CHANGING BODIES. Changing Lives.

Transcription

1 13430 North Meridian Street Suite 168 Carmel, IN CHANGING BODIES. Changing Lives. ADJUSTABLE GASTRIC BAND PATIENT EDUCATION PACKET 3/2016

2 The St. Vincent Bariatric Center of Excellence currently has six registered dietitians on staff all of which are available to answer nutrition questions, address food issues and provide encouragement. You are encouraged to visit the dietitian each time you see your surgeon after surgery. Appointments are required to see the dietitian. APPOINTMENT AVAILABILITY: Monday thru Friday: 8:30 AM to 4:30 PM APPOINTMENT LOCATION: St. Vincent Carmel Hospital Entrance 4 Suite #168 PHONE NUMBERS: Toll Free (317) (317) (317) (317) csleary@stvincent.org (Cathi) msmatthe@stvincent.org (Melinda) dmboxell@stvincent.org (Dawn, part time) emweaver@stvincent.org (Ellen, part time) lgribble@stvincent.org (Laura part time) shannon.drye@stvincent.org (Shannon part time) megan.mcdevitt@stvincent.org (Megan) through the St. Vincent system will be delivered in a secure manner. You may be required to create a password to obtain information via . Please be aware your computer may place this information in your junk or with spam. Your questions and concerns are very important to us; however, there are times that you may receive our voice mails as we attend to our assigned tasks. We document all incoming phone calls and request that you leave a message so that we can return your call as promptly as possible. In case of a medical emergency dial 911 or go to the nearest emergency room. Always contact your surgeon s office. SURGEON S OFFICE PHONE NUMBER Dr. Evanson, Dr. Inman, Dr. Cacucci, Dr. Diaz (317)

3 A special diet is not required the day prior to your surgery however NO FOOD OR DRINK IS ALLOWED AFTER MIDNIGHT!! You will be notified of medications to avoid and those to take the day of surgery by your surgeon and/or the nursing staff. Small sips of water are appropriate when taking medications the day of your surgery. Because you are eating much smaller amounts of food following surgery, vitamin supplementation is required. A chewable or liquid form is preferred because most multivitamins are large in size and may get hung up or stuck in the band. You will most likely require vitamin supplement for the rest of your life. Failure to take your vitamins can lead to serious deficiencies and ill health. 1 CHEWABLE COMPLETE MULIVITAMIN DAILY MILLIGRAMS CALCIUM CITRATE DAILY 2,000 INTERNATIONAL UNITS VITAMIN D (in form of VitaminD3) DAILY 100 MILLIGRAMS THIAMINE (VITAMIN B1) DAILY *TAKE MULTIVITAMIN AND CALCIUM AT LEAST 2 HOURS APART *TAKE CALCIUM IN MILLIGRAM DOSES 2 OR MORE HOURS APART 3

4 Protein is extremely important after surgery as it will build, repair and maintain tissues including your body s major organs and the skeletal muscles. Protein deficiency, when continued over a long period of time, can cause a disease known as protein calorie malnutrition (PCM). Common symptoms of PCM are: Poor healing Hair loss Muscle loss Lack of energy Protein sources include: lean meats, seafood, low-fat dairy products, beans, eggs and soy GRAMS OF PROTEIN IS REQUIRED DAILY AFTER SURGERY. You may find the following references helpful once using a protein supplement. Please begin the protein supplement once you are passing gas regularly after leaving the hospital. 4 8 ounces skim or 1% milk or lactose free milk = 8 grams protein 8 ounces skim or 1% milk plus ¼ cup dry milk = 14 grams protein 32 ounces skim or 1% milk plus 1 cup dry milk = 56 grams protein 8 ounces of soy milk = 6 grams protein (Almond milk and rice milk are not significant sources of protein following surgery) Flavoring as desired with extracts, sugar free syrups or powders, sugar free jello or pudding mixes, sugar free coffee flavorings, decaf coffee, blended fruit or baby food fruit and artificial sweeteners

5 PROTEIN SUPPLEMENT OPTIONS A protein supplement that provides at least 20 grams of protein and less than 5 grams of sugar per serving is recommended Protein supplements are widely available in the pharmacy section of Wal-Mart, Target, Meijer, Walgreens, CVS and many grocery stores. Costco and Sam s Club sells many products in bulk. Almost all communities have a health food store available to include Whole Foods, GNC, and The Vitamin Shoppe. The Women s Health Boutique is located on the St. Vincent Carmel campus at Entrance 3. The phone number to the boutique is (317) Orders may be made online at Some products you may consider: Protein Powders Body Fortress Six Star Muscle Whey Protein Isopure Nectar Unjury Any Whey Celebrate ENS Plus Protein Inspire Bariatric Advantage Sci Fit Designer Whey Syntrax Matrix CytoSport Muscle Milk Pure Pro 50 Lean Body Chike For lactose intolerance try: Genisoy Natural (soy) Jay Robb Egg White Protein Egg Pro Premixed Protein Drinks Ensure High Protein EAS Advantage Carb Control EAS Myoplex Muscle Milk Isopure Atkins Advantage Boost Calorie Smart Pure Protein Met-Rx Protein Plus Oh Yeah Premier Nutrition Slim Fast High Protein Lean Body CytoSport Monster Milk Mix protein powders with: Water or sugar free flavored water Milk or soy milk Ice Sugar free flavoring Blended/pureed fruit 5

