| You will get up and sit in a chair within 3 hours of returning to your room.
� You will have to go to the bathroom, since there is no catheter. Ring the nurses if you need help. � You might need some pain meds to take the edge off. Just let the nurses know. � On the day after your surgery, Dr. B will let you drink some water. � You will be walking the halls the following day. � By day 2 or 3, you should pass some gas. � Your tummy is brand new again, so it will gurgle and be mad at you. � Your first bowel movement will be yellow and liquid. It will probably be like this for several days. Think of it as having a newborns system. It will improve. � You will be on liquid/puree while in the hospital. � You will have a breathing incentive device. You HAVE to use this, even if it is uncomfortable at first DIARRHEA Diarrhea is not universal to the DS. Some patients are even constipated. You can have larger stools due to increased undigested food. Normally patients have to go to the bathroom very early and then after breakfast. Some may go once or twice more per day. It varies from patient to patient. Some patients may need to slow the bowel�s pace by using Lomotil (prescription) or Immodium (over the counter). Also you may need a antibiotic such as Flagyl if diarrhea happens while traveling and bowel flora changes. For many patients, diarrhea stops when they go on to clear fluids for a couple of days. In severe cases of diarrhea, patients may need to enter the hospital and have IV fluids to treat dehydration. When diarrhea has occurred because of a change in the normal bowel flora take �lactobacillus acidophilus�, �bifidobacteria� or �Ultraflora� dairy free. This may solve your problem completely. Avoid sorbitol since this white, sweet, odorless, crystalline alcohol found in berries, fruits used as a sugar substitute is not absorbed in the GI tract; it gets into the large bowel, bacteria ferment it and form gas and loose stools. Eat whole wheat, pasta and rolls made without sorbitol. FLATULENCE For most people gas is a problem because it causes (sometimes painful) bloating and (often mortifying) odors. Everyone has gas. The average person generates 1 to 3 pints of gas a day, but some people produce a lot more. The average is 14 times a day. Most gas is odorless. Gas is composed of hydrogen, nitrogen and carbon dioxide and some oxygen. One third of the adult population produces copious quantities of methane, while the rest little or none. Less than one percent of the gas smells. But boy, does it ever. Several sulfur-containing compounds are responsible for most fecal odors. The human nose detects hydrogen sulfide in concentrations as low as one-half pert per million. Certain foods are gassier than others. Beans, Brussels sprouts, raisins, apple juice and prune juice are a few. But a gas producing foods for one person may not be for the next. Extremely flatulent foods (more than 40 passages a day) vary from person to person. Carbohydrates are largely to blame, due to sugars, starches, and fiber that reach the colon (large bowel) without being digested or absorbed. Once in the colon, the colonies off harmless bacteria eat them and give off byproducts of hydrogen, carbon dioxide and in some people methane. These are the �good bugs� (bacteria) that are wiped out with antibiotics and need to be replaced by taking Ultradophilus, Ultrabifidus and lactobacillus acidophilus. The most common sources of gas are: 1) lactose, a sugar that occurs in milk product. Many people lack the enzyme (lactase) to digest lactose: 2) Soluble fiber, like the pectin in fruits and the beta-glucans in oat bran: 3) Gas producing bacteria feed off small amounts of starch that escape digestion by enzymes in the small intestine. 4) The most infamous source of gas (in large amounts) is beans, vegetables and grains. No one has the alphagalactosidase enzyme required to break them down. When they hit the large bowel, our bacteria have a feast. FOLLOW UP WEIGHT REGAIN BPD/DS patients may lose weight for 16 to 18 months. The lowest weight the patients reaches it is called the nadir. Once the patient reaches the nadir of their weight there is always the chance that a particular patient may regain weight, but without any doubt this is the operation with the lowest weight regain!. Surgeons who have been doing this surgery for 12-14 years state that the mean weight regain is about 4-5 Kg = 10 lbs. A patient who has lived a lifetime with the terror of weight gain, it may call their doctors even, if the weight regain is less than 2 lbs. This is understandable. So far, in my experience, no DS patient has required surgical revision due to weight gain. The phenomenon of weight regain and reoperation was very common with the VBG. FOOD AND NUTRITION CHILDBEARING Women of childbearing age who are having weight reduction surgery should use some type of birth control during the period of rapid weight loss (18 to 24 months). Maternal malnutrition may impair normal fetal development. All patients who are losing weight, at a rapid rate, are in some way suffering some form of malnutrition. Pregnancy should be postponed until your weight has become stable for some time. Women who become pregnant after WLS should receive specific attention from the surgical care team along with their obstetrician. Many patients have become pregnant after DS without any difficulty, but they do need to be watched more closely and they also need to make sure they are taking all necessary vitamins, minerals and proteins. Folic acid, one of the B vitamins, has been found to prevent neural tube defects (NTD). Increased intake of folic acid reduces the risk of NTDs such as anencephaly and spina bifida (open spine) by as much of 50 to 70 % if women take enough of it before conception and in the early months of pregnancy. Take your multivitamins containing 400 mg of folic acid (the standard in most multivitamins) every day. Many morbidly obese patients also have fertility problems, but after WLS they will frequently be able to become pregnant. Do not get pregnant until your weight has stabilized. SUPPLEMENTS REQUIRED AFTER SURGERY |