Microsoft word - bariatric education sleeve gastrectomy binder.doc

A Manual for Surgical and Life-long Success Preparing for Surgery ____________________________________ 3 Discharge Instructions____________________________________ 6 Medication Guidelines ____________________________________ 8 Complications and Concerns ______________________________ Emergency Contacts_____________________________________ 9 Complications__________________________________________ 10 Eating Successfully______________________________________12 Living Successfully______________________________________14 Exercise for Life________________________________________ 15 Resources _____________________________________________16 Vitamins_______________________________________________17 Stages of Diet Progression_________________________________19 Weight Loss Plateau______________________________________25 Congratulations you have made a wonderful decision to help yourself achieve a healthier life and body size. To ensure a safe procedure and minimize complications, a timeline for surgery preparation is outlined below. It is essential
you follow these guidelines EXACTLY and do not gain weight prior to your
surgery. In fact, the risk of developing a complication is lessened if you follow
the guidelines and lose a small amount of weight before your surgical date.
We understand that this is both an exciting and nervous time for you. If you have
any questions, please contact the Bariatric Center at Little Company of Mary at
708- 229-5969.
 1 month prior to surgery
o Stop the following medications and do not resume taking them until Birth Control Pills Hormone Replacement Pills o Stop smoking and the use of all tobacco products.
 2 weeks prior to surgery
o Stop taking the following medications and NEVER resume taking Aspirin, Ibuprophen, Motrin, Aleve, Nupril, Excedrin, This includes, but is not limited to Gingko Biloba, Garlic, o Stop consuming all alcohol


1 week prior to surgery
o Begin a high protein liquid diet. This diet is NON-
NEGOTIABLE! The purpose of this diet is to deplete your sugar
stores which will decrease the size of your liver, if it is enlarged. It
will make your surgery easier and safer. It will also give you a jump start on incorporating and understanding the post-operative diet. Consume a high protein low carbohydrate shake/drink 3-6 times per day. Choose from one of the following OR any
product you like that contains less than 5grams of sugar
per serving:
Protein Powders
o Zero Carb Isopure (25 g. protein per scoop)
o Pro Performance Powder (28 g. protein per scoop)
o Mega Whey Protein (26 g. protein per 2 scoops)
o Pro Blend 55 (27 g. protein per scoop)
o Nectar Whey Protein (23 g. per scoop)
o Matrix 5.0 Powder (22 g. protein per scoop)
o Bariatric Advantage
Ready to Drink Protein Shakes
o Zero Carb Isopure Clear Liquid (40 g. protein per 20 oz. bottle)
o Extreme Smoothie (35 g. per 11 oz. can)
o EAS AdvantEdge Carb Control (17 g. protein per 12 oz. container)
o EAS MyoPlex Carb Control (25 g. protein per 12 oz. container)
o Muscle Milk
Consume 64 ounces of water per day
If light-headedness occurs, you may have one of the following
pieces of fruit the first few days: apple, orange, or banana
Oral medications: Stop taking your medications and check
your blood sugar every 12 hours for the first few days. If
your blood sugar is below 150/dL do not take your
medication. If it is greater than 150/dL, take one half your
normal dose and retest your sugar again in 12 hours.
Insulin. Follow the Regular Insulin Sliding Scale coverage
 One day prior to surgery
o Consume a CLEAR LIQUID DIET from the moment you wake up.
A full description of a clear liquid diet is on page 20. o Do not eat or drink anything after midnight!

 The Day of Surgery

o Men must be clean shaven the day of surgery - no facial hair


 Medications
Lovenox: Lovenox is an injectable blood thinner to decrease the risk
of blood clot formation.
Self-inject 1 time per day for two weeks
Bring your sharps container to the office for proper disposal
Prevacid: Prevacid is a stomach acid-reducing solutab. It aids in the
prevention of stomach and stomal ulcerations.
Place one Solutab under the tongue every day for 12 weeks Lortab: Lortab is a liquid pain killer. Use of pain medication is not
mandatory. Use it only if needed.
15 milliliters (ml) every 4 hours as needed for pain Zofran: Anti nausea medication you can use every 6 hours
Welch's 100% Grape Juice mix 1 part water and 1 part juice
for nausea sip through out the day

