date jan 17th! HELP!!
Hi, I have my surgery on Jan 18th, I was told to take as little as possible. Other than what the surgeon has required me to bring. (meds, bp cuff) I just went and got something comfortable to wear home and some slippers for walking the halls. Congrads on your date and I wish you the best of luck. I'll see you on the losing side. Take care and God Bless.
Hi Nicole,
Good luck on your surgery, will put in some words with the Great Spirit for you... The following is what was sent to me by a lady, some really liked it not sure if some didn't but I'll put it on here again. For us guys, you won't need SOME stuff... lol.... I just got home the 11th I had open rny, you will need loose fitting cloths or sweats is better. I didn't need much else for me. Take care... PooBear 
Hi - I'm Jeanne in WI, one of the list moderators. Here is some info. that I received from a former member of GBIC. It's so thorough, that I try to send it out to as many pre-ops as I can. I've also added my own Dietician's Instructions as I thought they were well written and easy to understand. Some people don't receive much at all in the way of written instructions. Hope it helps you out.
Jeanne in WI
Age 41
Open RNY - 5/21/02
[email protected]
Included is: What To Take To The Hospital
What To Have At Home After WLS
A Surgery Day Outline
Surgical and Recovery Pain
'Hibernation' Syndrome
What To Take To the Hospital
Here's a fairly complete list of things:
(You won't need a nightgown or pj's; the hospital will provide a hospital gown that will fit over your IV's. If you are quite a bit larger than your surgeon's regular WLS patients, you might want to call the hospital ahead of time and make sure they have a gown that will fit; you don't want to spend 3-4 days in something that is uncomfortable.)
-a knee length bathrobe so you can walk the halls covered up:
-a non-slip pair of slippers that are easy to walk in
-a good hand lotion (hospital soap is very drying)
-a small mirror
-a comb and/or brush
-chapstick (especially for when you first wake up after surgery)
-a box of soft kleenex (if you use a lot of it)
-a small tablet and pen (to write down questions, nurses/friends names)
-tissue off face cream like Noxema (it'll be hard to wash your face with IV's in)
-toothbrush and toothpaste (and any other tooth/mouth supplies you use)
-supplies for your period (most of us gals start the day of, or day after, our surgery. Pads are hard to use because you won't be wearing panties; tampons work better.)
-a few magazines to thumb through, if you like, or a book
-your own pillow is handy, and more comfortable
-a small fan is very nice, particularly if it's summertime
-perhaps a phone card (Some hospitals don't let you make long distance calls without one; if you have a lot of relatives to call, it can come in handy.)
-don't forget to bring any meds your surgeon wants you to take before surgery, and for the rest of your stay, unless they'll be provided in the hospital
-eye glasses or contact lenses, and supplies, if you think you'll need them to see
-your address book of people you want to call
-a copy of your will and/or durable power of attorney, a living will, and the names and addresses of all next of kin to go in your chart and how to immediately contact your spouse, mate, significant other and/or parents
-wear a loose, A-line dress or duster that you can also wear home comfortably over your incision, loose fitting sweats also work well
-a pair or two of loose-fitting underwear and water bottle for the trip home
Take anything else you'd like to have with you, and good luc****ep a list of what you have brought with you to check off quick when you leave, and don't wear, or bring, any valuable jewelry, or watches-or anything else. If you are bringing your CPAP machine, label it carefully with your name as the hospital requires.
What To Have At Home After RNY Surgery
(This list refers to RNY surgery; other surgeries may require different things. Please ask your surgeon about their own recovery and eating plan that they want you to follow after surgery; this list is only a very general guide--you may or may not wish to use the things listed here--and they are only suggestions on what many of us have found helpful.)
NON-FOOD ITEMS:
-measuring cups
-measuring spoons
-small strainers for soup and canned goods
-disposable Zip Lock containers
-sandwich bags
-paper plates/bowls/glasses/silverware
-measuring scale for weighing food
-a measured water pitcher that isn't too heavy to lift when full
-a blender
-extra paper towels and tp
-have several clean nightgowns/robe/slippers/loose clothing/dusters to wear
-put clean sheets on the bed
-a bed wedge and/or extra pillows to help you get out of bed
-a mortar and pestle for crushing pills (or other pill crusher)
-a good body lotion for dry skin
-medication lists with timetables (especially for the narcotics) and a place to check them off as you take them
FOOD/MED ITEMS:
-the vitamins/calcium/B-12/acid-blockers etc. your doctor recommends including:
-Lactase (for being lactose intolerant)
-Phazyme (for excess gas)
-Maalox (for acid stomach)
-juice (unsweetened apple/grape/pear etc.)
-Gatorade (for electolyte imbalance)
-sugar free Popsicles/fruit juice freezer bars
-beef and chicken soup and/or bullion cubes or powder
-cream soups (Cream of Chicken/Mushroom/Celery/Potato/Tomato)
-unsweetened applesauce
-canned lite pears/peaches/fruit ****tail
-canned veg (green beans/peas/mixed veg.)
-refried beans (get lowest fat possible)
-mashed potatoes (KFC has them already prepared with gravy which is handy)
-sugar free jello and pudding
-skim milk (if you can tolerate the dairy and sugar in it)
-eggs
-lite yogurt
-low fat cottage cheese
-fat free cream cheese
-low salt saltine crackers
-baby food (the ones high in protein--meats etc.)
-grilled chicken that is pureed and poured into ice cube trays; this provides handy, 1 oz. per cube portions that are easy to microwave and keep track of serving size and protein content
-protein supplements (Contact Michelle Curran at www.vitalady.com ; she sells many different kinds, and has samples, so you can find one you like without great expense.)
Though some doctors and nutritionists say to use sugar free Carnation Instant Breakfast/Ensure and other popular supplements, I have not included them here because one, they are either high in calories, or you have to make them with milk, which makes many people dump. Also, the calories (sugar) in these products are too high for the best weight loss, and they do not provide the best protein supplementation. Patients DO use them, though, and I would say the choice is up to you and your doctor. I would suggest you write to Michelle and talk about it with her; she has tons of nutritional info and can explain this rationale further. Write her at:
[email protected]
-canned tuna, canned chicken, potted meats (when you are allowed to start meats)
I would also highly recommend Victoria Bowen's excellent cookbook:
Victoria's Recipes for Gastric Bypass Patients
Write her at: [email protected] and visit her website:
http://www.angelfire.com/ok3VBowenCookBook/
This book includes wonderful recipes that have been adjusted for fat and sugar content especially for gastric bypass patients. She includes conversion guides and other wonderful tips for those of us who have had WLS!
