Thursday, March 15, 2007

life changes

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Life After Roux-en-Y Gastric Bypass Surgery (RNY)

Most weight-loss surgery patients recover from surgery without complications. Although you will have some discomfort from the surgery, you will need to get out of bed and start walking the next day. This activity is crucial in preventing surgical complications, such as blood clots.

If you have been diagnosed with sleep apnea through a sleep study, you will remain on breathing monitors in a monitored bed overnight or until you are breathing well on your own.

The hospital stay for patients who undergo the Roux-en-Y procedure is usually two to four days. Before you are discharged, make sure to receive full instructions for your care at home and schedule to see your bariatric surgeon about one week after the surgery.

At Home After Surgery
If you have any questions or concerns once you are home, you should call the nurse who works with your surgeon. Specifically call your doctor if you experience any of the following:

* Persistent nausea or vomiting
* Vomiting a bright red or dark brown liquid (go to the emergency room)
* Increased redness, swelling or foul-smelling discharge at incision site
* Increased soreness or pain in your incision(s)
* Any new or unusual pain in your abdomen, chest or legs
* Temperature higher than 101°F
* Passage of very dark stool
* Acute depression or negative emotions

At home after surgery, you will need to follow specific eating guidelines that your dietitian will have explained to you. For the first six weeks after your weight-loss surgery, your diet will consist of liquid/pureed food. This includes foods that are liquid to soft in consistency. Examples of soft consistency foods are scrambled eggs, cottage cheese, sugar-free yogurt, hot cereal and mashed potatoes. You also can drink non-carbonated fluids that are sugar-free and caffeine-free. Good choices are water, milk, sugar-free flavored drinks and high-protein liquid supplements. Your dietitian should recommend liquid supplements to meet your nutritional needs during this time. As your tolerance builds, you will progress to a soft diet and then to regular foods.

Your “new” stomach is roughly the size of an egg. It will stretch to the size of a cup in about a year. You can avoid discomfort and complications if you do the following:

* Eat small, frequent meals (five or six) throughout the day. (Your stomach will be too small to hold large meals.)
* Chew all foods slowly and thoroughly. (It may take you up to an hour to complete your meals and snacks.)
* Drink fluids 30 minutes after your meal. Be sure to drink in sips.
* Do not drink fluids with your meals. Your smaller stomach may not be large enough to hold fluids and food at the same time.
* Do not eat sweets.

Avoid foods that cause any discomfort. You might consider keeping a diary of the foods you eat, as well as any foods that are difficult to tolerate. Your diary will help you identify which foods cause discomfort. During follow-up visits with your dietician, you can use your diary to report any foods you cannot tolerate.

Your dietitian will help you plan healthful, appropriate meals. You also will be guided in selecting a variety of foods that are rich in vitamins, minerals and protein so you will stay well nourished. Your dietitian will also recommend a multivitamin/mineral supplement.

Digestive distress, such as gas and constipation, is common in the first few weeks following bariatric surgery. Unless your physician instructs you otherwise, you can use over-the-counter gas relief medications and stool softeners. If you are constipated, you can add extra fiber to your diet by eating applesauce, oatmeal and pureed prunes.

Dumping Syndrome
Dumping syndrome is fairly common following bariatric surgery, particularly if you don’t follow all of the special dietary instructions given to you. The signs of dumping syndrome are:

* Nausea
* Vomiting
* Bloated stomach
* Diarrhea
* Excessive sweating
* Increased bowel sounds
* Dizziness
* Emotional reactions

These symptoms need to be addressed during the initial follow-up with your doctor.

To prevent dumping syndrome, DO NOT eat or drink the following:

* Beverages containing caffeine such as coffee, tea or chocolate
* Citrus food or juices such as orange, grapefruit, lemon or lime
* Carbonated beverages
* Sugar and sweeteners such as dextrose, fructose, mannitol, sorbitol, white sugar, brown sugar, syrup, molasses, candy, jelly, desserts, jams or preserves
* Alcohol
* Sweetened beverages including regular soda, coolers, drink mixes, Kool-Aid, fruit punch or undiluted fruit juice

In addition:

* Eat only canned or very tender, well-cooked fruits and vegetables.
* Do not eat any raw fruits or vegetables, except bananas.
* Do not eat the skins of any cooked vegetables or fruit.