 Activity
o If it hurts do not do it! Activities that cause pain and are too
Do not lift anything heavier than 5-10 pounds for 6 weeks. You may walk as tolerated. Ideally you should try to walk a
short distance 3-5 times per day, increasing distance and intensity as you heal. You may not drive a car for at least two weeks after surgery. Do not drive while taking pain medications If you spend more than 1 hour in a vehicle, stop and walk 5 minutes every hour to prevent blood clot formation. You may shower daily. Wash the incision(s), but do not Do not put creams, lotions, perfumed soap, or powders on Lap Band patients are not to shower for 5 days.  Follow-up Your follow up appointment at Dr. Cahill's office will be 1
week after surgery. Call 708-422-5658 to schedule your appointment. First Nutrition Class will be the following Tuesday after your surgery in the Mary Potter Pavilion Meeting Room A at 11:30. You will receive more information on the class at the time of your discharge.
 Diet
o Clear Liquid Diet Only: It is essential that you allow time for
the new stomach or "pouch" to heal. Be patient and continue to follow the clear liquid diet at home. Follow the diet for 7 days. Detailed instructions for the clear Aim to drink at least 48 ounces of water by SIPPING fluid Do not take any of the recommended vitamins until on a full After surgery, use caution when taking medications. Remember, your stomach size and function have been altered for life  General guidelines
o Medications should be liquid, chewable, or crushed for the first
year or longer after surgery. Taking pills larger than the size of an M&M may get stuck or lodged in the stoma causing discomfort. o Do not crush tablets that say "extended release," "sustained release," or "time released" prior to speaking with a pharmacist or your physician. o Do not take all of your pills at one time. Even if your medications are crushed, wait 10-15 minutes prior to consuming the next medication.  Medications to avoid after surgery
o Aspirin or medications containing aspirin o Celebrex or Vioxx o Non-steroidal anti-inflammatory drugs. These medications have been known to irritate the stomach lining.  Medications to choose if needed

o Pain relief: Tylenol (liquid) only!
o Constipation: Colace and Pericolace, Ducolax, Fleets enema, and
o Probiotics: Consider a daily regimen (Chewable Bariatric Advantage)
o Fiber: Benefiber - start adding to your diet daily as needed
Possible Post-Operative Complications and Concerns As with any surgery, there is a risk of post-operative complications. Although we do not anticipate complications, it is important to recognize the signs and symptoms, as well as the course of action to take if one should occur.
Emergency:
Please contact Dr. Cahill at (708) 422-5658 if you have
any questions / concerns or call 911 in the event of an
emergency.
Non Emergency:
Tony Romeo, R.N., C.R.N.F.A.
Program Director
Phone: (708)229-5969 (non-emergency)
tr@midwestbariatric.com
Lisa Micetich, R.D., L.D.
Nutritionist
708-229-5429
lmicetich@lcmh.org
We are here to assist you. If you have any concerns or questions
please contact us.
o Contact Dr. Cahill if any of the following occur
Incision pain, swelling or discomfort that cannot be relieved Unable to pass gas or have a bowel movement Shortness of breath or rapid heart rate Call 911 or have someone take you to the emergency room if the severity of
symptoms worsens or you suspect a serious complication such as a
pulmonary embolism
 Physical Complications

