THE PATIENT S GUIDE TO BARIATRIC SURGERY

Transcription

1 THE PATIENT S GUIDE TO BARIATRIC SURGERY What to Expect After Bariatric Surgery It is important for you to remember you are to lose at least 1% of your total body weight prior to your surgery or at least pounds. This not only shows your commitment to the program, but shows your determination to managing your weight loss. Another important thing for you to realize is you will not lose all of your weight in the first 4 months, 6 months, or year if ever. Success is measured by losing 60% to 80% of your excess weight and keeping it off for three years. 85% to 95% of people succeed with this surgery. With diets only 5% of the people ever succeed and keep it off. Ask yourself, if you could only lose 60% of what you have to lose and keep it off, would you be happy? If not, you may want to reconsider having this surgery. Don t have the surgery to become a size 2, 4, 6, 8, or even a 16; it may never happen. This surgery is designed to reduce the comorbidities you have; diabetes, hypertension, joint pain, breathing problems, and all of the rest of the medical problems you are having. It is to improve your health, help you regain the life you had, and to increase your quality of life. As we have talked many times before, this surgery is only a tool to assist you in your journey to a much improved quality of life; you have to be an active participant. You have to change your eating habits and learn to eat to live, not live to eat. You have to take an active part in an exercise program, to stop yourself from grazing, emotional eating, and eating when you are not hungry. Another aspect of this surgery is residual rebound of weight gain. It is not uncommon for you to gain pounds after your weight stabilizes. To keep from regaining more you must eat sensibly and exercise moderately. It is essential to take in fewer calories than what you are burning, and you will lose in a stair-step pattern; you will lose a great deal, then plateau, lose some more, then plateau. Remember, everyone is going downstairs, but each person has their own number of flights. Don t compete with others, strive to attain what your body will allow you to lose and then make the commitment to continue to lose the remainder. 1

2 You need to realize everyone is not the same. Some will be able to eat differing amounts of food depending on the following: pouch size eating and drinking at the same time types of foods eaten how far out from surgery you are Everything about this surgery is individualized. Do not compare yourself with what others are doing at the same time. Go by your percentage of weight lost: 60-80% of excess weight lost is considered successful; before you have this surgery, research every aspect of it. Enter with the knowledge you are as well informed as can be and you are expecting a realistic outcome. The Day before Surgery: Two days or more before your surgery you will be on a Bariatric Full Liquid Diet. The only thing we ask for you not to eat or drink those days will be anything with orange, red, or purple colors (Jell- O, Kool-Aide, Popsicles, or any artificially colored puddings). These foods for those two days may cause staining of your intestinal tract making it difficult to identify normal healthy tissue in surgery. You will also need to start your protein shakes at this time. You will be given a diet to follow and please follow the diet as written unless your doctor has given you other instructions. At midnight the night before surgery you will not have anything to eat or drink until your doctor tells you. The morning of your surgery you will take a shower and use some type of antibacterial soap to wash with. You may wash your hair and clean your naval. You may brush your teeth as many times as needed, but do not swallow any water. No breath mints, gum, or Lifesavers. You may use mouth wash, but do not swallow any fluids. You should have been instructed on taking any medications; take only the medications you have discussed with the Same Day Surgery Nurse and the Bariatric Program Coordinator. Do not take any other medications without the express instruction from your physician or the Anesthesia doctors. You will arrive at the time given to you the day before your surgery and report to Same Day Surgery on the second floor of the hospital. You will be taken into the holding area and prepare for your surgery. You may leave your overnight bag in the car until you have a room assignment. Have your friends or family bring it to you when you are admitted to your room. If you have been instructed to bring your sleep apnea machine to the hospital or you may only need to bring your mask and your settings, have it with you on admission you will need it in the recovery room (PACU). You will also need to bring your Incentive Spirometer to the hospital that morning. You should be practicing with it from the time you receive it to achieve the volume assigned. It is very important for you to utilize this piece of equipment; therefore, if you do not receive one before your surgery please ask the nurse taking care of you on the floor or in the ICU to give you one. You will need to use this when you go home from the hospital as well as while you are in the hospital. You will need to do the breathing exercise with the Incentive Spirometer every hour while awake after surgery. 2

