Bariatric Surgery provides an unparalleled tool that can be used to overcome morbid obesity, but because the procedure is extreme, the patient is exposed to new potential problems. Be well informed and pay attention to changes in your body. Don’t be afraid to go to the doctor. You don’t want your wonderful new life compromised by a hit you weren’t watching for.
1. 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 keep water down. 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.
2. 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.
3. Dumping Syndrome is technically only supposed to happen with gastric bypass but it is common in those who have been ‘sleeved’. Dumping is not simply ‘throwing up’ but a condition caused by an intolerance to foods that are high in sugar or fat.
When a food rich in fat, sugar, carbs or all three enters the intestines without first being even partially digested by gastric juices present in the full stomach – the body struggles to dilute the offending food, creating an unpleasant autonomic response.
This reaction occurs shortly, within five to fifteen minutes after eating. and includes a combination of nausea, vomiting hot flash, cold sweats, sharp cramps, diarrhea and overwhelming fatigue. This reaction is so unpleasant that most will avoid foods that caused the episode.
Dumping syndrome is negative reinforcement that helps many to avoid bad foods. Some erroneously consider themselves ‘lucky’ they don’t get sick after eating sugar, but this strong behavioral deterrent can remain a strong ally for years.
4. Reactive hypoglycemia is a set of symptoms created by low blood sugar usually 60 to 90 minutes after eating a meal 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, headache, nausea, vomiting, lightheadedness, confusion, irritability, and inability to focus.
The problem is caused by an imbalance between blood glucose and insulin in the blood. 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 is frightening to lose control of the senses and in extreme cases some are unable think clearly or recognize what is happening. Keep a protein bar or nuts in your bag at all times, so if you have not eaten and feel the tell tale headache coming on, you can stop the progression. To treat reactive hypoglycemia, drink a few ounces of juice or skim milk or a few bites of a low glycemic food, cheese or peanut butter on a cracker, to offset the insulin.
To prevent reactive hypoglycemia, eat three well-balanced meals that include protein and vegetables. Some prefer to manage the onset condition by eating five small meals each day. Eat the protein first, followed by the vegetables. If the symptoms continue, contact your clinic or bariatric nurse clinician.
5. Alcohol Use – do not use alcohol the first year after surgery. After that use alcohol with great caution, understanding that its effects are greatly amplified when compared to before bariatric surgery. With bariatric organ manipulation, 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.
6. Transfer behaviors or cross addiction – Many use food to satisfy emotional needs. When this is no longer possible after weight loss surgery, they turn to other behaviors instead, including alcohol abuse, excessive shopping, gambling, or promiscuous sexual behavior. These behaviors can be damaging and dangerous. Call your surgical center and ask for help.
7. Constipation after bariatric surgery is common because of pain medications, surgical interruption of the GI tract and small amount of food being eaten. If constipation becomes uncomfortable, or you have gone seven to ten days without a bowel movement, its important to treat the situation before needing a manual extraction. (yep, that is just what it sounds like)
Most patients know to use stool softeners but softening is not enough. The wavelike movements must be restored in order to move softened stool out of the body. A laxative slowly and gently squeezes the colon. Most doctors say its okay to take Colace as a softener and Dulcolax as the laxative. Take both in the evening before bedtime with plenty of water and the situation should correct itself in the morning. A second attempt is occasionally needed. If you still do not go, contact your doctors office as you will need their help.
After things are back to normal, include 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. Use of Colace or Miralax can keep stool soft and moving along.
8. Gas problems are also common after bariatric surgery. Gas is used to separate the organs during surgery and is absorbed more quickly upon walking after surgery. When you begin eating, if you have intestinal gas pains try to determine which foods are creating the problem and eliminate them. Gas and rumbling is usually caused by dairy products, 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 digests lactose.
9. 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.
Stay tuned for the other half of our list! There are more issues to watch out for.