Question:
A couple of questions for post op folks.....
I am 2 and a half weeks post op, and I am sort of concerned that I am not going number 2 often enough. How often, right after surgery, should someone with distal RNY go? Also, I wanted to get a few opinions on what I should do in respects to my P.O. diet. My surgeon and nutritionist are telling me two totally different things. My surgeon said he wants me on clear liquids and baby foods for 8 weeks. The nutritionist, who specializes in RNY gastric bypass patients, said that I should try to get on pureed/semi solid foods until 6 weeks out, then to try solids at will. Now, I am in a serious quandry for the basic fact that my surgeon is a great surgeon, but he is just a surgeon that does the surgery. He has no nutritionist on his staff, and the nutritionist I saw was through Portsmouth Naval and their gastric bypass program. Plus, the surgeon is very inconsistant on what he says. At first, he told me to follow what the nutritionist said, then before I was discharged, he told me to ignore what she said. He also told my one friend who had him for a surgeon that she couldn't drink 3 hours prior or after eating. So I am not too sure whether or not to listen to him. He also wants me only to take in 400 calories a day, and that is impossible, I believe. I take in 100 in suppliments alone! Anyways, I am sorry to ramble, but I just would like some opinions on what you all think I should do. Any and all advice will be greatly appreciated. Thank you all, and have a great day! :) — Lisa S. (posted on August 27, 2003)
August 27, 2003
Lisa, Most doctors tell their patients no drinking 30 minutes before or
after meals and this is sufficient time to move food out of your pouch.
How on earth would you possibly get enough time in a day to get in your
water requirements. That would make me positively miserable! I normally
would not say to go against your surgeon, but I'm afraid I'd have to ask
him how it would be possible for you to get in your required water drinking
six hours apart?
— Happy I.
August 27, 2003
As a post-op you will only be going #2 every few days or so, especially at
first. Don't worry about it unless you become very constipated. That is not
likely to happen at this point. I am 9 weeks out and have had no problems
with this. You are taking in far less and had a good clean out before
surgery. As far as the diet--from what you have said I would go with the
nutritionist says. Yes, the surgeon may be a great doctor but some of the
things he's said don't sound right. Go with your instincts. The
nutritionist specializes in by-pass and their dietary needs. Good Luck!
— Kathy J.
August 27, 2003
Hi, Lisa; I urge you to listen to what your nutritionist says. That is the
same diet I'm on; full liquids (scrambled eggs, cottage cheese, low-fat
cheese, creamed soups, yogurt, etc) for 6 weeks, then I start integrating
more foods after that. We should stop sipping 30 minutes before meals to
give the pouch time to empty itself of all fluids so it can accept food;
then we have to wait 30 minutes after eating so the pouch will empty the
food and be ready to accept liquids again. I mean no disrespect to your
surgeon, but I think HE needs to consult with the nutritionist! Good luck!
Proximal lap rny 08/19/03, -15 lbs.
— Moysa B.
August 27, 2003
I vote for going with the nutritionist. What she is suggesting you do is
pretty sound and sensible. I'm one of those clear to full liquids...pureed
to soft foods then slowly incorporate the general diet. It's just makes
sense and it would be easier on your new stomach as it is healing. You
sound pretty normal on the potty issue, unless you are feeling the need to
go and you cannot. I also noticed for the first several weeks, the need to
urinate was practically nil. Be sure you are drinking your water, stopping
30 minutes before your meal and waiting 30 minutes after before you resume
drinking. (Open RNY 10/30/02 minus 189. Fifty more to go! Woohoo!
— Ginger M.
August 27, 2003
I am three weeks post-op today. I had a open RNY and my guidence from the
nutritionist is to intake liquids for the first three weeks, then soft
foods for 4 to 6 weeks, then start bringing in real food at 6 weeks. I
never ate baby food, the sugar contents are way to high in sugar for me.
