Hi, I’m Jessica Snyder, registered dietitian, and outpatient nutrition director. Today, we’ll be discussing your nutrition preoperatively, so that you can be better prepared for your bariatric surgery. We’ll be talking about your anatomy and your new tool, and how that’s going to function. Our goals also incorporate anticipating common pitfalls, after surgery and learning about the preoperative process. We want to make sure you establish good habits, to ensure long-term success. We call these habits the rules of the tool. We also want you to make sure you learn, which foods will best serve you, and your specific needs and goals.

So you may ask what is different about me after surgery. Well, there are several different types of surgery, and based on the surgery that you, and your surgeon have selected, your procedure may look a little bit different. So we’ll be discussing that more in-depth today. For the gastric sleeve, bypass, duodenal switch and band, the stomach size will be significantly reduced, from 40 to 60 ounces which is, about the size of the football, just down to about one to four ounces, which is about the size of a hard-boiled egg. With the bypass only, the outlet of your stomach will be changed from two centimeters, to a rigid one centimeter and this is key for your pouch working as it slows digestion of the food, leaving you feeling fuller, longer. The bypass and duodenal switch also reroutes your food path, shortening it to reduce nutrient and calorie absorption. The next several images are, how your anatomy will be altered based, off of the surgery that you selected. The gastric bypass, the gastric sleeve, the duodenal switch, as well as the mini-gastric bypass. If you have questions about any of these procedures and your new anatomy.

This is your pre-surgery shopping list. These are items that you’ll need to purchase ahead of time, and some of these items you can actually start taking, ahead of time, so that you can be set up for success after surgery. We want you to go ahead and get a multivitamin, that is chewable or liquid. No gummies or patches. You also need to get a B12. It needs to stay on the bottle sublingual or nasal spray, or you’ll do an injection with your doctor once a month. You’ll need four by four-inch gauze pads and paper tape, and this is going to be required for the bypass, sleeve and duodenal switch and these are really, to go over your incisions after surgery. You will be on a clear liquid diet before surgery, so you will want to make sure that you have clear liquid products available in your house. Things that are appropriate on the clear liquid diet, for 48 hours prior to surgery include broth, decaf coffee, herbal teas, diet lemonade or other beverages that are non-calorie, non-carbonated, non-caffeinated. You also can do sugar-free popsicles and sugar-free Jell-o, and clear liquid protein drinks such as Isopure, Premier Clear or Trusource protein drinks. Protein powders and shakes are something that you also want to purchase ahead of time. These protein shakes need to be low in carbohydrates, less than five grams of carbohydrates per serving, and high in protein. These are not to be smoothies. They’re really supposed to be protein drinks, that you mix with water or low-calorie milk alternatives, to help meet your nutritional needs. When choosing protein supplements, we want to make sure you choose powder or premixed liquids. Those are both acceptable. The key is to try several brands and find which one you like before surgery. So don’t stock up, because you may not like them after surgery, but do make sure you trial them and find one that you do like. Look for at least 20 grams of protein on the serving label, and less than five grams of carbs. This is really going to be key for fueling your body after surgery, as you will be consuming protein drinks for about six weeks after surgery. Mixers such as water, non-fat milk, one percent milk, unsweetened soy or almond milk, and ultra-filtered milk are also appropriate, to utilize with your protein drinks. If you don’t like flavored protein drinks, there are unflavored protein powder options that you can use, to help increase your goal, and meet your nutrient needs better. It is critical that you maintain hydration after surgery. Not getting enough fluids can actually end you back up, in the hospital and it’s the number one reason, for readmission back into the hospital is dehydration. It’s hard to stay on top of that goal. So really, set a timer, make sure you’re keeping track of it, keep your favorite water bottle nearby and sip, sip, sip. Get used to this habit even now, pre-surgery, so that after surgery you can be successful. The goal is to get about 64 ounces of fluid, every single day, forever. This also is something that you really want to look at, to make sure there are no calories in your beverages that you’re consuming. So after the solid food plan begins after six weeks, we really don’t want you having liquids with meals, and that means no liquids at the same time as you’re eating. You can’t sit down to dinner and have a cup of water, as well as your dinner. We really want you to separate that time out. You can drink 15 minutes before you eat, and 45 to 60 minutes after you eat, but once again, not with your food. So start working on this habit now, so that when you get to that six-week mark post-surgery, you can be successful with this habit.

