A few (!) words about "cheating" on the post-op dietary instructions (don't do it)

The following is a long post I wrote in another forum quite some time ago, after one too many posts about people "cheating" on the post-op diet phase, and other people essentially patting them on the head and saying "that's OK, we're all human, we all make mistakes" and various comments about it being "too hard" to fight food addiction. Essentially giving the impression that it's no big deal to violate the post-op dietary instructions from your surgeon.

I dug it up and posted it as a comment over on the VSG board for someone who was struggling post-op and had gone WAY off plan, and was asked to post it as a stand-alone post. I'm happy to do so in case it's of help to someone.

Note: Where I am speaking of a specific surgery in the post, it's the VSG since that's what I had done and am most educated about. Anatomically, the RNY surgery is different, and I'm not educated enough to speak to it specifically, so please keep that in mind if you are post-RNY (others here are GREAT sources of info if you need). But some of the same concepts apply. Small surgery on the outside, BIG surgery on the inside, you need to PROTECT your incision while it heals.

If you need the TLDR; version, it's this... STICK to your surgeon's post-op plan, it's for your SAFETY. I KNOW it's hard, we've all been there, but STICK to it!!

Also, I'm going to work on tightening up the writing on this (it is literally a one-draft rant) and post it on my blog at some point in the future, so I welcome constructive criticism and suggestions for things to add/delete, questions people might have that I could answer in the re-write, etc.

Edit to add: I really haven't seen a lot of this on OH, and certainly haven't seen the coddling I witnessed in the other forum (one of the reasons I REALLY like it here). So please don't think this is in response to some rash of poor behavior I've seen here!! :) Someone thought it would be a good post as a standalone, and I'm always happy to re-post my stuff in case it helps someone. :) (Just wanted to clarify in case someone is thinking I'm pointing at them... I'm not...)

My best to everyone!
The AntiChick
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Over the last few weeks, I've seen a number of posts about "cheating" on the diet plan in the days and weeks immediately following surgery, and I am very concerned about this trend.

I am not a doctor, I do not play one on TV, and I am not dispensing medical advice.

However.

I am a registered nurse, and what I'm about to say is an informed and educated opinion.

Surgeons tend to give VERY detailed instructions about what to eat after a stomach surgery, and for VERY good reason.

Even when the surgery is arthroscopic and looks to be a very tiny surgery on the outside, it's a VERY BIG surgery on the inside. The VSG surgery leaves a staple/suture line the entire length of the stomach. That incision has to heal, and if you could see it, it would look like raw beef. If the incision were on the outside, we would be very careful with it, keeping it clean and bandaged while it healed. Of course, it's on the inside, so we can't do that. But we need to keep in mind that it needs to heal in the same way.

We have to eat, and that food will be against that raw incision. At the same time that we have to protect the healing stomach, we also have to get in plenty of fluids and nutrients, specifically protein, in order to support healing. Protein is the primary building block for tissue, so it's critical to healing. Carbs are mainly just energy sources, so they're not as important, especially given that people having bariatric surgery have plenty of energy in their fat stores. This is why protein is stressed so heavily over carbs in the diets.

Additionally, the stomach is now in a new shape, and it basically has to learn how to function as a slender tube instead of a big bag. There's a learning curve. Kinda like a newborn baby's stomach. We don't dump steak and salad into a newborn's stomach for good reason - it doesn't know how to deal with it. Similarly, we don't want to do that to our new sleeve. We start off with stuff that's easy on the suture line and easy to digest, and as the suture line heals and the sleeve learns its job, start working our way up to "real" food.

So over the years, doctors have learned what foods are best for a healing stomach, and that translates into the post-op diet progression instructions.

Typically, that looks like this: Clear liquids, then full liquids, then pureed foods, then soft foods, then slowly move into a "full" diet beginning with high moisture content foods first. When moving from one stage to the next, it's typically advised to add just one food at a time, in small amounts, and see how it's tolerated. A food that's not tolerated well can be tried later on as well. If an entire stage is not being tolerated, back up to the previous stage for a while, and then try again more slowly.

Surgeons tend to specify how long to stay in each of these stages, what types of food make up each stage, and how to transition to the next stage. Every surgeon's instructions are a little different, and it's based on their experience and sometimes changes based on the patient's specific medical case.

The general idea in the very early weeks is to eat foods that will not stress the healing suture line, and do not have particles that are known to cut into the raw tissue or get embedded into the suture line. If a cut or embedded food particle gets infected, it can become an abscess and develop into a leak. A leak can be life threatening, and at the very least cause the patient to have to be hospitalized and possibly have more surgery to correct it. Foods that are particularly known to cause issues are those that swell up like rice, have seeds like strawberries, or have rough hard edges or hard to digest fibers like wheat crackers or raw vegetables.

There are people who eat all sorts of things against their doctor's orders and have suffered no ill effects, but this should not be used as an argument that the doctor's orders are not important. Similarly, you will find some people who smoke a pack of cigarettes every day and drink a pint of whiskey every day but live to 100. They are not representative of most people, and should not be used as the example other people follow.

