Hydration

• You should still aim to drink at least 1.5 liters of fluid per day. It may still be difficult to drink this amount per day, so try to take small sips on a near-constant basis. Keep fluids within reach at all times; if you leave the house, take a drink bottle with you.
• Many patients find they cannot drink enough fluids due to eating as food gets in the way. This will improve with time.
• Your priority during this stage of recovery is fluid more than food.

Diet

• Continue with the puree diet for another week, then progress to a soft diet. Keep to a routine of three meals per day and avoid between-meal snacking.
• Protein Intake: Ensure you are having enough proteins (minimum 60g/day for Sleeve patients, 90g/day for Bypass patients) to prevent muscle tissue loss. You can use the protein powder included in the green bag given to you prior to your surgery. It is balanced and unflavoured and easy to mix with drinks and other recipes.
• Avoid Carbohydrates: Try to avoid carbohydrates (e.g., bread, pasta, rice) as they tend to swell up and fill the limited amount of space in your stomach tube, making it even more difficult to drink or eat.
• Introducing New Foods: During this time, as you slowly introduce new food items, consider food intake as a "test". Take a small spoonful and give yourself 5 minutes to finish it. Plan each meal ahead of time, and if you go out, either take your own meal or order food that you have already tried at home.
• Hunger: Most patients do not feel hunger at this stage and forget to eat. Even the concept of hunger can be confusing. This is normal. Make sure you are drinking enough and having enough protein. You will start to feel hunger again over the next few months.

Multivitamins

• You should have started taking your regular multivitamins when you started the puree diet phase.
• We give you a month’s supply of BN Multi chewable multivitamins. Take one twice a day.
• After the month, you can either continue taking the chewable multivitamins or switch to BN capsule multivitamins.

Fatigue (Hibernation Syndrome)

• It is common 2-4 weeks after surgery to experience a drop in physical and mental energy. This is a natural protective response from the body to the stress of the surgery and the decreased calorie intake—a way for your body to conserve energy.
• Be mindful that depression can worsen during this stage. If you take antidepressants, make sure you keep taking them.
• The Hibernation Syndrome phase will pass naturally, but you should increase your protein intake and walk to help your body recover.
• Having a family member or friend’s support is extremely beneficial during this time.

Feeling Cold

• You will most likely find yourself feeling the cold more than you did before your surgery. This occurs because your metabolic rate slows down after weight loss surgery.
• It will be most noticeable while you are losing weight but will also continue even once your weight has stabilised.
• Exercise, including light weight training, rebuilds your muscles and thus increases your metabolic rate.

Nausea/Vomiting

• You may have some nausea and/or vomiting from time to time, especially if you eat or drink too fast or if you eat or drink too much (even just one mouthful too much).
• If you are vomiting regularly or are not able to drink enough, then this is not normal, and you should see Dr. Zarrouk/Dr. Kirby.

Pain

• You should have minimal pain by now.
• You can expect to have some soreness at the incision sites with certain movements. You may also get some pain in the top part of the abdomen or the left shoulder when you drink too fast.
• You should learn to slow down your drinking.

Bowels

• Some people will experience constipation, whilst others may get diarrhoea. Most patients will settle into a pattern of a bowel movement every 2-4 days.
• During the fluid, puree, and soft diet stages, you will not be having enough fibre in your diet. This can lead to constipation.
• We recommend taking a fibre supplement like Benefiber (you can purchase this at the supermarket or chemist). Mix the Benefiber into any drink, including water, and you will not notice a change in taste or texture. Start with 2 spoonfuls a day, then adjust according to the results.
• Alternatives are Metamucil or Psyllium Husks.
• If the fibre supplements do not help your constipation, then we recommend Coloxyl with Senna tablets or Movicol sachets (both available over the counter at the chemist).

Weight Loss

• You will notice some weight loss during this period. It will be a modest weight loss as there will still be fluid retention as part of the normal physiological healing stages after surgery.
• We recommend you only check your weight once a week.

Exercise and Activities

• During these first few weeks, walking is the best form of exercise. Walking outside will help your healing and reduces the risks of blood clots and chest complications as well as lift your mood. Aim to walk 20 minutes a day, and increase as you feel better.
• Weight/muscle training/abdominal crunches can be started after the 6-week period.
• You can go up and down stairs as long as you are not experiencing pain.
• You can resume sexual activity as long as there is no pain.
• You will be able to drive as long as you are not taking any strong painkillers.
• Most people can return to work after 2 weeks, depending on your job. You should not lift anything more than 10kg for 4–6 weeks after your surgery to reduce the risk of getting a hernia at one of your incisions.