As far as your vitamins, it is really important that you start this regiment pre-surgery so that you don’t go into surgery with any deficiencies. You want to make sure you get a multivitamin, and this will also be started immediately following surgery. This is one time the dose for a sleeve, but if you are a duodenal switch or (mumbles) patient, gastric bypass, you will need to take two times the dose, then what is typically recommended. You can also opt-in for bariatric-specific vitamins. Vitamin B12 is something we want you to take, immediately following surgery. We recommend a thousand micrograms per day. This can be taken sublingually, which means under your tongue and dissolve completely, through a nasal spray or a muscle injection, done in your primary care doctor’s office. Calcium citrate is another vitamin that we want you taking. This will actually start six weeks post-op. So mark your calendars for that six-week date, to start taking calcium citrate. There’s a lot of different types of calcium on the market, and calcium citrate is the most appropriate one, for you to be taking. We recommend between a thousand to 1,500 milligrams a day, and it’s best absorbed if you break it up, throughout the day. So 500 milligrams in the morning, 500 milligrams at lunch, and 500 milligrams at dinner. For vitamin D, we recommend this, to be taken immediately following surgery, 3,000 IUs a day. Your fiber supplementation should start at six weeks post-op. We recommend that because you’re eating less food substance, your digestive habits will change, and so we do recommend fiber supplementation. You can start with one to two doses and work your way up to three doses per day. This can be added to your normal daily intake, to help you have normal digestion. For your fat-soluble vitamins, those are your A, D, E and K, these are required immediately, following your duodenal switch surgery. If you’ve had a duodenal switch, you’ll need to make sure you’re getting 10thousand international units of vitamin A, 3, 000international units of vitamin D, 50 IU’s of vitamin E and 300 micrograms of vitamin K. All of these vitamins are very important for you, to make sure you prevent deficiencies, and if you have any questions, you can ask your surgeon, as well as your registered dietitian. So make sure you’re taking these vitamins, and make sure you purchase them ahead of time, so that you can be prepared afterward.

For minerals, you may need to take these in addition, based on which procedure you’ve had, or if you’ve had a deficiency present. Iron is one of those labs that we check frequently, and if you’ve had a duodenal switch, you’ll need between 30 to 60 milligrams a day of iron supplementation. If you’ve had a deficiency, you need to talk with your doctor about what you need to supplement . You want to make sure that your iron is not taken, with a calcium supplement, as it actually can hinder absorption. So separate some of the vitamins out, so that you don’t have a decreased absorption of your iron supplementation. Biotin is not required, however some of our patients choose to take biotin as it can help with hair regrowth, and prevent shedding. It is recommended if you do take biotin, to take 5, 000 micrograms per day Omega-3 fatty acids can be helpful, for decreasing inflammation. It is recommended if you do take an omega-3, to take 2, 000 milligrams a day, and many of our patients choose to take this, but it is not required. Thiamine, you may need a supplement if your labs are low, between one to two milligrams per day, as well as zinc, once again, if that’s needed, between 10 to 20 milligrams per day, and then copper if needed, between one to two milligrams per day. So please look through this chart, speak with your provider, if you have any questions about vitamins, or minerals or supplementation in general. If you have a deficiency, we need to make sure we stay on top of that and once again, we’re always here, to help you if you have questions.

Getting used to your kitchen even now can be helpful for you after surgery. So some post-surgery cooking rules that we would encourage you to implement now is to fry nothing. Also removing any visible fat from meat prior to cooking, and adding no calories to the cooking process. So no added butter or oils. Our preferred method for cooking includes baking, broiling, poaching, barbecuing, using a crockpot, or even an instant pot. Trying to focus on more protein, for the calories you consume is important so every food that you eat should have a good amount of protein for the calories. If you were to take the total number of calories, and divide it by the grams of protein, it should be less than 15 calories, for one gram of protein consumed. So if you have a 200 calorie protein bar, it should ideally have at least 10 grams of protein in it, and you can use this chart to help you identify other food sources that would better fit your nutrient needs. Nutrition is really important as well as reading your label.

