One of the unfortunate side effects for bariatric patients is unexpected sickness. Most of these uncomfortable episodes can be avoided if you understand what is happening to your body and what you must do to avoid them. Perhaps the most common unexpected—and most preventable—illness is dumping syndrome.

Dumping syndrome can be an issue for some patients who have undergone a gastric bypass. Dumping syndrome occurs when your stomach moves food through the digestive tract too quickly. The stomach “dumps” undigested food and liquid into the small intestine before it is ready to be moved there. The small intestine is not prepared to handle the food and your body pays the price. You end up feeling nauseated, dizzy and even sweating uncontrollably. Sometimes this happens very soon after you eat (early dumping) and other times it takes between one and three hours for your body to feel the effects (delayed dumping). In either case, it is a very uncomfortable and avoidable situation. You can avoid most instances of dumping syndrome by following some guidelines about what you eat and when.

Let’s start with what you eat. First of all, avoid greasy or sugary foods. Neither one is good for you in general and both can cause dumping syndrome. These dietary guidelines will also help Lap Band patients to avoid discomfort even though they are not directly affected by Dumping Syndrome.

• Choose lean proteins (poultry and fish are great) and protein powders as the basis of your meals.
• Then eat fresh, non-stringy vegetables and skinless unsweetened fruit.
• Choose complex carbohydrates that are made from whole grains. These are also often high in fiber which will help reduce dumping.

We know that you have heard this about your diet before but the truth is that it’s the best way to eat. Not only will you be healthier, you will help avoid the discomfort of dumping syndrome. Cook all of your foods well so that they are easier for your stomach to break down. Anything that you can do to help your stomach digest food is a good idea.

Once you have made the right food choices, it is time to eat correctly. While we do think manners are important, that is not what we are talking about. We want you to think about how you are going to eat and plan ahead.

· Watch your liquid consumption. No drinking within a half an hour of your meal or while you eat. Excess liquid can cause dumping and if you had a Lap Band procedure liquid can push foods into your larger stomach cavity which eliminates the whole point of the procedure.

· Also try cutting your food into small pieces before you eat. This will make digestion easier on your stomach.

· While eating, chew your food thoroughly. We advise that you chew each bite twenty times before you swallow. This will make sure that your food is in smaller pieces before it gets to your stomach.

· One last tip is to watch your portions. Do not eat huge portions, your body will tell you when it is full and you should listen. Overeating leads to a variety of complications besides dumping.

If you are having any complications after your bariatric surgery or if you would like to find out more about the procedures and how they can help you call us. Our telephone number is 1-800-611-6913.

SOURCES
North Florida Regional Medical Center Bariatric Department
National institute of Health – Dumping Syndrome
DocShop.com
International Foundation for Functional Gastrointestinal Disorders
Medical Center – Ohio State University

Congratulations! You’ve taken a huge step in getting healthy. You’ve had bariatric surgery, and you’re looking forward to the pounds coming off. This is an exciting time in your life!

So, once you’ve gone home, do you know what to expect? You may have worries, and you may be surprised by some of the feelings you have. After a few weeks, and as you start eating solid food, your body may experience a variety of reactions. Here are some tips to help you be ready for anything.

What If You’re Nauseated?

Patients can experience nausea and vomiting. Remember to

• Eat slowly
• Take small bites
• Chew each bite at least 15 times
• Eat small portions
• Drink enough water (as much as 2 liters a day) to stay hydrated

Keep in mind that you’re filling a much smaller space now, so you may feel full faster. If vomiting is severe or persists, call your doctor right away. If you have an adjustable gastric band, it may need to be altered.

What If Some Foods Don’t Agree with You?

After surgery, you may find that you can’t tolerate some foods. Even if you take small bites, there may be some food items you should avoid. For instance,

• Vegetables, such as cauliflower and broccoli, which can cause gas and stomach pain
• Meat that is overly dry or tough
• Gummy foods such as bread, pasta, and rice
• Sticky items such as peanut butter
• Dairy products, since some patients become lactose intolerant

Don’t despair! There are still so many other foods to enjoy. Just learn to make substitutions, such as tender poultry instead of some other meats and soy milk instead of regular.

What If You Suddenly Feel Faint or Have a Rapid Heart Beat?

If you’ve had bypass surgery, these symptoms could be the result of “dumping syndrome,” which happens as the stomach empties too quickly into the small intestine. You may also experience sweating or stomach cramps.

These problems will probably pass on their own, but they can be unpleasant and frightening. To avoid this condition, try not to eat fatty foods and sweets. These foods are not nutritionally beneficial anyway, so—for the most part—strike them off your list.

What If You’re Losing Your Hair?

Don’t panic! Many people experience hair loss after surgery. This is normal, and usually the hair regrows after several months. Make sure you’re eating enough protein.

What If You’re Constipated?

This is a common occurrence, too. Try to eat a good variety of fruits and vegetables, and add a fiber supplement as needed. Get regular exercise, and drink plenty of water.

What If Your Skin Is Loose?

