

 

Recover time from surgery

Walk every day…after surgery

Plan to stay 2-3 days in hospital after surgery

--Hospital stay length varies with each patient

--Lap band: same day surgery or 1 overnight

--Sleeve: 2 overnights

--Gastric Bypass: 2-3 overnights

Plan to take off from work for 3 weeks

--Often patients are able to go back to work in 2 weeks

--You will fatigue easily

--Light duty/activities for 6 weeks

Do not

--Lift greater than 10 lb or do heavy housework for 6 weeks

--Drive for 2 weeks

Walk every day…after surgery

 

 

Follow up appointments

Lap band- every 4-6 weeks for band add/remove fluid

Sleeve & GBP- 2 wk, 1 mo, 3 mo, 6 mo, 1 yr and then annually

Protein

After weight loss surgery the goal is to maintain lean body mass, as well as support successful weight loss. Protein supplementation is essential to health and promotes healing. It is recommended to take in 60-70 grams of protein daily. Also, after the surgery, if your protein status is low, your body will heal more slowly, sometimes very slowly.

WHAT ARE THE SYMPTOMS OF INSUFFICIENT PROTEIN?

The first sign of lack of protein is often fatigue and/or weakness. Not just the feeling that we didn't get enough sleep last night, but deep fatigue….or weakness where it's hard to get through the day.

A second sign is weight loss plateau. When we don't get enough protein, there is increasing evidence that the body tries to store calories rather than burning them. We hear from many patients who do get enough protein that they are successful in reaching their weight loss goal.

A third sign is hair loss, and we believe it is often preventable. While one cause of hair loss following the surgery is the "shock" of the surgery to the body, another leading cause of hair loss in weight loss surgery patients is insufficient intake of protein.

HOW TO GET THAT MUCH PROTEIN?


An ounce of meat (the weight after the shrinkage of cooking) provides about 7 grams of protein.

An egg contains about 7 grams of protein. Milk contains 8 grams of protein per 8 ounce cup

Example: To get 70 grams of protein from meat, you would need to eat 10 ounces of cooked meat each day.

Purchased Protein powder

* This is a general recommendation that of course cannot consider individual patient needs. It does not, and should not, supersede the recommendation of medical professionals who best know the individual patient needs.

 
 

 
 

 
 

Purpose of the 2 week liquid diet

Every patient that has WLS (weight loss surgery) will be put on a 2 week liquid Pre-op diet. This has some important benefits:

1. To shrink the liver- this makes the surgery safer for the patient and allows the surgeon better view to create the new stomach pouch
   
2. Shrink intra-abdominal fat- all the fat that everyone has around their organs, weight loss of 10-20 lbs
   
3. This is the same liquid diet you will be on after surgery while your new digestive system heals
   

**Comments from post-op patients: you will be starving on this liquid diet, you will be irritable, you will want to cheat, it will be hard to stick to the diet, tell friends and family so they can support you, know that after surgery you will not feel hungry on the liquid diet like you did before surgery, your taste may change-what you liked before surgery you may not like after surgery.

Daytime Support Group Today

Come out and join us for the Daytime Support Group
In the General Surgery Clinic @ 1130-1230
No appointment needed - just show up!

YOU ARE THE KEY TO YOUR SUCCESS!

Habits that are the key for long-term success:

• 3 meals plus 2-3 planned snacks
  
• Adequate water (at least 8-9 glasses)
  
• Daily supplements (your vitamins, calcium, B-12)
  
• 7-8 hours of sleep
  
• Regular Exercise
  
• Personal responsibility
  

 

Behaviors that are red flags for Failure:

• Starting to eat sweets                
  
• Eating Fast Food often
  
• Skipping meals
  
• Eating after your stomach is full
  
• Eating rapidly
  
• Grazing mindlessly
  
• Eating when you are bored, upset, angry, or depressed
  
• Clinging to the couch and not exercising
  
• Choosing favorite carbohydrates first
  
• Snacking from vending machines
  

 

The choice is yours.

Best wishes for your continued success!