Surgery Day Outline
This is a basic description of a typical surgery day. Every hospital, procedure, and doctor will vary, and this outline covers abdominal surgery only.
1. Surgery preparations at home depend on the type of procedure you're having. Some doctors may have you take a laxative the day before to clean out your intestinal tract, or you may be asked to wash a part of your body with antibacterial soap. Wear no make up, gals; it's important that the anesthesiologist see your natural color during surgery. Have a simple hair style; you will probably be asked to wear a shower-cap type head covering during the operation.
2. When you get to the hospital, sign in where you've been instructed. You may be expected to pay for your surgery and anesthesia if you do not have insurance. It is prudent to bring a copy of your will, durable power of attorney, and living will if you have one. Include the names and addresses of family and friends who are helping you, and an organ donor card, if you want to donate organs, to go in your chart.
Eventually, you will be taken to the surgery area. Much of the time, this can involve a lot of waiting. If your surgeon has had an overnight emergency, if one of his hospital patients needs more surgery, or if you're not his first surgery of the day, you might have to wait quite awhile. Be prepared for this so it does not add to your stress. Have a friend or spouse there to talk to, or bring something to read.
3. When you are taken to the surgical floor, you will be asked to change out of your clothes and into a hospital gown. A nurse may wash the area to be operated upon, if it wasn't done before. You'll cover your hair and be put on a gurney. At this point, you'll probably be asked to put on a pair of thigh-high tight elastic stockings; they help to prevent blood clots. Most likely, you'll will have had nothing to eat or drink since midnight, though your doctor may want you to take any meds you have now, with a sip of water.
If your mouth is unbearably dry, carry water with you along with paper cups. Rinse your mouth with water and spit it into a cup; make it clear to the nurse that you will not swallow any. If they won't allow that, ask for a wet washcloth to moisten your mouth. You may have to wait some more, at this point. They can usually give you some meds to calm you down--take them.
4. Eventually, you will be moved to the pre op area. Here, your IV line will be put in. You may have more waiting to do. As your surgery draws near, your anesthesiologist may give you an epidural painkiller, if that's what your doc uses to control pain. Blood pressure and oxygen level measurers may be attached to you.
5. Suddenly, everything seems to happen at once. You're moved into the OR and a mask is placed over your face and you fall asleep. A catheter is put into your urinary tract, an ng tube is placed in your nose, and you will be entubated with an airway placed in your throat to help you breath. You will be asleep during all of this and will not feel it. You should not feel anything during the entire operation.
6. Afterwards, you will become aware of noises in the recovery room. If you still have your airway in, it may feel very funny, but the nurse will come and take it out the minute you're alert enough to breath on your own. (Most of us do not have any memory of this and do not even feel it.) People keep banging things, or talking, and you can't really figure out what's going on. Gradually, you'll become aware of someone saying your name. You want to go back to sleep, but they won't let you. Then, you start to remember where you are, and the pain of the operation starts to be felt. At this point, try to take some deep breaths; they'll give you pain meds as soon as they know your awake and they are sure they won't affect your breathing.
7. You may feel a blood pressure cuff tighten on your arm and have a finger oxygen monitor on your index finger. If you're still in a lot of discomfort, you can usually mutter a few words about it to the nurse and they'll do something about it. The nurses will tell you your operation went fine, they'll give you pain meds if you need them, and you'll fall into a drowsy state.
8. You'll stay like this--in and out of sleep--for several hours. After about an hour or 2, they'll move you out of recovery and either into your own room, or into a step-down recovery room for the first 24 hours. As you continue to wake up, you'll feel a need to urinate. That's the catheter keeping your urethra open and you don't have to worry about it. They'll probably take it out after 24 hours, and it does not hurt to have it removed. Try to breath deeply and regularly to make sure you get enough oxygen. Tell the nurses if you have any pain; you may be a bit uncomfortable, but you should not be in so much pain you cannot fall asleep.
After several hours, you will wake up more or less. As soon as you can, stand up and take a few steps (the first time is not much fun). Walk as much as you can every 2 hours or so. This is the best prevention of blood clots. Have some chapstick available nearby; your lips may be dry after the
operation. You will continue to sleep a lot the rest of the day.
Surgical and Recovery Pain
I think the pain of surgery is the thing that frightens us most about WLS. We can't quite figure out how bad it will be, so it becomes bigger and more unbearable in our mind. Some people even decide against the surgery just because they are scared of the pain! However, there are many things we can do to make this huge issue more manageable and less frightening.
Understanding the purpose of pain is the first step. Pain exists as a warning. It tells us that there is something wrong with our body that must be fixed. The slow ache of a toothache tells us we may wait a week or so for that visit to the dentist, while the acute pain of appendicitis tells us we must seek help quickly. Pain on the surface or in the extremities--a boil or broken wrist--is usually not as life threatening as an injury to the heart, lungs and internal organs, though places that have many nerve endings--the
fingertips, the face--can give us very acute localized pain!
Pain literally compels us to do something to relieve it; it is part of our survival system that has allowed us to get help for bodily damage so that we may live. Pain causes many of our bodily systems to help us cope with the injury: it raises our blood pressure, increases our heart rate, produces adrenalin, makes our muscles rigid and us unwilling to move about. This prevents further damage to the area and allows our body to marshall it's defenses to help with the hurt: it sends blood to the needed areas/restricts other blood flow so we do not lose too much blood from the injury, maintains our blood pressure so our system does not collapse, and performs many other vital functions so that we can have the best chances for survival.
When we have surgery, our body does not know that we have had a planned remedy or a terrible injury; the same tissue damage, blood loss, shock to our system, release of maintenance chemicals occurs. Thus, after surgery, we
are in the same amount of pain as if we had been injured in the same way we'd been operated on: an incision is still an opening in our abdominal cavity--though, hopefully, our surgeons have made very exacting, precise moves as they work--so we have minimal tissue damage and blood loss.
Doctor's have access to many different kinds of analgesics that they give us so that we do not have to feel much pain, however. Careful management of pain is a key to having as comfortable a surgery as possible. Several things have a direct affect upon our pain management:
1) Our individual pain threshold
2) Whether we have a chronic pain condition already going on--or other condition--that surgery could aggravate
3) The fact that we are morbidly obese; current pain meds used slow the central nervous system (heart and lungs). If we already have a problem with sleep apnea or hypoxia/getting enough oxygen, and since our obesity already puts a tremendous strain on our heart and lungs, doctors can only use up to a certain amount of pain meds--more would put us in danger of stopping our heart and lungs.
