SHOWER: You may shower beginning the day after surgery. Avoid aggressive scrubbing of the incision sites, but it is fine to allow water and soap to run over them. You may submerge your incisions in a bath or pool only once they have healed (typically 10-14 days).
WOUNDS: Your laparoscopic incisions will have a 'Derma-Bond' glue dressing. You may have a small amount of clear yellow or pink drainage from wounds; this is normal. The drainage should NOT look like pus, be foul smelling, or be red around the incision. Call the clinic if this occurs. *****NOTE: For laparoscopic procedures we inflate the abdomen with carbon dioxide. You may experience pain in your shoulder or lower rib cage due to retained carbon dioxide (this is temporary and will go away). A heating pad on the shoulder or lower rib cage, as well as changing positions, should help ease this discomfort.
DIET/VITAMINS: Follow your diet stages as per your Nutrition Handout. Remain on your 'full liquid' Stage 2 diet until your 2 week follow up appointment. Do not advance or change diets until directed by one of our surgeons. Take your chewable multivitamin and chewable Calcium citrate with Vitamin D every day.
RECOVERING: After 2-4 weeks you should begin to feel like yourself again. Fatigue occurs after every major surgery; the degree will vary from person to person. You probably will still tire easily for several months (up to 6) because your body is using a lot of energy to heal itself as well as adapt to the new physiology and calorie restriction. Make it a point to rest when you feel tired, but at the same time do your best to be active and alive!
CPAP: If you are on CPAP prior to surgery, you will need to continue to wear it for at least 3 months after your surgery. At your 6 month follow up visit a consult for a repeat sleep study may be ordered. Once the results are reviewed by the doctor, you will be contacted and informed about discontinuation of the device. Until then, it is imperative that you continue to wear the device.
EXERCISE: Do not lift anything over 20 pounds for 4 weeks. No heavy lifting, holding babies, children, or animals for 4 weeks. No heavy housework or strenuous exercise for 4 weeks. You may begin walking for exercise IMMEDIATELY, including the day of surgery. Begin in limited amounts, and gradually increase your time and distance. Back off of any activity if experiencing substantial discomfort, especially incisional or abdominal discomfort. Both water and 'regular' aerobics are fine 4 weeks after surgery. Typically there are no exercise or activity restrictions 4 to 6 weeks after surgery; confirm this with your surgeon.
DRIVING: Do not drive for 2 weeks following surgery, or at any time while continuing to take narcotic pain medicine, such as Lortab, Percocet, Vicodin, or Tylenol with codeine. Consider contacting your auto insurance company to inquire about restrictions they may have regarding driving following major abdominal surgery.
WORK: Generally speaking, plan on taking 2 to 3 weeks off from work. Some are able to return as soon as one week (especially gastric band patients), and some require more than three weeks. Ensure that you are able to tolerate your current diet stage in your work environment and that your energy levels are sufficient to permit the hours and physical activity required for your job.
MEDICATION: All medication must be crushed, chopped, chewable, or in liquid form for 4 weeks after surgery or until cleared by your surgeon. You will be given a prescription of Tylenol with codeine, Lortab, or some other pain medication. Over-the-counter liquid or crushed Tylenol may be used once this medication has been consumed. You may resume your routine medications, unless otherwise directed by your surgeon. Patients with diabetes: please check with your surgeon before restarting your diabetic medications for diabetes, as your requirements may be much different than they were prior to surgery. If you have pre-existing problems requiring narcotic pain medication, you will need to continue seeing the appropriate provider. These prescriptions for pre-existing chronic pain will not be renewed by the Bariatric Clinic. Make appointments with your Cardiologist and/or Primary Care Provider as appropriate within the first few weeks after discharge to monitor heart, blood pressure and diabetic medications.
PAIN MEDICATIONS TO AVOID: If you have had a GASTRIC BYPASS, you should permanently avoid medications which are classified as "NON-STEROIDAL ANTI-INFLAMMATORY DRUGS" ('NSAIDS'), such as the following:
ADVIL ASPIRIN NAPROXEN / NAPROSYN
MOTRIN EXCEDRIN ALEVE
IBUPROFEN BC Powder TORADOL
NSAIDs are notorious for causing ulcers after gastric bypass. If you have had a sleeve or band, you may use these medications WITH CAUTION, since these medications may cause ulcers in you, too.
CARE OF DRAIN: If you have a sleeve or gastric bypass you may have a 'JP' drain while in the hospital. This is usually removed before discharge. If you do go home with it, you may shower with soap while the tube is in place. After showering, use a Q-tip saturated with half hydrogen peroxide/half water to cleanse the area around the tube; when finished apply gauze around the tube site.
FOLLOW UP APPOINTMENTS: Your 2 week, 1, 3 & 6 month appointments are scheduled. Call one month prior to schedule your yearly appointments. Fasting labs are required prior to your 1 month and all subsequent follow-up appointments. The lab orders will be placed in computer, once you have made the appointment. You should have them drawn one week prior to your appointment. **** YOU MUST BE FASTING TO HAVE LABS DRAWN.****
WHEN TO CALL YOUR SURGEON: Bleeding from incisions (moderate to large amount). Blood in vomit or stool. Nausea or vomiting that prevents fluid intake for 12 hours, not relieved by medication. Worsening abdominal pain that is not relieved by your prescribed medication. Signs of infection: temperature of 101 F or greater, redness and swelling at incision site(s). Foul-smelling drainage from incisions. Calf or leg pain and swelling. Call the Bariatric Clinic at 210-292-4303 during clinic hours Monday-Friday from 0730-1600. If after clinic hours, or on weekends or holidays, report to the nearest Emergency Room.
SIGNS/SYMPTOMS OF A LEAK: Increased heart rate > 120 beats per minute, increased respiratory rate >22 breaths per minute, persistent shoulder pain, chest pain, shortness of breath, fever, extreme tiredness or fatigue, severe abdominal pain, excessive thirst, difficulty breathing. IF YOU EXPERIENCE ANY OF THESE SYMPTOMS GO TO THE NEAREST EMERGENCY ROOM IMMEDIATELY or Call 911.
DIARRHEA/CONSTIPATION: Some patients my experience occasional diarrhea related to certain foods; first try switching to Lactose Free Skim Milk. Constipation may be related to your narcotic pain medication. In this case, you may take Milk of Magnesia, 1-2 tablespoons every 6 hours as needed until your constipation resolves. If this does not alleviate your constipation in 1-2 days, PLEASE CALL the Bariatric nurse at (210) 292-4303 during duty hours, Monday-Friday 0730-1600.
COUGHS AND COLDS: You may take Sudafed for your nasal congestion and Sugar Free Cough syrup for your cough. If symptoms do not improve within 48 hours, CONTACT YOUR PRIMARY CARE PROVIDER. All your routine medical care should be handled by your Primary Care Provider.
Make appointments with your Primary Care Provider within the first few weeks after discharge to monitor heart, blood pressure and diabetic medications. You may also want to schedule visits with your diabetes specialist (if not your PCP) or cardiologist.
FOR QUESTIONS /CONCERNS: Please contact the Bariatric nurse, at (210) 292-4303, during clinic hours, Monday-Friday from 0730-1600. IF after 1600 or on weekends or holidays, report to the nearest Emergency Department.
Wilford Hall Medical Center Bariatric Surgery Clinic
