This recipe will supposedly help any “lodged” pieces of protein break apart. Be extremely careful when using this, since it does contains a good amount of lemon juice, which is acidic. A teaspoon may not seem like much, but you need to consider that your pouch is very small initially. Your pouch can hold approximately 1 ounce. One ounce is equal to 2 tablespoons or 6 teaspoons. Now a teaspoon of lemon juice sounds like allot, doesn’t it? You want to protect your new pouch and not increase your chances of developing ulcers.
You may experience diarrhea when you first get home and don’t be alarmed if your stools are very dark / black. Remember that the digestive tract is one long tube! The surgery was on your digestive tract so the dark stools are a result of some of the bleeding that occurred with surgery. After a few bowel movements, the stools will get lighter. An off color and strong odor, later on, is also not unusual. This is caused by the mal-absorption created by surgery. You may also become slightly lactose intolerant after surgery. You can eliminate dairy products from your diet for a few days and see if the diarrhea resolves. There are several lactose free products that can be used in place of dairy products. You can also try lactaid tablets.
It is also not uncommon to become very “gassy” after surgery. The increased flatulence is due to the undigested food that is now going through your digestive tract. The “gas” pains can actually become very strong. Some people have gone to the ER due to the severity of the gas pains. Over-the-counter products such as Mylicon (yes, the stuff for babies) or Gas-X can be effective. Drinking hot beverages (if you tolerate temperature extremes) can also help. Be careful of soy products, those have been known to also cause increased flatulence.
It is common to have a heightened sense of smell. Some people describe it as being similar to what women experience during pregnancy. Odors may start to bother you since your sense of smell will be heightened. You may be able to smell something hours after it has left the room. Physicians are not really sure why this happens. It will subside after a few months. So don’t think it is all in your head. Others who have had the surgery experience this as well.
During the first 2-3 months, you may also develop what is known as a stricture. As you heal, scar tissue may develop around the stoma (opening that connects the pouch to the intestine) causing that opening to narrow. The opening may become so small, that food and eventually even liquid may not go thru. There are a few signs that may indicate you have a stricture. The first is that you will be constantly spitting up “white foamy stuff” – this is swallowed saliva that is sitting in your pouch because the stoma is too narrow. The second is that you food consistency will digress and you will only be able to tolerate soft consistency proteins (i.e. cottage cheese, yogurt, protein shakes). The third is that you will start to vomit frequently after your meals.
The goal of surgery is to promote weight loss, but without affecting quality of life. If you are vomiting with every attempt you make to eat, you need to consult your surgeon to find out what is going on. Assuming, of course, that you are taking small bites, chewing each mouthful 25 times or to puree consistency, and that you are not overeating. Chronic vomiting can lead to dehydration and potential nutritional deficiencies.
Once you contact your surgeon, he / she will most likely ask you to come in for a UGI x-ray or endoscopy to confirm the diagnosis. If the test shows that the stoma is narrow, you will need to have an endoscopy. This is an outpatient procedure and does not require hospitalization. You will be sedated and a balloon attached to the outside of the scope (instrument used for the endoscopy) is passed into the stricture and inflated under pressure to dilate the narrow stoma and reopen the passageway. Unfortunately, the stricture may not be corrected after only one balloon dilation. The scarring may recur and procedure will need to be repeated within a few weeks.
It is very important that you inform your surgeon or someone in the health care team, that you are having the aforementioned symptoms. Don’t keep this from your health care team because you will be putting your health at risk. Don’t be afraid of the endoscopy. You will be sedated and will not experience any discomfort from the procedure. The chronic vomiting, dehydration and potential vitamin deficiencies can do much more harm than having a procedure (that you may be nervous about).
Just remember that the first 3 months may be difficult, but things will get better. It is normal to compare yourself to others who have had bariatric surgery, but keep in mind, that everyone is different. Some people “breeze” through the first 3 months without any problems at all. Some people have on going food intolerances that last past the initial 3 months. The most important thing to do, is get support from your health care team and keep in mind that things will pass. Every day things get a little bit better!