Definition: Pulmonary embolism is a blood clot that can
develop after surgery which travels to the lungs. It can block the flow of blood to the lungs and, if not recognized and treated in a timely manner, can be fatal. Signs and Symptoms: Sudden sharp chest pain,
shortness of breath, coughing up blood, rapid heart rate and sweating. Course of Action: If you suspect a pulmonary embolism go
Signs and Symptoms: The incision line may be red and
warm. In addition you may have a fever. The incision line may also open or weep fluid. Course of Action: Contact your surgeon's office for advice
 Side Effects
o Dumping Syndrome (Gastric Bypass Only) Definition: Rapid passing of simple sugars into the small
Signs and Symptoms: Nausea, rapid heartbeat, vomiting,
abdominal discomfort, body weakness or sweating which is usually, but not always, followed by severe diarrhea. Course of Action: Let dumping syndrome run its course. If
diarrhea is severe, remain hydrated with water and/or broth. Walking or standing may ease the severity of symptoms. Possible Causes: Eating or drinking too fast, not chewing
food adequately, stomal stenosis, overeating, strong smells or odors and not following "The Rules" Course of Action: Return to a clear liquid diet and advance
as tolerated. If stomal stenosis is suspected contact your surgeon. Signs and Symptoms: Dry mouth, fatigue, headache, light-
headedness, constipation, dark colored urine, and a rapid
heartbeat.
Course of Action: Increase fluid intake to 48-64 ounces
per day. Remember to carry a water bottle around with you at all times. Aim to drink 8-12 ounces in between each meal. Definition: A stricture or tightening of the opening between
the stomach and the small intestine, or a Band that is too tight. Signs and Symptoms: Repeated vomiting shortly after
eating or drinking even small amounts of food or beverage. Inability to tolerate any food or beverage. Course of Action: Contact your surgeon's office and return
Definition: Frothing is not a complication per se, but a
normal consequence of reducing the stomach size for some patients. Instead of using stomach acid to digest foods the stomach produces extra mucus to aid digestion. Signs and Symptoms: Vomiting or spitting up clear
Course of Action: Drink or sip hot water 1/2 hour prior to a
meal to break up the mucus. You may add lemon or lime to the hot water
Your stomach has been altered in size. As a result, changing the way in which
you eat is essential for healing, avoiding discomfort and successful weight

maintenance. These guidelines should be must be followed for the rest of your
life.
1. Eat Slowly
 Take 20 minutes to eat each meal. Consider placing your fork or spoon down in between each bite. Focus on the taste, mouthfeel and texture of each bite.  Eating too quickly may result in vomiting or an uncomfortable  Stop eating the moment you feel satisfied. One additional
mouthful can cause discomfort.
 Be cautious not to extend your meal beyond 20 minutes. Do not remain sitting at the table until you can finish the plate. Once you feel full remove yourself from the table to prevent overeating.  Sit down at a table while eating. 2. Chew Thoroughly
 One of the stomach's functions is to grind and chop food. Now that your stomach is smaller, your knife, mouth and teeth must take over the
responsibility. Chew food until it is baby food
consistency prior to swallowing.
 Swallowing large amounts of food may result in discomfort or feeling like the food "stuck" in the stoma (opening) between your stomach and small intestines. 3. Separate your beverages
 Stop drinking 30 minutes prior to a meal and resume drinking
60 - 90 minutes after the meal ends. Sip fluids in between your
meal times only.
 Avoid eating and drinking at the same time. Fluid can fill you up resulting in less room for protein and nutrient dense foods. Secondly, mixing liquid and food turns the stomach contents into a "slushy" consistency. The food will empty out of the pouch quicker resulting in increased food intake and the feeling of hunger after eating. The goal of eating is to fill the pouch and allow food to slowly empty over several hours. 4. Eat your protein first
 Adequate protein intake is essential to reduce the risk of nutritional complications related to surgery such as hair loss and anemia. For the remainder of your life, you will have to remain conscious about consuming adequate protein.
 AT EVERY MEAL, ALWAYS CONSUME YOUR PROTEIN FIRST!
You may follow protein only with the following: fruits, vegetables and low fat dairy.  Foods high in carbohydrate such as breads, rice, pasta or potatoes should be limited or completely avoided. If chosen, they should be eaten last.
5. Do not snack
 Snacking is associated with weight gain. It usually entails empty-  Picking or grazing all day long will never result in a feeling of satisfaction and pouch fullness. Your pouch is designed to fill up and slowly empty. Over time, snacking, picking or grazing will add extra calories, defeating the restrictive component of surgery resulting in weight regain.  If you want to remain successful do not even start snacking. Every meal (3 times per day) should be about 20 minutes in duration, not picking for several hours.  If you suspect that you are snacking, grazing or picking, start keeping a food log to raise awareness and identify areas to improve. Eat every meal at a table with a knife a fork and a spoon