4) Our surgeon's personal views on pain management
5) Our communication with our doctor before surgery
6) Our understanding of pain and pain remedies
7) Whether you are having a laproscopic or open procedure (an open procedure is an operation using the traditional incision, a laproscopic procedure is one done using thin tubes, and it involves approx. 5-6 inch-long incisions, which obviously reduces pain and recovery time.)
Doctors use two methods for controlling our pain: an intravenous pain killer that enters our bloodstream through a needle placed in our veins, and an epidural, which is a needle placed into the spinal column that delivers pain meds directly to the nerve systems responsible for the perception of pain--bypassing the effects on the heart and lungs. Though the epidural system would seem safer than the IV system, it DOES carry a small risk of spinal column problems, so some doctors do not choose to offer it as a first choice for pain relief unless there are proven problems with your breathing and oxygen level, which would make it safer than IV narcotics.
Some people having RNY surgery say the pain is quite bearable; women who have had children often say it's comparable to a hysterectomy or C-section. Other people say the pain is more than they expected. A few people say the pain was quite a bit worse than is usual. There is no way to predict how bad your pain will be before you have the operation. One guide is if you've had previous surgery; an incision in the abdomen feels pretty much the same no matter which surgery you're having.
The worst of it only lasts about 3-4 days; most doctors will keep you in the hospital until your acute pain is well under control, or has stopped (to make sure nothing has gone wrong, remember: pain is a warning that something is not O.K.). You are given IV or epidural pain relief this entire time and should not be suffering. An epidural block pain perception completely, but it does not work in everyone. If it does not work, you will be given IV narcotics for pain relief.
IV narcotics do not block the perception of pain 100% (if they did, you would be unconscious, and that high a dose would affect your heart and breathing). If you are given IV narcotics, or if your epidural is taken out and you are put on them, you will feel sore during this time. You will not be moving quickly. The pain will feel very vaguely there, but not really. As the dose wears off, you will be in a little more pain until your next dose.
To ensure good pain control, many hospitals, instead of doling out the meds at 4 hour intervals the way they used to, give you a narcotic pump that uses a button you can push whenever you feel the pain build. Though this does not give you unlimited narcotics--you can push the button only about every 12 minutes for a measured dose--many patients prefer this self-administration because it gives them a feeling of control over their pain without having to track down a nurse and convince them they need more relief. Along with these narcotic meds, doctors also use non-narcotic anti-inflammatory meds (like Toradol) that can help a lot with the inflammation of surgery without affecting your heart and lungs. This works very well for the majority of RNY patients and, between the epidural and/or IV, and non narcotic meds, the pain of the operation IS very bearable.
When we go home, we are given liquid, or tablet-form, narcotic medication. The tablets must be crushed and mixed in unsweetened applesauce to take, the liquid is easier, though neither is especially tasty. We take these meds for approx. about a week or so, maybe 10 days. If we are having pain beyond this point that needs narcotic medication, it is unusual and can be a sign that something is not quite right, and our doctors will want us to come in to the office, or undergo some tests to gauge our condition. Our surgeons want to make sure we don't have a post op infection, or other problem.
Some people are concerned about the issue of addiction. They worry taking narcotic meds in the hospital, and now at home, will cause them to become addicted to them. Some people are even reluctant to take their meds when they are home just for this reason, and they often try and delay taking them as long as possible. This is a mistake; pain that builds up takes a much bigger dose, in the end, to relieve, than beginning pain does. When you are home, especially the first 3 days, take your meds about at the interval that is prescribed, but do not wait until your pain is severe. Take your meds when you are just moderately uncomfortable and that will prevent it from building up to severe levels that require a large dose of meds to relieve.
Addiction is not a problem when you take narcotic meds for pain control only. Addiction can start to become an issue if you start to take your meds to get that rush of euphoria and good feeling narcotics provide. Narcotics act on the pleasure centers of the brain, and that's why we feel that rush when we take them. After surgery--especially WLS--we have no energy and do not feel particularly good. We can't do our regular activities, and we are uncomfortable. If you start taking pain meds to counteract these feelings, instead of your pain, then addiction is possible.
As long as you use your pain meds ONLY for pain, take them approx. at the prescribed intervals, and start to get your good feelings from your environment, as you always have, addiction is very unlikely to occur. People become addicted when they use the meds for feeling good emotionally instead of their regular activities. Plan to NOT feel like your usual self after surgery--and don't expect to. Tell yourself this will pass, and give yourself time to rest and recover. Do not use pain meds to pep yourself up, go to sleep (though you may certainly take or save your regular dose for night to help with that), put yourself in a good mood, cheer yourself up, or to get up and around before you are ready.
After we get home and have been on narcotics for about a week-10 days at home, the pain will diminish greatly and will gradually fade into a vague soreness. It will hurt only when we try and sit up, or get out of bed. Maybe we'll feel a little more sore at night after being up all day. At this point, Adult Liquid Tylenol--which you can buy over-the-counter at the
pharmacy--is usually enough to control any discomfort we have. (And it is only at this point that I am GOING to call it discomfort; before this it is pain and we should not be deluded that it is anything else). If your pain is worse than this, it is very important that you call your doctor and see if you should come in for an office visit.
For the Best Pain Relief:
If you are terribly afraid of pain, have never had an operation before and dread that aspect of it, and want superior pain relief, there are several things you can do to ensure the highest quality care:
1. Have a long talk with your surgeon. Tell him how apprehensive you are about pain. Do not let him brush off your concerns, or tell you that 'everything will be fine', or that 'most people find it adequate'. Tell him about your reactions to pain in the past; state firmly that you are prepared not to feel 100% pain-free, but that you DO NOT want to suffer. Let him know that you don't want a cookie-cutter approach used for your pain relief.
2. If you've had previous surgery, or have used pain medications for past relief of an injury, TELL your doctor. Specify what drug it was, and how well it worked. Go back in your memory and recall your reaction to these meds. Note if they made you feel dizzy, nauseous (a common side effect), or if you had an allergic reaction to them.
3. Have a plan in place--and ask your doctor specifically--what he will do if you wake up after surgery and the current method of pain control is not working, if you are still in the hospital and it is the middle of the night and the pain meds aren't working, and when you're home--and/or--it is the middle of the night and your pain meds aren't working. In the hospital, to change pain meds, or up the dose, a doctor has to write the order. Nurses are often reluctant, or just won't call the doctor in the middle of the night to do so. Have a plan in place--or an actual written order in advance--so you are not in worse pain than normal until morning. This is especially important if you are in a teaching hospital; doctor's 'rounds' there (where they drag all the student docs with them and visit you) is often the first time your doc will have a chance to write a new order--and that may not be
until mid-morning.