(Information from WHMC Gastric Bypass Nutritional Guidelines Handbook)

 

Food intolerances

After surgery each patient may have a certain food they say "doesn't agree with me." It is important to recognize that these are usually the very foods which fill up the pouch the fastest! If a bite of chicken fills up your pouch and makes further eating impossible, often it isn't because "the chicken doesn't agree with me", but rather, because that small amount of chicken was enough to fill up your pouch! STOP eating right then and there!

 

To have that "second bite" is often to overeat. Your new restricted stomach can't handle it - even one more bite will distend the pouch and make you feel miserable. When you have an experience like this (most patients do) use it to learn how much of different kinds of food it takes to feel full. Try to train yourself to recognize an adequate amount of food while it is still sitting on the plate, and avoid that "painful full" feeling altogether.

This is a new concept and it will take time to adjust to it. So, go easy on this new eating pattern in the first few months until you know what that new "feeling of fullness" is like. Eating such small amounts of foods seems strange, but it is all you need to be healthy and will promote maximum weight loss.

(Information from WHMC Gastric Bypass Nutritional Guidelines Handbook)

Vitamins and Minerals

Post surgery common deficiencies

    *Iron *    Vitamin B12 * Folate * Thiamin * Calcium * Vitamin D * Vitamins A, E , K * Zinc

Post Surgery Supplementation

Multivitamin with Iron – chewable or liquid, avoid time released or enteric coated

    Choose a complete formula with at least 2/3 of nutrients including folic acid, zinc, iron and selenium

    --Begin 1 day after discharge from hospital

        Gastric Bypass and Lap Band patients need 100% Daily vitamins

        Sleeve patients need 200% Daily vitamins

Calcium citrate with vitamin D – chewable or liquid

**Remember

Calcium and Iron should be taken 2 hours apart

Take Iron with orange juice or water to aid in absorption, never with milk, coffee, tea

 

 

    

    

Exercise after surgery

 

Exercise is just as important as your diet. For successful weight control, you should combine a healthier diet with a consistent exercise program. Exercise is a healthy habit that burns calories, reduces fat, and tones muscles.

 

Immediately after surgery, do not engage in heavy exertion, bending or lifting over 10 pounds. If any activity or position causes pain around your incision, don't do it. Do not sit in one place for long periods without getting up and changing position because inactivity increases the risk of blood clots forming in your lower legs. Another important note, do not engage in any abdominal exercises the first six weeks after surgery.

 

When your surgeon says you are ready, adopt a routine of regular exercise a minimum of 30 minutes, at least four days a week. Studies of people who succeed in reaching their goals after bariatric surgery indicate that over 75% exercise regularly to help maintain weight loss. Not only does regular exercise burn calories, but it also helps you avoid becoming weak and losing muscle mass as your body loses fat.

 

Within four to six weeks after bariatric surgery, it is extremely important to walk as much as you can to speed recovery and regain your strength. Walking promotes wound healing, circulation, bowel function, weight loss, and a healthy heart and lungs.

 

To maximize success, consult an Exercise Therapist to obtain an exercise program designed specifically for you.

 

This information taken from: http://www.bethesda.med.navy.mil/patient/health_care/surgery_services/bariatric_surgery/index.aspx#Handouts

Solid foods vs. soft calories

To maximize weight loss and to maintain nutrition, solid foods are preferred over soft calories. This means that soup, yogurt, and other healthy but soft calories should be minimized.

You should generally eat the same foods as the rest of the family, only in much smaller amounts (e.g. a chicken wing might constitute an entire lunch). The best foods here are meats and vegetables (including salads). Since the quantity of your intake is very limited, it is very important that you eat highly nutritious foods and don't waste valuable space in your new "stomach pouch" with empty calorie, junk foods. This is a great incentive to "eat healthy."

Fruits may also be added during this time, though they do contain natural sugar and should not be a big part of your diet. In the long run fruits are best used sparingly as "dessert."

All meats can now be eaten. The most important things to remember when eating meats are:

-To cut up each piece of meat to the size of the eraser on a wooden pencil.

-To chew up each piece of meat individually, before swallowing.

-Avoid any gristly meats (including Spam) at this time because
gristle tends to get stuck in the pouch.

