Bariatric Surgery Post-Op Pre Select Diet Class

– Hi, I’m Jessica Snyder,
registered dietician and outpatient and nutrition director. Welcome to your first week after surgery post-operative pre-select diet class. Our agenda today is to discuss
your questions and concerns, really bringing in the full picture of if your experiences are normal. We want to bring this all together, so that you know how to
effectively use your tool. We need to address what
you’ll be eating and drinking during the pre-select phase
and what your food choices are. We’ll also be discussing
supplements, exercise, wound care, medications,
expectations and warning signs, as well as upcoming events. It’s important we discuss your diet and lifestyle after surgery. Following a precise diet
progression after surgery is an important piece to
ensure proper healing. There’s a modified texture of
this diet during this process to help decrease inflammation during the post-surgical process. Liquids move through rather easily, and soft foods do as well. However, staying away from solid foods or foods that are coarse
in nature or stringy during this time frame. Your portion size may be based
on your tool after surgery. For bypass, that’s typically
about one to two ounces at this point. For a sleeve, it’s between
two to three ounces, and for a duodenal switch
between two to four ounces. Your food should be
measured in a measuring cup during this timeframe to ensure accuracy. During this presentation
today, we’ll be addressing your pouch as your new stomach and your remnant as your old stomach, and this is for bypass procedures only. So, once again, listen to your pouch and your volumes may be dependent on the surgical procedure you
chose and the healing process. Dumping syndrome occurs
for gastric bypass patients when they consume too many
carbohydrates at a meal. This causes food to rapidly empty into their small
intestines, causing symptoms such as diarrhea, sweatiness,
dizziness, lightheadedness, fainting, nausea, or vomiting. So be cautious about the
carbohydrates you’re consuming and make sure you’re focusing on protein. Your pre-select food choices
will start on day seven and these foods are typically tolerated for bypasses at one ounce every two hours, and for a sleeve or duodenal switch at one to two ounces every two hours. Small, frequent protein rich meals is our focus during this timeframe, and your pre-select diet will
be from day seven to day 21. The pre-select diet foods include things such as low-carb yogurt,
low-fat refried beans, egg whites or Egg Beaters,
fat-free cottage cheese, as well as sugar-free pudding and tofu. These are appropriate during
this pre-select diet phase from day seven to day 21. Protein shakes and
powders can be continued during this phase to help
you meet your protein goals. Protein drinks are used to help supplement your nutrient needs. You can consume between
one to eight ounces of protein drinks every two hours. It’s important that you
keep track of a food log, to help ensure you’re
meeting your protein needs throughout the day. Additional protein powder can be used in soft foods that you’re consuming. This can help enhance the protein quality of the food you’re eating
and better help you to meet your protein
needs throughout the day. The number one reason for
readmission into the hospital is dehydration, so sip,
sip, sip, throughout the day and stay hydrated. This may feel like a full time job, but getting a minimum of
48 ounces of fluid per day and a goal of 64 should
feel like something that you’re working towards. Also, avoiding any straws, carbonation, caffeinated beverages, as
well as calorie beverages during this phase. Water is your best
choice during this phase, and making sure you stay on top of fluids, but you do not need to separate your meals from your fluids at this point. That doesn’t begin until six weeks. Vitamin supplementation
is a lifelong requirement to prevent deficiencies. Your food path has been
rerouted and absorption has been decreased, as
well as you’re not eating as much food as you once did, so supplementation is crucially important. Liquid and chewable
options are your best form of multivitamin supplementation. You can talk with your
doctor about switching to a pill-sized tablet after
about three to six months. You’ll just wanna make sure that they’re smaller
than the size of a pea, to avoid them getting stuck,
and you may, at that point, address if you can cut your
pills with a knife cutter, and absorb them appropriately. Once again, talk to your doctor, if this is a modification
you want to address. Taking a multivitamin after surgery is something that you’ve already started. You will need to make sure
you’re maintaining that regimen of taking two doses per day, depending on the surgical
procedure you’ve had. For B12, it needs to be taken
at 1000 micrograms per day, sublingually, which
means under your tongue and melting completely,
or that nasal spray, or the once a month injections
with your physician’s office. Additional vitamins and
minerals may be recommended based off of your labs, and doses may be changed
based off of your lab values. So work with your dietician and doctor to make sure you’re up to date with the appropriate vitamins and minerals you should be taking. Calcium and fiber supplementation does not start until six