We follow what’s called the rule of 15. When reading your label, you want 15 total calories or less, for every one gram of protein you consume. No more than 15 grams of carbs per meal, as this could cause dumping syndrome. So check your carbohydrates out on that label, and make sure you’re not eating, more than 15 grams of carbs per any meal. Aiming for 15 grams of protein per meal is ideal, as it will help you to reach your protein goal, at the end of the day. Ideally choosing low-calorie protein choices are going to be most helpful for meeting your protein goal, but not exceeding your calorie goal. These options include things such as fish and shellfish, low-fat dairy such as cottage cheese or Greek yogurt, or low-fat cheese, poultry, light or dark meat, lean beef and lean pork. So 93 over 7 would be ideal when picking lean beef. Egg whites or egg substitutes or tofu as well, also fit these low-calorie protein choices, that you can choose from more frequently. Medium and high-calorie proteins such as nuts and seeds, vegetable proteins such as beans, high-fat pork, such as bacon sausage or ham, high sugar yogurts, soft cheeses and whole eggs will be things we want you to include in your diet less often. So try and choose these medium, to high calorie proteins less often. We want to make sure you’re feeling your body appropriately, so avoid these white carbohydrates, as they really provide no nutrients. Things like popcorn, white pasta, potatoes, breads, crackers, cereals, white rice and grains, and refined sugar products are things we really want you to avoid as they’re not going to help you meet your nutrient goals at the end of the day. We also want you to get in the habit of making sure that you listen to your body when eating. You don’t need to eat until you’re stuffed or full. Really just make sure you’re thinking about fueling your body. It can actually take your brain about 20 minutes for you to get full, so don’t overstuff your new stomach, as it doesn’t feel good. Give yourself that time before you decide you need to go back for more. Focusing on lean animal proteins, and low-fat dairy options should be something that you choose most frequently. Fruits and vegetables will be added back in, after about three weeks and we really want you to stay away from soups, salads and cereals. Once again, your focus after surgery should be hydration, protein and making sure you get adequate amounts of nutrition, not excessive amounts of nutrition. You can start working on some of these habits now.

So prior to surgery, we want you to start working on smaller, more frequent meals. We encourage five protein-rich mini-meals per day. That means eating within the first hour or so of waking up, and every three hours thereafter. We also want you to start cutting back on those carbohydrates that we talked about. Those pastas, the potatoes, the grains, the crackers. We want you to start an exercise habit, and really get your body moving. Find something that you enjoy such as walking, dancing, the elliptical, bike riding. Doing something to move your body, to build a fitness habit and routine, or strength training if that’s something that you enjoy. Start taking a multivitamin even now, once again, so that you go into surgery healthy as can be. Experiment with different protein shakes and once again, find out which ones you like before surgery. Make sure it’s high in protein, more than 15 grams of protein per serving, and low in carbohydrates. Less than five grams of carbohydrates per serving. Practice taking smaller bitesand chewing your food well. This is an important habit to get into prior to surgery, because once again, that outlet may be changed in your surgical procedure and we want to make sure that you fully digest your food and that way, it doesn’t feel like it’s going to get stuck. Since we’re working on smaller portions, many of our patients find it helpful to use smaller plates, or appetizer silverware so that they can help to decrease the volume of the food that they’re consuming. So getting smaller plates and smaller silverware help you to decrease the volume of what you’re consuming, and help you feel like you’re eating more, because of that smaller serving. We also want you to stop caffeine and alcohol. So start working on this now as we don’t want you to have to struggle through this after surgery.

Prior to surgery, we want you to stop smoking. This is crucially important and required of your surgeon prior to surgery. If you do not stop smoking, your surgery will be canceled. It is really important that you stop all cigars, cigarettes and vaping. Even secondhand smoke can make you test positive. So it is crucially important that you stop smoking, as this will decrease healing potential, and increase the risk of your post-op complications. So once you stop, it is forever quit. In the rules of the tool, there are four parts of your program. Your diet, your exercise tool and you. Your surgery is the tool. These four pieces will help you to be successful, even after surgery. The diet after surgery is something we want you to focus on even now and work towards. You will need to make sure you’re getting 75% of whatever you eat on your plate to be protein-rich, and only 25% is complex carbohydrates. Once again, your proteins are typically things, like animal meats, beans, nuts, dairy, and your complex carbohydrates, are typically your fruits and vegetables. We want you to have no more than one, two high-fat food choices per day. So trying to limit things like bacon, sausage, and high-fat cheese. We want you to eat five to six protein rich meals per day. That means within the first hour of waking up, and every three hours thereafter, and protein really should be your priority. You should be having protein with every meal. Your first meal within the first hour of waking up, you may need to set a timer to help remind you, to eat every three hours and your last meal, one hour before you go to bed, if necessary. When following your rules of the tool, ideal volume depends on you, your surgery, your pouch size, and your specific level of restriction. So you don’t need to eat till you’re full. Really stop eating before that point, so that you don’t overstuff yourself and feel sick.