<p>At two weeks, I was having trouble with liquids, they filled me up
but did not stay with me long enough, so the nutritionist moved me to soft
foods, now I am doing better. My protein intake is good but my calorie
intake needs to be increased, and now that I am eating soft foods I hope to
be able to do that. Every body is told different, mine is 800 to 1200
calories a day, 70 to 100 protein a day, 30 to 50 carbs a day and 10 to 25
fats a day. Drink 64 oz's of water, and popcisles count as water, so does
crystal lite and Diet snapple.
<p>About the BM, I knew that I would have problems because of all of
the iron and protein, and I disagree with some of the other posters, I
think you need a BM everyday. I felt bad on Monday, because I did not have
a movement, and had built up gas inside my tummy that was causing me
pressure on the place were they removed my gallbladder and on my new pouch.
I took a tablespoon of Phillips Milk of Magnesia, and had a movement, now
I am taking one teaspoon about every third day, and have a good movement
everyday. You have to do what is best for you.
— cindy
August 27, 2003
BM is going to be less frequent because you are just not taking much in.
I'd say every 2-3 days is average now, but gas is an important thing to
remember - even if you don't have a BM, you should still be producing gas.
If you have no gas or BM for a couple days, and have pain, it could be a
sign of a problem. So as long as you are passing wind, don't worry about
it. You definitely do not need a BM every day - some people who have never
had surgery have a BM only every couple days normally - as long as you
establish a pattern and notice if you get things out of whack, and don't
develop constipation.
I agree that your nutritionist seems to be the one who knows what she's
talking about. For comparison, my postop plan is 2 weeks liquids, 6 more
soft/mushy, so by 8 weeks out the tummy is supposed to be completely healed
and ready for you to get back to eating real food, but small amounts of
course. You also don't need to be having baby food - you can have just
about anything mushy by putting in in a blender or even chopping it well -
my nutritionist said I could take a casserole that my family is having
(like lasagna) and put it in the miniblender and eat it - it doesn't sound
pretty, but its a whole lot better than baby food!
— bethybb
August 27, 2003
It's really sad that your surgeon and nutritionist are not on the same
page. Who's bariatric program is this? If it's the surgeon then why are
you not being sent to a nutritionist who is following his program? This is
just very strange.
<p>My gut reaction is that the nutritionist has the more sensible
plan but part of me says the surgeon knows specifically what he did to you
and there may be a very strong reason to do the liquids longer. Maybe he
had some issue with something during surgery. I don't know. The
nutritionist's plan will help you transition to real food much better. I
guess I would talk to the surgeon and ask why the plans are so different
and why he wants you on liquids so long. If you are having problems
complying with his request tell him so. I was put on real food at 7 days
PO and had no problems. I was expected to chew the heck out of the food
and basically puree it in my mouth. It worked good because I got the full
signal from that day forward and I learned to eat in a new way.
— zoedogcbr
August 27, 2003
I go every day now but in the beginning, the first couple of months, I went
every few days at best and it was not an easy task. I know people who are
still like that at 7-8 months out and others like me. What were you like
before? It should be somewhat of an indicator. It took me a couple of
months at least to get over 500 calories because I could only eat an ounce
or two at a time and was just not hungry. I eat 800-1000 now at 7+ months
post op and am still losing 1-4 pounds a week and 20 pounds from my goal. I
have always looked at the surgeon as the technical guy and the nutritionist
as the food person. I have faithfully seen her every week since surgery and
she has never told me anything that has hurt me and has really been my
lifeline and taught me so much. The studies say that people who regularly
see a nutritionist lose faster and more consistantly and I have never had a
plateau and have been able to stay on track with her support. I have heard
my surgeon say to ignore the nutritionist but they are all about pounds
lost as opposed to healthy nutrition. I do take his advice as he has been
doing this for a while and has seen the results of compliance and
non-compliance but the nutritionist, if well trained in WLS post op diet is
the best resource for actual applicable diet stuff. GOOD LUCK!
