DISCLOSURE DOCUMENTS: SECTION 7

The patient will receive the appropriate dietary education and a book designed to act as an instruction manual for the bariatric procedure. The general guidelines are as follows:

- Post-discharge Diet - First 2 weeks after Surgery:

It is very difficult for the early post-operative patient to maintain a significant calorie intake. The emphasis is on hydration. Patients are instructed to sip small amounts of calorie-free fluids (water, diet ice tea, crystal light, etc.) on an almost constant basis. The patient’s tolerance for volume is limited; therefore, we advise the patient to intake fluid on a very frequent basis. Patients should drink a minimum of one [1] liter per day of fluid during that time [all fluids included: protein supplements, etc.] Indicators of adequate hydration are absence of dry mouth, and light colored urination three to four times per day. If a patient complains of constipation, this is usually due to an inadequate fluid intake.

Patients should should not eat frequently or "snack". Three meals per day is appropriate and each meal may be quite lengthy. "Snaking" or  "grazing" may promote a long-term failure of the procedure.

The diet consist of “full liquids”. This will allow the anastomosis or "hook-up" between the stomach and the small bowel [Roux Limb] to heal. Carbonated beverages should be avoided. Foods with high fat content, fried foods, and foods with added sugar should always be avoided. Foods high in protein are encouraged. Patients should use protein supplements to increase their protein intake [ 40 gm minimum daily].

The patient must take two multivitamins with supplemental iron every day. The patient should take about four TUMS tablets (or two Ultra TUMS) per day for life to maintain adequate Calcium levels.

Moderate alcohol consumption is to be avoided during that time. 

- Post-discharge Diet - Week 2 to 4 after Surgery:

If cleared by your surgeon, your diet will be upgraded to a soft diet [no solid food intake]. This will allow the patient's newly formed gastric pouch to fully heal.

- Post-discharge Diet - 4 weeks after Surgery:

Patients are now on a regular diet.

·        Lack of Appetite

Most patients are not hungry or have no "hunger sensation" for almost 3 months.  It is to be expected.  In the early post-operative period, it is normal to experience a complete lack of appetite and the patient should not be "force" eating. Post-operatively, patients will be supervised and evaluated on a constant basis by the staff of this office. You will need to comply as these mechanisms were put in place to ensure your prompt and safe recovery. Patients need to adhere to these directions in order to ensure a prompt and safe recovery.

·        Nausea and Vomiting

Early post-operative nausea and vomiting are a common problem after this procedure. In this early post-operative period the new gastric pouch and the attached small bowel will not function well together. Eating small meals slowly can decrease these problems. When these symptoms do occur, patients should follow a clear liquid diet only. The problem will usually subside in 12-24 hours. If the vomiting continues or if the patient becomes dehydrated, they should be seen in the office or in the Emergency room. Arrangements will be made for intravenous fluid hydration.

·        Pain

Incisional pain is usually almost resolved by the time the patient is discharged from the hospital. If the laparoscopic approach is used, patients may experience some shoulder pain (from diaphragmatic irritation) and an inability to expand their lungs well. It is critical that patients ambulate as much as possible and use the Incentive Spirometer (blowing machine) they were given upon discharge.

·        Rate of Weight Loss

Every patient is unique and has a unique, individual weight loss pattern. However,  the weight loss will be rapid in the first three months, continue steadily for six months, and usually stabilize around twelve months (weight loss will generally continue for a longer time if the patient begins at a very high weight).

For the first four months, all patients will lose weight almost automatically and effortlessly. Four months after the surgical procedure, patients should be informed continued, appropriate weight loss will require active patient participation.

If the patient’s weight loss stops in the three to six months after surgery, or if they begin to regain significant amounts of weight at any point after surgery, they should be evaluated by their surgeons. However, most often, the problem of persistent weight or weight regain is a behavioral problem rather than a surgical one.

·        Management of Medications

Almost any medications patients can still be taken after the Gastric Bypass with Roux en Y Reconstruction. During the first month after surgery, only small pills should be taken or swallowed intact. Larger pills should be crushed. Afterward, (assuming the patient is tolerating their diet well) the patient can take pills of any size (ask the surgeon if unsure).

Oral hypoglycemic agents and insulin should be significantly reduced or eliminated after gastric bypass. This will be a physician supervised withdrawal.

Diuretics should be stopped immediately after the procedure. A patient generally experiences a substantial diuresis due to ketosis, making the diuretics less necessary. Furthermore, the potassium wasting effects of most diuretics can cause serious hypokalemia (low potassium levels) in these patients who have dramatically restricted oral intake.

NSAID's (Ibuprofen, Naproxen, and other drugs in this class) may cause gastritis or ulcers in the newly created gastric pouch. Tylenol is safe.  If the patient needs anti-inflammatory medications, some options are available but this should be discussed with the surgeon.

·        Frequent Stools/Diarrhea

During the first month after surgery, approximately one quarter of patients will report loose and frequent bowel movements. The frequency may range from two to six bowel movements per day. This is normal. Malodorous stools are also frequent.

·        Constipation

Early in their post-operative course some patients may be constipated. This is usually due to dehydration. The patient should immediately increase their fluid intake.  If the constipation persists after a few months, we recommend Metamucil -Diet Formula- one pack (daily dose) per day in divided doses.