You want to make sure that after the six-week point, you avoid protein drinks. This is when food should be your focus. Your protein drinks should be supplements, for when you can’t meet your nutritional needs by food. Protein bars can be helpful in situations, where you may not be able to prepare a meal, but we do not encourage that you use these, on a frequent basis. They’re okay as a once in a while food. When you are picking a protein bar, you want to pick a low-calorie, high protein bar, and watch out for those excessive amounts of carbohydrates that sometimes can be hidden in them. No more than one sheet per week. We’re not encouraging that you get off your diet, but we realized that life can be challenging, and that food obstacles can be present. We want you to stop and plan your cheat in advance, and really think about if it’s worth it, and in line with your health goals.

Exercise is an important part of your health, as well as your continued journey for weight loss. We want you to exercise at least 150 minutes per week. That’s thirty minutes a day, five days a week. You can break it up however you want. You can do 15 minutes in the morning, and 15 minutes in the evening and you can really start to build an exercise program that you like. A variety of exercises can be enjoyed, however we encourage you to wait, on strength training exercises until six weeks out, after surgery and cleared from your physician. It is important that you think about changing up your fitness routine, about every eight weeks as this can be really helpful, in preventing plateaus as well as weight regain. Fit is an acronym we use to help improve your outcomes. Really changing the frequency, intensity, type or time of exercise will help to optimize your weight loss results, and improve your overall fitness enjoyment. You may be asking, what is your tool? The surgery is your weight loss tool. Constantly assessing the effectiveness of your tool will be helpful in advancing your weight loss.

We want to make sure that you’re getting an adequate amount of protein, between 10 to 15 grams of protein, every three hours. You do not need to eat to capacity or fullness, and you do need to listen to your tool in your body. This will help to accelerate your weight loss. The fourth piece of the puzzle is you. We know that patients who stay connected and stay supported have better outcomes. So making sure you stay connected not only online, but with your follow-ups, with your dietitians, and your surgeons are crucially important. Behavior modification can be a challenge, so working through that with your team can be helpful, in navigating through emotional eating, eating when you’re bored or stressed or even on holidays. Working through behavior modification can be challenging, and we’re here to help you do that. So make sure you reach out and stay connected so that you can achieve optimal success. Some preoperative considerations. It’s normal to have anxiety before any surgery, and concerns are normal. So reach out with your questions, concerns, and your challenges prior to surgery. The weeks prior to surgery, you will have a phone call with pre-op admissions as well as your pre-op nurse. You will need to do your labs and EKG, and you will have an appointment with your surgeon, or nurse practitioner. Your pre-op diet instructions include 48 hours of clear liquids or clear liquid protein drinks. You’ll also be given clear instructions on how to prep your skin prior to surgery and once again, a reminder, no smoking or alcohol prior to surgery.

You may be worried about pain control, during your surgical process. Many non-narcotic pain tools will be used both pre-surgery, and post-surgery to enhance your hospital experience. We also like to use preventive methods, which may be administered prior to your surgery, to help with your healing process. Your medications may be adjusted after surgery, and this is something you’ll want to review, with your surgeon or with the anesthesiologists. You want to make sure you stop everything. NSAIDs, and pain relievers two to three weeks prior to surgery. This includes things like aspirin. Motrin, Aleve, ibuprofen and naproxen. Tylenol is now your new pain med of choice. If this doesn’t cover your pain needs, once again, reach out to your surgeon as well, as your primary care doctor, to make sure we get those adjustments taken care of. If you’re having a bypass procedure, no large capsules, or extended-release capsules are encouraged. The size of your new pain meds should be about the size of a pea. Your tablet should be easy to dissolve. If you take as an experiment at home, one ounce of warm water with your medication, or tablet inside, it should dissolve within 10 to 15 minutes.

