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Renaissance Hospital
Frequently Asked
Questions
1:
Why do blood clots sometimes occur after
surgery?
2:
What if I can't eat a few days after surgery?
3:
What do I do if I want to eat in a fancy
restaurant?
4:
Can I eat fast food?
5:
What about exercise?
6:
What is a Bariatrician?
7:
How Prevalent is Obesity?
8:
What about childhood obesity?
9:
What are the Health Risks of Obesity?
10:
How is a Patients BMI Related Health Risk
Determined?
11:
What happens after the surgery?
12:
What should I eat after surgery?
Q1:
Why do blood clots sometimes occur after surgery?
A: Blood clots form
because of pooling of the blood in the large veins in the legs. This
occurs when patients move their legs less, such as either during
surgery or when spending a time in bed recovering after surgery.
Stress, such as from surgery or injury, causes the blood to clot in
these pools to clot more easily. Combine these changes with thickening
of the blood that can occur after surgery due to mild dehydration, and
the result is an overall increased risk of blood clots forming in the
legs. Your doctors will use early ambulation, automatic compression
stockings, and blood thinners to prevent these clots from forming. Be
sure to do what you can to help, by getting up as much as is
practical, and by putting your compression stockings back on when you
get back into your hospital bed, and your risk of forming blood clots
will stay low, hopefully just a few percent or less .
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Q2:
What if I can't eat a few days after surgery?
A: It is hard to eat much
5 days, or even a week or 2 after surgery. Your small stomach pouch,
and the opening between the pouch and your intestine are swollen and
almost closed off. You also are recovering from major surgery, and
don't feel like eating much. Concentrate on taking liquids so you
don't become dehydrated, and eat simple pureed and soft foods as you
are able to. The problem up till now has been too many nutrients. You
probably have great nutritional reserves, and can go for some time
without depleting your stores. As you feel better and the swelling
goes down, and you learn what agrees with you, you will take more. As
you begin to take more, try to lean toward high protein foods and
supplements, bearing in mind that some people can't take dairy
products or dairy based supplements. Do let your doctors know how you
are doing, especially if you have diabetes, so that they can adjust
your medicines as your intake goes up and down.
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Q3:
What do I do if I want to eat in a fancy restaurant?
A: The rule of thumb is always eat protein. Most will gladly grill or
roast a piece of chicken, fish or steak. Even if not mentioned on the
menu restaurant's menu most willingly makes substitutions of permitted
vegetables spinach, green beans etc., instead of potatoes or rice. If
the restaurant simply will not prepare a dish which you are permitted
to have order something with fish, poultry or steak and a separate
plate. Take the protein and scrape off the offending sauce, breading,
etc. and place it along with any permissible vegetables on your
"keeper" plate and give the "Fattening Stuff" back to the waiter (you
don't need the temptation to sneak a taste and no-one in your party
needs extra fat or calories). If there is one food you can eat with
impunity it is protein. At the dinner party load up on salad and
protein (push the gravy or sauce to the other side of your dish) and
dig in! Although you may not be following the program 100% it won't be
too bad or hurt your progress that much. Back
Q4: Can I
eat fast food?
A: Many patients worry
about where they can get meals in fast food chains or restaurants. It
is very easy to get the types of food you need at many of the fast
food chains such as Burger King, Wendy's, or McDonald's. (These are
good choices to make even if you have not had the surgery.) All three
offer salads that are low in calories and fat. Both Wendy's and Burger
King offer Chunky Chicken Salads. Unfortunately, Long John Silver's
offers fish and chicken entree's which are both fine (remember no
rice, cole slaw or bread sticks) and they will be happy to substitute
a salad for the starches you are not permitted to have. Hardee's
offers a grilled chicken sandwich, which will be permissible for lunch
if you eat only one slice of bread and request it without mayonnaise.
Arby's offers the only turkey sandwich in the fast food circuit, which
is fine with only 1 slice of the bread. Mrs. Winner's offers broiled
chicken with green beans. Remember the old standby at any of these
fast food places. You can always order a garden salad and a hamburger
pattie with mustard. This is a quick meal that is available at all the
fast food chains.
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Q5:
What about exercise?
A: It's important to
exercise while trying to lose weight. Walking is the key. The bike
manufacturers and gym owners would like you to think that heavy
exercise is the key, but, research is recommending less vigorous and
stressful physical activities for those of us who wish to lose or
control our weight.
