(C)
Life After Weight Loss Surgery
| Q. What
will I eat after surgery? |
A. You will be on
intravenous fluids on the day of surgery. The day after we may
do a swallow study to be sure there is no leak in the staple
line. If there is no leak, you will be started on liquid diet 24
to 48 hours after surgery. Intake is limited to 1 or 2 ounces
per meal so that the stomach can heal properly. If this is well
tolerated, next day you will be advanced to blanderised soup.
You will be discharged on liquid diet. We begin patients with
liquid diets, moving next to semi-solid foods and about 4 to 6
weeks later, back to solid foods. This transition is necessary
to allow time for your newly created stomach pouch to heal
properly. Drink 2 liters or more of water each day. Water must
be consumed slowly, 1-2 mouthfuls at a time, due to the
restrictive effect of the operation.
| Q.
What's so important about exercise? |
A. After weight
loss surgery, you will lose weight because the amount of food
energy (calories) you are able to eat is much less than your
body needs to maintain itself (the basal metabolic rate). The
difference or caloric shortfall has to be made up by burning
(metabolizing) caloric reserves and the tendency will be to burn
unused muscle before stored fat. If you do not exercise daily,
your body will consume your unused muscle, and you will lose
muscle mass and strength. However, daily aerobic exercise for 20
minutes shifts your metabolism away from muscle reserves and
forces your body to burn fat instead.
| Q. What
is the right amount of exercise after weight loss surgery? |
A.
Exercise actually begins on the afternoon of weight loss surgery
when you get out of bed and start walking. The goal is to walk
further the next day and progressively further every day after
that extending into the first few weeks at home. Patients are
often released from medical restrictions and encouraged to begin
exercising about two weeks after surgery, limited only by the
level of wound discomfort, if any. The type of exercise is
dictated by the patient's overall condition. Patients with
arthritic knees, for example, can't walk well, but may be able
to swim or bicycle. Most rehabilitation facilities offer water
aerobics, which is an excellent form of exercise for patients
with arthritis and degenerative joint problems. Many patients
begin with low stress forms of exercise and are encouraged to
progress to more vigorous activity as they are able to perform
more.
| Q. What if I have had a previous weight
loss surgical procedure and I'm now having problems? |
A.
You should contact your original surgeon. He or she is most
familiar with your medical history and can make recommendations
based on knowledge of your previous surgical procedure
| Q.
What happens to the lower part of the stomach that is bypassed? |
A. The stomach is left in place with intact blood
supply. In some cases it may shrink a bit and its lining (the
mucosa) may atrophy, but for the most part it remains unchanged.
The lower stomach still contributes to the function of the
intestines even though it does not receive or process food. It
still produces the secretion necessary to absorb Vitamin B12 and
contributes to endocrine hormonal balance and motility of the
intestines in ways that are not entirely understood.
| Q.
How big will my stomach pouch really be in the long run? |
A.
This can vary by surgical technique and the bariatric surgeon.
In the Roux-en-Y gastric bypass, the stomach pouch is created
with a capacity of one ounce or less (15-20cc). In the first few
months it is rather stiff due to natural surgical inflammation.
About 6-12 months after surgery, the stomach pouch can stretch
and will become more flexible as swelling subsides. Many
patients end up with a pouch capacity of 4-6 ounces.
| Q.
What if I'm not hungry after weight loss surgery? |
A.
It's normal to have very little appetite for the first month or
two after weight loss surgery. As long as you are able to take
three meals with about 1000 calories, there is nothing to worry.
Q. How can I know that I won't just keep
losing weight until I waste away to nothing? |
A.
Patients may begin to wonder about this early after the surgery
when they are losing 10 - 20 pounds per month. Two things happen
to allow weight to stabilize. First, a patient's ongoing
metabolic needs (calories burnt) decrease as the body sheds
excess pounds. Second, there is a natural progressive increase
in calorie and nutrient intake over the months following weight
loss surgery. The stomach pouch and attached small intestine
learn to work together better and there is some expansion in
pouch size over a period of months. The bottom line is that as
long as there are no surgical complications, patients are very
unlikely to lose weight to the point of malnutrition.
| Q.