Gastric Banding
The first weeks after surgery you will probably be sore. Your incisions and the area where the port has been placed will be sore. The port area may be sore from a few weeks to a few months. You want to take it easy, but there is no reason to stay in bed. It is actually, very important that you do just the opposite, get up and walk around several times a day. This will help prevent blood clots.
The first few days or weeks following surgery, you will most likely be on a liquid /full liquid diet. The length of time you will need to stay on the diet, will depend on your surgeon. You will receive specific instructions - ask questions if they are not clear to you.
Different bariatric programs have different protocols. Some recommend replacing meals with protein shakes. Some recommend protein shakes, low fat cream soups, fat-free sugar-free puddings, fat-free low-sugar yogurts and other soft foods. Just make sure the liquid diet provides protein.
If your surgeon insists that you follow a clear liquid diet (liquids that can be seen thru, when held up to a light) for more than 1-2 days, make sure that you use a high-protein low-carbohydrate sports drink (i.e Protein Water, Nectar). Protein is very important for healing and you do not want to have only clear liquids for an extended period of time following surgery.
A liquid / full liquid diet following surgery is very important. Not eating solid foods soon after surgery, will allow the stomach to heal and for the band to properly secure in place. There are sutures holding the band in place and they need to heal properly. Eating too soon may cause vomiting, disturbing the healing process. This can also cause the band to slip. This liquid phase, it is not for weight loss, it is for healing.
Make sure that you take in small amounts of liquid / full liquids at a time. Increase amounts or volumes slowly, for just one ounce, can make all the difference in the world. You will find that you will be able to tolerate a greater volume of liquids like protein shakes, in comparison to full liquids like pudding or yogurt – the liquids will go thru the band easier. Make sure that you sip non-carbonated low calorie beverages all day long. You will not be able to “gulp” liquids, so make sure you are constantly sipping in order not to become dehydrated.
Make sure that you follow the 30-minute rule when it comes to beverages. You should not drink anything 30 minutes before a meal, nothing to drink with the meal, and nothing to drink until 30 minutes after the meal. This may take a while to get used to, but it is very important. Initially, it is a question of volume – you fill yourself up with water, there will not be much room for the protein. If you drink right after your meal, you will make your pouch too full – this may lead to nausea and vomiting. Drinking with the meal will decrease your protein intake during the meal, may cause you to become nauseous and lead to vomiting, and may cause your pouch to stretch.
If you are doing a few weeks of protein shakes after surgery, don’t be surprised, if by the second or third week you can tolerate 8 ounces or more at each meal. There is nothing wrong with your pouch! Also, don’t be surprised if you feel hungry during this liquid / soft diet phase. Remember, this procedure is restrictive only. The hormones that control hunger are unaffected, so your hunger does not go away. Try to drink as much as you can in-between meals so that your pouch is full. If the pouch is full, the brain gets a message that you are full. It is also very common after surgery, to mistake thirst for hunger. So drink something, wait 30 minutes and see if you are still hungry.
Most bariatric programs recommend a liquid or soft diet for a few weeks following band placement. It is important to comply with these recommendations in an effort to prevent the band from slipping down the body of the stomach (known as slippage). The risk is highest during the first 3 weeks post-op. It is absolutely important to avoid solid foods and severe nausea / vomiting during this period.
Once you begin eating more soft foods, it is very important to take small bites and chew each mouthful 25 times or to puree consistency. Start with 1-2 ounces of food. It should take you at least 30 minutes to finish your meal. Once you start belching, your meal should end. Belching is a sign that your pouch is full. If you continue to eat past this point, you may end up feeling nauseous and you may end up vomiting.
If you find that food is not “sitting” well during breakfast, it may help to start your morning with a warm beverage. Upon rising, drink a warm low calorie beverage, wait 30 minutes, and then eat. The warm beverage seems to relax the pouch and “opens” up the outlet. It also helps “wash” down all the saliva that may have collected over night. Most people tolerate breakfast better if they start the morning with a warm beverage.
It is fairly common for the band to fell tighter in the morning, especially for people with bands that are tight or just after an adjustment. During the day, the water content in the body changes and this may cause the band to feel "tighter" some of the time. Some women may also notice that the band feels tighter during menstruation.