When you are home and your pain meds aren't working, ask in advance if you should take more of them, take them off schedule, or call his office (the usual thing to do). Ask if anyone is on call at night and/or the weekends who is willing and able to write a prescription for narcotics if you need them. Have the number of a 24 hr. pharmacy ready and someone who can drive to get them. If they will not take calls at night/weekends, do not wait until nighttime to find out if your meds aren't quite working. Take your pain meds before the pain is severe to avoid a painful build up over the course of the day, and pay attention to how well they work while it is still daytime during the week, so you can call your doctor's office, or go in for a visit, if they are not working.
For the ride home from the hospital--especially if it's quite a
distance--make sure you have gotten your last dose of pain meds just before you leave the hospital so they'll work on the ride home. If your trip will take more than 3 hours, make sure you have some pain meds with you; get your home prescription filled in advance. Have a pillow along to place across your stomach for the ride.
Prescription narcotics are controlled substances. Make sure your prescription is written out completely (very strong pain meds cannot be called in; you HAVE to take in a written script), all in one color of ink (or they may appear forged), and has all the doctor's license numbers/addresses/phone etc. on it that it needs to be filled--ASK the doc/nurse if the prescription is complete before you leave their office! Prescriptions of controlled substances have a limited number of times they may be transferred to other pharmacies, so try and get them all filled at the same one (that's why getting them filled in advance, a day or so before you come home is handiest). Often, liquid narcotics are ordered into a pharmacy in a bulk jug; if your hometown pharmacy is small, these jugs may come in only at certain intervals. Find out if you'll need to call a day or two in advance for a refill--we don't want you to have to wait for them!
Hibernation Syndrome
After WLS, you may be feeling tired and become depressed. When you are several weeks post op, and are either on a liquid diet or you are eating many fewer calories than you were pre op, this depression and inactivity can become more pronounced. All you want to do is sleep, you may have crying spells, you may begin to believe that the surgery was a mistake, or you may think 'what in the world have I done to myself?'
All these feelings are completely normal and, to a certain extent, are to be expected. The low number of calories you are eating produces what many of us call the 'hibernation syndrome' and your depression and feelings of despair, are a direct result.
During the weeks immediately following surgery, our body starts to notice that we are not taking in enough calories. It doesn't know we've had WLS, or that it's the year 2003. Our body is missing food, thinks this is a famine, and struggles to conserve our energy. The human body reacts like it always has in a famine; it makes us depressed--so we don't have the motivation to do anything, and it makes us tired--so we don't have the energy to do anything. In this way, we will conserve as many calories as possible and remain alive. You can see the practical value of this as our bodies have been living through famines, snowstorms, and other periods of unstable food supply for centuries.
This stage can last several weeks. Our discomfort is compounded as we are, at this same time, trying to recover from major surgery, adopt new eating habits, and deal with a liquid or soft diet. To get out of this stage, our body has to say to itself 'gee, this famine is lasting a bit too long. If I keep conserving my energy with inactivity, I will starve to death. I'd better use my last store of energy (the remaining fat and muscles in our body) to hunt up some food'. At this point, our body will switch from getting energy from food, to getting energy from our fat (and muscle too if we don't eat enough protein) and that is what we want.
In order to deal with this difficult transition period, tell yourself that you're right on track; this is exactly what is normal and to be expected. Tell yourself that, in a few weeks, this will pass, and you will feel like a completely new person. We all seem to turn the corner about 4-6 weeks post op. Then, your mood will lighten and, with your weight loss starting to add up, you'll feel more positive and have a better outlook on life. Just keep telling yourself that you will not always feel this way! You WILL be back to feeling like your old self. Just give it time!
WEIGHT REDUCTION SURGERY DIET
These guidelines describe the dietary changes you will need to follow after your surgery for weight reduction. Choosing a well balanced diet and following the types and amounts of foods listed here will help you to maintain good health while you are losing weight. The surgery will help you lose weight quickly at first. But to help you lose weight safely, you must follow these guidelines closely. Remember - to successfully lose weight and then maintain your weight loss, you must develop life long healthful eating and lifestyle habits.
Your Diet After Surgery
Your diet will progress from liquids to pureed to mechanical soft (foods that are chopped or ground, tender and easily chewed), soft, and finally to foods of normal consistency. Your surgeon will order a diet when you are ready to start eating and will advance it to the next step when appropriate. Drinking and eating slowly and stopping when you feel full are important for each diet, whether it is liquid or solid. The diet generally progresses as follows, but this will vary with each individual:
Clear Liquids will be started soon after surgery and will include unsweetened juices, regular gelatin and broth. No carbonated beverages will be allowed. The surgeon will order small amounts of liquid. These liquids should be sipped very slowly.
Full Liquids include low-fat milk, strained cream soups, cooked cream of wheat, puddings and baked custard. It is important that you eat very small amounts of food every few hours and that you sip or eat them slowly.
Pureed foods are foods that have been blenderized and need no chewing. The consistency is that of smooth paste or plain yogurt. The pureed diet is followed until the surgeon allows progression to more solid foods.
- Meal size is limited initially to about 4-6 tablespoons (2-3 ounces) and can gradually be increased to 8 - 12 tablespoons (4-6 ounces)
- Eat 4-6 small meals each day
- Do not drink liquids with your meals
- Drink at least six 8 ounce cups of liquids daily
- A food can be pureed by blenderizing it with a sugar-free low-fat liquid in a blender or food processor until smooth. If chunks remain, the food should be strained.
- Blenderized foods should be used immediately, but can be refrigerated up to 48 hours or frozen immediately after blenderizing to prevent growth of harmful bacteria.
- Extra pureed food may be put in ice cube trays and frozen.
Mechanical Soft foods are chopped or ground, tender and easily chewed. Examples include flaked fish, cooked eggs, low-fat cheese or cottage cheese, casseroles made with ground meats and very soft vegetables, soft pasta, toast, crackers, canned fruits, bananas, and soft cooked vegetables.
- Meal size should not exceed 6-8 tablespoons (3-4 ounces)
- Eat 4-6 small meals each day
- Do not drink liquids with your meals
- Drink at least six 8 ounce cups of liquids daily
Soft to Regular Diet - The soft diet allows you to try finely diced lean meat and poultry and includes fresh melon, as long as they are chewed well and eaten slowly. New foods should be tried gradually and in small amounts. If a food is not well tolerated it should be avoided and possibly retried at a later date, in very small amounts. Eventually you may be able to eat a regular diet provided that you have learned to chew all food thoroughly before swallowing.
