Home today from Surgery

Larry_Emerson: Welcome home and to the other side! Thank you for bringing up the topic of sipping fluids after WLS. I had put this together for support group but may be helpful for you and/any newbies! In addition hibernation is typical at this point. Making naps  no more than 30-45 min setting a timer or we coulod end up sleeping for hours w/o getting in needed fluid and movement to prevent the deadly blood clots! Be well.

Focus on Fluids

One of the main challenges for a gastric bypass patient over time is to maintain hydration. Your body needs just as much fluid after the surgery as it did before surgery, yet the new stomach pouch limits you to 1-2 ounces at a time.  (NO MORE GUZZLING!) Maintenance of fluid intake may also be difficult because of the necessity to take in food or fluids, and not both at once. You must compensate for this by taking small amounts of fluid on a near-constant basis. Usually this means that you should carry your fluid source with you at all times.

*** We cannot overemphasize that the liquid must be a caffeine, carbonation & calorie-free. Patients who use fruit juice or other calorie-containing liquids for hydration may experience inadequate weight loss because of the calories in these fluids, and can experience dumping syndrome from the sugar. Caffeine is a possible appetite-stimulant, diuretic and irritant and can potentially cause ulcers in the new pouch and add to dehydration and low-iron blood (which we already poorly absorb iron post-op). Carbonation can possibly cause gastric irritation, if carbonated beverage also contains phosphorus it may act to leach calcium out of bones, and some feel it may stretch pouch/stoma.

Drinking at least 64 ounces of fluids post-op is a necessity. Water is the body’s best source, and serves the purpose to aid digestion and absorption of food; it regulates temperature and circulation, carries nutrients and O2 to the cells of the body and removes toxins and waste.

Dehydration can cause/aggravate constipation, kidney stones, urinary infections, high or low blood pressure, difficulty controlling diabetes and migraines. Dizziness,  clumsiness, muscle cramps in arms and legs, dark yellow urine, fatigue, irritability, are sunken eyes, low blood pressure and fainting, bloating, and a fast, weak pulse -- are signs that dehydration is setting in.

Fluids should be consumed on a near-constant basis, but not during meals and not soon following food. If you drink during your meal, you will tend to wash the food out of the stomach pouch, and consume more food than is desirable. It may seem strange at first to eat without drinking but it works fine. A good tip here is to actually not have any fluid on the table while you are eating. In addition to reducing your overall food intake, this new habit will encourage you to chew more thoroughly before swallowing, because you will not count on the fluid to wash down half-chewed food. Also note that soup is kind of like drinking liquids with food – soup is not an absolute "no-no" but recognize that it should not be a regular part of your diet.

Liquids should not be consumed for about 30-60 minutes after eating. This is because the food actually forms a plug that blocks the outlet from the pouch until it has all passed through. If you drink liquids on top of this plug it will create a very uncomfortable sensation and may also force food downstream more quickly than it should go.

A brief review on coordinating liquids and food:

ü       Sip liquids constantly, even just before eating. Don’t drink liquids while eating.

ü       Don’t drink liquids until about one hour after completing your meal.

ü       When the stomach pouch is mature (six months or more after surgery) it is useful to wait two or three hours after eating before consuming liquid.

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 2008. 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! JAMIE