The reality is that some people will develop abscesses and leaks because they ate things before they were cleared to by their doctors, and there is no way to predict who will have the complications and who will not. And the consequences can be as severe as death. It's not common, but that's how bad it can get. That's why the doctors give the instructions they do. They're not just testing you or trying to make your life hard. They are giving you the best information they have to keep you safe.

Violating these orders is not "cheating" on a diet. It's risking your life. I am not being overly dramatic with this statement, it is a fact that it has happened. You are risking your safety and your health if you violate these orders. It's not about "being human", it's not about "food addiction". It's about your safety and your health. It's hard to be on liquids only for 2 weeks (or more). Some people have huge cravings, or "head hunger" as we tend to call it here. Or just want desperately to chew something. No one is saying it's easy. But it's necessary. Distract yourself. Eat/drink anything that's allowed on your plan - freeze it, heat it up, try something that's opposite of what you've been having to shake it up. Walk around the house or the block. Suck on an ice cube. Count to ten or a hundred. Post about how hard it is, and ask people to help you get through it. But muscle through. It's nothing less than your health and safety.

As for why one surgeon will have his patients on clear liquids for 2 weeks while another only does 2 days? Or why one will skip a phase entirely? Each surgeon has different experiences that inform his practices. One is not right and the other wrong. They are each operating out of what they were taught and what they have seen in their own patient groups. They may have even modified the plan because of a specific health concern in your specific case. As a patient, you need to fully understand what your surgeon expects, and if you have a problem with the protocols get it straight with your surgeon and team BEFORE you go under the knife.

If you don't trust your surgeon and his protocols, find another surgeon. I personally would question a surgeon who doesn't allow any Protein drinks including the clear ones for 2 full weeks post op (saw that in one patient's instructions on this site) and likely wouldn't work with that surgeon, given what I know about the needs of protein for healing. But after surgery is not the time to be questioning the surgeon's protocols. Get those questions asked and answered to your satisfaction well before the surgery date.

If you are having surgery, and you have not been given your post-op instructions, at the very least for the first 2 weeks post-op, do not proceed with the surgery until you have that information. We have people posting here stating that they were sent home without clear instructions as to what they were supposed to eat or drink, just a vague statement about "full liquids". That is not sufficient information, and instructions should be given WELL BEFORE the surgery, not after. You should fully understand what will be expected in the weeks after the surgery before consenting to the surgery, or your team is not doing their job.

(This ends my sorta rant about post-op diets and "cheating")

Good luck to everyone!

This is awesome, Anti-chick! I hope every person who is pre-op reads this and takes it to heart!

Thanks for this excellent post. My surgery will be in 2 weeks and I really, really want to do this right. I appreciate the straight talk.

Bravo! This is not a rant; this is a well-written informative piece. I am a writer and editor, and I did not edit as I read. That means it is a well-written article. You may see things you want to tinker with, but I don't see any extra or duplicated information. Thanks for sharing!

Thanks! My English teachers over the years would be grateful that their lessons did not go to waste. I can usually put together something coherent and decently written in a first draft, which is a good skill in the business world and in grad school. But I do get the TLDR; comments a lot. :D

What is TLDR? It depends on the audience you want to reach and you can often write the same message in two formats to reach more people. Clearly, I am a reader, so when I am looking for deep information, an article such as yours is not too long. Non-readers probably won't make it all the way through so you can encapsulate main points in a PPT format for them. I'm a teacher by trade, so elaborating seems important to me. And also as a fiction writer. So many people are just not readers. It's all about the target audience. I read so many LONG articles that promise information but which are full of fluff. I can clearly see how the entire article could be reduced to a meme. Your article is not one of those.

TLDR; or TL;DR is internet shortcut/slang for too long, didn't read.

https://en.wikipedia.org/wiki/Wikipedia:Too_long;_didn%27t_r ead

I have spent many years writing technical requirements documents, so I tend to elaborate every point. I've had to start putting essentially an abstract at the top of many of my work related emails because my boss doesn't bother reading most of what I write, but since much of it is of the CYA category, I still do it. :) I try to make sure I'm clearly understood, and sometimes that takes more words than some people like to read. :D

I think it would be very helpful to condense this a LOT. If someone can't be bothered to pay attention to their surgeon, they're DEFINITELY not going to pay attention to a wall of text.

I agree - even though I'm on the "wordy" side myself. I wanted to read it and couldn't get through it. Can't imagine someone slogging through that newly post op with all our bodies are going through emotionally and physically.

If you want to keep all of the detail it might make for sense to split it into two posts. Just my thoughts.

LOL. I do tend to be verbose!! ;)

I agree that it's a LOT of verbiage, and it really does need a good trimming. I'm one of those who if I ever tried to earn a living as a writer, would have to employ a REALLY dictatorial editor. ;) It's been a help in grad school, though. I have no problem throwing out the requisite 500+ word postings on request. LOL.