Hi - I'm Jeanne in WI, one of the list moderators. Here is some info. that I received from a former member of GBIC. It's so thorough, that I try to send it out to as many pre-ops as I can. I've also added my own Dietician's Instructions as I thought they were well written and easy to understand. Some people don't receive much at all in the way of written instructions. Hope it helps you out.
Jeanne in WI
Age 41
Open RNY - 5/21/02
[email protected]
Included is: What To Take To The Hospital
What To Have At Home After WLS
A Surgery Day Outline
Surgical and Recovery Pain
'Hibernation' Syndrome
What To Take To the Hospital
Here's a fairly complete list of things:
(You won't need a nightgown or pj's; the hospital will provide a hospital gown that will fit over your IV's. If you are quite a bit larger than your surgeon's regular WLS patients, you might want to call the hospital ahead of time and make sure they have a gown that will fit; you don't want to spend 3-4 days in something that is uncomfortable.)
-a knee length bathrobe so you can walk the halls covered up:
-a non-slip pair of slippers that are easy to walk in
-a good hand lotion (hospital soap is very drying)
-a small mirror
-a comb and/or brush
-chapstick (especially for when you first wake up after surgery)
-a box of soft kleenex (if you use a lot of it)
-a small tablet and pen (to write down questions, nurses/friends names)
-tissue off face cream like Noxema (it'll be hard to wash your face with IV's in)
-toothbrush and toothpaste (and any other tooth/mouth supplies you use)
-supplies for your period (most of us gals start the day of, or day after, our surgery. Pads are hard to use because you won't be wearing panties; tampons work better.)
-a few magazines to thumb through, if you like, or a book
-your own pillow is handy, and more comfortable
-a small fan is very nice, particularly if it's summertime
-perhaps a phone card (Some hospitals don't let you make long distance calls without one; if you have a lot of relatives to call, it can come in handy.)
-don't forget to bring any meds your surgeon wants you to take before surgery, and for the rest of your stay, unless they'll be provided in the hospital
-eye glasses or contact lenses, and supplies, if you think you'll need them to see
-your address book of people you want to call
-a copy of your will and/or durable power of attorney, a living will, and the names and addresses of all next of kin to go in your chart and how to immediately contact your spouse, mate, significant other and/or parents
-wear a loose, A-line dress or duster that you can also wear home comfortably over your incision, loose fitting sweats also work well
-a pair or two of loose-fitting underwear and water bottle for the trip home
Take anything else you'd like to have with you, and good luc****ep a list of what you have brought with you to check off quick when you leave, and don't wear, or bring, any valuable jewelry, or watches-or anything else. If you are bringing your CPAP machine, label it carefully with your name as the hospital requires.
What To Have At Home After RNY Surgery
(This list refers to RNY surgery; other surgeries may require different things. Please ask your surgeon about their own recovery and eating plan that they want you to follow after surgery; this list is only a very general guide--you may or may not wish to use the things listed here--and they are only suggestions on what many of us have found helpful.)
NON-FOOD ITEMS:
-measuring cups
-measuring spoons
-small strainers for soup and canned goods
-disposable Zip Lock containers
-sandwich bags
-paper plates/bowls/glasses/silverware
-measuring scale for weighing food
-a measured water pitcher that isn't too heavy to lift when full
-a blender
-extra paper towels and tp
-have several clean nightgowns/robe/slippers/loose clothing/dusters to wear
-put clean sheets on the bed
-a bed wedge and/or extra pillows to help you get out of bed
-a mortar and pestle for crushing pills (or other pill crusher)
-a good body lotion for dry skin
-medication lists with timetables (especially for the narcotics) and a place to check them off as you take them
FOOD/MED ITEMS:
-the vitamins/calcium/B-12/acid-blockers etc. your doctor recommends including:
-Lactase (for being lactose intolerant)
-Phazyme (for excess gas)
-Maalox (for acid stomach)
-juice (unsweetened apple/grape/pear etc.)
-Gatorade (for electolyte imbalance)
-sugar free Popsicles/fruit juice freezer bars
-beef and chicken soup and/or bullion cubes or powder
-cream soups (Cream of Chicken/Mushroom/Celery/Potato/Tomato)
-unsweetened applesauce
-canned lite pears/peaches/fruit ****tail
-canned veg (green beans/peas/mixed veg.)
-refried beans (get lowest fat possible)
-mashed potatoes (KFC has them already prepared with gravy which is handy)
-sugar free jello and pudding
-skim milk (if you can tolerate the dairy and sugar in it)
-eggs
-lite yogurt
-low fat cottage cheese
-fat free cream cheese
-low salt saltine crackers
-baby food (the ones high in protein--meats etc.)
-grilled chicken that is pureed and poured into ice cube trays; this provides handy, 1 oz. per cube portions that are easy to microwave and keep track of serving size and protein content
-protein supplements (Contact Michelle Curran at www.vitalady.com ; she sells many different kinds, and has samples, so you can find one you like without great expense.)
Though some doctors and nutritionists say to use sugar free Carnation Instant Breakfast/Ensure and other popular supplements, I have not included them here because one, they are either high in calories, or you have to make them with milk, which makes many people dump. Also, the calories (sugar) in these products are too high for the best weight loss, and they do not provide the best protein supplementation. Patients DO use them, though, and I would say the choice is up to you and your doctor. I would suggest you write to Michelle and talk about it with her; she has tons of nutritional info and can explain this rationale further. Write her at:
[email protected]
-canned tuna, canned chicken, potted meats (when you are allowed to start meats)
I would also highly recommend Victoria Bowen's excellent cookbook:
Victoria's Recipes for Gastric Bypass Patients
Write her at: [email protected] and visit her website:
http://www.angelfire.com/ok3VBowenCookBook/
This book includes wonderful recipes that have been adjusted for fat and sugar content especially for gastric bypass patients. She includes conversion guides and other wonderful tips for those of us who have had WLS!
Surgery Day Outline
This is a basic description of a typical surgery day. Every hospital, procedure, and doctor will vary, and this outline covers abdominal surgery only.
1. Surgery preparations at home depend on the type of procedure you're having. Some doctors may have you take a laxative the day before to clean out your intestinal tract, or you may be asked to wash a part of your body with antibacterial soap. Wear no make up, gals; it's important that the anesthesiologist see your natural color during surgery. Have a simple hair style; you will probably be asked to wear a shower-cap type head covering during the operation.