As far as hormone replacement therapy, this is something we want you to talk to your doctor about. This next year is about you. So make sure you’re using preventive measures for pregnancy. As your hormones after surgery, as well as fertility can be increased, so make sure you’re using back up. Many of your medications will be reviewed, with your surgeon as well as with your anesthesiologist. Keeping your blood sugar in check is important. You should be checking your blood sugars frequently, prior to surgery and notifying your surgeon, if your blood sugar is greater than 200 prior to surgery. If you are on insulin, you will also need to talk with your healthcare provider about your plan, before and after surgery. If you struggle with high blood pressure, you should be checking your blood pressure, more regularly as well, and adjusting your medication plan, with your primary care doctor. If you’re on a blood thinner prior to surgery, you’ll also want to talk with your healthcare provider team, in regards to this. This medication may need to be stopped or you may need to have an alternative plan for use during this timeframe. You and your surgeon have talked about how important follow-ups are. So make sure you get an appointment with them, shortly after surgery. It is typical that you’ll need to meet with them, one week after your surgery to discuss how you’re doing as well as any medications, or challenges that you might have had.

Let’s talk about what your experience will be like in the hospital. You’ll be given instructions in regards to your diet, your skin prep and what to bring to the hospital, such as your CPAP or BiPAP or oxygen tank. You’ll need to arrive three hours prior to your scheduled surgery start time. An IV will be started for medications as well as helping you, to maintain hydration and fluids, and antibiotics will be given prior to surgery. You’ll also have leg compression devices on, during your surgery to help prevent blood clots. Medications may be used also to prevent blood clots, and your family will be with you for most of the preoperative process, but not the surgery. They will meet you in the recovery process, and your surgeon will notify them when it’s appropriate for them to come and meet you. Surgery takes about an hour with one to two hours, in the PACU recovery before you are taken, into your hospital room. So you can let your family know that they will be seeing you, about two hours after your scheduled start time. One to two drains are typically placed in your abdomen, to help decrease any fluid collected during the surgery. A G-tube may be placed for some patients, who need additional nutrition support and once again, this is something your surgeon can review, with you if needed. You’ll also be given a local numbing agent, that will help to prevent pain.

Activity is a big part of your healing process. We encourage all of our patients to get up and get moving three hours after surgery. So your nurse will be helping you, in that healing process of your activity. All of our patients will make sure that their oxygen needs are assessed prior to surgery. You’ll be given what’s called an incentive spirometer, which is also known as a breathing device that you’ll need to use hourly to help in your recovery process. Some of our patients will also have done what’s called an upper GI, if the surgeon thinks it’s warranted after surgery, and this is just assessing and making sure that your surgical process and the way that your food is now routed is done correctly. Our gastric band patients usually go home from the PACU right from recovery after surgery. They do not need to spend the night unless they have additional oxygen needs. Expect some pain after surgery. It is a surgical process, but you’ll have many options to help manage this pain and discomfort so that you can be more comfortable in the healing process. Getting up and being active is an important part of that, as well as non-narcotic pain options. Some patients may start on IV for pain medications, or transition to oral pain medications and you, and your surgeon will discuss the appropriate measures to take for your pain control. The left side of your abdomen is commonly where most discomfort is felt and this is normal. Some people report feeling remorse or regret, the first or second day after surgery, and this is also normal it’s a stress hormone, that begins after surgery, but you’ve put a lot of effort, into this process and you should be very proud, of the decision you’ve made, to improve your health and well-being. We have teamed up with our surgeons, dietitians, as well as nurses to provide a variety of safe, nutritious options for bariatric patients. Once you are cleared to start drinking, which is about three to four hours after surgery, you’ll be on what we call the bariatric stage two diet, which is one ounce of water every 30 minutes, then your diet will advance to one ounce every 15 minutes, and you’ll progress as you improve. You’ll receive a tray of liquids that include a variety of options to help meet your liquid requirements, as well as your hydration needs. Once you’re tolerating your stage two diet, your diet may be advanced, to what we call the bariatric stage three diet. You will be given one ounce of protein drinks per hour, as well as one-ounce portions of fluids for hydration IVs are commonly continued, to help meet your fluid requirements, and you will be encouraged to get up, and get walking six times per day. Our gastric sleeve patients are commonly discharged, on the second day. When you’re tolerating your fluids well, your IV will be stopped or capped and it is encouraged that you continue drinking your hydration, and staying on track with your fluid requirements. You’re encouraged to continue with your walking, and breathing exercises, as well as maintaining adequate fluids. Once again, during that first week, it is really difficult for you to stay on top of your hydration if you get behind, so set a timer or use an app to help you stay on track. It is required that a minimum of four, to eight ounces per hour be consumed from your liquids, and protein drinks do not need to be clear, during this juncture IV lines and drains will be removed and gastric bypass, and duodenal switch if you’re doing well, will go home on this third day, after two nights in the hospital. For your discharge instructions, you’re encouraged to drink adequate amounts of fluid, getting at least 48ounces of fluids in a day, but the goal is closer to 64. Also making sure you stay on top of your protein, and getting 60 to 70 grams a day should be a focus. Minimum, 30 to 40.