As you shed pounds, your excess skin may be loose and hang from your body. You may find this frustrating, since you want to look great after weight loss. But be patient. After you have attained your goal weight, there may be options. Talk to your doctor about the possibility of plastic surgery. In the meantime, make sure you participate in resistance exercises to tone muscle.

In the weeks and months after bariatric surgery, monitor your body for changes. Never hesitate to contact you doctor if you have concerns about symptoms you’re experiencing.

If you have questions about what to expect after surgery, contact North Florida Regional Medical Center. You can visit out bariatric page online or call 1-800-342-6057. We’re here to answer your questions and help you meet your weight-loss goals.

SOURCES
http://www.bariatricsurgerypittsburgh.com/surgery/side_effects.html
http://www.webmd.com/diet/weight-loss-surgery/gastric-banding-surgery-for-weight-loss

If you have an adjustable gastric band, you know it works. The band was placed around the upper part of your stomach, dividing the stomach into two parts. Now you’re eating less because the upper portion of your stomach is small, making you feel full faster.

You probably also know that the band has to be adjusted over time. The adjustment, known as a fill, takes just 5 or 10 minutes and does not require surgery. The idea is to customize the band, either by slightly inflating or deflating it, based on your needs and goals. This is accomplished by changing the amount of saline that’s in the band. The saline is injected through an access port just under your skin.

So when is it time for an adjustment?

• It’s been a few weeks. Once you have been eating solid food for several days, usually about 4 to 6 weeks after the initial procedure, you’ll need to be evaluated. Your first adjustment may happen then.
• You’re pregnant. If you become pregnant while having a gastric band, talk to your doctor right away. You will probably need to have the band deflated to allow more nutrients to reach your growing baby.
• Food disagrees with you. While eating less is a good thing, eating too little can be problematic. If you can’t tolerate food, explain the symptoms to your doctor. Your band may need to be adjusted to better fit your body.
• Weight loss is slow. Most gastric band patients lose 1 to 2 pounds a week. If you find yourself losing less than that, your doctor may inflate the band more.
• You’re sick. If you are under the weather, your body may need more food. This may be a time to have the band deflated temporarily.

Some people have only one band adjustment during the first year, while others require several fills. Everyone is different, so listen to your body and stay in contact with your doctor.

If you have questions about gastric band adjustment, contact North Florida Regional Medical Center. You can visit out bariatric page online or call 1-800-342-6057. We’re here to answer your questions and help you meet your weight-loss goals.

Regardless of which bariatric procedure that a patient undergoes, they will be on a planned diet as part of the recovery process. One of the most important things to remember is to follow your diet plan designed by our nutritionist and the team at North Florida Regional Medical Center. The post-surgery diet consists of four “phases” of foods. Following the plan, phase by phase, facilitates the healing process and allows the body to acclimate to its new condition.

Phase1: Liquid Diet (Days 1-10)

Immediately after surgery, patients are put on a liquid diet which consists of mild sources of nutrients for the healing stomach. It has two stages: clear liquids and full liquids.

• Clear Liquids (Days 1-4 for Gastric Bypass; Days 1-2 for Adjustable Gastric Band)- The substance of the diet is clear to nearly clear liquids. The liquids cannot have any solid pieces in them; this includes small pieces of pulp in juice. Liquids are to be sugar free and non-carbonated. The patient will sip them slowly. The goal is to build up to consuming 48-64 ounces a day without drinking so quickly that the patient feels nauseas. This limit applies to both Gastric Bypass and Adjustable Lap Band procedures.
• Full Liquids (Days 4-10 for Gastric Bypass; Days 3-10 for Adjustable Gastric Band) – After the body can handle clear liquids without a problem, the patient should switch to “full liquids”. These liquids can have some solid pieces in them, but it is important to make them as fluid as possible. Supplement shakes and even well cooked cereals (oatmeal or grits) can be eaten. The limit is 64 ounces of liquid per day for Gastric Bypass procedures and 78 ounces a day for Adjustable Lap Band patients. Low fat, low sugar food sources that are high in protein are the ideal choices.

Phase 2: Pureed Foods (Weeks 2-5 for Gastric Bypass; Weeks 2-3 for Adjustable Lap Band)

Once the healing process is finishing up and the patient’s body is adjusting to its new stomach, some more traditional foods can be included in the diet. 64 ounces of water should be drunk a day for Gastric Bypass patients while Adjustable Lap Band Patients should consume 72 ounces per day Keep in mind that it should be consumed in between meals. Drinking with a meal will cause the stomach to be full faster and reduce the amount of food that can be eaten. All food must be naturally soft or pureed so that any large pieces are broken down. Patients must avoid food choices that are hard to digest. For Gastric Bypass patients weeks 2 and 3 will be entirely pureed foods, in weeks 4 and 5 the patient can start to have some foods that are soft. For patients who undergo an Adjustable Lap Band procedure, pureed foods are eaten for 5 days and the rest of the phase can consist of soft foods. Remember to eat slowly so as to not over do it. The following food groups (with suggestions) are the basis of the pureed food diet and are listed in order of importance.