Most patients have adequate amounts of lean body mass. In many
overweight individuals this mass will be very close to or exceed their
ideal weight range. This means that they do not need additional muscle
and need to lose fat.
Remember you cannot exercise fat
and can only exercise muscle. Our body responds to exercise by
increasing muscle size and thereby increasing lean body mass. Adding
additional lean body mass to an individual who is trying to loose fat
undermines the whole process. It is quite likely that you will gain
weight if you exercise extensively. This will be more pronounced if
your protein intake is increased while dieting.
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Q6: What is a
Bariatrician?
A: A Bariatrician is a licensed physician
(Doctor of Medicine [M.D.] or Doctor of Osteopathy (D.O.) who, as a
member of the American Society of Bariatric Physicians (ASBP), has
received special training in bariatric medicine the medical treatment
of overweight and obesity and its associated conditions. Bariatricians
address the obese patient with a comprehensive program of diet and
nutrition, exercise, lifestyle changes and, when indicated, the
prescription of appetite suppressants and other appropriate
medications. (The word bariatric stems from the Greek word barros,
which translates as heavy or large.)
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Q7:
How Prevalent is Obesity?
A: Obesity is a chronic,
debilitating and potentially fatal disease that requires treatment by
a physician trained in bariatric medicine. It is marked by an excess
accumulation of body fat sufficient to endanger health. The United
States is currently suffering an obesity epidemic contributing to the
premature death, sickness and suffering of millions of Americans.
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Q8:
What about childhood obesity?
A: Approximately one in five children in the US between the ages of 6
and 17 is overweight. The number of overweight children in the US has
more than doubled in the past 30 years. The number of overweight
children (age 6-17) has doubled within three decades. Obesity in
children is a chronic disease that overshadows all others in frequency
in the pediatric population. Changes in the Western lifestyle have led
to significant reductions in energy expenditure of children and have
encouraged "super-sizing" of calorie-dense, high-fat foods and snacks.
Physical inactivity, "junk" food diets (including high calorie soft
drinks and fruit beverages), increased television watching accompanied
by snacking, increased time playing video and computer games all
contribute to increased obesity among the young. When we think of the
major problems facing pediatrics in the next millennium, the
disturbing trend toward obesity has to be among the most serious, with
all the adverse health implications that obesity carries. (Pediatric
Alert, March 27, 1997)
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Q9: What are the Health Implications of Obesity?
A: Obesity
has been established as a major risk factor for diabetes,
hypertension, cardiovascular disease and some cancers in both men and
women. Other co morbid conditions include sleep apnea, osteoarthritis,
infertility, idiopathic intracranial hypertension, lower extremity
venous stasis disease, gastro-esophageal reflux and urinary stress
incontinence. Obesity-related medical conditions contribute to 300,000
deaths each year, second only to smoking as a cause of preventable
death.
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Q10: How is a
Patients BMI Related Health Risk Determined?
| |
No
Obesity |
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BMI
>= 27 kg/m2
(approximately 20% above ideal weight) |
| |
BMI
>= 30 kg/m2
(approximately 30% above ideal weight) |
Back
Q11: What happens after the surgery?
A: After your Gastric Bypass surgery, you
will begin to awaken in the post-op recovery room, in what may seem
like just an instant. Many patients will have little or no
recollection of being there, a normal side effect of the medicine
given to you during anesthesia. Ordinarily, your breathing tube is
removed from your throat as you begin awakening usually before you
are aware of it being there. You will be started on pain medication by
the nurses in recovery as soon as you need it. The IV line for fluids
and medications that was started in the operating room will remain
with you for your entire stay in the hospital and will take care of
your required fluid intake. Although you won't be allowed to drink
water for the next day or so, you will be allowed to suck on ice chips
after the first day if your mouth is dry. About 4 hours after surgery,
the nurses will ask you to sit up again, only this time, you will
dangle your legs off the side of the bed and put your feet on the
ground. We check to see that your vital signs are ok, your pain
medication is ok and that you are recovering normally in preparation
for your first walk. The nurses will get you up again in preparation
for your first walk about 5 hours after surgery. Along with your deep
breathing and coughing exercise, walking is essential to your
recovery. For your entire stay in the hospital, the nurses will get
you up and make you walk around the floor about every 2 hours. As your
recovery continues, we monitor your pulse, your temperature, and your
blood count caref ully.
