Guide to Health & Nutrition

With Bariatric Surgery

Part 1

Bariatric Surgery

Gastric Bypass / Sleeve Gastrectomy

Obesity Surgery Center of Louisiana

Dr. Keith Chung

4150 Nelson Road, Suite B6

Lake Charles, LA 70605

337-433-1303

Chapter 1

Preparing for Surgery

Expectations & Timeline for Weight Loss Surgery

The following is information that is important to your health and the success of your weight loss. Following the information in this booklet is recommended to assist you in successful healthy weight loss following bariatric surgery.

Prior to Surgery:

  • Stop drinking and do not plan to resume consuming carbonated beverages/sodas/pop.
  • If you smoke or use tobacco products you must have stopped at least 3 months prior to surgery and DO NOT plan to resume after surgery!!!!!
  • Including electronic devices and vapors.
  • If you resume using tobacco products you WILL HAVE COMPLICATIONS.
  • Complications can lead to stomach ulcers, gastric leak or even death!
  • Patients who continue tobacco use may be dismissed as patients of this practice.
  • We encourage you to attend the monthly Bariatric Support Group meeting held at Lake Area Medical Center the second Thursday of the month at 6 PM (more information call 337-475-4075).
  • Complete nutrition visits and evaluation per insurance requirements/orper Dr. Chung’s recommendation.

2 Weeks Prior to Surgery:

  • Stop talking all diet medications (prescription and over the counter)
  • Stop taking all herbal supplements.
  • Attend Bariatric Nutrition Class at Lake Area Medical Center
  • RSVP: 337-475-4075 to register.
  • Attendance to this class occurs 2 weeks prior to surgery or within the first 3 weeks after surgery.

1 Week Prior to Surgery:

  • Stop taking all blood thinners or anticoagulants.
  • These include aspirin, Plavix, Coumadin, Vitamin E, St. John’s Wart, Gingko Biloba, Garlic, etc.
  • Stop taking birth control pills and hormone replacement therapy.
  • Stop taking all Aspirin, Ibuprofen and non-steroidal anti-inflammatory medications (NSAIDs).
  • Anti-inflammatory medication that is allowed: Celebrex.
  • Please check labels to be sure if medications contain aspirin, ibuprofen or NSAIDs.
  • Examples: Mobic (Meloxicam)AnacinNaprosyn

BC PowderBufferinIndocin

TalwinAlka-SeltzerPercodan

DoansEcotrinAnaprox

DristanMidolAdvil

NorgesicBayerArthrotec

Tramadol (Ultram)AleveMotrin

Alka-SeltzerEtodolacIndomethacin

5 Days Prior to Surgery

  • Start a liquid diet.
  • A shopping list will be given to you that will include good items to have available.
  • Rule of Thumb during this time period: you can have it if it can fit through a straw. ***If you have to chew it, then do not eat it!***
  • Patients with Diabetes:
  • Important that you monitor you blood sugar level while on this diet.
  • Blood sugars tend to drop significantly on the liquid diet.
  • You may need to decrease your diabetes medications while on this diet.
  • Recommended you consult/call your physician who prescribes your diabetes medication to adjust the dosages prior to starting diet.
  • You may need to test your blood sugar levels more often.

Day Prior to Surgery

  • If you are having an EGD, nothing to eat or drink after 12 Midnight on this morning. Only take scheduled blood pressure and thyroid medicationwith a small sip of waterthis morning.
  • If you are not having an EGD – please continue your liquid diet on this day.
  • Report to Dr. Chung’s office at appointment time to sign consents.
  • Bring with you COMPLETED PRE-OP TEST, ANESTHESIA FORM, and AGREEMENT.
  • Once you have finished at Dr. Chung’s office- ->Proceed to Lake Area Medical Center at scheduled time.
  • Bring your medication bottles or a list of medications with dosages and frequency taken.
  • Meet with pre-op nurse for pre-op testing:
  • Labs
  • Chest X-ray
  • EKG
  • For those having an EGD, Dr. Chung will be in before noon to perform the EGD.
  • A scope is passed through the mouth and used to visualize this esophagus and stomach.
  • You will be sedated for this procedure and someone will have to be available to drive you home.
  • After your pre-operative testing at the hospital, resume your liquid diet.
  • NO cottage cheese or egg beaters today.
  • NOTHING TO EAT OR DRINK after midnight tonight.
  • It is a good idea to pack an overnight bag for your hospital stay.
  • Possible items include: CPAP machine (if have sleep apnea), robe, slippers, loose night gown or easily removable shirt and pants that are comfortable, toothbrush, toothpaste, hair brush, shampoo, conditioner, lip balm, etc.