Follow-Up

Please contact the rooms at any time if you are having any problems – if it is out of hours, please see your GP or attend Campbelltown Public Emergency Department.

Medications

• Nexium: You will be given a script for Nexium 40 mg once daily for 3 months. This helps to stop the stomach from producing acid, prevents acid reflux (common in the first few weeks), and helps the stomach staple line or joint to heal. You can swallow the Nexium tablet whole or, if unable, you can disperse it in a small amount of water.
• Ondansetron: You will be given a script for Ondansetron (Zofran) wafers in case you have nausea. The wafer dissolves under your tongue.
• Endone: You will be given a script for Endone (an opioid). Most patients should have minimal pain by the time of discharge. Take regular Panadol (liquid or tablet) for pain, but if you still have bad pain, take Endone as required.
• Multivitamins: Start your multivitamins a week after surgery when you start your puree diet. You will have been given a bottle of chewable multivitamin tablets in your pre-op green bag. Chewable multivitamins are easier to take at this stage.
• Clexane: To reduce the risk of blood clots, we recommend that you have a Clexane injection once a day for 2 weeks once you go home. This is a self-administered injection, and you will be taught how to do it while you are in the hospital. Some higher-risk patients may be required to have Clexane for 4 weeks.

Your Usual Medications:

You should discuss with Dr. Zarrouk/Dr. Kirby whilst in the hospital which of your regular medications to continue. You should be able to swallow tablets once you can drink well. Take one tablet at a time. You may need to break big tablets in half, but be aware that controlled-release tablets or enteric-coated tablets should not be broken. You will be able to continue most medications after surgery with a few exceptions:

• Diabetic Medication:
  • You will need to measure your blood sugar level regularly to help guide the dose of your diabetes medication.
  • Insulin doses will need to be reduced to avoid hypoglycemic attacks.
  • Oral diabetes medication should not be restarted until your blood sugar levels start to rise again after surgery.
  • You should follow up with your GP or endocrinologist regarding your diabetes medications.
• Blood Pressure Medication:
  • ACE Inhibitors (e.g., Perindopril, Ramipril, Lisinopril, etc.), Angiotensin Receptor Antagonists (e.g., Candesartan, Olmesartan, Telmisartan, Irbesartan, etc.), and Diuretics (e.g., Frusemide, Hydrochlorothiazide, Spironolactone) should be stopped on the day of your surgery and not recommenced until your blood pressure starts to rise again and you are drinking well. The combination of reduced fluid intake, these medications, and low blood pressure can cause kidney damage.
  • Follow up with your GP about a week after your surgery to monitor your blood pressure and adjust your blood pressure medication as required.
  • Beta Blockers (e.g., Metoprolol, Atenolol, Bisoprolol, etc.) should NOT be stopped before or after surgery as this can put stress on your heart and result in a heart attack.
• Blood Thinning Medication: Let Dr. Zarrouk/Dr. Kirby know if you take any blood thinning medication (e.g., Aspirin, Clopidogrel, Warfarin, Pradaxa, Xarelto, Eliquis, etc.). Restarting these medications will depend on what surgery you’ve had (the risks of bleeding from it) and the reason that you take these medications.
• Anti-inflammatory (NSAID) Medication:
  • If you have had a Gastric Bypass, you can NEVER have anti-inflammatories ever again as they can cause an ulcer at the joint where the stomach pouch connects to your intestine.
  • If you have had a Gastric Sleeve, you must not have anti-inflammatories for 3 months while your new stomach heals.
  • Anti-inflammatory medications include Nurofen, Ibuprofen, Brufen, Advil, Mobic, Meloxicam, Voltaren, Diclofenac, Feldene, Piroxicam, Celebrex, Celecoxib, Naprosyn, Naproxen, Naprogesic, Indomethacin, and Indocid.