If you are showing good medical progress, we start you on swallows of
water, followed by Jell-O and broth your meals for the next few
days. Don't worry about finishing your meals. When you feel full or
just don't feel like eating stop. Depending on the patient, on the
second or third day you will be instructed in preparation for leaving
the hospital. If you are taking fluids well, can tolerate Jell-O and
broth, don't have a fever and are breathing and walking well, we will
send you home.
Back
Q12:
What should I eat after surgery?
A: Follow these four simple rules
faithfully and the weight will come off and stay off. Break these
rules continually and long term you will gain weight. Your surgery
is a tool to be used with these four rules and experience shows that
unless you follow them, we cannot predict any weight loss results.
When patients reach a 'plateau' and stop losing weight, it is usually
because they are not following these simple but very important rules!
Protein first every meal:
Eat the protein portion of your meal
first, very meal! One to three meals per day. Eating protein helps the
body to feel 'full' and sends a signal to stop eating. Protein is very
important to building tissue in the body muscle, your organs, your
brain everything is built with proteins. Now, the body does not need
three meals a day, so listen to your hunger cues and don't worry about
the clock. It the beginning - after you can tolerate solid food - most
patients only eat one or two meals a day.
No snacking between meals:
Eating anything flavorful or
containing calories in between meals is considered snacking. Do not
eat between meals at all! If you absolutely have to snack, the only
snack that is acceptable is protein. In the beginning, turkey jerky is
a good protein and you must work at it a little to eat it! Later on,
after 6 months, beef or venison jerky is acceptable but only if you
just have to eat something. The main problem with snacking on
flavorful food is that it contains glucose or some other sugar. We
feel good when we eat sugar and when that sugar is gone one to three
hours later our brain sends a message to snack again! Snacking
actually makes us hungrier! Do not open the door to snacking. Snacking
will slow down or even stop your weight loss! And depending on how
much or how often you snack, you can actually gain weight! Not good!
You can get this big again. Remember, the surgery has only changed
your digestive system and not your eating habits. Your commitment to a
change in lifestyle is the key to making the surgery work for you for
the rest of your life.
Drink water:
Drink water, drink water, drink water! Especially in the beginning,
when you can only tolerate a mouthful at a time, it is so important to
continually sip water all day - and make sure you drink 48 to 64 oz. a
day minimum - that's 2 to 3 quarts per day. Eventually, you will able
to drink 2 to 4 oz. at one time. No tea, soda (with or without sugar),
coffee, or juice are allowed. There are a couple of problems with
drinking flavorful liquids in between meals. First and most
importantly, it encourages snacking not good! Second, flavored
drinks with any sugar can cause dumping making you very sick!
Exercise: Exercise every day for at
least 30 minutes. Walking is fantastic exercise and is probably the
easiest way to get started exercising. We understand that in the
beginning you may struggle with a simple walk down the hall and that
your energy level can be very low. Your job is to move your body a
little more every day. At 4 to 8 weeks (everyone is different) you
will mostly feel back to normal. After you have been cleared by your
physician, you may begin other forms of exercise. Eventually,
incorporating both aerobic and resistance training into your daily
exercise routine will help you remain healthy - at a healthy weight -
for the rest of your life.
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After Surgery | |
Patients will be on a clear liquid diet for the
first few days immediately following gastric
bypass surgery, and then advance to a pureed
diet. These foods will be very soft, so as to
pass through the small, newly formed pouch and
stoma. One of the main issues during this period
will be adequate fluid intake, and dehydration
can be a problem for patients recovering from
this surgery. We will
ask patients to take in at least 32 ounces of
liquid a day before leaving the Gastric Bypass
Surgery Center.
Approximately one month after the gastric bypass
surgery the patients can expect to advance to a
transitional diet. They begin to take more
regular table foods, but will often still go
back to eating the pureed foods that they have
tolerated well. They will still be learning how
to eat right, including chewing food carefully,
learning to drink most of their liquids between
rather than with meals, and learning that eating
the wrong foods, such as sweets or fatty foods,
can make them ill.
Patients experience the most rapid weight loss
during this period. They are often thrilled to
see the weight coming off, sometimes at the rate
of 20 pounds a month, but it is not an easy
time. Patients feel the loss of calories taken
in, and are sometimes low in energy. Their small
pouch will make them uncomfortable when they eat
too much or too fast. They may have diarrhea,
which can usually be controlled by avoiding
certain foods or by taking medication. They may
experience hair loss, though the hair usually
begins to grow back within a few months.
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