6 The next few pages of this handout will describe, in detail, the necessary lifestyle changes for successful weight loss and maintenance of one s health after surgery. As previously explained to you in the preoperative consultation with your surgeon, Bariatric surgery does not guarantee weight loss. Bariatric surgery is best described as a tool for weight loss and maintenance. Your health and weight loss are dependent upon your choices. The Bariatric staff is available to guide you and provide you with the information and encouragement to make the best choices for yourself following surgery. Spend 15 to 30 minutes to eat your meals Stacking your foods at your meals will keep you full longer. Layer with solid protein (chicken, turkey, pork, fish) first and then fruits and vegetables. Do not go longer than 6 hours between meals AVOID SNACKING AND EATING BETWEEN MEALS Fluid, in particular water, is crucial to one s health. Dehydration can happen very quickly following surgery, drinking the appropriate amount of fluid for your body will aid the digestive process and weight loss. Sip on fluids throughout the day to prevent dehydration Low calorie fluids to include: Water Skim or 1% Milk Sugar-Free, Non-Carbonated Beverages Decaf Tea and Decaf Coffee Avoid drinking from a straw or large cup as this may cause excess air intake which may lead to gas and belching. No drinking during mealtime to prevent the fluid from pushing the food through the band causing you to feel hunger before your next meal. No drinking for at least 60 minutes after meals 6

7 Stimulates appetite Can be irritating to stomach lining Acts as a diuretic Increased gas May lead to ulcer formation Empty calories Irritating to stomach Does not promote weight loss or maintenance Walking is the preferred exercise until you are released by your surgeon Walk every 2 hours in the hospital Walk 30 minutes daily to promote weight loss Schedule exercise beyond your daily activities YOU MUST BE RELEASED BY YOUR SURGEON TO BEGIN ANY FORMAL EXERCISE PROGRAM. Record type of food, amount of food and time food is eaten Record fluid intake Record protein intake Bring to dietitian visits Exercise can be tracked in the same way 7

8 As explained to you previously by your surgeon and in this hand out, Bariatric surgery does not guarantee weight loss. Bariatric surgery is best thought of as a tool you can use to lose weight. As with any weight loss program, you must do your part to achieve the results you desire. The meal plans are best thought of as plans of action to achieve your weight loss and health goals. Consider the meal plans a prescription from your doctor. For example, if you go to the doctor for a cold you may be prescribed antibiotics to fight off infection and keep your body healthy. The same is true for the meal plans, you have a medical condition and have been prescribed surgery in conjunction with the meal plans to improve your health. The meal plans were developed for several reasons: To promote rapid weight loss following Bariatric surgery To keep your body healthy while losing weight after surgery To maintain weight loss and improved health To prevent adverse effects of surgery to include nausea and vomiting Food is measured easiest by volume after surgery. Below is a list of measurements that may be helpful following surgery: 1 ounce = 2 tablespoons = 1/8 cup 2 ounces = 4 tablespoons = ¼ cup 4 ounces = 8 tablespoons = ½ cup 6 ounces = 12 tablespoons = ¾ cup 8 ounces = 16 tablespoons = 1 cup 8

9 Full liquids are foods that have a semi-solid or pudding-like consistency. You will begin with 2 ounce meals immediately following surgery. To prevent PCM, it is best to emphasize the high protein foods as much as possible in addition to the protein supplement or milk supplementation. Meals are to be designed from the foods listed below. Remember that you are to eat three meals a day. The protein supplementation and fluids are in addition to the meals. Sugar-free popsicles, sugar-free Jell-O and broth are allowed between meals. FOOD GROUP ACCEPTABLE FOODS FOODS TO AVOID Modified Solids Strained Baby Cereals Cream of Wheat Cream of Rice Malt-O-Meal Oatmeal Grits Cocoa Wheats Farina Strained Cream Soups Instant Mashed Potatoes Applesauce Baby Food Fruits/Vegetables (Step 1 or 2) Sugar-free, Fat Free Pudding Protein Sources Yogurt Light Smooth Variety Cottage Cheese Cheese Beans (Fat-free Refried, Pinto, Navy, Kidney, Lentils, Great Northern) Oatmeal with Chunks of Fruit Soups with Pasta, Rice and Noodles Desserts, Pasta and Meat Yogurt with Fruit on the Bottom Frozen Yogurt and Ice Cream Baked Beans You may add flavorings and spices to foods including, but not limited, to margarine and salt and pepper. Sugar substitutes are preferred to sugar for sweetening. You may add other condiments to your food as tolerated. Pick the lower fat version of a condiment if it is available. 9

