Life After Weight Loss Surgery
Going Back To Work
Your ability to resume pre-surgery levels of activity will vary according to your physical condition, the nature of the activity and the type of weight loss surgery you had. Many patients return to full pre-surgery levels of activity within six weeks of their procedure. Patients who have had a minimally invasive laparoscopic procedure may be able to return to these activities within a few weeks.
Diet
As you might expect, the diet that immediately follows a Gastric Bypass or Adjustable Gastric Banding is somewhat specialized, to be gentle on the new stomach pouch and Roux intestinal limb as they heal. As a result, sample Gastric Bypass and Adjustable Gastric Band meal examples are listed in the below links.
Birth Control & Pregnancy
It is strongly advised that women of childbearing age use the most effective forms of birth control during the first 24 months after weight loss surgery. The added demands pregnancy places on your body and the potential for fetal damage make this a most important requirement.
Side Effects
The following are some of the problems that patients may experience that do not fall into the medical category of "complications." However, these problems arise that some patients have to deal with. As a result, we are providing you with proactive information on the potential side effects of having weight loss surgery.
Nausea and Vomiting
Patients can commonly get episodes of nausea, vomiting, and abdominal discomfort after surgery, especially within the first 2 or 3 months after surgery as patients are getting used to their new diet habits.
Nausea after surgery is usually due to:
- Eating too much at once. Remember, the stomach pouch is only 1 oz. - the size of a thumb.
- Eating too quickly.
- Advancing diet too soon or eating something too "tough." Patients should NOT try to eat steak or pizza within 2 or 3 weeks after surgery; they WILL GET SICK.
- Eating something with a high sugar content (See “Dumping Syndrome”)
Eating smaller portions, eating slower, chewing foods well, and avoiding high sugar foods can easily resolve this problem. Also, taking a step back (such as to a liquid diet) can help. Patients need to learn to stop when they feel satisfied. The one additional bite is enough to cause problems. Patients with post-nasal drip may also develop episodes of nausea after surgery.
Dumping Syndrome
One of the key features that help a patient control calorie intake after Gastric Bypass is the fact that food leaves the tiny stomach pouch only into a section of the small intestine called the jejunum. This pathway for the food is the "Roux-en-Y" part of the full name for the procedure, and it matters because the jejunum is simply not made to handle concentrated calories, especially refined sugar. The effect of this is that if a person consumes sugar after a gastric bypass (such as ice cream, chocolate candy, or a soda) the presence of the sugar in this segment of intestine will create a reaction called dumping syndrome that affects the whole body.
An episode of dumping shows up as palpitations (heart racing), a sweaty and clammy feeling, cramping abdominal pain, diarrhea, and then a feeling of weakness during which the person simply must lay down for an hour or so until it passes. Dumping syndrome is not dangerous, but it feels terrible. It is not exactly a side effect, in the sense that works in a beneficial way by steering patients away from that type of food.
Patients with an Adjustable Gastric Band should not have dumping syndrome.
Vitamin and Mineral Deficiency
Vitamin and mineral deficiency can occur when the restrictive diet of the post-operative patient is not afford the ability to consume the amounts of vitamin-rich foods that an average adult eats during the course of any given day. Malabsorption is part of the reason why the post-operative patient loses weight. However, to remain healthy we can still eat less and maintain the necessary vitamin intake, by taking the vitamin and mineral supplements that our doctor recommends, for the rest of our lives.
Hibernation Syndrome
About two or three weeks after Gastric Bypass or Adjustable Gastric Band, the patient's body "figures out" that it is not going to be receiving its accustomed calories for a long time. In about half of patients this results in what is called the hibernation syndrome, where one's body falls back on its built-in evolutionary response to a low food supply - the person just wants to rest and be as still as possible until the food returns. Energy level drops through the floor, and the patient can become emotionally labile (tearful or irritable). There can also be a component of depression caused by the loss of the previous relationship with food. This syndrome can be unnerving for patients because it comes at a time when they are just beginning to get over the pain and other effects of surgery - they believe they should be feeling better but they just want to curl up and go to sleep. The good news is that this is not a dangerous or unusual thing, and it should be resolved in about 2 weeks when the body figures out how to use fat as its main energy source.
Changed Bowel Habits
After surgery, the amount of bowel movements may be fewer causing less frequent bowel activity and constipation. Occasionally, fiber supplements or stool softeners may be necessary for regularity.
Lactose Intolerance
The enzyme needed to digest milk and other dairy products (lactase) does not reach food in the usual fashion and may not be able to fully digest milk. Undigested milk can lead to gas, cramping, and diarrhea. You may need to avoid dairy products and eat foods which do not contain lactose (e.g.. soy milk, lactaid).
Pregnancy
Many obese women have trouble with fertility and regular menstrual cycles. As weight loss occurs, this situation may change quickly. It is important to avoid becoming pregnant during the first year after surgery. Women of childbearing age must use some form of birth control during this rapid weight loss phase. Rapid weight loss and nutritional deficiencies can harm a developing fetus. After weight loss has stabilized, it is possible to have a healthy pregnancy by close communication with your obstetrician and surgeon. Patients need to take extra vitamins prior to becoming pregnant and get adequate nutrition during pregnancy.
Excess Skin
After a large amount of weight-lost, you may find yourself with excess skin in places you never knew existed. The logical question is "What happens to the excess skin?" Weight-loss after surgery continues for about 18-24 months. After that, your body is equilibrated and ready for surgery for excess skin removal. This is typically performed by a plastic surgeon experienced in this field. The plastic surgeon will evaluate you and decide with you what areas need "tightening-up". Unfortunately, this is cosmetic surgery and is not covered by insurance. However, there are many plastic surgeons who are flexible and may be able to work out a payment schedule with you.
Gallstones
More than one-third of obese patients who have gastric surgery develop gallstones. Gallstones are clumps of cholesterol and other matter that form in the gallbladder. During rapid or substantial weight loss a person's risk of developing gallstones increases. They can be prevented with supplemental bile salts taken for the first six months after surgery.
Transient Hair Thinning
About one-third of patients notice hair thinning after surgery. This usually occurs between months 2 through 10, the rapid weight loss phase. There is little treatment for this phenomenon other than maintaining adequate protein intake, taking a daily multivitamin, and possibly an additional zinc supplement. The important thing is to remember that this phase is temporary and hair does come back to normal.
Loss of Muscle Mass
Loss of muscle mass can occur when the body perceiving that it's starving, stores its fat until any other usable fuel has been burned. Loss of muscle mass is preventable. During active weight loss after surgery exercise vigorously as soon as your doctor gives you the okay.
Bariatric Support Group and Diet Classes
Please confirm official meeting dates, times, and locations prior to attending any meeting by contacting us at:
Vicky Blackard
1840 Mease Drive, Suite 301
Safety Harbor, Florida 34695
Telephone: (727) 287-1011
Facsimile: (727) 712-1853
Support Group Meetings
Support Group Meetings are typically held on the 1st Tuesday of each month at 6:00pm at the Mease Dunedin Hospital Education Conference Room and the 4th Tuesday of each month at 6:00pm at North Bay Hospital meeting rooms.
Dates and times subject to change.
Please contact Vicky Blackard at 727 734-6879 to confirm dates and times.