Starting a multivitamin as well as your B12 as soon as you get home and then, once again, staying on top of your pain medication, and discussing that with your doctor. You may also be given nausea patches, and medication if needed and stay on top of your activity, and walk to keep on track. Most of our patients go home on oxygen and once again, this is an important part of your healing process, and it will be discussed when that will be discontinued, with your surgeon. Your oxygen needs will be discussed with your surgeon, as well as potentially with a respiratory therapist. Nighttime oxygen will be retested in about three, to four weeks to determine if it needs to be continued. This is typically not a long-term thing, however once again, it is important for the healing process. So oxygen is not a bad thing, it can actually help you heal faster. Your first follow-up with your doctor is typically, one week out after your surgery.

Your post-op nutrition classes are held one week, three weeks and six weeks after your surgery. So mark your calendars and check with your surgeon’s office about when you can attend these classes. They can be done in person or over video conferencing. Pain management is once again something that we want you to be working with your doctor’s office in regards to. You will be given a prescription for pain as well as nausea, and start to wean yourself off of those pain meds, a few days after surgery and using. Tylenol, to control your pain if needed. When you’re discharged, you’re going to be focused, on your water as well as your protein drinks, for the first week making sure you’re getting at least 64 ounces of fluid in and ideally, 60 to 80 grams of protein a day. This is what you do for the first full seven days.

On day 7, you can start what we call, the pre-select food diet. This will continue from day 7 until day 21 post-op. You will be doing one ounce every two hours, of these pre-selected foods which include refried beans, cottage cheese, eggbeaters, low-carb yogurt, as well as sugar-free pudding are appropriate options, on the preselect diet which once again goes from day seven to day 21. On day 21 to day 42, your diet will advance to the soft food diet. This will be one ounce to three ounces max per serving. We want you to listen to your tool, and not overfill your pouch. You’ll be eating every two to three hours, pureed forms of protein. These include soft flaky fish, easy-to-digest proteins, such as rotisserie chicken that you can puree, as well as egg whites, cottage cheese, refried beans, low carb yogurt and sugar-free puddings, which can also be continued. We want nothing crunchy, spicy and things should be so easy to cut that you don’t need to use a knife. In six weeks, your diet will advance to your lifelong diet. This is known as the solid food plan, and this is where it’s time to start following, what we call the rules of the tool. Diet, exercise, tools and you. Now starting to prepare for eating and drinking, those primary proteins as well as produce. Making sure that you’re sticking to small bites, and chewing your food well, and not overfilling your pouch. This is also when you can start adding, the fiber supplementation.

If you’ve had a gastric band, you will require what’s called a band fill. These are typically done at four, to six weeks out after surgery. Your second fill will be done on average, two weeks out after that. You will maintain four to six fills during the first year. Before you get a band fill, you’ll want to make sure you have no solid food, for one to two hours prior, but liquids are okay. After you’ve received a fill, you want to be careful of eating too much, too fast or taking too big of a bite, as it can make you feel uncomfortable. Band adjustments may need to be done, over the course of the year depending on your weight loss, or if you’re feeling under the weather. So make sure you’re reaching out to your doctor’s office, to assess what is appropriate for you.