10 Once you have successfully made it through the first week after surgery and are tolerating full liquids well you may advance your diet to this meal plan. Follow this meal plan weeks two through six after surgery. Remember that a protein supplement will still be needed to meet your protein goals. Remember to use healthy methods of food preparation including baking, grilling, broiling, boiling and steaming. 1 OUNCE PROTEIN 1 OUNCE PROTEIN 1 OUNCE PROTEIN 1 OUNCE STARCH 1 OUNCE FRUIT 1 OUNCE VEGETABLE Appropriate food choices are listed by category below: PROTEIN: Cottage cheese, eggs, egg whites, light yogurt, chicken breast, turkey breast, pork chop, pork loin, pork roast, 95% lean ground beef, fish, beans, cheese, canned tuna, canned ham, canned chicken, canned lump crab meat, quinoa, Kitchen Table Bakers cheese crisps (Women s Health Boutique) and tofu STARCH: Cream of Wheat, Cream of Rice, oatmeal, Malt-O-Meal, Cocoa Wheats, Grits, Farina, sweet potato, mashed potatoes, baked potato without skin, unsweetened dry cereal Unsweetened dry cereals include Fiber One, Bran Flakes, All Bran, Cheerios, Rice Krispies, Corn Flakes, Rice Chex or Puffed Wheat VEGETABLE: Green beans, peas, carrots, beets, squash, asparagus, zucchini, cucumbers, mushrooms, water chestnuts, okra, turnips, cauliflower, broccoli and tomatoes FRUIT: Applesauce, peaches, pears, pineapple, bananas, cantaloupe, honeydew melon, fruit cocktail, watermelon, mango, papaya, kiwi, strawberries, cherries, blueberries, blackberries and prunes 10

11 You will follow this regimen until you reach your goal weight however, your surgeon may adjust your diet after a fill and as needed. The volume of food may vary from meal to meal however it is recommended that protein is at least half of each meal. The total amount of food at each meal should be no more than 4 to 6 ounces (the size of a computer mouse). Protein supplements may still be required. Continue to use healthy food preparation methods. *EATING SEMI-SOLID (i.e. yogurt, soup, mashed potatoes, pudding) FOODS MAY LEAD TO HUNGER. *REMINDER: AVOID DRINKING WITH MEALS AND FOR AT LEAST AN HOUR AFTER MEALS. *STEAK AND BREAD ARE COMMON FOOD INTOLERANCES. PROTEIN PROTEIN PROTEIN STARCH VEGETABLE STARCH FRUIT FRUIT VEGETABLE Appropriate food choices are listed by category below: PROTEIN: Cottage cheese, eggs, egg whites, egg substitute, light yogurt, ham, chicken breast, turkey breast, pork chop, pork loin, pork roast, veal, 95% lean ground beef, beans, fish, cheese, canned tuna, canned ham, canned lump crab meat, lobster, scallops, shrimp, and tofu STARCH: Cream of Wheat, Cream of Rice, oatmeal, Malt-O-Meal, Cocoa Wheats, Grits, Farina, sweet potato, mashed potatoes, baked potato, unsweetened dry cereal, whole wheat crackers, saltine crackers, brown rice and whole wheat pasta VEGETABLE: (Recommended but not limited to) Green beans, peas, carrots, beets, squash, spinach, greens, asparagus, zucchini, cucumbers, mushrooms, water chestnuts, okra, scallions, celery, corn, cauliflower, broccoli, peppers, tomatoes, onions, eggplant, radishes, cabbage, iceberg lettuce, romaine lettuce, endive and raw vegetables FRUIT: (Recommended but not limited to) Applesauce, apples, peaches, pears, pineapple, bananas, cantaloupe, grapes, honeydew melon, fruit cocktail, watermelon, mango, papaya, kiwi, strawberries, cherries, blueberries, raspberries, prunes, raisins, apricots, oranges, grapefruit, tangerines, nectarines and plums If you are near or have reached goal weight, please contact the Bariatric dietitians so that we may give you guidance for maintenance. 11

12 TO MAXIMIZE WEIGHT LOSS THE FOLLOWING FOODS SHOULD BE AVOIDED Bacon in any form Sausage in any form Hot dogs in any form Bratwurst Bologna in any form Braunschweiger Salami Potted meat Spam in any form Vienna Sausage in any form Beef Jerky Breaded and fried foods Fast Food Pork rinds Potato chips in any form Movie popcorn Snack crackers Regular pop Alcohol Starbucks Candy including sugar-free Desserts including sugar-free Ice Cream in any form Alfredo sauce Cheese Sauce Gravy 12