Is there a difference in the outcome of weight loss surgery
between men and women? |
A. Both men and women
generally respond well to this surgery. In general, men lose
weight slightly faster than women.
| Q. Will I
be miserably hungry after weight loss surgery since I'm not
eating much? |
A. Most patients say no. In fact, for
the first 4-6 weeks patients have almost no appetite. Over the
next several months the appetite returns, but it tends not to be
a ravenous, "eat-everything-in-sight" type of hunger.
Small pouch results in a very early sense of fullness followed
by a very profound sense of satisfaction. Even though the
portion size may be small, there is no hunger and no feeling of
having been deprived. When truly satisfied, you feel indifferent
to even choicest of foods. Patients continue to enjoy eating,
but they enjoy eating a lot less.
| Q. What if
I am really hungry? |
A. This is usually caused by
the types of food you may be consuming, especially starches
(rice, pasta and potatoes). Increasing protein intake is
helpful. There may also be a psychological problem with lack of
food in your life “head hunger”. Be absolutely sure
not to drink liquid with food since liquid washes food out of
the pouch.
| Q. Is sexual activity restricted? |
A.
Patients can return to normal sexual intimacy when wound healing
and discomfort permit.
| Q. Will I be able to take
oral contraception after surgery? |
A. Most patients have
no difficulty in swallowing these pills.
| Q. I
am thinking about getting pregnant. Will I be able to have
children after weight loss surgery? |
A. Many women
have had successful pregnancies after weight loss surgery. There
is nothing per se that would prevent pregnancy. Infact,
bariatric surgery enhances fertility in those who have had
difficulty in conceiving. We recommend, however, that you wait
until your weight loss is complete before becoming pregnant.
This may take a year or more. The effect of rapid and prolonged
weight loss on the developing fetus is unknown but it could have
dire consequences and pregnancy is not recommended until a
stable weight has been attained.
| Q. Is there
any difficulty in taking medications? |
A. Most pills
or capsules are small enough to pass through the new stomach
pouch. Initially, It is suggested that medications be taken in
liquid form or crushed.
| Q. Will I have to
change my medications? |
A. Your doctor will
determine whether medications for blood pressure, diabetes, etc
can be stopped when the conditions for which they are taken
improve or are eliminated after weight loss surgery. For
medications that need to be continued, the vast majority can be
swallowed, absorbed and work the same as before weight loss
surgery. Usually no change in dose is required. Two classes of
medications that should be used only in consultation with your
surgeon are diuretics (fluid pills) and NSAIDs (most
over-the-counter pain medicines like aspirin, ibuprofen,
naproxen, etc.). NSAIDs may create ulcers in the small pouch or
the attached bowel. Most diuretic medicines make the kidneys
lose potassium. With the dramatically reduced intake experienced
by most weight loss surgery patients, they are not able to take
in enough potassium from food to compensate. When potassium
levels get too low, it can lead to cardiac problems.
| Q.
Will there be any hair loss? |
A. Hair loss can
accompany rapid and significant weight loss. The most common
reason for this is poor intake of protein. Lack of mineral zinc
can also lead to hair loss. Patients who have not been eating
enough protein will usually show some hair loss between four and
six month after surgery. Consistent intake of protein at
mealtime is the most important prevention method. Also
recommended are a daily zinc supplement and a good daily volume
of fluid intake. Happily, most patients experience natural hair
re-growth after the initial period of loss.
| Q.
What can I do to prevent excess hanging skin? |
A.
The amount of excess skin depends on the age, skin elasticity,
total weight loss and how much the skin was stretched. Many
people, heavy enough to meet the surgical criteria for weight
loss surgery have stretched their skin beyond the point from
which it can "snap back". Some patients will choose to
have plastic surgery to remove loose or excess skin after they
have lost their excess weight.
| Q. Will
exercise help with excess hanging skin? |
A.
Exercise is good in so many other ways that a regular exercise
program is recommended. Unfortunately, most patients may still
be left with flaps of loose skin.
| Q. What
will the staples do inside my abdomen? Is it okay in the future
to have an MRI test? Will I set off metal detectors in airports? |
A. The staples used on the stomach and the
intestines are very tiny in comparison to the staples used for
skin incision closure. Each staple is a tiny piece of titanium:
so small it is hard to see other than as a tiny bright spot.
Because the metal (titanium) is inert (not chemically reactive),
most people have no reaction to them. The staple materials are
also non-magnetic which means that they will not be affected by
the magnet in an MRI. They will not trigger airport metal
detectors. |