Bariatric surgery will change your eating habits quite a bit. Rely on close family members and friends for support and encouragement, as this may be an emotional time in your life. It is important that you keep a healthy mind and body. Keep your follow-up appointments, exercise and learn to cope with emotional difficulties. Your healthcare team will also be there to guide you after your weight-loss surgery.

Activity Restrictions
Avoid any strenuous activity until you are healed, but do not avoid walking! Walking is a required activity at this stage of your recovery. Don’t drive if you are taking pain medication other than Tylenol. At your first follow-up visit, your doctor will determine when you can return to work.

Incision Care
Even though you may have staples or steri-strips on your incision when you are discharged, you may wash your abdomen with mild soap and water in the shower. Do not take a tub bath or use a Jacuzzi, pool or hot tub until your incision is fully healed.

Call your doctor if you experience any of the following:

* Increased redness, swelling or foul-smelling discharge at incision site
* Increased soreness or pain in your incision
* Temperature higher than 101°F
* Any new or unusual pain in your abdomen, chest or legs

After you have healed, you are encouraged to embark on a physical fitness program. Exercise will keep you feeling well and energized. Always discuss exercise options with your doctor so you know what type of exercise is most appropriate for you. Choose an exercise that you will enjoy and look forward to doing. In fact, for many people, returning to physical exercise is an important step toward feeling better.

Avoid Pregnancy
If you are a woman of childbearing age, you must not get pregnant within the first 18 months to two years following bariatric surgery. The rapid weight loss and nutritional deficiencies associated with weight-loss surgery make pregnancy very dangerous for you and for a developing fetus. Take special precautions to prevent an unsafe pregnancy, particularly because weight loss after bariatric surgery tends to increase fertility.

Follow-up Visits
Regular follow-up visits are scheduled during the first year after weight-loss surgery to check your overall physical and mental health, metabolism and nutritional status. It is crucial to your health that you keep these follow-up appointments.

Your first follow-up visit with your bariatric surgeon will be seven to 10 days after discharge. Subsequent visits are scheduled for one month, three months and every three months thereafter for the first year. After the first year, follow-up visits are required on a yearly basis. You also will likely be scheduled to see your dietitian and psychologist about one month following discharge and for regular follow-up visits to help you adjust to life after bariatric surgery.

Many patients may need plastic surgery one to two years after weight loss to remove skin folds around the abdomen.

Body Contouring
Major weight loss in the wake of bariatric surgery or a steady diet-and-exercise program is a significant personal accomplishment and often a life-changing event. But the experience often leaves conspicuous — and permanent — signs of the former physical self: excess skin that has lost its elasticity and that drapes the body in heavy folds.

This weight-loss legacy can make getting dressed a chore and clothing choices problematic, interfere with mobility — particularly with exercise — and even precipitate the development of troublesome dermatologic conditions. Aside from medical issues, after losing so much weight, patients want their bodies to more closely match the new image they have of themselves.

Several criteria must be met before contouring surgery begins: weight trend (i.e., weight has been stable for at least one year and no further weight loss is expected), physical status (e.g., whether abdominal hernia is present), overall health (i.e., what the body can tolerate surgically and whether a patient has a chronic medical condition, such as diabetes, hypertension or heart disease), nutrition (e.g., patients must be screened for protein deficiencies that can impede proper healing), psychological status (i.e., patients must be psychologically “fit”) and patient expectations (i.e., what the patient expects to look like after surgery). Patients who have undergone bariatric surgery shouldn’t go forward with contouring surgery until at least one year has passed.

Some of the most common post-weight loss procedures are:

* Barchnoplasty: removal of excess skin of the upper arm
* Breast Lift and Augmentation
* Panniculetomy: removal only of the overhanging lower abdominal skin for medical purposes
* Abdominoplasty: removes excessive abdominal skin
* Lower Body Lift
* Face and Neck Lift

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