Post Op WLS issues

January 3, 2006

What kinds of problems do WLS patients typically experience after

their surgery?

Nausea

One of the most frequent problems patients experience after surgery

is nausea. The nausea after surgery caused by using narcotics for

pain control disappears when you stop taking these medications. A

second type of nausea is seen about two weeks after surgery, about

the time you advance your diet beyond the liquid stage.

The cause of this nausea is unclear. Some surgeons recommend that

patients be routinely placed on acid lowering medications, such as

Prilosec, for a month or so following surgery despite the fact that

the pouch secretes only minimal gastric acid. They claim there is

less chance of patients developing an inflammation of the lining of

the pouch if patients take the medications. Many patients get relief

of their symptoms by taking low dose Pepcid, an over-the-counter

remedy that is much less expensive.

It's possible that over-distension of the pouch by accidentally

eating too much at one time may be a cause of nausea, especially

during the first post-operative month. Patients must learn to stop

eating at the first sensation of fullness, but this is difficult to

learn because patients cannot initially believe the small amounts

that will fill their pouches. The nausea seems to resolve by the

second month after surgery, but if it persists or if you develop

nausea several months after surgery, you may ask for an endoscopy

procedure to look directly at the lining of the pouch.

Belching

Belching is the regurgitation of swallowed air. Some patients are

habitual air swallowers (aerophagia). Patients break this habit

after several months, but you may choose to use a straw to drink

your liquids if this is a major problem. Gulping your liquids will

tend to make this problem worse. Carbonated beverages can also cause

belching and you should let all such drinks " go flat " to prevent

this.

Fatty Food Intolerance

Fifty percent or more of patients develop a distinct intolerance to

fats following Roux-en-Y surgery. Patients describe a " heavy "

sensation in the upper abdomen, a " lead " ball in their stomach,

nausea, bloating and sometimes diarrhea if they eat too much fat.

This is most likely caused by the fact that the bile salts, which

help digest fats, are not mixed with your food until the food is

much father along in your intestines than was the case before

surgery. This results from the rerouting of your intestinal tract by

the proximal Roux-en-Y gastric bypass. This intolerance seems to be

permanent, but is not necessarily an undesirable side effect.

One of the major problems with Americans' diets today is the

excessive amounts of fatty food we consume, particularly " fast

foods " . Most patients tell us about a year after surgery that they

are eating much better quality foods than prior to surgery and us

that they are avoiding nearly all fast foods and foods with high fat

content. You should try to purchase only the leanest of beef, always

discard the skin of chicken, cut the fat from all meat prior to

cooking and grill, rather than pan fry, whenever possible. Deep

fried foods may likewise cause adverse symptoms. Breading, such as

that on deep fried shrimp or halibut should be removed before eating.

Sweets

Between 20 to 30% of WLS patients develop side effects when eating

concentrated sugars after Gastric Bypass surgery. Some surgeons feel

the incidence is even higher and go so far as recommending certain

operations, mainly the duodenal switch, to prevent these symptoms.

If you experience a true dumping syndrome attack you will be very

careful about the quantity of sweets you eat forever after. The

dumping syndrome consists of a feeling of faintness, or like you are

about to pass out, often a cold sweat, a rapid heart beat and

perhaps explosive diarrhea. The symptoms are very dramatic and

extremely annoying. They can be controlled by limiting the amount of

sugar you eat at any given time.

Pain and vomiting after eating

By six weeks after your surgery you will probably have advanced to

an unrestricted diet following your surgeon's guidelines. This is

when you relearn how to eat, what to avoid, and when to stop eating.

It seems to take another two months for most patients to finally

learn what works for them, and a support group can be especially

valuable during this phase.

Pain and vomiting is nearly always the result of filling the pouch

too full. Over-filling the pouch is usually caused by eating too

fast, eating too much, or not chewing well enough. If you chew twice

as much as you have in the past, you will eat more slowly and

recognize that the pouch is getting full and then stop before you

eat too much. If you are vomiting after eating solid foods, but can

eat chips and popcorn without problems, this highly suggests you are

not chewing the solids well enough. Another reason that you may over

fill the pouch is that you become distracted while eating. It may

help to focus on your meal and be alone while eating. You should not

be watching a TV program, reading, talking on the phone, etc. while

you are eating.