3 For the women: You will need to be prepared to have a period. It is most likely you will have one anesthesia and the stress of the surgery will almost guarantee menses even if you have had one that month. For those of you that have had a hysterectomy no worries. You will be placed on a regular surgery cart in the holding room, but will most likely wake up in a bariatric bed. These beds are designed for ease and comfort of the bariatric patient and you will utilize this bed during your hospital stay. You may also have a device under you when you wake up that helps move you if need be. It will be removed as soon as you are up out of bed or transferred from the cart to your bed on the floor. You will be admitted to a bed as an in-patient after surgery. The placement on a specific unit depends on many things; how long the surgery took, how well you did during the surgery, your health prior to surgery, your comorbidities, and any respiratory problems. It will also be your doctors decision where to place you for the best of care following surgery. It will be important for you to remind your friends and family to follow all of the hospitals policies on visitors and their ability to remain with you during your stay. If you are admitted to the ICU or Telemetry units you will have a cardiac monitor on with a blood pressure monitor and a probe on your finger to watch your oxygen levels. You will also continue to have a nasal cannula in your nose for oxygen. Do not be alarmed it is important to maintain a good oxygen supply to the tissues after surgery and to help with waking from the anesthesia. The nursing staff will have you to cough, deep breathe, and turn about every two hours to keep your lungs clear and help restore good blood flow. Place a pillow over you lower abdomen, take three deep breaths, and on the third breath cough. This will help bring any phlegm up out of your lungs and oxygenate your tissues. You will have special compression stockings on your lower legs; you will need to keep them on while in bed but will come off when you are up and walking. You will need to do leg exercises when you are awake. Point your toes to the ceiling and your heels to the floor. This will keep the blood from pooling in the deep veins in your legs. You will also have a catheter in your bladder to help you urinate. This will come out when you are up and able to get to the bathroom by yourself. The night of your surgery you will sit up on the side of the bed to dangle your legs. You may get up to the bedside chair. It will be uncomfortable, but the more you are up and about you will be able to work out the soreness. This keeps your lungs clear, restores good blood flow, and keeps you from forming blood clots in your legs and lungs. It will also help to start the motility in the intestines again so you can start to pass gas. Some of the patients come out of surgery with an abdominal binder; this will be determined by your doctor at the time of surgery. You will have pain medication available for your comfort. Remember The first 48 hours will be the worst! You will be asked to assess your pain on a pain scale from 0-10; 0 is no pain 10 is the worst pain you have ever had. The nursing staff will attempt to keep your pain 4 or less. This is good pain relief with the medications and for the type of surgery you are having. Try to take slow deep breaths and relax your muscles. The more anxious and guarded you become, the less the medication will help. You will also have medication available for nausea. If you feel the slightest bit of nausea, ask your nurse for the medication. 3

4 You will have a swallow study scheduled following your surgery. Depending on what type of surgery you have, you may have your study within the first hours after surgery. You will be taken to the Radiology department and asked to drink a contrast so the doctors can see if you are ready to start your new diet. Remember you will not eat or drink anything after surgery until you have completed your swallow study. When you have completed your swallow study and are taking liquids once again it will be very important for you to remember to drink slowly. All of the practice before surgery will come into play now. Drink no more the one ounce every hour. Drinking one ounce every hour will allow the fluid to go into the newly created pouch without overcrowding it, and it will also keep you from becoming nauseated. It is very important not to vomit during this early part of your recovery and is to help you remember not to drink too fast. When the dietary people bring your Bariatric Clear Liquid Diet it may seem like the gelatin and drinks are too sweet. You may ask if this is a Bariatric diet just to make sure, but usually things taste differently after surgery. Continue to eat and drink very slowly. Do not over eat or drink too much this first time. You will be very thirsty, but try not to drink too fast. You will only be allowed to drink one fluid ounce (1 ounce) every hour in the beginning. When you go home you will need to be able to support your fluid intake, so it is very important for you to be able to drink without any difficulty. Remember 64 ounces of fluids daily! Fluids will be counted as broth, Jell-O, water, protein shakes, etc ounces the first two days post-operatively will do until you are more alert and can drink a little more. The amount of time you remain in the hospital is totally dependent on how you do, your comorbidities, and your level of comfort. There is no race to get you discharged from the hospital in 24, 48, or 72 hours. The nursing staff and your doctor want you to feel ready to go home. This is your new lifestyle you have elected to adopt, so we want you to be confident before you are discharged from the hospital. You will be discharged from the hospital when you have no fever, able to be up and about without assistance, and are taking fluids by mouth to support your needs. The nursing staff will bring your discharge medications to you to have filled when you are going home. You should have a prescription for pain medication this should be in liquid form, nausea, medication for reflux if needed, and stool softeners. Do not go more than hours without having a bowl movement. You may have had a bowel movement already, if not be sure you are passing gas before you leave the hospital. You may or may not have staples on your abdomen, but you will be able to shower when you get home unless it is the day of your surgery. You may also be discharged from the hospital with drains. These drains will stay in place until your doctor sees you at your two week post-op visit. Do not sit and soak in a bathtub until your staples have been removed or until your doctor tells you it is appropriate. Do not take a shower without someone being close by the first time. Some people get dizzy or weak in the shower and we do not want that to happen if you are alone. You will also continue to do your Incentive Spirometer when you get home. It is very important to remember to deep breath, cough, and move! You should continue to do the leg exercises point your toes to the wall and your heel to the floor. Do not cross your legs or let them hang down for long periods of time. Try to walk at least once an hour to increase your endurance and profuse the blood through the tissues. 4