Since this surgery is only restrictive, you do need to be more aware of calories. The band will create restriction, but there is no mal-absorption of calories. Every calorie you eat will be absorbed. You also have fewer food intolerances (i.e. dumping syndrome), making eating the wrong foods easier. There are many high-calorie, high-fat, high-sugar foods that will go down really well. Since all the calories are being absorbed, the weight loss will be affected.
If your program requires you to eat protein only for a certain period of time, you will find that you may experience some food intolerances. Protein is harder to digest, but is very important during the period of calorie restriction. You may find that mixing protein textures (i.e. ground meat with beans), may improve your food tolerance. Mixed textures are tolerated better than one food eaten alone at a time. You may need to experiment with different cooking methods. Make sure your food is always most and tender. Dry foods will feel like they are “stuck”.
Initially it helps to weigh your food so that you don’t experience what is known as the “hard stop”. This is what happens when you eat until you are stuffed or experience pain in your chest. Most banded people can tolerate only ½ cup food at a time. Purchase an inexpensive food scale and weigh your food. This way, you will know exactly how much to eat each meal with coming to a “hard stop”. Over time, if you find that you are experiencing hunger after your meal, sooner than you used to, increase your portion size by ½ ounce. You will be surprised how much of a difference ½ an ounce can make.
It will also help curb your appetite longer, if you choose foods that are dense. Very soft foods will leave the pouch sooner. Foods that are dense and less processed will give you a feeling of satiety for longer than softer processed foods. These foods make take more work on your part (more chewing) to go through the band, but they are usually more nutritious choices. You diet will start with soft foods and progress to dense foods.
Limit your mealtime to 30 minutes. Doing this initially, will ensure that you take your time eating and chew your food properly. Later, this will help you to not overeat. If you sit at the table for an hour, you will be able to eat a much larger portion. Most of the time, as long as you chew your food well and take small bites, it will go down. The first bite you take during a meal is the most important. If the first bite is too big or not chewed well, the remainder of the meal will most likely stay on your plate and your meal will be over before it even starts.
You may experience some vomiting after surgery, but the goal should be to try to prevent it as much as possible. Chronic or frequent vomiting after surgery may cause the band to slip. When the band slips, it moves out of place. This may cause problems and lead to the removal of the band. If you have an adjustment and you start to vomit frequently when eating, it is important that you contact your surgeon. Most likely too much saline was put in the band and some needs to be taken out.
Vomiting after surgery is much different than it was before surgery. Since the food is not mixed with much of the gastric juices and it is not partially digested, the food will come up pretty much the way it went down. The food will usually come up within a few minutes of overeating or feeling that the food is “stuck”. Vomiting becomes more of a form of unloading after surgery. This is not a “green light” to vomit. This description is simply to help you in knowing what to expect.
You will most likely require 3-5 adjustments within the first year. An adjustment or “fill” is when saline is injected into the band via the port. This makes the outlet from your pouch to the remainder of your stomach smaller. An adjustment may also refer to removing fluid from your band.
How often you need an adjustment depends on several variables. Lack of weight loss alone, should not be main reason to have an adjustment. Find out from your surgeon what the expected monthly weight loss is. The monthly weight loss goal is usually 5-7 pounds. However, if you do not lose that much weight during the month, you should not automatically have an adjustment.
Your dietitian will need to assess what you are eating, how much you are eating, how often you are eating, your physical activity level and how much restriction you still feel. Lets say a person goes for follow-up and the weight reflects not weight loss for the month. This person is not tolerating most types of protein, but has been drinking milkshakes (not protein shakes, but the kind made with ice cream). This person is also not exercising. This person does not need an adjustment. Having an adjustment may actually lead to problems.
The adjustment may be done under fluoroscopy in the radiology department or in your surgeon’s office. Fluoroscopy is a moving x-ray. The doctor will ask you to drink a chalky drink and he / she will be able to watch with this moving x-ray, how quickly it is going through the band. This is a fairly simple procedure and you will not require sedation for it.