2. When you get to the hospital, sign in where you've been instructed. You may be expected to pay for your surgery and anesthesia if you do not have insurance. It is prudent to bring a copy of your will, durable power of attorney, and living will if you have one. Include the names and addresses of family and friends who are helping you, and an organ donor card, if you want to donate organs, to go in your chart.
Eventually, you will be taken to the surgery area. Much of the time, this can involve a lot of waiting. If your surgeon has had an overnight emergency, if one of his hospital patients needs more surgery, or if you're not his first surgery of the day, you might have to wait quite awhile. Be prepared for this so it does not add to your stress. Have a friend or spouse there to talk to, or bring something to read.
3. When you are taken to the surgical floor, you will be asked to change out of your clothes and into a hospital gown. A nurse may wash the area to be operated upon, if it wasn't done before. You'll cover your hair and be put on a gurney. At this point, you'll probably be asked to put on a pair of thigh-high tight elastic stockings; they help to prevent blood clots. Most likely, you'll will have had nothing to eat or drink since midnight, though your doctor may want you to take any meds you have now, with a sip of water.
If your mouth is unbearably dry, carry water with you along with paper cups. Rinse your mouth with water and spit it into a cup; make it clear to the nurse that you will not swallow any. If they won't allow that, ask for a wet washcloth to moisten your mouth. You may have to wait some more, at this point. They can usually give you some meds to calm you down--take them.
4. Eventually, you will be moved to the pre op area. Here, your IV line will be put in. You may have more waiting to do. As your surgery draws near, your anesthesiologist may give you an epidural painkiller, if that's what your doc uses to control pain. Blood pressure and oxygen level measurers may be attached to you.
5. Suddenly, everything seems to happen at once. You're moved into the OR and a mask is placed over your face and you fall asleep. A catheter is put into your urinary tract, an ng tube is placed in your nose, and you will be entubated with an airway placed in your throat to help you breath. You will be asleep during all of this and will not feel it. You should not feel anything during the entire operation.
6. Afterwards, you will become aware of noises in the recovery room. If you still have your airway in, it may feel very funny, but the nurse will come and take it out the minute you're alert enough to breath on your own. (Most of us do not have any memory of this and do not even feel it.) People keep banging things, or talking, and you can't really figure out what's going on. Gradually, you'll become aware of someone saying your name. You want to go back to sleep, but they won't let you. Then, you start to remember where you are, and the pain of the operation starts to be felt. At this point, try to take some deep breaths; they'll give you pain meds as soon as they know your awake and they are sure they won't affect your breathing.
7. You may feel a blood pressure cuff tighten on your arm and have a finger oxygen monitor on your index finger. If you're still in a lot of discomfort, you can usually mutter a few words about it to the nurse and they'll do something about it. The nurses will tell you your operation went fine, they'll give you pain meds if you need them, and you'll fall into a drowsy state.
8. You'll stay like this--in and out of sleep--for several hours. After about an hour or 2, they'll move you out of recovery and either into your own room, or into a step-down recovery room for the first 24 hours. As you continue to wake up, you'll feel a need to urinate. That's the catheter keeping your urethra open and you don't have to worry about it. They'll probably take it out after 24 hours, and it does not hurt to have it removed. Try to breath deeply and regularly to make sure you get enough oxygen. Tell the nurses if you have any pain; you may be a bit uncomfortable, but you should not be in so much pain you cannot fall asleep.
After several hours, you will wake up more or less. As soon as you can, stand up and take a few steps (the first time is not much fun). Walk as much as you can every 2 hours or so. This is the best prevention of blood clots. Have some chapstick available nearby; your lips may be dry after the
operation. You will continue to sleep a lot the rest of the day.
Surgical and Recovery Pain
I think the pain of surgery is the thing that frightens us most about WLS. We can't quite figure out how bad it will be, so it becomes bigger and more unbearable in our mind. Some people even decide against the surgery just because they are scared of the pain! However, there are many things we can do to make this huge issue more manageable and less frightening.
Understanding the purpose of pain is the first step. Pain exists as a warning. It tells us that there is something wrong with our body that must be fixed. The slow ache of a toothache tells us we may wait a week or so for that visit to the dentist, while the acute pain of appendicitis tells us we must seek help quickly. Pain on the surface or in the extremities--a boil or broken wrist--is usually not as life threatening as an injury to the heart, lungs and internal organs, though places that have many nerve endings--the
fingertips, the face--can give us very acute localized pain!
Pain literally compels us to do something to relieve it; it is part of our survival system that has allowed us to get help for bodily damage so that we may live. Pain causes many of our bodily systems to help us cope with the injury: it raises our blood pressure, increases our heart rate, produces adrenalin, makes our muscles rigid and us unwilling to move about. This prevents further damage to the area and allows our body to marshall it's defenses to help with the hurt: it sends blood to the needed areas/restricts other blood flow so we do not lose too much blood from the injury, maintains our blood pressure so our system does not collapse, and performs many other vital functions so that we can have the best chances for survival.
When we have surgery, our body does not know that we have had a planned remedy or a terrible injury; the same tissue damage, blood loss, shock to our system, release of maintenance chemicals occurs. Thus, after surgery, we
are in the same amount of pain as if we had been injured in the same way we'd been operated on: an incision is still an opening in our abdominal cavity--though, hopefully, our surgeons have made very exacting, precise moves as they work--so we have minimal tissue damage and blood loss.
Doctor's have access to many different kinds of analgesics that they give us so that we do not have to feel much pain, however. Careful management of pain is a key to having as comfortable a surgery as possible. Several things have a direct affect upon our pain management:
1) Our individual pain threshold
2) Whether we have a chronic pain condition already going on--or other condition--that surgery could aggravate
3) The fact that we are morbidly obese; current pain meds used slow the central nervous system (heart and lungs). If we already have a problem with sleep apnea or hypoxia/getting enough oxygen, and since our obesity already puts a tremendous strain on our heart and lungs, doctors can only use up to a certain amount of pain meds--more would put us in danger of stopping our heart and lungs.
4) Our surgeon's personal views on pain management
5) Our communication with our doctor before surgery
6) Our understanding of pain and pain remedies
7) Whether you are having a laproscopic or open procedure (an open procedure is an operation using the traditional incision, a laproscopic procedure is one done using thin tubes, and it involves approx. 5-6 inch-long incisions, which obviously reduces pain and recovery time.)