5 Before you have surgery, find a support person. This person should be someone that will look out for you in the hospital and help you when you get home. There are a number of things you can do to make your recovery easier. Rearrange the house to make it easier and more accessible to you. Have lots of pillows on your bed, have phone numbers at the bedside: your surgeon, Bariatric Program Coordinator, family, friends, and pharmacy. Figure out where you will sleep and sit after you come home. A recliner may be your choice for a few nights; it is very comfortable. Have your bandages, medications, protein shakes, foods, and items for your personal hygiene ready. Going Home: Follow all of your surgeon s instructions! Know the signs of infection regarding your incision or a problem you should report to your surgeon: Fever greater than 101 degrees Fahrenheit with an oral thermometer. Cloudy or foul-smelling drainage from your incisions. Redness around the incision that is hot or tender to touch. Increasing abdominal pain or pain in other areas your pain medication will not help. Shortness of breath. Pain in your legs. Chest pain Any time you vomit and there is blood in the contents Any thing you do not feel is right! Always try to go back to the Emergency Department where you had your surgery done unless it is a life threatening emergency, then call 911 and go to the nearest Emergency Department. It is always in your best interest to have the surgeon who performed your surgery see you for any problems at any time after you have recovered from the surgery. Only your surgeon knows what he/she has done. Do not let just anyone treat you after Bariatric surgery! CALL YOUR SURGEON IF YOU HAVE ANY OF THESE SYMPTOMS! Return to the University of Kansas Hospital for any problems or concerns! You have already prepared your foods to have on hand when you get home. This includes: Sugar free popsicles Sugar free gelatin Sugar free pudding Hot cereal (cream of wheat or cream of rice) Strained cream soups Decaffeinated tea or coffee Sugar free drinks such as: Propel water, Diet Snapple, Crystal Light, Sugar free Tang, Diet Green Tea or any non-carbonated diet drinks Do not drink carbonated beverages or beverages that contain caffeine. When you get home you will want to start to increase your activity. Do not stay in bed! Do not go to the gym or work out for 5

6 the next few weeks. You will want to get into the habit of walking to increase your stamina. You can start out walking five minutes to and five minutes back; that is ten minutes worth of exercise. Do that at least three times a day until you can walk at least an hour twice daily. The more you exercise the more weight you will lose. 10,000 steps is a great way to exercise. Get a pedometer so you can count those steps. 10,000 steps equal 5 miles. Do not do anything that will strain your abdominal muscles for about the next two months. Do not lift anything greater than five pounds for the first three weeks and nothing greater than ten pounds for the next six weeks. We want your incisions to heal and this will ensure you get the greatest healing strength back in those muscles. You will want to avoid the following during this time: Vacuuming Making beds Lifting chairs Carrying heavy bags of groceries Lifting children or pets Pushing sliding glass doors Moving furniture Riding an exercise bike Lifting weights Aerobics Anything you normally do not do! You will want to follow your diet plan as ordered. You should be on a Bariatric Full Liquid Diet and drinking your protein shakes. A copy of the diet will be given to you prior to your surgery so you can purchase the foods necessary. Always prepare hot cereals with skim milk for added protein and calcium. Use a protein supplement that contains Grams of WHEY protein. Always eat protein food first. Eat for minutes only and stop eating when you feel full or at the end of that time. Do not eat between meals, do not snack unless directed, and do not over eat! Water is a very important part of your recovery. You will need to drink no less than 64 ounces daily along with any additional liquids. These are guidelines to assist you with your intake. You will feel as though you are doing nothing but drinking or eating these first few weeks, but once you get used to drinking that amount it will become very natural for you to be able to get in the required amounts of fluids. These guidelines will assist you with your fluid intake: Sip slowly the use of a child s Sippy cup can help you from drinking too fast. Warm or room temperature liquids often feel better at first Carbonated beverages and caffeine are to be avoided Variety is important to keep you from becoming bored with the diet Limit total sugar to less than 5 Grams to decrease nausea DO NOT GULP YOUR DRINKS 6