Morning of Surgery

  • No make-up or perfume.
  • Remove all jewelry, finger nail polish and false nails.
  • Nothing to eat or drink.
  • Do not take medications unless instructed to do so (usually hypertension and thyroid medications are taken with a small sip of water).
  • Arrive at the time instructed to you by your pre-operative nurse.
  • Someone must drive you to the hospital.

What to expect while in the Hospital

  • A family member or friend may stay with you overnight; however nursing staff will be rounding on you often.
  • Expect some pain after surgery. Pain medication will be available after surgery, you must notify the nurse when you are in pain and she will dispense the pain medication.
  • Nausea medication is also available if necessary.
  • Vital signs will be monitored every 4 hours. This can be aggravating but is necessary.
  • You will be provided an incentive spirometer during your stay.
  • Your nurse will show you how to use the incentive spirometer to expand your lungs to prevent pneumonia.
  • Continue to use incentive spirometer (inspire [take a deep breath in]) a few times every hour while awake during your hospital stay.
  • Four hours after arrival to your room you will be assisted by the nursing staff to get up and walk.
  • DO NOT get out of bed without assistance of the staff.
  • You will still be under the effects of medication and could easily fall.
  • You may not feel like getting out of bed but it is necessary to decrease your risk of blood clots and to start passing gas.
  • Dr. Chung inflates your abdomen with carbon dioxide to be able to visualize the operative field.
  • This gas can cause you abdominal pain, pressure and back pain.
  • Walking, deep breathing and sitting up in bed will help with pain relief.
  • Frequent short walks during the day can be beneficial in your recovery.

Day of Discharge from the Hospital

  • Someone must drive you home from the hospital.
  • You have been on pain medication and will not be able to drive yourself.
  • Dr. Chung will prescribe pain medication to be taken after surgery. The medication is usually taken as needed every 4-6 hours for the first few days after surgery. If the medication is too strong you may take extra-strength Tylenol instead. Take the Tylenol as directed on the bottle. Dr. Chung does not usually refill pain medication. If you do not live in the state of Louisiana, you must have your medication filled before leaving the state.
  • Plan on having someone stay with you for the first 24-48 hours after discharge.
  • Dr. Chung will instruct you on medications to continue after surgery.
  • Do not stop thyroid medication or anti-depressant medications without approval from the prescribing physician.
  • If you have hypertension, please monitor your blood pressure readings and if they are abnormally low or high please notify us.
  • Patients with diabetes, please continue to closely monitor/check your blood sugars. Please let us know if they are abnormally low or high.
  • Notify your primary care physician of your weight loss procedure and keep them active in your care.
  • The physician who originally prescribed these medications (high blood pressure and or diabetes medication) needs to be made aware that you have had the procedure and will guide you on how to adjust the medication.
  • FEVER: a low grade temperature (under 101.0) is normal. This is usually due to atelectasis from your surgery.
  • Atelectasis is caused by the anesthesia from your surgery making your lung capacity a little less than normal.
  • As a result, you are not circulating enough blood through our body which will cause a slight increase in temperature.
  • To ease this, you should do the following breathing exercises:
  • Take 8-10 deep breaths and hold as long as you can before exhaling.
  • Continue to do this until your fever subsides. Usually 2-3 hours.
  • VERY IMPORTANT: If you have excessive bleeding, excessive pain, or sudden spike in temperature or heart rate call the office immediately at 337-433-1303.
  • The nurse in the hospital should instruct you on dressing changes.
  • Please leave the little white pieces of tape called steri strips on your incisions until Dr. Chung instructs you to remove them.
  • Change your dressing around your JP drain daily or as needed.
  • You may notice some drainage around your drain, this is normal.
  • Continue drinking sugar free grape Kool-Aid several times per day until your JP drain is removed.
  • Monitor your JP drain for signs of purple fluid (grape Kool-Aid) and notify the office immediately if you suspect it.
  • Empty your drain as needed and remember to compress it to form suction after emptying.
  • Schedule an appointment with the office for 6 days from date of surgery.
  • ACTIVITY-take it easy for the first week. Walk often but avoid strenuous activity and heavy lifting. No heavy lifting (over 10 lbs) for 6 weeks.
  • You may take showers but no tub baths or swimming until incisions healed.