Doctors use two methods for controlling our pain: an intravenous pain killer that enters our bloodstream through a needle placed in our veins, and an epidural, which is a needle placed into the spinal column that delivers pain meds directly to the nerve systems responsible for the perception of pain--bypassing the effects on the heart and lungs. Though the epidural system would seem safer than the IV system, it DOES carry a small risk of spinal column problems, so some doctors do not choose to offer it as a first choice for pain relief unless there are proven problems with your breathing and oxygen level, which would make it safer than IV narcotics.
Some people having RNY surgery say the pain is quite bearable; women who have had children often say it's comparable to a hysterectomy or C-section. Other people say the pain is more than they expected. A few people say the pain was quite a bit worse than is usual. There is no way to predict how bad your pain will be before you have the operation. One guide is if you've had previous surgery; an incision in the abdomen feels pretty much the same no matter which surgery you're having.
The worst of it only lasts about 3-4 days; most doctors will keep you in the hospital until your acute pain is well under control, or has stopped (to make sure nothing has gone wrong, remember: pain is a warning that something is not O.K.). You are given IV or epidural pain relief this entire time and should not be suffering. An epidural block pain perception completely, but it does not work in everyone. If it does not work, you will be given IV narcotics for pain relief.
IV narcotics do not block the perception of pain 100% (if they did, you would be unconscious, and that high a dose would affect your heart and breathing). If you are given IV narcotics, or if your epidural is taken out and you are put on them, you will feel sore during this time. You will not be moving quickly. The pain will feel very vaguely there, but not really. As the dose wears off, you will be in a little more pain until your next dose.
To ensure good pain control, many hospitals, instead of doling out the meds at 4 hour intervals the way they used to, give you a narcotic pump that uses a button you can push whenever you feel the pain build. Though this does not give you unlimited narcotics--you can push the button only about every 12 minutes for a measured dose--many patients prefer this self-administration because it gives them a feeling of control over their pain without having to track down a nurse and convince them they need more relief. Along with these narcotic meds, doctors also use non-narcotic anti-inflammatory meds (like Toradol) that can help a lot with the inflammation of surgery without affecting your heart and lungs. This works very well for the majority of RNY patients and, between the epidural and/or IV, and non narcotic meds, the pain of the operation IS very bearable.
When we go home, we are given liquid, or tablet-form, narcotic medication. The tablets must be crushed and mixed in unsweetened applesauce to take, the liquid is easier, though neither is especially tasty. We take these meds for approx. about a week or so, maybe 10 days. If we are having pain beyond this point that needs narcotic medication, it is unusual and can be a sign that something is not quite right, and our doctors will want us to come in to the office, or undergo some tests to gauge our condition. Our surgeons want to make sure we don't have a post op infection, or other problem.
Some people are concerned about the issue of addiction. They worry taking narcotic meds in the hospital, and now at home, will cause them to become addicted to them. Some people are even reluctant to take their meds when they are home just for this reason, and they often try and delay taking them as long as possible. This is a mistake; pain that builds up takes a much bigger dose, in the end, to relieve, than beginning pain does. When you are home, especially the first 3 days, take your meds about at the interval that is prescribed, but do not wait until your pain is severe. Take your meds when you are just moderately uncomfortable and that will prevent it from building up to severe levels that require a large dose of meds to relieve.
Addiction is not a problem when you take narcotic meds for pain control only. Addiction can start to become an issue if you start to take your meds to get that rush of euphoria and good feeling narcotics provide. Narcotics act on the pleasure centers of the brain, and that's why we feel that rush when we take them. After surgery--especially WLS--we have no energy and do not feel particularly good. We can't do our regular activities, and we are uncomfortable. If you start taking pain meds to counteract these feelings, instead of your pain, then addiction is possible.
As long as you use your pain meds ONLY for pain, take them approx. at the prescribed intervals, and start to get your good feelings from your environment, as you always have, addiction is very unlikely to occur. People become addicted when they use the meds for feeling good emotionally instead of their regular activities. Plan to NOT feel like your usual self after surgery--and don't expect to. Tell yourself this will pass, and give yourself time to rest and recover. Do not use pain meds to pep yourself up, go to sleep (though you may certainly take or save your regular dose for night to help with that), put yourself in a good mood, cheer yourself up, or to get up and around before you are ready.
After we get home and have been on narcotics for about a week-10 days at home, the pain will diminish greatly and will gradually fade into a vague soreness. It will hurt only when we try and sit up, or get out of bed. Maybe we'll feel a little more sore at night after being up all day. At this point, Adult Liquid Tylenol--which you can buy over-the-counter at the
pharmacy--is usually enough to control any discomfort we have. (And it is only at this point that I am GOING to call it discomfort; before this it is pain and we should not be deluded that it is anything else). If your pain is worse than this, it is very important that you call your doctor and see if you should come in for an office visit.
For the Best Pain Relief:
If you are terribly afraid of pain, have never had an operation before and dread that aspect of it, and want superior pain relief, there are several things you can do to ensure the highest quality care:
1. Have a long talk with your surgeon. Tell him how apprehensive you are about pain. Do not let him brush off your concerns, or tell you that 'everything will be fine', or that 'most people find it adequate'. Tell him about your reactions to pain in the past; state firmly that you are prepared not to feel 100% pain-free, but that you DO NOT want to suffer. Let him know that you don't want a cookie-cutter approach used for your pain relief.
2. If you've had previous surgery, or have used pain medications for past relief of an injury, TELL your doctor. Specify what drug it was, and how well it worked. Go back in your memory and recall your reaction to these meds. Note if they made you feel dizzy, nauseous (a common side effect), or if you had an allergic reaction to them.
3. Have a plan in place--and ask your doctor specifically--what he will do if you wake up after surgery and the current method of pain control is not working, if you are still in the hospital and it is the middle of the night and the pain meds aren't working, and when you're home--and/or--it is the middle of the night and your pain meds aren't working. In the hospital, to change pain meds, or up the dose, a doctor has to write the order. Nurses are often reluctant, or just won't call the doctor in the middle of the night to do so. Have a plan in place--or an actual written order in advance--so you are not in worse pain than normal until morning. This is especially important if you are in a teaching hospital; doctor's 'rounds' there (where they drag all the student docs with them and visit you) is often the first time your doc will have a chance to write a new order--and that may not be
until mid-morning.
When you are home and your pain meds aren't working, ask in advance if you should take more of them, take them off schedule, or call his office (the usual thing to do). Ask if anyone is on call at night and/or the weekends who is willing and able to write a prescription for narcotics if you need them. Have the number of a 24 hr. pharmacy ready and someone who can drive to get them. If they will not take calls at night/weekends, do not wait until nighttime to find out if your meds aren't quite working. Take your pain meds before the pain is severe to avoid a painful build up over the course of the day, and pay attention to how well they work while it is still daytime during the week, so you can call your doctor's office, or go in for a visit, if they are not working.