7 As you progress with your diet and become more familiar with the foods you are able to eat and tolerate, there is certain information that will be helpful to you. The following information is designed to assist you when you are ready to progress in your diet. Tips for Eating in the Real World Do not drink 30 minutes prior to the meal, during the meal, or for one hour after the meal. Do not graze. This behavior will worsen cravings and will not allow you to have a feeling of being full or satisfied with the meal. Get a smaller plate and fork to have at home. The smaller plate will make the food you eat more appealing and will lessen the amount of empty room on the plate. A smaller fork will encourage you to eat smaller bites so you can chew your food more thoroughly. Only eat for minutes and discard any leftover food on the plate. Eat no sooner than every four hours. You do not want to get into the habit of watching the clock to see if it is time to eat. Eat when you would normally eat; breakfast, lunch, and supper. Avoid eating another meal prior to bed. Teach yourself to pay attention to feelings of being full, then the feeling of being empty, then full, then empty. Start to find the signals indicating it is time to eat! Dumping Syndrome is an unpleasant side effect of ingesting too much sugar, fat, or drinking with foods. It includes the following symptoms: Rapid heart beat Fuzzy thinking Blurred vision Cold hands and feet Dry mouth Nausea/Vomiting Diarrhea General feeling of misery These feelings can last for minutes to hours This is a syndrome associated with gastric bypass and not gastric banding! 7

8 Eating from Day One: Never eat more than 6-8 Tablespoons of food at any meal. You should never try to eat all of the food. Always eat protein first, vegetables, then fruits. When you first start to eat after pureed foods, never take a bite of any meat larger than your little finger nail or any other foods larger than your thumb nail. Always chew till it is the consistency of baby food before you swallow. Wait at least 5 minutes between bites. Never take a drink during your meal. All meals should last at least 30 minutes. You may feel like you can eat too much. It may depend on the time of day or what you eat that allows you to eat more or less. Keep to one ounce portions until you reach your goal weight. This will keep you from sabotaging your new life style and ensure that you do not out eat your pouch. Live by the 3 Bite Rule. Eat only three bites of solid food then wait for five minutes. In the beginning you may find it is difficult to eat all of the food in the meal, but by waiting it gives your mind and stomach time to communicate. This is a very helpful rule when you start eating solid foods to eliminate the possibility of over eating. Make good choices in the foods you eat. Avoid fast foods and foods high in fat, carbohydrates, and calories. The gastric bypass patients may find the fat content of the food can cause dumping syndrome or diarrhea. The gastric banded patients will not lose as much weight with the higher fat diet. Foods high in carbohydrates or sugars can cause a dumping syndrome in the gastric bypass patients. A good rule of thumb is to avoid foods high in processed sugar, greater than 5 Grams of sugar or carbohydrates, and foods that say no sugar added. These are not sugar free foods. Gastric banded patients will not lose weight as quickly eating high sugar or high carbohydrate foods and will make you feel hungry quicker. You may find pasta, rice, and bread difficult to eat. Take very small bites and chew thoroughly. Eat a very small amount and chew well to see if you will be able to tolerate these foods. These foods will swell and take up a larger volume in your new pouch making you feel uncomfortable until they have been digested. Wait to eat melted cheese until you can chew very well. It is easy for melted cheese to get stuck and cause discomfort. You may find grated cheese easier to eat in the beginning. 8

