Part Two – 16 Problems to watch for after Bariatric Surgery

In our last article we started the conversation about situations that may arise after having a bariatric weight loss procedure – even years after surgery. It’s important to be well-informed so you recognize and handle these scenarios if or when they occur. Physical pain is an obvious signal but there is also emotional pain due to changes that come with surgery. Some of these issues grow quickly when allowed to bloom.

10. Problem Foods – Food texture is the key to bariatric eating. Foods that are dry, tough, or dense do not work and it’s a good thing to spot these problems before the food goes into your mouth. Cook meats at a lower temperature for a longer period of time – low and slow cooking in a liquid is called braising. Spit out anything that you cannot chew to the consistency of applesauce. Some foods will always be difficult and it is simply better to avoid them.

– Tough or stringy beef cuts such as chuck or flank steak -thinly slice across the grain
– Dense meats such as pork chops or ribs – pork is a dense dry mouthful unless braised
– Membranes of citrus — eat the juicy bits from inside the membrane of oranges or grapefruit
– Skins and seeds of some fruits and vegetables – apple, cucumber and tomato skin, and pom seeds are a lifelong problem for some
– Fibrous vegetables such as celery and cabbage
– Raw vegetables that are very hard – carrots, broccoli, cauliflower – whereas cooked are fine
– Bread may create a dense dough ball
– Pasta and rice expand to create discomfort and cause vomiting
– Fried foods can cause dumping due to the concentration of grease which can cause nausea
– Chicken skin is fatty and does not chew up well
– The casing or skin from a hot dog or sausage will not digest or break down

11. Post-Surgical Drag – Four to six weeks after surgery, the body is still reeling from the impact of surgery and has reacted to the small amount of food is now receiving, leaving you feeling tired, lethargic and often depressed. The body wants to slow down and conserve energy and resources until the old abundant food supply returns. For the first few weeks it is not abnormal to feel as if someone has pulled the plug on your light source! You should not be in great pain at any time – if you are in pain and question as to whether or not it is normal, call your surgeon’s office with helpful descriptions such as stabbing, diffuse or aching and do you best to pinpoint location.

The best way to deal with feeling tired and not wanting to go out is to recognize the symptoms and know that they are somewhat normal. Force yourself to get up and walk as light exercise, so your body will be pushed to use stored fat as its energy source. Call your doctor’s office if you are unable to shake these symptoms and they last longer than six to eight weeks.

12. Protein Deficiency – When you are not eating enough protein it is common to see changes that first show up in the hair and nails. Early on, taking in 75 grams of protein each day is not possible without the use of protein shakes or smoothies. When you have a surgical weight loss procedure you must make up the difference between what you are able to take in and what your body needs via the use of protein supplements. Without adequate protein you will not lose as much weight, hair loss will likely begin in months 3 through 8 and will not grow back until you are in a protein positive situation, and you will notice a loss of muscle mass in arms and legs. Protein fuels your body to burn its stored fat.

Understand that protein shakes do not taste as if they came from DQ or McDonald’s – but if you have the right attitude, you won’t notice. Having a positive outlook and viewing protein shakes as the liquid gold that will help you achieve your goals will carry through to other aspects of your life. There is a very big difference between post-ops who whine that they can’t tolerate the taste of protein shakes versus those who would drink a protein shake that tasted like mud because they are committed to do anything it takes.

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13. Body Changes
Women often will have a menstrual cycle immediately after surgery, sometimes while still in the hospital. It is also not abnormal for it to remain irregular for a few months as surgery and the weight loss that follows places great stress on the body.

All women of reproductive age need to be aware that non-oral contraceptives are often recommended following bariatric surgery and that they should avoid pregnancy for 12 to 18 months. Use effective birth control even if you believe you are unable to become pregnant as many women with fertility issues, including PCOS, find that their status often improves after weight loss.

Patients who do become pregnant should have nutritional surveillance and lab screening for deficiency – including iron, folate, B12, calcium, and fat soluble vitamins. It is recommended that you find an Ob-Gyn who is familiar with the challenges of a pregnancy while undergoing early massive weight loss or will work with your bariatric surgeon’s office for guidance.

You may find that you are unable to drink milk or eat dairy products after surgery because they contain lactose, a natural sugar that your body may reject.

You may get light-headed or dizzy when you get up from a chair or bend over – this is often caused by not drinking enough water early after surgery. Dehydration is real and is cause to be hospitalized.

You may feel shaky, faint, or have a headache that could be caused by hypoglycemia or low blood glucose. The situation may be helped by drinking skim milk or by eating a few bites of cheese or a protein bar. You may have low blood glucose symptoms if you skip a meal or don’t eat before exercising.

Emotional issues – As your body goes through dramatic change, there will be emotional change as well – and some people find these changes disturbing and difficult to deal with.

Obese people have sometimes used their size to hide from life and insulate themselves from the outside world; losing weight can make them feel vulnerable at times. If you are having trouble dealing with increased attention while losing weight or being noticed by men or women, find someone to talk to. It may help to seek professional counseling. This will allow you go through periods of great change more smoothly and help you to be more successful with your weight loss.

Depression after weight loss surgery is common – for some women, estrogen hormone is released while fat is burned to make energy. This release of estrogen may cause mood swings. People who eat as a way to manage their emotions may become depressed because they can no longer eat like they used to.

If you take a mood stabilizing medicine, it is important to keep taking it after surgery. Do not stop taking any medicine without talking to your health care provider. You may need a dose adjustment of your medication after surgery as absorption of the drug may be affected by surgery.

13. Partner Jealousy – Your partner may have a hard time dealing with the new you. Not only has your body changed, but you may be changing emotionally as a result of your increased self-confidence and self-esteem. This can cause your partner to feel insecure. He or she may become possessive or distant. It does not help that friends and family suddenly pay great attention to your weight loss – many even making jokes about the spouse or partner needing to improve or risk being left behind. This is unkind, yet common – prepare for it.

If problems develop in your relationship, you may benefit from seeing a couples therapist. Ask your bariatric team for help.

14. Divorce – Even if the change is positive, change in a relationship can add stress. If you are married, you should plan for added stress and develop a strategy for how you are going to deal with it. A therapist or counselor can help you and/your partner work through these changes. Losing weight does not magically fix a bad marriage. It does give someone enough self worth to leave a bad or dangerous situation.

15. Friend loss – Losing a lot of weight can disrupt friendships as it upsets the dynamics of the friendship. You are changing every day and you may find that your friends are unwilling or unable to change with you. Your friends may be feeling jealous of you the attention you are getting, or your happiness and success. The food that used to be a common bond is no longer your focus and often the person who emerges as the largest in the group once you have lost weight is not happy with her new position. While you may have good intentions in offering a friend or family member your ‘old clothes’ it is often interpreted as an insult – think before making the gesture.

16. Body image – when your body goes through such a rapid and drastic change, you lose a sense of yourself and can actually go through an identity crisis. You literally may not recognize yourself and feel as if you are walking around in someone else’s body. In Las Vegas, I remember seeing my two friends across the casino and wondering who was with them – when I realized they were on either side of me and we were a reflection in a wall of glass.

It will take some time getting used to what is deemed as ‘the new you’ but truth is that it’s the old you in a new package. Counseling or even having someone to use as a sounding board may help you during these times of unprecedented change in your life.

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