weeks, or the solid food plan, so you can hold on that for now. This is your vitamin and mineral chart. So review your current supplementation, and the timeline in which you should be progressing these vitamins. At this point, you should be at minimum taking your multivitamin,
as well as your B12. And for the duodenal switch patients, making sure you take
your fat soluble vitamins A, D, E and K. Exercise is as important
as water and protein, and it must be used
together to ensure success. It helps with healing,
and promotes circulation, it improves your mood and energy, increases your metabolism, and is a part of your lifestyle change. So start a routine today,
if you haven’t already. You should be walking four
to six times a week at first, and working on increasing that over time. Work towards getting 30 minutes a day, and you can split it up if needed. Set obtainable goals, and start working on progressing towards those
goals throughout the day. You may get fatigued, but remember, you can break up your activity. Still, no heavy lifting, such as pushing or pulling or straining. No more than 15 pounds at this point. So focus on activities you can do, instead of the ones you can’t. In regards to your wound care,
if your incisions are oozing, you can dress and gauze
those with paper tape. Change the dressings daily. Daily checks for incisional
infection are important, so make sure you’re taking
care of your incision, and assessing how they’re healing. No soaking in baths, as that does increase
the risk of infection. You should be waiting at
least three to four weeks for wounds to heal before
you start soaking in a bath, swimming, or going in a hot tub. Although baths and bathing
are not appropriate, showering is always okay. After surgery, we want to make sure that you have your follow-up appointment scheduled with your
primary care physician. This should be completed within one to two weeks of your surgery, especially if there’s medication
changes that are needed. Many of our patients
experience medication changes due to their change in
blood pressure, blood sugar, as well as other challenges
they may be having that need medication adjustments. A small amount of weight loss
can make a big difference in these medication changes. Monitor your blood sugars
frequently if you’re diabetic, as well as monitor your
blood pressure daily, if you have blood pressure challenges such as hypertension. We wanna set you up for
success with your expectations. Many of our patients will ask, “Are these aches and pains normal?” It is more common to have
left-sided abdominal pain, as there was a lot of manipulation during the surgical process
on this side of your body. Make sure your pain is not accompanied by unexplained nausea, vomiting,
a fever greater than 101, unresolved diarrhea or constipation. If these concerns are happening, please reach out to your surgeon. Mild nausea can be a normal symptom of your recovery and healing process. Make sure when you’re eating, that you’re not overfilling your pouch. Also, make sure that you’re staying on top of your fluid requirements,
as well as your protein goals. This will help to reduce hunger, and improve your overall
energy and healing as well as recovery. Your bowel habits may
change after surgery, and it’s normal to
experience these changes. Looser stools are common
on the liquid diet. Less frequent stools are also common, as you’re eating less food and less fiber. You will be adding fiber back in at the six week post-op phase. If you’re having diarrhea, it can increase your risk of dehydration. If your urine is dark and you’re starting to
feel tired and dizzy, you may need to have an IV placed to get your hydration back up to par. So stay on top of your hydration, and if you’re unable to do so, please reach out to your surgeon’s office. Constipation is also something that some of our patients struggle with. If you’ve had no bowel
movement for three days, please reach out to your surgeon’s office, as they may prescribe a stool softener. Minor symptoms require a call
to your surgeon’s office, especially if symptoms persist. A fever of less than 101, a seroma, which is that blister-like
appearance around your incision, temporary numbness in extremities, incisional abcess along your suture lines, fluid retention, loose knot or suture, constipation or diarrhea, mild nausea, or an oral yeast infection can be minor symptoms after surgery. Once again, reach out
to your surgeon’s office if these persist. Major symptoms that require a
911 call, emergency room visit as well as a call to your surgeon include: Fever greater than 101,
leg pain or swelling, shortness of breath, severe
nausea with protracted vomiting, dizziness, as well as chest pain. Our upcoming events include
our soft food class, which is at three weeks, our solid food class at six weeks, the three and six month office visits that you’ll need to schedule with labs, the six to nine month back
to basics review class, and our monthly support groups for all of our patients including bypass, band, duodenal switch, and sleeve.

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