Another common mistake is to " forget " to eat all day or to skip

meals during the day. You may then think you are starving and will

have a tendency to eat too rapidly and over distend the pouch. You

will gradually learn these lessons, but it requires several months

of " accidents " for you to break old habits.

Weakness

During the first 6 to 8 weeks following surgery you may feel

relatively weak. This is because your diet has been restricted to

soft type foods, your body is healing from the trauma of major

surgery, and you may be relatively anemic following the surgery. If

you have been able to take the liquid protein supplements, this side

effect will be minimized, but may still occur. Once you are 3 months

post-operative, your weight loss should be associated with an

increased energy level and the feeling that you are much stronger.

If you begin to experience weakness after this the possibility of

anemia secondary to iron or B12 deficiency becomes a more likely

explanation. You must take your vitamins. If you are not consuming

adequate protein in your diet, you may become protein malnourished

and this will cause you to feel weak. Your doctor must know about

these symptoms so they can perform the appropriate blood tests to

rule out (or treat) these problems.

Dizzy spells

A small number of patients complain of dizziness several months

after surgery, even though they did not have anemia or any vitamin

or protein deficiencies. Some surgeons feel the dizzy spells are

secondary to either dehydration or salt deficiency. It has been

recommended that these patients try eating high salt foods and

increasing their fluid intake. We don't yet know if this is

effective.

Hunger

After Weight Loss Surgery many patients report that they have lost

their sensation of hunger. This is transient and lasts for about

nine to twelve months. This is one of the reasons that

patients " forget " to eat and skip meals. During this " grace "

or " honeymoon " period as it is called, you will have your most rapid

weight loss, but eventually the sensation of hunger will return. It

is critical during this time that you adopt a permanent change in

your eating habits and behavior so that these new habits become so

ingrained in your lifestyle that you no longer think about them.

If you have not adopted new eating patterns by the time your hunger

returns you will have a tendency to turn to snacking or " grazing "

and your weight loss will stop and you will potentially start to

regain some, if not all of your lost weight. Post-op WLS patients

must learn to distinguish between " head hunger " and true

physiological hunger. Head hunger is the " munchies " or impulse to

eat between meals simply to have the taste or something to do with

your mouth, i.e. chewing. Food commercials on TV and in magazines

tend to stimulate this craving, as does boredom and anxiety. You

must find substitute activities for eating at these times and try to

avoid such commercials.

Social issues

Your interpersonal relationships can change after you experience

radical weight loss. Some patients lose some friendships, and may be

rejected by even close relatives. Reasons for these reactions may

include other people's jealousy, envy, anger and fear of change. Any

real friend will respond to your weight loss and surgical success

with happiness for you. As you make the decision whether or not to

have Weight Loss Surgery, know that some of your social

relationships may be radically altered following your operation.

Many post-op patients report that they try to de-emphasize

socializing organized around food or meals.

Relationship With Your Partner

In addition to altered relationships with friends, some patients

find that their relationship with their husband or wife changes

dramatically following massive weight loss, and not necessarily for

the better. It is not uncommon for a spouse to develop a sense of

insecurity when their partner suddenly develops an entirely

different body image. This is more prominent when the female

undergoes the surgery and becomes more physically attractive than

when the male is the patient.

After surgery, women may notice that other men are " looking " at

them. Although this usually pleases them, at least on some level,

they may also feel threatened and verbalize these emotions in a

fashion that tends to inadvertently provoke insecurity in their

partners. It's important to recognize this as a potential problem

and to be prepared to deal with the issue after surgery. If a spouse

is adamantly against the partner undergoing the surgery for reasons

other than the potential risks associated with the operation, this

may be a clue of pending feelings of insecurity after surgery, and

pre-operative counseling may be indicated.