— Carol S.
August 27, 2003
to be honest with you. I hardly ever go. We don't know why, I have had all
kinds of tests and they can't find a reason. I just don't go. I go once
every 3-4 weeks and then it is only a little. I'm hoping when they do my
tummy tuck and I am all open they will be able to find out why.
— nicole79
August 28, 2003
I read you post a couple times and sorted it out as best I could, 1. pureed
and baby foods really are not so different, both are smooth , no lumps or
chunks , beyond that I would talk to the surgeon about the 6 vs. 8 weeks.
It seems many different surgeons have differing views on how & when to
eat solids. It seems to me that people do better overall if they do liquids
for a while and ease into the solids. I had clear liq the first week, full
iquids til i thnk week 4, then pureed for a weeks and soft for a week then
regualr diet . As far as whet you friend reports the Dr. told her, follow
what he told you, I KNOW for a fact that people misinterpret and
misunderstand directions given bt their dr/nurse! I am a nurse and deal
with this all the time, tell a patient one thing & they hear something
totally different. After my RNY I didn't have a bm for over a wekks and not
more than once a week til I was eating friuts and veggies every day.
— **willow**
August 28, 2003
The diet that the Dietician puts you on is a General Diet that they have
found that the "Majority" of individuals are able to follow.
However, before discounting what your Surgeon tells you, I'd ask why his
directions and the Dietician's vary. It is possible that there was
something about your healing or digestive system that makes him feel the
need to ease you along the phases of the diet. With regards to bowel
movements, I initially had to go nearly everytime I ate something. I
expressed my concern to the doctor who told me that sometimes it takes the
body a minute to get itself together and that typically he finds that
people will get into the habit of either going daily or every other day. W/
regards to Calories my Dietician feels that most take in approx 500
calories per day the first couple of weeks.
— [Deactivated Member]
August 28, 2003
My opinion on the bowel movements is that the pattern should not change
drastically from what was normal for you before surgery, after your body
has settle down, but the quantity will drastically reduce. If your pattern
is very different and you are not experiencing any problems with feeling
like you need to go but cannot (constipation), then you may very well have
developed a new patttern. However, you are only 2-1/2 weeks PO and things
are still working out in your body. The 2nd week I had severe diarrhea and
about week 4 bad constipation. It took about 6-8 weeks to get back to my
normal routine, which is daily.
<p>If you are feeling the least bit constipated then I would look
into taking a stool softener like Dulcolax. Make sure it does not have the
laxative in too as they make both kinds. This works very well and what my
surgeon preferred I use.
— zoedogcbr
August 28, 2003
It's not unusual to have infrequent bowel movements early on when you're
eating so little to begin with. As long as I didn't *feel* constipated, I
didn't worry about it too much. I did take Milk of Magnesia a couple of
times and some people find they need to take things like FiberCon, but your
body may still adjust on its own. As long as you're going at least every
other day, you're probably ok. As to the diet, I think your nutritionist's
diet sounds reasonable and close to what mine was. I was supposed to do
liquids for two weeks - some soft solids allowed - and pureed for 2 to 3
weeks. I think you'll find that it will be hard for you to do
liquids/pureed for the 8 weeks your doctor recommends! I know lots who
didn't make it through the 2 weeks of pureed that my surgeon recommended.
I've never heard anyone say not to drink for three hours before eating
before! I've heard 1/2 hour to an hour, but the more crucial info is not
to drink during your meal or for 30 mins to an hour afterwards. If you
didn't drink for 3 hours before a meal, you'd never get all your water in.
I have to say that I think I'd follow the nutritionist's advice for post-op
diet. Surgeons aren't necessarily nutrition experts. For that matter,
nutritionists aren't necessarily well versed in WLS. There's nothing wrong
with gathering a variety of opinions and deciding for yourself what your
own plan will be, based on the info that's out there.
— sandsonik
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