 

(Information from WHMC Gastric Bypass Nutritional Guidelines Handbook)

 

 

 

Constipation

Constipation is very common after weight loss surgery. Symptoms of constipation are painful bowel movements, difficulty passing stool, and/or when your stool is very hard. Constipation is often times due to narcotic usage after your operation. It can also be due to inadequate water intake or insufficient amount of fiber in your diet.

 

Remember also the amount of food you are eating is much less and therefore you have a lot less material to make stool. For these reasons your surgeons ask you to take supplemental fiber such as over the counter Bene-fiber.

 

Weight loss surgery patients do NOT need to have a bowel movement daily. If you are having bowel movements every 2-4 days, and your stool is soft, brown, and not difficult to push out, then you are normal. In contrast, if your stool is very hard, you are on the toilet a very long time, your bowel movements are painful, your bowel movement makes you bleed, or your stool is difficult to push out, then you are probably experiencing constipation. Things that will improve the regularity of your bowel movements and make them softer are the following:

 

1. Increase your fluid consumption. This includes water or any other zero-calorie liquid such as Crystal Light.
   

   
    

2. Fiber. Increase fiber consumption by regularly taking over the counter fiber supplements such as Benefiber. You can start this when you are eating regular food.
   

   
    

3. Take mineral oil. Take 1-2 teaspoons once or twice daily - this will draw water into your colon and soften your stool
   

   
    

4. Colace. This is available over the counter in a suppository or pill form - it should be initially taken once or twice daily, however can be taken more frequently if necessary.
   

   
    

5. Eat more vegetables.
   

   
    

6. Milk of Magnesia. This is not to be taken regularly, but may be required occasionally.
   

 

You should not hesitate to call the Bariatric Nurse if your problems persist or if the above measures do not help @ 210-292-4303

 

(Information from WHMC Gastric Bypass Nutritional Guidelines Handbook)

 

 

 

Support Group--Tonight

Come out and join us for the Evening Support Group
At the Gateway Club @ 6:30pm to 8:00pm
No appointment needed - just show up!
**Reminder each patient must attend one meeting before surgery


Many pre and post surgical patients attend
Bariatric Surgeons will be there
Guest Speaker: Plastic Surgeon from BAMC

Directions to Gateway Club
Enter Lackland AFB at Main gate (Vistor Center) off Military Dr
Go straight from gate to stop sign club will be catie-corner to you
Questions call (210) 292-4303 during duty hours

From a post surgery pt…

things I wish I had known.. hmm.. well, I knew a lot of stuff from reading on the internet before going in, so I felt pretty prepared already…

I would stress the no carbonation thing.. I know of people that drink it even after the surgery.. bad idea. and the no drinking 30 mins before and after eating.. they should be prepared for their mind to play games with themselves.. they dont do brain surgery when they do stomach surgery.. and you will see something and think you can eat that and you really cant.. then you'll get sick. or your brain will tell you that you are still huge after you've lost weight and you're not so huge anymore.. it affects the self esteem..

and theres the sugar issue.. i know a lot of people don't even try sugar after surgery because of the fear of 'dumping'.. but some of us do try it and discover that it doesn't effect us like that.. which is bad because now we know we can eat sugar and not hurt (yes, I'm one of those) take your vitamins!! cant be stressed enough. im bad about it.. and im low in iron and b12.

and after we lose the weight, we still have to continue with our 'diet' or lifestyle.. we cant just go back to how we used to eat.. we can gain the weight back. i think people tend to forget that after time.

tell them to try a bunch of different protein drinks.. they don't all taste the same. and even if they hate one, try it again after surgery.. your tastes change. I have only found one type i like, and i cant stand the kind my MIL likes.. so it varies with everyone. protein protein protein. need lots of it daily!

the first 6 months after surgery are your 'honeymoon period'.. you lose the weight the fastest.. after that it slows down some. so, during those 6 months, eat the way you should, and do some form of exercise.. even if its just going for walks around the block.

I typed the 6 month date out, printed it, and taped it to the wall in front of my treadmill. I also taped up pics of outfits/styles in magazines I wanted to be able to wear. It gave me a little bit of incentive. ;)