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Do not eat with your hands
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Throw away the crisper in your refrigerator
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Tupperware with prepared foods at eye level in refrigerator
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Grocery Shop in the outer isles only
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Always leave plenty of time to prepare and store food after grocery
shopping
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Exercises 60 minutes every day - If you do not want to excersie on a
particular day then don't eat that day.
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Physical Activity
 Use the FITT Principal
o The FITT principal is an easy way to incorporate physical activity at a pace that suites you. Each step is designed to build off of the previous one. Take this one piece at a time and you will be successful! 1. Frequency is HOW OFTEN you complete the activity. It
includes adjusting your schedule to accommodate physical activity at least 5 days during the week.
2. Intensity refers to HOW HARD you work during a particular
You know how your body feels. If at any time, you feel overexerted, pain or tightening in your chest,
dizzy, severe shortness of breath or notice that
you have stopped sweating STOP THE ACTIVITY
IMMEDIATELY! Ask for help or call 911 if
needed.
3. Time indicates the LENGTH of the activity. There are two
ways to increase time. First you can increase time by adding minutes to your current activity or you can increase the amount of times a day you engage in the activity which was described in the section above. 4. Type - Once you have mastered the basics, it is time to
have fun and experiment! There are many different forms of physical activity. Consider some of these options: If you feel stuck in a rut with your physical activity, consider investing in a personal training session to help you "switch it up." Pam Stroffergen a qualified personal trainer who has worked with bariatric patients for years. (708) 227-6627 Resources

 Magazines

Lifestyles www.wlslifestyles.com or (866) 255-4WLS Obesity Help Magazine www.obesityhelpmagazine.com  Websites
Online WLS communities


Dietary supplementation is mandatory. It is essential that you take the products
listed below every day for the remainder of your life. By having bariatric
surgery, you have committed to nutritional supplementation.
Vitamins, minerals and protein are essential for optimal functioning and to live a
long, healthy and happy life. By reducing food intake (smaller stomach) and/or
absorption (gastric bypass) you are at risk for deficiency. Your surgeon or
physician will monitor your vitamin status at least every year.
 Multiple Vitamin and Mineral

After surgery your caloric intake will be substantially lower. A vitamin, ensures that your nutritional needs will be met. It is an adjunct to the foods you will be eating, not a replacement. After a bariatric surgery, you will not absorb all of the vitamins and minerals from you food. Supplementation is necessary to prevent deficiency.  Calcium plus Vitamin D
o 1,200-1,500 mg per day of liquid or chewable calcium. This is usually achieved in two doses. Take separately from your multiple vitamin or iron o A calcium supplement should also contain 200-600 IU of Calcium is essential for the prevention of osteoporosis. Rapid weight loss, decreased food intake and being female increase the risk of bone thinning. Vitamin D increases calcium absorption in the small intestine. Deficiency is common in the Midwest. Low vitamin D is linked to certain cancers, bone disorders and autoimmune disease.
 B-Complex
o Choose any B-Complex with 100 mg of thiamin (B1)
o Take 1 time per day
o Must be crushed (if available in a chewable form) Thiamin and the "B-vitamins" are necessary for nervous system function, blood glucose regulation and the cardiovascular system.  B-12

o 1,000 micrograms (mcg) sublingually 1 time per week
Sublingual (under the tongue) B-12 is available in liquid or tab form. Place a drop or tab under your tongue one time per week until it dissolves. B-12 is critical for the function of the nervous system and the formation of red blood cells. Absorption requires high levels of stomach acid, which is typically decreased after bariatric surgery. It can be absorbed under your tongue (sublingual), bypassing the need for stomach acid. Bariatric Advantage Chewable - www.bariatricadvantage.com 1-800-898-6888 PASS HEALTH FOODS - 7228 W. College Drive (119th St.) Palos Heights, IL 60463 SLEEVE GASTRECTOMY Stages of Diet Progression

