This is Diana Axiotis, your PA or physician assistant, I am sure you know my voice by now. Congratulations, you have made it to 1 month!!. Before I get all medical, let’s review some of the exciting dietary changes that you will be exploring. As you know, at one month you can start transitioning to a regularly textured diet. Remember to go slowly and chew, chew, chew. Your pouch is very small and the difference between full and too much can be just one bite. If during transition you experience pain and vomiting, be sure you are chewing your food to a consistency similar to puree and eating slowly. If you are doing this and continue to have problems there may be other things going on, which we will discuss in a few minutes. Remember you will be eating small amounts about 4-6 times per day. Try one new food at a time, this way if you do not tolerate it, you can take that food out of your diet for a while and maybe introduce it again in a few weeks. You may find some types of meat difficult to digest.
As you learned in Nutrition Class, protein should always be eaten first. You need this for energy. Your goal in 60 grams of protein per day. Limit foods like breads, spaghetti and rice, as they can stick and swell in the pouch making you very uncomfortable. As always do not drink fluids with meals. Also drinking your calories should be avoided, so no soda, alcohol or sweet tea.
Now you have been taking your multivitamins and B12 for about 30 days, as you transition to regular texture food, we want you to add in your calcium citrate pills. Yes all of them. You need a total of 1500-2000 mg of calcium citrate every day. This means taking 1-2 pills, 3-4 times per day. If you are confused about which pills and how many to take, bring your calcium pills to your next visit and the dietitians will review with you. Sometimes patients get some constipation with calcium pills, so be sure your fluid intake is up around 64 ounces a day. If you are still having problems we can talk about it at your next visit.
Ok now let’s talk medications. First your Pepcid or Famotidine. You were prescribed this at discharge. You can stop taking it now. Some patients may be on similar medications such as Nexium, and those can be stopped also. If you start to get heartburn type symptoms or indigestion, call the office and we can review what may be going on.
Now for those of you who still have a gallbladder after gastric bypass and were sent home on a medication call Ursodiol. You should be taking 2 pills a day, 1 in the morning and one in the evening. You need to do this for a full 6 months after surgery. Why you ask? This medication can help decrease the risk of formation of stones in your gallbladder. Some of the biggest risks for gallstones include being overweight and rapid weight loss. That is why we ask that you take it for 6 months during your rapid weight loss phase.
At one month, if you are having problems eating well chewed foods or even problems with fluids, you may have developed any ulcer or a stricture. A stricture is a narrowing where the pouch attaches to your intestines. If you are having problems like this call the office and we may prescribe some medications or schedule you for an endoscopy. An endoscopy is where a camera is placed down into the pouch to see what the anatomy looks like. If there is an ulcer, you will be given medications and it will take a few weeks to start feeling better. If there is a narrowing, the area can be stretched so you can eat and drink. If you remember from Nutrition Class, some of the things that increase the risk of ulcers are smoking and taking medications such as Motrin, Aleve, Indocin, Goody powder and BC powder. These medications are best avoided after gastric bypass. And smoking is best avoided forever.
You should make an appointment to see your family doctor in the next few weeks as they may have you stop or reduce some of the medications you are currently taking, especially diabetes and blood pressure medications.
I know everyone has been walking up a storm since the day after surgery. At one month you can start lifting weights and doing abdominal work. Just be sure you have clearance from your family doctor to exercise. Take is slow and easy to start. Remember we can refer you to cardiac rehab here at MUSC if you want some monitored guidance as you start exercising. Your goal is 60 minutes of exercise a day, most days of the week.
Finally let’s talk about fertility. Remember we ask that you try NOT to get pregnant for at least 18 months to 2 years after gastric bypass. This is the timeframe where you lose your excess weight best. Do not short change yourself. You should discuss birth control methods with your family doctor or gynecologist as birth control pills may not be as well absorbed in the pouch and you may not be getting full protection from pregnancy. We recommend 2 forms of birth control in the first 2 years after gastric bypass.
If you do become pregnant, please contact our office, we have guidelines for you and your obstetrician.
Well that is it for one month. Hope to see you in clinic soon. Appointments can be made by calling 843-792-7929. IF you have a more immediate concern call the Nurse Triage line at 843-876-5788.
Your MUSC Bariatric Surgery Team wants you to be successful and stay in touch. If you need an appointment, call us at (843) 792-7929 or visit us at www.muschealth.com/weightlosssurgery