Changing Self-Identity

When patients undergo a dramatic change in their physical

appearance, they may also experience a personality change. This may,

in part, explain some of the altered relationships that occur. For

example, some patients will become more assertive and outspoken

following weight loss. This is probably secondary to greater self-

confidence, but may surprise co-workers, employers and friends. It

is not necessarily a negative change, but needs to be recognized as

a potential side effect. If used constructively this can be

beneficial. Remember who and what you are is " inside " , and not how

you look. Your appearance does not define who you are.

Antidepressants

Studies reveal that a significant percentage of WLS patients are on

chronic antidepressants before their surgery. Sometimes patients

become euphoric during the first few months after surgery and decide

to independently stop their medications. This is usually a mistake.

Several studies have now shown that simple weight loss does not

eradicate all of a patient's " troubles " and stopping these

medications prematurely can result in a rebound and an even more

severe depression. You should discuss with your physician the timing

of stopping any of your medications and how best to proceed with

reducing them before completely discontinuing them.

Constipation

Constipation is a common complaint after Weight Loss Surgery. It

is caused by decreased food and water intake and, in some people,

supplemental iron, or narcotic pain killers, tranquilizers, and

antidepressants. It is often aggravated by weak abdominal muscles

or busy schedules wherein people defer having a bowel movement when

the urge exists.

Bariatric surgeons and clinics generally encourage WLS patients to

do exercises that strengthen the abdominal muscles and assist in

bearing down. Most people experience the need for a bowel movement

after breakfast and that is the natural and easiest time to have a

bowel movement, and should not be ignored. Increase water intake.

An increased intake of any vitamin except B12 and vitamin A tends to

produce diarrhea and has not significant other side effects and is

helpful in eliminating constipation. Especially useful in this

regard is Vitamin C or ascorbic acid since in addition to preventing

constipation, it enhances the absorption of iron in Trinsicon or

other forms.

Next add fiber to the diet: Eat high fiber breakfast (bran-based

cereals, oatmeal) and add vegetables to other meals. 's

unprocessed bran found in the cereal section of the grocery store

can be taken with juice, or sprinkled into salad, meatloaf, cereal,

etc. The same thing can be done with Metamucil, or psyllium seed.

These are more expensive forms of non-digestible cellulose or

fiber. The water content of stool can also be increased with a

stool softener, docusate sodium marketed as Colace, or Peri-Colace

or P-Col-Rite. If the above measures are still not correcting the

problem, the electrolyte laxatives such as Fleet Phospho-Soda,

Magnesium citrate, Milk of Magnesia, or Colyte, to name a few,

should be tried. Avoid laxatives that directly stimulate the bowel

smooth muscle eg. Senecot, as tolerance develops and more and more

is required over time.

Hair Loss

Hair loss is commonly assumed to be due to lack of adequate dietary

protein, but a clear cause and effect relationship is lacking. Some

doctors measure the patient's prealbumin, and if it is low, increase

their protein intake. Hair loss due to dietary restriction is

nearly always temporary. Rogaine and Nexium shampoo have both been

reported to be effective and should be tried if the loss is

excessive.

An alteration in intestinal flora usually caused by antibiotics may

produce gas. Ultraflora—a bacterial preparation—may be given to

repopulate in intestinal tract normally. When the cause is fungal

overgrowth, Diflucan (fluconazole) may be effective. Flagyl is

sometimes tried to suppress anaerobic bacterial growth in bypassed

portions of the intestine. Other causes are gallstones,

diverticulosis, irritable bowel syndrome, and parasites, and,

rarely, cancer of the ovary or bowel.

Is hair loss typical?

Hair loss is commonly assumed to be due to lack of adequate dietary

protein but a clear cause and effect relationship is lacking.

Nevertheless, one should measure the prealbumin, and if it is low,

increase protein intake. Ephedrine is said to be effective in

restricting protein weight loss and enhancing fat weight loss. Hair

loss due to dietary restriction is nearly always temporary. Rogaine

and Nexium shampoo have both been reported to be effective and

should be tried if the loss is excessive.

January 3, 2006

This is great.......Glad you posted!!

sharonloserswebmaster wrote: What kinds of

problems do WLS patients typically experience after