Diet

• Free Fluid Diet:
  • You should aim to drink at least 1-1.5 L of fluid per day. This will be harder at first; keep a bottle of your preferred fluid with you at all times and constantly sip, sip, sip.
  • Depending on your surgery, your stomach has now been reduced to a narrow tube or made into a small pouch, which will be stiff and swollen in the first few days. This, together with the effect of the removal of the hunger hormone, can make you not feel thirsty. So you must consciously remember to drink at least 1-1.5 L of fluid per day.
  • Start off with small sips. If it hurts to drink, then slow down and try again.
  • It is common to feel like you need to burp before fluid goes down. This is due to air bubbles and is normal as there is not enough space for both air and fluid at the same time.
  • Avoid using straws as you will end up swallowing more air.
  • Avoid carbonated drinks as this will fill your stomach with gas.
  • Coffee and other caffeinated drinks act as a diuretic and can make you more dehydrated, so try to avoid these for the first few days.
  • You can have one Optifast drink a day to help get enough protein.
  • Keep an eye on the color of your urine. If it is light in color, then you are probably well-hydrated. If your urine is a deep yellow or dark color, you need to drink more fluid.
• Puree Diet: Follow a puree diet for 2 weeks. Ensure you still maintain an adequate amount of fluid during the puree phase.

Wound Care

• You will have waterproof dressings over your wounds when you are discharged from the hospital. Remove these dressings after 5 days; there will be paper tapes (Steristrips) under the dressings. Leave these Steristrips on, and they will fall off when they are ready.
• Your skin will have been stitched from the inside with a clear dissolving suture.
• You may feel more pain at the wound on the right-hand side of your abdomen, as this is where your stomach is pulled out. The muscle is stitched closed to prevent a hernia.
• Your wounds may feel lumpy for the first few months; they will soften and become smooth.
• Some patients notice a clear, orange, odorless drainage from one of the wounds within the first couple of weeks. In most patients, this is normal and represents liquefied fat. If you are concerned, come and see Dr. Zarrouk/Dr. Kirby.
• You can get your wounds wet in the shower. Dab your wounds dry with a towel. Do not soak your wounds in a bath or swimming pool until 2 weeks after surgery.
• Some patients like to apply Vitamin E ointment or silicon tapes to the wounds to reduce scarring. There is no evidence that these make any difference to scarring, but they also cause no harm, so you can use them if you wish.

Activities

• TED Stockings: Continue to wear your TED Stockings for 2 weeks after surgery.
• Triflow (Breathing Exerciser): Take your triflow home and continue to use it for 2 weeks after surgery.
• Walking: Essential in the healing process. It improves circulation, burns calories, prevents muscle loss, prevents respiratory complications, and reduces the risk of blood clots. Start off slow and increase as you are able. Aim for 30-60 minutes per day.
• Stairs: You can walk up and down stairs.
• Lifting: Do not lift more than 10 kg for 4-6 weeks after surgery.
• Driving: You can resume driving 1 week after surgery. However, you cannot drive if you are still taking painkillers.
• Work: Most people will need 2 weeks off work, depending on the type of work you do.
• Sexual Activity: You can resume sexual activity 2 weeks after surgery; use your judgment.

Bowels

Some patients will experience constipation, while others will experience diarrhea. Changes in bowel habits are normal.

• Constipation:
  • Make sure you are drinking enough fluid.
  • Walking will help with constipation.
  • Take Benefiber or Metamucil twice a day.
  • If you have not had a bowel movement after 4 days, try Coloxyl with Senna tablets twice a day and/or Movicol sachets twice a day.
  • You can also try prune juice or pear juice.
• Diarrhea:
  • Patients can develop lactose intolerance after weight loss surgery, causing diarrhea. Sorbitol present in sugar-free drinks can also be a cause.
  • Change the type of fluid you are consuming and see if this helps.
  • Often, it settles after progressing to puree and soft diets.
  • If you are still having issues, come and see Dr. Zarrouk/Dr. Kirby.

Your Weight

You will be very likely to weigh more when you get home than when you came into the hospital. This is completely normal and is due to fluid retention that occurs as a response to any major surgery. Your body will shed this fluid via urine after 7 days.

Remember: For the first 6 weeks, you should be focusing on healing and hydration rather than weight loss.

Follow Up

• The Practice Nurse will call you within 14 days of your surgery.
• You will be given a blood test form while in the hospital. Have this blood test done 2 weeks after your surgery.
• Sleeve Gastrectomy: You will have a phone call with the dietitian 2-3 weeks after your surgery.
• Gastric Bypass: You will have an appointment in the rooms 2-3 weeks after your surgery with the surgeon/nurse and dietitian.

Critical Signs and Symptoms

You should contact us if you develop any of the following signs or symptoms:

• Temperature of 38.5 degrees or higher
• Chills
• Worsening pain
• Smelly or pus-like discharge from the wounds
• Redness, swelling, or pain over one of the wounds
• Vomiting or unable to drink enough fluid
• Shortness of breath
• Calf pain or swelling

If you are worried or not sure about anything, please get in touch with us immediately.