6 Days After Surgery

  • Follow-up appointment in office. JP drain will be removed.
  • Patients with diabetes need to bring in a log of blood sugar readings.

2 Weeks After Surgery

  • Start taking a complete multi-vitamin and calcium citrate supplement (1500 mg per day).
  • Multivitamins must be labeled as a complete multivitamin.
  • Please do not substitute vitamins with herbal supplements or drinks.
  • Calcium can be supplemented with Caltrate, Tums or Viactiv.
  • Dr. Chung offers Bariatric Advantage products for vitamin, calcium and protein supplementation.
  • Plan to attend monthly Bariatric Support Groups at Lake Area Medical Center on the second Thursday of the month at 6 PM (more information call 475-4760).
  • Attend Bariatric Nutrition Class at Lake Area Medical Center
  • RSVP: 337-475-4075 to register.
  • Attendance to this class must be completed before the 3 week post-op visit with Dr. Chung.

3 Weeks After Surgery

  • Follow-up appointment in office.

3 Months, 6 Months, 1 Year, 1 ½ Years and 2 Years After Surgery

  • You will receive a lab slip in the mail.
  • Have labs drawn at any local lab and they will fax results to our office (433-4644 fax).
  • Please follow-up with Dr. Chung’s office about 2 weeks after having blood work to ensure that his office did receive the lab paperwork.
  • Once we received the results we will contact you for a follow-up appointment. (It may take up to two weeks for us to get all the results).
  • Please log a diet and liquid intake journal prior to this appointment. Usually a few days preceding the blood work. This diet journal is very important to help keep diet on track!

2 Years After Surgery:

  • Our office will always be open to you.
  • Please call our office with any questions or concerns.
  • Please keep our office up to date with any address and phone number changes.
  • Come by the office so we can see how good you look and if you want to check your weight.
  • At this time yearly lab work is usually turned over to your primary care physician.
  • If you have any gastrointestinal problems please keep Dr. Chung informed – he is most familiar with your new anatomy.

Labs that are checked include:

CBC

CMP
LIPID PROFILE

HgA1C

B-12

TIBC

TSH

THIAMINE

VIT D 25-Hydroxy

Chapter 2

Patients with Diabetes

1)While you are following the liquid diet 5 days prior to surgery, make sure you have enough blood glucose test strips to check blood sugar more often.

  1. More prone to hypoglycemia (low blood glucose)

2)In the hospital the nursing staff will monitor your blood sugar and if needed will treat any abnormalities.

3)Continue to monitor your blood sugar after discharge from the hospital.

4)Bring a log of readings to follow-up appointments.

5)Please follow up with your primary care physician who follows your diabetes to have medications adjusted accordingly.

6)Some patients are able to stop taking their medications completely, immediately following surgery while others have to have their medication dose gradually decreased.

Signs of LOW BLOOD SUGAR (Less than 70 mg/dL):

Sweating

Nervousness, shakiness and weakness

Extreme hunger and slight nausea

Dizziness and headache

Blurred vision

A fast heartbeat and feeling anxious

Follow treatment for hypoglycemia per your provider’s recommendation.

Signs of HIGH BLOOD SUGAR:
High blood glucose

High levels of sugar in urine

Frequent urination

Increased thirst

Dry mouth

Breath smells fruity

Nausea and vomiting

Shortness of breath

Chapter 2

Patients with Hypertension

1)In the hospital the nursing staff will monitor your vital signs including blood pressure every 4 hours throughout both day and night. This can be aggravating but it is necessary.

2)Continue to monitor your blood pressure once you have been discharged from the hospital.

3)Follow-up with your primary care physician to have medications adjusted.

4)Regularly monitoring your blood pressure is STRONGLY RECOMMENDED.

