Potential Long Term Problems: What do I do if a problem develops?

Click on one of the following post-surgery problems to find out how you should deal with it:
Anorexia (not eating because of fear of gaining weight)

Try to be more realistic about how much you should weigh. Try to see yourself as an average, fit person instead of a “skinny” one. Examine the real reasons for your poor eating habits. Try counselling or join our group therapy support to help you. Getting help is not a weakness. It can be a sign of strength because you are taking a positive action! Ask for the name of a group you can join.

Constipation

Because of the 2 week OPTIFAST diet before the surgery and the low fiber diet in the first 35 days after surgery, all our patients experience constipation. It is important to drink enough water to prevent dehydration and constipation by taking very frequent small sips. Add benefiber or Metamucil to your constipation regimen. In the long term, increase intake of fiber foods such as bran, fresh fruits and vegetables, prunes, prune juice and whole grain breads and cereals. Get plenty of exercise.

Dehydration (when your body does not get enough fluids)

The symptoms of dehydration are: dark yellow, strong smelling urine; a small amount of urine; dry skin and mouth; feeling tired and not well. Try to drink a total of 1.5 to 2 litres of water per day. Sip water continuously until your urine becomes a normal color. This should occur within 24 hours.

Depression / Poor tolerance of people’s moods / Irritability

Eat a well balanced diet at regular times. Take the vitamin and minerals prescribed for you. Sleep at least 8 hours each night. Exercise or take a walk each day. Make some positive changes in how you live; even a small change is a start! Talk your problems out with a trusted family member or good friend. Join a bariatric support group. In the past one of your most common methods of coping was to eat. You no longer have the ability to relieve your frustrations by eating and still lose weight. Develop new strategies to relieve the stress you feel. It takes time to figure out which ones will work for you. Instant relief is not in sight. Be patient and try! If you want to have counseling with a psychologist, talk to your doctor or the bariatric nurse-clinician.

Dumping Syndrome (applicable to Roux en Y Isolated Gastric Bypass only)

Dumping syndrome occurs after eating food that is high in sugar. The most common symptoms are crampy abdominal pain, heart palpitations, nausea, diarrhoea and sweating. This discourages patients from eating these types of foods and promotes additional weight loss. Avoid eating high carbohydrate, solid foods and drinking liquids at the same time. The operation is also intended to produce dumping if you eat high calorie foods like milk shakes, especially rapidly or in large volumes.

Frequent Bowel Movements

Limit the amount of sweet foods such as: soft drinks, fruit juices, candies, chocolates, pastries, cakes, cookies and any other foods containing sugar. Artificial sweeteners and artificially sweetened foods do not cause this problem. Limit the amount of fried foods and other high fat foods that you eat such as cheese, potato chips, gravy, cakes and mayonnaise. Try new foods in small amounts at a time. This way you will know what you tolerate and how much of that food you can eat without having problems.

Gas and bloating after drinking milk

If you have those symptoms, you may be intolerant to lactose, the sugar in milk. Try replacing regular milk with lactose reduced milk (e.g. Lactaid, Lacteeze, Dairy Free, etc.) found in large supermarket. You can buy LACTAID pills or LACTAID liquid to make your own LACTAID milk. Taking smaller amounts of dairy product more often may reduce symptoms. Yogurt, buttermilk or cheese is better tolerated. This intolerance to lactose may be temporary and you could slowly introduce small quantities of regular milk. Discuss any intolerance of milk or milk products with your dietitian in the Bariatric Surgery Clinic.

Hair loss

The hair loss usually occurs anywhere from 3 to 5 months after surgery. Take your multivitamins regularly and consume at least 70 grams of protein per day. Learn what foods are good sources of protein. Drink at least two 8 oz. glasses of skim or 1% milk each day. If hair loss persist you may try sugar & fat free protein powder supplement. Ask the bariatric nutritionist for more information about those protein powder supplements.

Heartburn (burning feeling in stomach)

Heartburns may be the cause of food intolerance and vomiting. Avoid coffee, tea, soft drinks, alcohol, chocolate, black and red pepper, spicy foods or any other foods that may cause burning. Food temperature should not be too hot or too cold. It is important to eat regularly. If you prefer, have six small meals. Stop smoking; it makes your stomach burn more. If you have a lot of acidity during the day, nibble on some crackers or antacid tablets (e.g. TUMS). Do not take antacids like Milk of Magnesia more than twice per day.

Use Tylenol, Atasol or any other non aspirin product for pains and headaches.

If you suffer from articular pains, Non Steroidal Anti-Inflammatory Drugs (NSAIDs) such as Motrin (ibuprofen), indocid, celebrex, naprosyn, aspirin, novo-defenac, etc, are not recommended because they can cause irritation and ulcers at the exit of your small gastric pouch. Consult your family practitioner if needed.

Hunger / Strong desire to eat more than usual

Stop eating as soon as you feel full even if you have not finished all the food you were intending to eat. Measure your portions of food and eat only that quantity. If you guess at amounts, you may be wrong. Count the number of calories that you eat. Do not become a compulsive overeater or nibbler again. Remember to try to see why and when you have these cravings, and do something else instead. Eat regular meals only. Don’t allow yourself to give into an intense and an immediate desire to eat food. Reward yourself when you do not give in by going to a movie or doing something positive. Do something that is not related to food intake. Women tend to feel hungrier before their menstrual period begins. Compare your desire to eat with your menstrual cycle to help you spot the difference between a normal increase in hunger and the return of your old hunger sensations.

