There are many situations that may arise after having a bariatric weight loss surgery procedure – even long after the initial healing. It’s important to be well informed so you recognize and handle these scenarios if or when they occur. Some can be dangerous if not recognized and immediate medical action taken.
Potential problems after bariatric surgery:
Vomiting -Avoid bringing up your food by chewing well, waiting 30 seconds between bites, and limiting the size of the bite you put in your mouth. Call your surgeon immediately if you are unable to stop vomiting water and liquids. Vomiting may be caused by eating too fast, eating too much, not chewing food to the consistency of applesauce, drinking liquids with or too soon after your food, or a stricture which is a narrowing of the surgical opening from the pouch to the intestine.
Food Blockages can occur when you haven’t chewed food well and it gets stuck in the outlet between your pouch and intestines. Usually, the food will soften and work its way through on its own. While the food is clogged, it can be very uncomfortable and you will be able to feel pressure of the blockage. It is not a good idea to drink fluids on top of the clogged food, but a few small sips of very warm water can sooth tissues and loosen the food. A food blockage can cause vomiting.
Dumping Syndrome is caused by an intolerance to foods that are high in sugar or fat. When you eat a food rich in fat, sugar or even carbohydrates, it enters the intestines without first being partially digested by the gastric juices that were present in the full stomach – the body then struggles to dilute and process the offending food, creating an unpleasant autonomic response.
This response usually occurs shortly, within five to fifteen minutes after eating. When this happens, you may have nausea, vomiting, a hot flash, cold sweats, sharp cramps, diarrhea and then overwhelming fatigue. This reaction is so unpleasant you will want to avoid foods that caused the episode of dumping syndrome. Dumping syndrome is a negative reinforcement and helps many to avoid high sugar or high fat foods. There are some who consider themselves ‘lucky’ they don’t get sick after eating sugar, but this strong behavioral deterrent can remain strong ally for years.
Reactive hypoglycemia – is a set of symptoms that results from low blood glucose. It happens 45 to 60 minutes after eating a meal, especially one that is high in carbohydrates. It can also be caused by skipping a meal or going too long without eating. Symptoms of hypoglycemia may include sweats, rapid heartbeat, lightheadedness, confusion, and inability to focus.
The problem is caused by an imbalance between blood glucose and insulin in your bloodstream. The rush of insulin stays in the blood after the glucose from the meal has been used. This over correction causes low blood glucose or hypoglycemia. It can be frightening as you can lose control of your senses and in extreme cases are unable think clearly or recognize what is happening. Many bariatric post ops keep a protein bar in their purse or bag at all times, so if in a position where they haven’t eaten or feel the tell tale headache coming on they can stop the progression. To treat reactive hypoglycemia, drink a few ounces of diluted juice or skim milk or a few bites of a high carb food to offset the insulin.
To prevent reactive hypoglycemia, eat three well-balanced meals that include protein, whole grains, fruits and vegetables. Some prefer to manage the onset condition by eating five small meals each day. Eat the protein from your meals first, followed by the vegetables. If the symptoms continue, call your surgeon or bariatric nurse clinician.
Alcohol Use – avoid alcohol under all circumstances for the first year after surgery. Once past this period, use alcohol very carefully, understanding that its effects are greatly amplified when compared to before your surgery. With a gastric bypass, the alcohol is not digested before reaching the intestines. It is rapidly absorbed into the body at full potency and you could become very drunk or even incapacitated in a short period of time. Alcohol poisoning can damage your liver or even cause death.
There is also a risk of addiction to alcohol after surgery that could affect your health, relationships and well-being.
Transfer behaviors or cross addiction – many people use food to satisfy emotional needs. When this is no longer possible after weight loss surgery, people turn to other behaviors instead. Some of these behaviors might include alcohol abuse, excessive shopping, excessive gambling, or promiscuous sexual behavior. These behaviors can be damaging and dangerous. Do not delay in seeking help.
Constipation after gastric bypass surgery is common. Early on, due to the small amount of food you are eating, it is not uncommon to have a bowel movement only every two to three days. If constipation becomes uncomfortable, most doctors say it is okay for you to take Milk of Magnesia or Miralax.
If your stools are hard, include some higher fiber foods in your diet – a tablespoon of ground flax seed has a nutty flavor and a flavorful addition to a protein smoothie. Drink at least 64 ounces of water each day between meals.
Taking iron supplements can cause constipation but it is important that you take these supplements as required. Hematologists or blood specialists often recommend a form of iron called Ferrochel(R) ferrous bisglycinate. BE felt it was necessary to develop a better iron supplement because of the widespread incidence of low iron in the bariatric population. The unique attributes of Journey Ferrochel(R) ferrous bisglycinateIron Capsules or Grape Melt tablets makes this an excellent supplement choice – it’s non-constipating and gentle on the stomach, does not react with other nutrients or block uptake of other minerals such as calcium.
Gas problems are also common after bariatric surgery. If you have gas pains try to determine which foods are creating the problem and eliminate them. Gas and stomach rumbling is usually caused by dairy products such as milk and cheese, as lactose intolerance is common in new post ops. Straws and chewing gum can also cause gas due to gulping and swallowing air. Even though yogurt is a dairy product, the live bacterial cultures produce the enzyme that helps the body to digest lactose – and solves lactose intolerance for many.
Gallstones are clumps of cholesterol and other matter that form in the gall bladder. During rapid or massive weight loss, there is a greatly increased risk that your body will make gallstones and it is common for a bariatric post op to need a procedure to remove the gall bladder secondary to the bariatric surgery.
Symptoms of gallstones would include feeling a steady, severe pain on the right side of your abdomen going to your back that starts soon after eating a meal. You might also feel bloated or nauseated and vomit after meals as the condition progresses. Call your surgeon if you present these symptoms. Some surgeons prescribe a medication called Actigall for their higher risk patients to take for a few months after surgery to help prevent gallstones from forming.
Part II to follow…