You have undergone a procedure which leaves your stomach and digestive tract
highly sensitive to foods, odors and tastes. Each person who begins on the
journey of progressing his or her diet will have a different and unique experience.
Below are simple guidelines to assist you. During this process, if you experience
discomfort, return to a clear liquid diet until your stomach settles.
There are two purposes for these guidelines. First, adequate time must be
allotted for your stomach and intestines to heal. Advancing the diet too quickly
can compromise the healing process, resulting in complications. Secondly, the
pouch is vulnerable to stretching during the first few weeks after surgery. Take
time to experiment with the "new" feeling of fullness to avoid overeating.
STAGE 1
2 weeks Clear Liquids followed by
4 weeks Protein Shakes

STAGE 2
Sleeve Gastrectomy beginning of 7th week for 2 weeks

STAGE 3
Sleeve Gastrectomy beginning of the 9th week for 2 weeks

STAGE 4

Sleeve Gastrectomy beginning of the 11th week

 Clear Liquid Diet for 2 weeks

o Consistency: Foods must be liquid at room temperature and
64 ounces of fluid per day
Use smaller spoons and cups to slow eating
No carbonated beverages or straws
o Grocery List
● Decaffeinated tea & coffee plain, no lemon or cream - NO ● Low-sodium broths (chicken and beef) ● Sugar-free beverages (non-carbonated) e.g. Crystal Light ● Flavored waters, artificially sweetened, non-carbonated  Protein Shakes for 4 weeks after clear liquids


 Full Liquid Diet
o Consistency: All foods must be a liquid consistency and be able
to pour out of a glass or bowl. Do not use a straw. 64 ounces of fluid per day
40-60 grams of supplemental protein per day
Begin MULTIPLEVITAMINS, B VITAMINS and CALCIUM

Continue sipping on water in between meals


o Grocery List

 Blenderized Canned or soft fruits (peaches, pears packed in extra light or natural juices) and vegetables (green beans or carrots)  Skim milk, 1% milk  Strained or blenderized (low fat) cream soups (cream of  Smooth hot cereal: Cream of Wheat, Farina, Cream of  Applesauce (plain or flavored - 100% pure, no sugar  Yogurt (low sugar/ low fat - no fruit pieces) must have less  Fruit or vegetable juices without added sugar  Soft to Regular Foods


o Goal: Eat a high protein-food first! This is the rule for the

o Grocery List
 Seafood - moist white fish like tilapia, orange roughy, catfish, fillet of sole, tuna fish (can add low fat or light mayonnaise), shellfish: crabmeat (imitation or regular)  Deli style meat; chicken, turkey and ham sliced thin or shaved (no spicy, no honey or BBQ flavor)  Low fat Cheese (5 grams of fat or less per slice)  Cottage cheese, made with 1% milk fat, small curd  Soups prepared with skim milk (cream of chicken, cream of  Salt, Salt substitute, other spices, I can't believe it's not Begin with soft, cooked and moist foods. Chew until each bite is baby-food consistency prior to swallowing. Try only one new food at a time. By eating this way, you will be able to identify the specific food if you experience a reaction or food aversion. If you are unable to tolerate an item on the first try, wait one to two months and retry the food. This does not mean you will not be able to have the food again. First week after soft
 Seafood: shrimp, scallops, lobster, salmon, halibut  Vegetables - soft cooked such as carrots and green beans,  *Cold Cereals - should not contain more than 3 grams of sugar Second week after soft
 Fruits - canned or soft bananas, apples, melons, peaches (peal  Plain Lettuce - iceberg or bibb  Chicken or Turkey - moist white meat - BAKED- not fried -  Ground turkey, chicken meat, fajita meat, turkey sausage  Boca Products, Garden Burgers, Morning Star Farms  *Pasta - do not use white sauces, they are high in fat, use red CONTINUE TO AVOID THE FOLLOWING FOODS FOR 6 MONTHS


* These foods are high in carbohydrates and should be consumed in
minimal amounts.