9 Things to Remember: Take it one step at a time! This is a journey. All journeys have ups and downs. Do not weigh yourself every day! This will only add to your frustration and anxiety. Choose one day of the week to weigh, do it the same time every time and with the same type of cloths. This will give you an idea of your weight loss, but the scales at your doctors office is the most reliable. A better way to judge your weight loss is with a tape measure. Measure around your waist and keep that total for a more accurate weight loss. You will be surprised at the difference in your cloths and it is a good indication of the loss of body fat. Do not compare your weight loss to anyone else. This is not a competition. There are many factors that influence weight loss: medications, body type, and men lose weight quicker than women, and the amount of weight you need to loose. Gastric bypass women will need to use a barrier type of birth control after the surgery for 18 months. Birth control pills will not work properly or be as effective in your new pouch. Women who have been infertile for many years find themselves pregnant after a great deal of weight loss. Gastric banded women do not have an absorption problem, but may find they are pregnant after losing a great deal of weight if not using some type of birth control. Everyone heals at a different rate. You were asked to stop smoking before your surgery and it is recommended to remain smoke free. There are smoking cessation classes available for anyone who would like information. Please ask about the program. Your tissues will not heal as well and it decreases your lung function. Healing takes place from the inside out; therefore, it will take the six weeks for you to completely heal the areas on your abdomen. Let the doctor know if you have any areas you feel are not healing as well. Most all patients of weight loss surgery go through a period of depression after the surgery. There is a large hormone shift after weight loss along with the reaction to the anesthesia. It is also not uncommon for you to mourn the loss of food. These feelings are normal and will pass. If you find you are becoming more depressed and it is interfering with your daily activities of life, contact your surgeon or your Primary Care Physician for their help. Do not try to deal with this alone. Continue to attend the support groups to work through these feelings. If you are taking any type of medication for depression or other psychological problem, please contact your doctor to find out how long it will take you to withdrawal from your medications prior to surgery. You will need to ask if you are on any extended release medications and if so you will need to possibly have them changed all medications will need to be made available to be crushed, in liquid form, or 9

10 chewable. If you are currently seeing a therapist or a Psychologist, continue after the procedure it will help with some of the food issues you face. Warning: Some medications cannot be stopped abruptly. Contact your pharmacist or physician and ask about all of your medications. Also, you can restart any of your medications as soon as you return home discuss this with your surgeon if you have not resumed them in the hospital. If you are an emotional eater, you may need to consult a therapist to deal with the changes that are happening to you. Again, continue to come to the support groups. There are subjects discussed during the meetings that help you answer the questions that are coming up after the surgery. You will find you are not alone in these thoughts and feelings. Support groups are held for Gastric Bypass/Vertical Sleeve Gastrectomy patients on the first Tuesday of the month at 6:00 pm to 7:00 pm. The Lap-Band support group meets the fourth Wednesday of the month at 5:30 pm to 6:30 pm. All of the support groups are held in the Community Room at KU Medwest 7405 Renner Road, Shawnee, KS Please, do not bring small children to the groups. Support Groups are available for all patients who have had bariatric surgery. You will find that you will have questions answered when you attend these meetings you thought only you were wondering about. The support groups are for you and your family and you are encouraged to attend on a regular basis. Make a list of the milestones you have conquered since surgery. Be proud you are able to sit in the bathtub, walk up a flight of stairs, walk a mile, or whatever your goal has been. Do not consider the scales as your marker. You are much more than a number and this is so much more than a size. Journal. You will find so many good things about journaling and it is also very helpful when you hit a plateau. Journaling enables you to tell your story and helps you to understand what and why you have done some of the behaviors you do. It allows for expression. Please keep a food journal for the first 6 months so we can go through it and assist you with any problems you might be having with your diet or with weight loss. 10

11 Long Term What to Expect: You can expect to have relief from most of the comorbidities you were suffering with prior to the surgery. You are counted as successful if you have lost 60-80% of the excess weight needed to be lost. You may experience greater self-esteem. You can never eat the way you ate prior to the surgery. You must modify your present behavior or you will not obtain your goal or your goal weight. You can gain all of your weight back if you do not follow the guidelines: Gastric Banding: patients will regain all the weight lost if their band is removed or the fluid is taken out for long periods of time. Gastric Bypass: patients can start to regain weight after 3-4 years if diet and exercise are not followed. Vertical Sleeve Gastrectomy: patients that do not adhere to the recommendations for portion control may stretch out the pouch. You have 85% of your stomach removed and there is no reversing this procedure. The list is endless to what you may experience or do with the inner person that has been hidden for so long. There may be some foods you are never able to eat again or it may take time before you can. These foods may be or not limited to the following: Milk Red meat (hamburger, steak, or pork) Pasta Bread Rice Sea food (salmon & tuna) Alcohol 11

12 Eat to LIVE! Do Not Live to EAT! The key to your success lies with the following: Apply good sense Follow the rules for success Make wise food choices Exercise some control You do not want to go back to your previous ways of eating You must make lifestyle changes If you eat for reasons other than hunger, get counseling. Commit to an exercise program you can stay with. THIS IS A TOOL!!!! Your success is dependent on how well you utilize this tool. We would like to thank you for your interest in the Bariatric Program here at the University of Kansas Hospital. If you have any questions or concerns please feel free to call or me at any time. Patricia A. Sell, RN, BSN Bariatric Program Coordinator Office psell@kumc.edu Emergency Department: Main Hospital: Information Desk: Sutherland Institute Desk: