What to expect 2-6 weeks after sleeve gastrectomy?
You should have minimal pain by now. Some soreness in the incisions with certain movements can be expected and some pain in the top part of the abdomen or the left should when you drink fast is normal. You should learn to slow down your drinking.
Very few patients will have nausea from time to time.
This is usually caused by drinking too fast as you are still getting used to the new size of your stomach. If your vomiting regularly or not able to drink enough then this is not normal.
- Forgetting to eat:
Most patients do not have hunger at this early stage and forget to eat. Even the concept of hunger can be confusing. This is normal. Make sure that you drink enough and have adequate proteins (60gm/day). You will start feeling hunger again over the next few months.
- Fatigue (The hibernation syndrome):
Many patients experience a drop in physical and mental energy 2-4 weeks after surgery. This is natural protective response from the body to the stress of surgery and the decreased calorie intake. It is a way for the body to conserve energy. Be aware that depression can get worse at this stage and if you take antidepressant, make sure you continue to take them. The hibernation syndrome phase will pass naturally but walking and increasing protein intake will help your body to recover from this phase. Having a supportive family member or friend will help you immensely at this stage.
- Sensation of Cold:
You will feel the cold more that before. This happens because your metabolic rate slows down after weight loss surgery. This is most noticeable while your are losing weight but will continue even after your weight has stabilized. Exercise including light weight training rebuilds muscle and thus increases your metabolic rate.
- Bowel movements:
Some people get constipated while other get diarrhoea. Most patients will settle into a pattern of a bowel movement every 2-4 days
- Weight Loss:
You will notice some weight loss during these 2- 6 weeks. This is going to be a modest weight loss as there is still fluid retention as part of the normal physiological healing stages after surgery. We recommend you check your weight only once a week.
Your Main Goals 2-6 Weeks After Sleeve Gastrectomy
Drink at 1.5 litres of fluid per day. It may be still difficult to drink the 1.5 litres per day at this stage. You need to take small sips on near-constant basis. Keep fluid within your reach at all time. Many patients find they can not eat and still drink enough fluid as food gets in the way of drinking. Remember this will improve with time. Your priority at this stage of recovery is fluid more than food.
1. Diet Stages: As the sleeve heals and the stomach tube get softer and more pliable, diet can be progressed slowly. There is no exact timetable for this progression as each patient is different but as a guide we recommend you stay on fluid for one week after surgery then purée diet stage for two weeks then soft diet stage for three weeks followed by normal diet starting after week six.
2. Have enough proteins (minimum 60 gm/day) from purée diet and/or protein supplement. We recommend Beneprotein powder as it is well balanced and unflavoured making is easy to mix with drinks and other recipes.
3. You should avoid carbohydrates as they will work against your weight loss goal. Bread, pasta and rice tend to swell up and fill the limited space inside the stomach tube. This making further drinking or eating difficult.
4. As you slowly introduce new food items over the next few weeks consider food intake as a "test". Take a small spoonful and give yourself 5 minutes to finish. Plan each meal ahead of time and if you go out bring your own meal or order food that you have already tried at home.
You should have started your regular multivitamin supplements when you have started the purée diet stage. We give you a month supply for BN Multi chewable multivitamins. Take one twice a day. After the month you can stay on the chewable multivitamins or switch to tablets such as Elevet women multi or Blackmore Conceive Well.
4. Fibre supplements
In the first few weeks after surgery while you are on the fluid, purée and soft diet stages, you will not be having enough fibre in your diet. This can lead to constipation. We therefore, recommend that you have fibre supplements. We recommend Benefibre from the supermarket or chemist. You can mix Benefibre with any drink including water and you will not notice a change in taste or texture. Start by taking two tablespoonful a day then adjust depending on the result. Other fibre supplements that you can use are Metamucil and psylium husk. If despite fibre supplement you still have constipation we recommend Coloxyl and Senna tablets from your local chemist (over the counter).
5. Exercise and Activities
Walking is the best exercise in the first few weeks. Walking outside will help your healing and reduce the risks of blood clots and chest complications. It will also help your mood and lift up your spirit. Aim to walk 20 minutes each day and increase this as you feel better. When you are comfortable you can go for a swim (4 weeks after surgery) or ride a bike. Leave weight training or abdominal crunches till after 6 weeks from surgery.
Driving: One week after surgery provided you are not taking any pain killer medications and can wear the seatbelt.
Sex: Ok to start as long as you do not experience pain
Going up or down stairs: Ok to start as long as you do not experience pain
Work: Majority of patients need two weeks off work. If you do a desk job you may be able to return to work after only one week provided that you are keeping well hydrated and your energy level is good. You should not lift weight of more than 10 kg in the first 4 weeks after surgery to reduce the risk of getting a hernia at one of the incisions.