• Protein (The most important part of your diet) – Protein is the anchor of the diet and should be eaten first before the patient is full. Soft food choices are important and it is recommended that meals be pureed in a food processor. We suggest:

• Baby Food
• Scrambled Eggs
• Low Fat Yogurt
• Hummus
• Broiled fish (weeks 4 and 5)
• Tofu

• Fruits- Even though fruits are generally soft they should be mashed. All skin must be removed.

• Ripe bananas
• Unsweetened Applesauce
• Sugar free jams/jellies
• Strawberries

• Vegetables- Vegetables provide necessary vitamins. As with fruits, remove all skin and do not choose fibrous vegetables like celery. Remember green vegetables are the best.

• Mashed Potatoes (Not sweet potatoes)
• Boiled Carrots
• Well Done Spinach

• Grains- Grains must mostly be in pureed form as well. Many hot cereals are good choices. Use low fat milk when they are prepared to add protein.

• Grits
• Oatmeal

• Cream of Wheat
• Whole wheat toast (weeks 4 and 5)

Phase 3: Soft Foods (Weeks 6-8 This additional time with soft foods is only for Gastric Bypass patients. Adjustable Lap Band recipients move on to their permanent diet at week 4 or as instructed by their physician. The food suggestions here can be consumed during the second stage of Phase 2 for those who undergo Adjustable Lap Band procedures.)

The third phase does not require that any food be pureed. The diet consists of the soft foods that were eaten along with pureed foods at the end of the previous stage. Remember that patients should not drink within 30 minutes of a meal. They should chew food thoroughly, at least 20 times before swallowing. No fibrous foods are allowed, only soft easily digestible choices. Try:

• Protein- Beef is not allowed nor are cuts of poultry unless they are pureed.

• Fish
• Soy Burgers
• Tofu

• Fruits- Fibrous fruits and skins are still not allowed.
  • Mangoes
  • Berries
• Vegetables- Vegetables are to be cooked well until they are soft. Avoid raw vegetables and fibrous choices like asparagus.
  • Collard Greens
  • Carrots
• Grains- Toasting bread is still necessary as it makes it easier to digest. Enjoying hot cereals is still a great idea but do not add nuts, raisins or anything else.

For Gastric Bypass patients there is a fourth stage that includes the hard foods that can be eaten for the remainder of the patient’s life. This is to be discussed at a different time. Above all, heed the warnings in each dietary stage. Cooking foods well and following the steps precisely will produce the best results for the body.

For more information on bariatric procedures please contact North Florida Regional Medical Center. Visit our bariatric page online or call 1-800-342-6057.

Weight loss surgery makes some significant changes to your body in a short amount of time. As a result, you will have some physical limitations after surgery. Beginning or getting back onto an exercise plan is very important for your health and weight loss goals. At the same time you will need to follow some guidelines so that your body is able to recover and allow you to exercise.

Timeline for physical activity after surgery

• Immediately after surgery- Begin walking as soon as you physically can. Mild walks will take place at the hospital before you are discharged. Try to take 3 or four short walks a day. This will give you some basic exercise and help to prevent blood clots from forming in your legs.
• 7 to 10 days after surgery- At this point you can begin some light exercise. You can walk moderate distances on foot or on a treadmill. You can also use an exercise bike or elliptical machine set to an easier level. Remember this is only moderate exercise so don’t overdo it. Your body will tell you when you have had enough. Do not be concerned with what others (outside of your doctors) say about your exercise regimen. It is your plan, not theirs.
• 4 to 6 weeks after surgery- Now you can begin strenuous exercises. This is the point where your full-time exercise regimen, which you should continue on for the rest of your life, begins. Now you can jog, bike or even do sit-up and lift weights at the gym.

Committing to a full-time exercise plan is necessary. Your doctors and even a personal trainer can be great resources to help you put together a plan. A full exercise plan incorporates several different types of exercises:

• Aerobic- These exercises are often called “cardio.” They get your heart rate up, allowing you to burn calories. These exercises are also good for overall cardiovascular health.
• Resistance- These exercises are aimed at building muscle and strength. They make your body and skeleton stronger. An added bonus is that the more muscle you have, the more calories your body burns on a daily basis.
• Stretching- Stretching exercises are good for all muscle groups. They help to make you flexible and improve your range of motion. They also stretch muscles, which is necessary because resistance training can tend to shorten muscles. Stretching also makes you body more flexible, which could potentially save you from some basic injuries down the road.
• Stability- These exercises help you develop and maintain balance. Your body will be different after you lose weight and your balance will change. These exercises help you regain balance once your body changes.

Making sure that you perform all of these types of exercise as a part of your plan will help you lose weight and keep it off, as well as increase coordination and mobility. Keep in mind that the amount of food that you eat after surgery will be reduced. Exercise requires that your body take in enough calories to provide “fuel” for your physical activity. One of our dieticians will be able to advise you on how much to eat to fuel your body once you begin a work-out routine. An approved personal trainer will also be able to make good suggestions. One possible plan is to eat complex carbohydrates (we suggest whole grain breads and pastas) before a workout and plenty of protein after exercise. At some point, your body will burn fat and use that for energy during your work out which is exactly what you want to happen.

For more information on bariatric procedures please contact North Florida Regional Medical Center. Visit our bariatric page online or call 1-800-342-6057.