It is important that you know potential complications after surgery. Minor warning signs after surgery commonly require a call to your doctor’s office, but not necessarily an emergency room visit. Where major warning signs require a consultation, with your surgeon’s office and a call to 911, or your closest emergency center. For those minor complications, that we would consider your calling your physician’s office, that would be something like a low-grade temperature, less than 101, a little seroma, which is a blister-like appearance around your incision, temporary numbness in your extremities, incision or abscess along your stitch or suture. Also mild edema or fluid retention or swelling. Loose knot or suture from one of your surgery sites. Digestive changes such as constipation, diarrhea, mild nausea or an oral yeast infection, where your tongue appears white and food starts to taste a little bit different. This is known as thrush and these are things that are all considered minor. Once again, call your doctor’s office, have a conversation with them, and make sure they’re aware of these issues, but these do not require an emergency room visit. Major concerns are fever greater than 101, leg pain or swelling, shortness of breath, severe nausea, with protracted vomiting, dizziness and chest pain. Once again, call 911 or go to an emergency room, and make sure you’re keeping your surgeon aware of what’s going on. Exercise is an activity that we’ve covered throughout this course. It is important that you start slowly, and build up your exercise routine. There are no limits on walking, but the minimum is 30 minutes a day. Keep active, even around your home. Heavy lifting should be avoided for the first six weeks. Things like pushing and pulling anything greater than 15 pounds of straining should be avoided, for the first six weeks. No abdominal crunches or heavy lifting, for the first six weeks. Swimming will be approved after about three to four weeks, from your doctor’s office and working with your healthcare team to develop an exercise plan, for you that work is going to be helpful in maintaining your weight loss ability long term. For resistance training, it is encouraged, three to four times a week and starting that once again, after the six-week post-op visit.

There are some challenges that many of our patients have after surgery. This could include social eating or eating out. Staying connected to our support groups can help you navigate through some of these challenges. We want you to look up nutrition facts online, before going out to eat so you know what you’re getting. Make sure once again, that you focus on protein, and produce, getting adequate nutrition. You can always ask for a to-go box or smaller meals, and remind yourself that you’re the customer, so making modifications to your meal is appropriate for your health. If you have questions about the risks and complications of the surgery, make sure you’re reaching out to your medical team and surgeon to address those, as we want to make sure you have a very clear understanding of the surgical process and how you will heal. Staying connected is crucially important. Follow up every three months, until you reach your personal goals with support groups, asking for a bariatric buddy or partner that can help you along the journey, visiting our social media sites, and reading our monthly newsletter will help you to stay on track. You can always email us with any questions, or concerns that you have or reach out, by a simple phone call. Your support continues for a life, so if you have challenges, we’re here for you. Many of our patients ask questions in regards to will their hair fall out. It is normal during the weight loss process, that your hair will go through a shedding phase. You will not go bald, however thin, and taking adequate supplementation, as well as making sure you maintain your protein levels, will help to prevent this excessive hair loss. Many of our patients ask, can they drink milk. And most patients can, however sometimes the digestive enzyme for milk, called lactose is decreased in the surgical process. So lactose-free milk may be better digested or tolerated.

Many of our patients ask about alcohol consumption after surgery. Although alcohol consumption is allowed after surgery, we encourage caution while using alcohol. With alcohol consumption, you may absorb it differently, and so you need to be cautious when consuming alcohol, as your body now processes it differently. Will there be weight plateaus after surgery? Absolutely, this is something we need to work through together. What is considered a plateau is typically if you haven’t lost weight over the course of one month. You may be experiencing other changes, in your waist circumference, in your body fat. These are all continued successes, however, if your weight is not changing, over the course of one full month, please reach out to us so we can help you address what needs to be modified with your diet or activity, and help you get through that plateau. Many of our patients after surgery, will consider cosmetic surgery such as a tummy tuck. This is not required, however, it is something that many of our patients will opt-in for if they feel like they have excess skin. For our gastric bypass patients, it’s important that we know what dumping syndrome is. Dumping syndrome is if you consume more than 15 grams of carbohydrates in one sitting. It will cause you to feel like you’re having flu-like symptoms, such as a rapid heartbeat, flushing, fatigue, nausea and sometimes vomiting. This is something you don’t want to experience often, ’cause it’s not comfortable so we encourage you to stay away from those simple carbohydrates and watch what you’re eating.