Most programs will have a post-adjustment dietary protocol for you to follow once you go home. It may be a good idea to have protein shakes for a few days and slowly advance diet consistency and texture. Remember, the outlet has been made narrower with the adjustment so you will not be able to eat the same quantities or textures you might have been eating prior to your adjustment. Make sure you take your time eating – take small bites and chew very well.
The rate of weight loss with the gastric banding is slower so don’t get frustrated. The expected weight loss is 50% of the excess weight within 2-3 years. Some people lose more and others lose less. Studies are showing that the weight loss rate with gastric bypass is quicker, but over time, the total weight loss is the same for those having gastric banding and gastric bypass. As long as you use your band right, it should work for you!
Sleeve Gastrectomy
After surgery you may feel some incision soreness and feel a little fatigued. You will go home 48 hours after surgery and it will most likely take you 1-2 weeks to fully recover. You may be required to be on a liquid diet or on a soft diet initially. This is important to allow your new gastric pouch to heal properly.
As you probably already know, the sleeve gastrectomy leads to weight loss by creating a smaller stomach. During this procedure, approximately 60 to 75% of the stomach is removed. The stomach is shrunk from the size of a cantaloupe to the size of a banana. This portion of stomach restricts the amount of food that you can eat and leads to significant weight loss – up to 30 to 50% of excess weight.
The sleeve gastrectomy is a relatively new operation. It was originally considered to be the first part of a two-stage laparoscopic operation. This gastrectomy procedure was usually performed on super-obese patients (BMI greater than 60) or high-risk patients, with the intention of performing another surgery at a later time. The second procedure would either be a gastric bypass or duodenal switch.
Some surgeons are now offering the sleeve gastrectomy, the first part of this two-stage procedure, as a stand alone bariatric surgery option. This is an option for those with a BMI above 35. In England, the sleeve gastrectomy proved to be quite safe and quite effective even at 5 years. Ten percent of the patients did fail to achieve a BMI below 35 at 5 years, however, these tended to be the heavier patients. The same ones we would expect to go through a second stage as noted above.
Low BMI individuals who should consider this procedure include:
1-Those who are concerned about the potential long term side effects of an intestinal bypass such as intestinal obstruction, ulcers, anemia, osteoporosis, protein deficiency and vitamin deficiency.
2-Those who are considering gastric banding but are concerned about a foreign body.
3-Those who have other medical problems that prevent them from having weight loss surgery such as anemia, Crohn's disease, extensive prior surgery, and other complex medical conditions.
4-People who need to take anti-inflammatory medications may also want to consider this. Usually, these medications need to be avoided after a gastric bypass because the risk of ulcer is higher.
5-Young people.
6-Older / elderly people.
The capacity for sleeve gastrectomy pouch is between 100 and 150 mL, which is roughly ten times larger that of the gastric bypass. The capacity of the gastric bypass pouch is between 15 and 30 mL. As a result, those post sleeve gastrectomy tolerate a wider variety of food consistencies and can transition to solid foods more quickly.
In the immediate postoperative period, as with the gastric bypass, you will consume limited portions of food. This is possibly due to postoperative swelling. Also you experience no physical hunger for approximately 9 months. Since ¾ of the stomach is removed, the ghrelin producing cells are also removed. Ghrelin is an appetite control hormone that is produced by cells lining the stomach. Ghrelin levels are increased before a meal and decreased after a meal. The decreased capacity of the stomach and the lower level of ghrelin leads to a significantly reduced intake.
Most bariatric programs use the same dietary protocol for those having a sleeve gastrectomy as those having a gastric bypass. Food intolerance is minimal with the sleeve gastrectomy, but you do need to eat small portions, eat slowly, and chew very well. Overeating may cause significant discomfort, leading to nausea and vomiting. Over time, continuous overeating will lead to stretching of the gastric pouch. It is important to avoid vomiting during the first few weeks post-operatively to allow proper healing of the new gastric pouch.
It is important to be aware of calories since this procedure does not create any mal-absorption. Make sure you choose lean proteins and avoid eating foods with a high sugar or high fat content.
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