Signs of LOW BLOOD PRESSURE
Dizziness

Weakness

Light-headed

Chest pain

Signs of HIGH BLOOD PRESSURE

Headache

Dizziness

Blurred vision

Nausea

Some individuals will have NO SYMPTOMS

Chapter 3

Welcome to Your New Way of Eating

  • HEALING:
  • Your new stomach will take six to eight weeks to heal. To allow your stomach to heal properly, without stretching, you will have to slowly progress your diet from a liquid diet, thicker liquids, soft stage diet then to solids. It is important that you follow these stages to ensure proper healing.
  • SUPPORT:
  • Monthly support group is held by Dr. Chung and hospital staff at Lake Area Medical Center. Support group is usually held at 6 PM on the second Thursday of the month. More information, contact the hospital Bariatric Coordinator 337-475-4760.
  • Newsletters are usually written quarterly and can be downloaded at
  • Another helpful website is . This website offers a chat forum and information from bariatric surgery patients across the country.
  • CHANGE IN DIETARY NEEDS
  • Your meal plan will be high in protein, which is essential for optimal healing and weight loss. Your diet will ALWAYS be low in fat and concentrated sweets. You will be on a liquid diet for about two weeks before advancing to pureed, soft solid foods and finally to soft, moist whole foods. At your follow up visits, you will be evaluated for your readiness to advance to the next stage of your diet.
  • TAKE TIME TO EAT
  • Your meals should last at least 20-30 minutes. Foods should be at a liquid consistency in your mouth before you swallow.
  • Chew foods completely.
  • Liquids should be sipped slowly, between meals only, so you will still have room in your stomach for meals and so that you do not wash your food out of your pouch during meals. This prevents you from overeating.
  • FINDING WHAT YOU CAN EAT
  • If you are experiencing any cramps, gas or diarrhea in your initial stages, you may have developed intolerance to lactose, the sugar found in milk. If this occurs, changing your diet to a lactose-free diet will usually reduce these symptoms. Please be aware of your symptoms and write down any foods that irritate your body so that we can find out the causes and make necessary changes.
  • IT’S A BUILDING PROCESS
  • This will be a progressive diet and each stage will add more foods for you to include in your diet. When advancing, it is important to try ONE new food at a time so that if you do have a difficult time tolerating it, we will know exactly which food cause the trouble.
  • DON’T FORGET TO EAT
  • Patients often report that they do not feel hungry or have a loss of appetite after surgery. In turn, this often causes patients to skip meals, depriving themselves of their nutritional needs. Many also believe that skipping meals will speed their weight loss. This is not true, nor is it healthy. You should eat a minimum of three small meals per day. It is acceptable to be unable to finish the food that is recommended. Do not force yourself to finish food with in a specific period of time. Stop eating as soon as you feel full. If necessary, put away the food that you didn’t finish and eat it later. Keep a food diary or record to facilitate your meal timings and help keep track of what you need to finish by the end of the day. Most often your three meals may turn into 4-6 small meals. Feelings of hunger and fullness take time for your mind and body to recognize. Bring these records with you to your follow up consultations.
  • IT WILL GET EASIER
  • Five to six weeks (Stage 5) following your surgery, you will advance to the final stage, which is solid food that is low in fat and low in sugar. This is the time to introduce different food groups into your diet. Your diet will incorporate a wide variety of foods from the different food groups; however your portions will be less/smaller.
  • Food groups include: protein/meat and meat substitute sources, vegetables, fruits, whole grains, and healthy fats.
  • Within these groups focus on low-fat, low sugar foods (no concentrated sweets) to minimize stomach upset and to promote further weight loss. If you eat foods high in fat and sugar, you may experience dumping syndrome which causes dizziness, sweating, diarrhea, nausea and cramps.
  • YOU ARE CHANGED FOREVER
  • Over time, you will be able to tolerate and eat more foods. To help with weight maintenance and a healthy eating lifestyle, it is important to keep this in mind. This is a drastic change that may affect all areas of your life. You may start to feel anxious about comments that are made to you about your weight loss, “feeling fat” in spite of weight loss, dealing with social situations and experiencing new emotions. Remember that you are never alone in this process. It is important to keep yourself involved in support groups, talk to any member of the team and be open with family and friend.

Chapter 4