Inability to eat like everyone else

Remember how the surgery works. You can’t eat like everyone else. Accept that the operation will restrict the type and amount of food that you might be used to eating. Remember that it is possible to stretch your new “stomach” and you will end up not losing weight. This could happen when you eat larger quantities than the amount of food that fits comfortably into your new small “stomach”. Focus on the goal of a healthy body and a new outward appearance.

Inability to keep down foods or liquids

Do not eat more than your stomach can hold. Chew your food slowly. Overcook pasta, rice and vegetables. Never eat solid food and drink liquids at the same time. If medications and vitamins are larger than the size of a regular aspirin, they should be crushed into a powder before taking them with some unsweetened apple sauce. If you cannot eat any food, at least try to sip some water, bouillon, fruit juice or any other liquid so you don’t become dehydrated. If the problem persists, please call us. If you vomit bright red blood, quickly go to the Emergency room of the Royal Victoria Hospital or to your nearest hospital.

Inability to lose weight

Stay away from junk foods, foods that only have calories and no other nutrients. Pay attention to what and how much you are eating. Limit portion sizes. Avoid swallowing food without tasting it and chewing it properly. Snack less and exercise more. Renew your motivation to keep weight loss as a goal. Identify your reasons for overeating. Change any activities that may cause you to overeat. Make a decision to make a change today. Try counseling or join the bariatric support group meetings. This is not a weakness – it should be considered a strength as you are taking positive action.

If you have had Adjustable Gastric Banding surgery, your band may require further adjustment as you lose fat around the upper part of the stomach. Make an appointment to see Dr. Christou to check if your band needs adjustment.

Leg cramps

Eat a well-balanced diet. Milk products and vegetables are especially important. Take vitamins daily. Do not sit in the same position for a long time. About every half hour, stand up and move around a little. Do not cross your legs. Do not use “knee-highs” or socks with a tight band on them. If your legs become swollen, lie down on a sofa or a bed and elevate your legs above your heart.

Lightheadedness

If you feel dizzy or shaky, quickly eat a few soda crackers. DO NOT EAT CANDY OR CHOCOLATE. Eat a protein and starch snack, such as 1/2 of a meat sandwich or cheese and crackers. Chew it well. This problem develops when there is a long time between meals or when you have skipped a meal. It is very important to eat your regular meals daily. Avoid alcohol.

Monotony of the Diet

Keep a positive attitude. Concentrate on making the weight loss a success! By eating in a well-balanced way, your outward appearance will improve and this can affect your self esteem. Read books, magazines and newspapers for recipes and new ideas to prepare food. Talk to others who have successfully lost weight. What did they do when they were discouraged?

Nausea / Heaviness in chest after eating

Only eat until you feel full. Nibble on dry soda crackers. Do not drink any beverages when you first feel nauseated. When you feel better, take some chicken noodle soup, soda crackers and warm tea. If the problem continues, please call the Bariatric Surgery team.

Stomach bloating after eating

Eat only up to the point of feeling full. Try to drink only between meals. Test small amounts of new foods at a time. If you become uncomfortable, cut back on the new foods that caused you the problem and proceed more cautiously. Do regular exercise. This will help to eliminate any gas that may be building up. If this happens after each time you eat, make a clinic appointment to see the Bariatric Surgery team.

Tired or weak

Eat a well-balanced diet. Increase your intake of proteins and fruits/vegetables. Plan to have one serving of foods in your daily eating plan which contains iron. Take vitamins and minerals every day that are prescribed to you. Limit your drinking of caffeine products to 1 to 2 cups per day, including regular coffee, tea, chocolate and cola drinks. Sleep at least 8 hours each day. Do not try to be a superman or superwoman! Be realistic about what you can do in a day. Do not try to solve everybody’s problems. Save some energy for yourself.

Watery stool / Very tired after eating / Abdominal cramps or pain

Avoid eating foods high in fat and sugar. When you have diarrhea, keep away from milk products, fruit juices, sweet foods and drinks, and spicy and fatty foods. Sip all liquids very slowly (about 50 – 125mL or 1/4 – 1/2 cup per hour). Begin eating the foods that you were able to eat just after your operation. Some easy-to-eat foods are oatmeal or cream of wheat, rice, bananas, applesauce and toast and tea. When feeling better, start again on the liquid meals and advance the diet when you feel comfortable.

Wound infection

If you notice that a part of your incision is painful, red, and hot to touch, you may have a wound infection. About 4% of patients having adjustable gastric banding can experience a port site infection; if you notice that your port site incision is painful, red, and hot to touch, you may have a port site infection. Contact Dr Christou’s office or the Bariatric Surgery Team.

If your wound is oozing a bloody, smelly liquid or you have a temperature greater than 38.5° C (101° F), go to the Royal Victoria Hospital main emergency and ask that they notify the Bariatric Surgery Team..