Alcohol can be very dangerous after gastric bypass. The alcohol is absorbed
much more quickly after surgery and will reach much higher levels in the blood.
You will experience a greater degree of intoxication on very little alcohol because
of the rapid absorption. General rule to follow is drink only on special occasions
and never more than 2 drinks in a 24-hour period. And remember don't drink and
drive.

Foods that may be difficult to tolerate:

Tough, dry or coarse meats such as steaks, grilled chicken Skins and membranes of fruits. Peel all fruit prior to eating. In addition, discard the membranes around orange and grapefruit wedges. Stringy vegetables such as celery and sweet potatoes.
Nuts and seeds
Fried foods
Spicy foods
Breads and rice can form a gummy ball in the stomach. This
can result in heart-burn like symptoms or feeling that the food is stuck. Weight Loss Plateaus
Weight loss plateaus are natural. By identifying a plateau and taking action early, weight regain will not occur. If you are experiencing a plateau or weight regain contact us at (708) 229-5969. Begin following these easy-to-use steps.
1. Thinking positive yields positive results.
o What is your mental outlook regarding this "bump in the road?" How you view this natural process of weight loss will greatly determine your
outcome at the end of the road. Slips and setbacks are a natural part
of the ups and downs of life and a natural part of the weight control
process. If you can prevent slips from occurring that would be great,
but it is even more important to know how to handle these situations
once they arise.

o Understand and accept that this is slight bump in the road and not a
natural disaster. It takes months or more of high-calorie eating and physical inactivity to re-gain the weight that you have lost. One meal or even a week of being off course will not make or break your success. o Reframe your thinking. Negative thinking and outlook can quickly crowd out the many great things you have done thus far to advance weight control efforts. Rather than lettering one negative episode overshadow the positive, focus on all of your great successes and how to apply the skills you have gained to the current situation.
2. Keep a food and Exercise log.
o Old habits die hard. Often old patterns of eating slowly creep up without notice. Begin keeping a food log of everything you eat and drink for a week. Note the time you are eating, the duration of the meal and the amount you consumed. Review the food log, asking yourself these questions: Am I snacking, picking or grazing throughout the day? Am I drinking beverages that contain calories? Am I eating and drinking at the same time? Do I fill my "pouch" each time I eat? Am I choosing foods that are high in fat and sugar? Am I filling up on breads, rice, pasta or other high Are my meals every 3-4 hours? Am I eating sooner or later? Are my foods soft, mushy or lack fiber? These foods pass

3. Choose solid foods.
o Solid foods take longer to digest, leaving your feeling full for a longer
o By choosing semi-solid or liquid foods, you will feel hungry soon after
eating. These foods quickly pass through the "pouch" and do not cause a sensation of fullness. This may lead to snacking, grazing or picking in an attempt to feel satisfied. o Your meals should consist of the following: lean protein
Cooked or fresh non-starchy vegetables
 Potatoes, peas, corn and winter squash are "starchy"
4. Do not eat and drink at the same time.
o Eating and drinking at the same time turns the contents of the pouch into a soup. This soup will drain quickly, leaving you feeling hungry shortly after eating.
o You may fill your pouch up with water 15 minutes before you begin
eating. Do not resume drinking until 60-90 minutes after the
meal has ended.
o Although this task may seem minute, this tip may the most powerful for helping you continue on your weight loss journey.
5. Fill up each time, every time.
o After surgery, the feeling of fullness is created by slight stretching (pressure) of the pouch wall. If you only eat half a meal or do not fill up your pouch, the feeling of fullness will not be generated. This can lead to grazing, picking or snacking.
o Eating until full (not stuffed) is the only way to slightly stretch the
pouch, creating a feeling of fullness and satisfaction.
6. Increase your physical activity.
o The majority of successful weight loss patients engage in 1 hour of moderate-intensity physical activity per day.
7. Attend support group.
o You will never be alone on this journey. Attend support group to listen, learn and share with others. Attending meetings before surgery will help you prepare for success, attending after surgery will make you successful. First Tuesday of Every Month
GASTRIC BYPASS and GASTRIC SLEEVE
meets 7:00 pm to 8:00 pm

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