For the ride home from the hospital--especially if it's quite a
distance--make sure you have gotten your last dose of pain meds just before you leave the hospital so they'll work on the ride home. If your trip will take more than 3 hours, make sure you have some pain meds with you; get your home prescription filled in advance. Have a pillow along to place across your stomach for the ride.
Prescription narcotics are controlled substances. Make sure your prescription is written out completely (very strong pain meds cannot be called in; you HAVE to take in a written script), all in one color of ink (or they may appear forged), and has all the doctor's license numbers/addresses/phone etc. on it that it needs to be filled--ASK the doc/nurse if the prescription is complete before you leave their office! Prescriptions of controlled substances have a limited number of times they may be transferred to other pharmacies, so try and get them all filled at the same one (that's why getting them filled in advance, a day or so before you come home is handiest). Often, liquid narcotics are ordered into a pharmacy in a bulk jug; if your hometown pharmacy is small, these jugs may come in only at certain intervals. Find out if you'll need to call a day or two in advance for a refill--we don't want you to have to wait for them!
Hibernation Syndrome
After WLS, you may be feeling tired and become depressed. When you are several weeks post op, and are either on a liquid diet or you are eating many fewer calories than you were pre op, this depression and inactivity can become more pronounced. All you want to do is sleep, you may have crying spells, you may begin to believe that the surgery was a mistake, or you may think 'what in the world have I done to myself?'
All these feelings are completely normal and, to a certain extent, are to be expected. The low number of calories you are eating produces what many of us call the 'hibernation syndrome' and your depression and feelings of despair, are a direct result.
During the weeks immediately following surgery, our body starts to notice that we are not taking in enough calories. It doesn't know we've had WLS, or that it's the year 2003. Our body is missing food, thinks this is a famine, and struggles to conserve our energy. The human body reacts like it always has in a famine; it makes us depressed--so we don't have the motivation to do anything, and it makes us tired--so we don't have the energy to do anything. In this way, we will conserve as many calories as possible and remain alive. You can see the practical value of this as our bodies have been living through famines, snowstorms, and other periods of unstable food supply for centuries.
This stage can last several weeks. Our discomfort is compounded as we are, at this same time, trying to recover from major surgery, adopt new eating habits, and deal with a liquid or soft diet. To get out of this stage, our body has to say to itself 'gee, this famine is lasting a bit too long. If I keep conserving my energy with inactivity, I will starve to death. I'd better use my last store of energy (the remaining fat and muscles in our body) to hunt up some food'. At this point, our body will switch from getting energy from food, to getting energy from our fat (and muscle too if we don't eat enough protein) and that is what we want.
In order to deal with this difficult transition period, tell yourself that you're right on track; this is exactly what is normal and to be expected. Tell yourself that, in a few weeks, this will pass, and you will feel like a completely new person. We all seem to turn the corner about 4-6 weeks post op. Then, your mood will lighten and, with your weight loss starting to add up, you'll feel more positive and have a better outlook on life. Just keep telling yourself that you will not always feel this way! You WILL be back to feeling like your old self. Just give it time!
WEIGHT REDUCTION SURGERY DIET
These guidelines describe the dietary changes you will need to follow after your surgery for weight reduction. Choosing a well balanced diet and following the types and amounts of foods listed here will help you to maintain good health while you are losing weight. The surgery will help you lose weight quickly at first. But to help you lose weight safely, you must follow these guidelines closely. Remember - to successfully lose weight and then maintain your weight loss, you must develop life long healthful eating and lifestyle habits.
Your Diet After Surgery
Your diet will progress from liquids to pureed to mechanical soft (foods that are chopped or ground, tender and easily chewed), soft, and finally to foods of normal consistency. Your surgeon will order a diet when you are ready to start eating and will advance it to the next step when appropriate. Drinking and eating slowly and stopping when you feel full are important for each diet, whether it is liquid or solid. The diet generally progresses as follows, but this will vary with each individual:
Clear Liquids will be started soon after surgery and will include unsweetened juices, regular gelatin and broth. No carbonated beverages will be allowed. The surgeon will order small amounts of liquid. These liquids should be sipped very slowly.
Full Liquids include low-fat milk, strained cream soups, cooked cream of wheat, puddings and baked custard. It is important that you eat very small amounts of food every few hours and that you sip or eat them slowly.
Pureed foods are foods that have been blenderized and need no chewing. The consistency is that of smooth paste or plain yogurt. The pureed diet is followed until the surgeon allows progression to more solid foods.
- Meal size is limited initially to about 4-6 tablespoons (2-3 ounces) and can gradually be increased to 8 - 12 tablespoons (4-6 ounces)
- Eat 4-6 small meals each day
- Do not drink liquids with your meals
- Drink at least six 8 ounce cups of liquids daily
- A food can be pureed by blenderizing it with a sugar-free low-fat liquid in a blender or food processor until smooth. If chunks remain, the food should be strained.
- Blenderized foods should be used immediately, but can be refrigerated up to 48 hours or frozen immediately after blenderizing to prevent growth of harmful bacteria.
- Extra pureed food may be put in ice cube trays and frozen.
Mechanical Soft foods are chopped or ground, tender and easily chewed. Examples include flaked fish, cooked eggs, low-fat cheese or cottage cheese, casseroles made with ground meats and very soft vegetables, soft pasta, toast, crackers, canned fruits, bananas, and soft cooked vegetables.
- Meal size should not exceed 6-8 tablespoons (3-4 ounces)
- Eat 4-6 small meals each day
- Do not drink liquids with your meals
- Drink at least six 8 ounce cups of liquids daily
Soft to Regular Diet - The soft diet allows you to try finely diced lean meat and poultry and includes fresh melon, as long as they are chewed well and eaten slowly. New foods should be tried gradually and in small amounts. If a food is not well tolerated it should be avoided and possibly retried at a later date, in very small amounts. Eventually you may be able to eat a regular diet provided that you have learned to chew all food thoroughly before swallowing. 
Good gravy Nicole! If you are going to a hospital that normally does these procedures (which I hope you are), you won't have to bring anything except some change of clothes and your chapstick! Call the hospital and speak to one of the nursing supervisors on the bariatric wing and they will have the best advice for you.
I didn't have RNY but all I needed was my chapstick, they took care of all the rest.
Best of luck to you.
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