Updated 7/2011
Discharge Information Following Bariatric Surgery
Physicians East Bariatrics
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This guide is to help you to adjust to your new lifestyle following your bariatric
surgery. Our goal is to help you to be success with our weight loss journey. If at
any time you have any questions or concerns following your surgery, please do
not hesitate to contact our office for further instructions.
Office Phone Number
252-413-6735 or 252-413-6298
Please call our office phone number if you have any questions or concerns. Our
office hours are Monday through Friday 8am to 5pm and someone will be
available to talk with you. If you need to contact your surgeon before or after
these hours, on the weekend or on holidays, please call 252-752-6101.
Signs and Symptoms to Report to Physicians East Bariatrics
You will need to contact our office with any questions or concerns that you have
concerning your surgery. You will need to report anything that does not appear
normal to you. The list that follows are things that we feel are important to be
reported to our office. If you feel you have a problem that is not listed, please
contact our office.
*Persistent nausea and vomiting
*Abdominal pain that is not relieved by your pain medication
*Redness, swelling, or a bad smelling drainage from your incisions
*If any of your incisions opens or pulls apart
*Fever greater than 101.5 (Please take your temperature twice a day
for the first week after surgery)
*Redness, warmth or pain in your lower legs with shortness of breath
*Anything that does not seem normal to you
Activity and Lifestyle Restrictions
-Do not lift anything heavier than 10 pounds for at least 1 month following
surgery (10 pounds equals a gallon of milk)
-Please do not drive until you have stopped taking your pain medications or until
your surgeon releases you to do so
-Do not return to work until your surgeon as released you to do so
-Do not smoke following surgery
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-You will need to use your incentive spirometer four times a day for the first two
weeks following surgery. This was given to your during your stay in the hospital.
-You will need to work on increasing the amount of exercise that you incorporate
into your daily routine. You will need to work up to doing 30 to 45 minutes of
exercise daily. You do not need to go home and sit in a chair or lay in the bed all
day. You need to get back into your normal daily routine as soon as you can.
Good forms of exercise include walking, bike riding, swimming, jogging, water
aerobics or working out at a gym.
-When you first go home you will be very tired, but you need to walk around your
house or yard at least once every hour while you are awake. If it takes you more
than one hour to drive home from the hospital you will need to stop on the way
home and walk every 30 minutes. This will help to decrease the chance of a
blood clot forming in your leg.
-When you are moving around and getting up and down from the bed and a
chair, please may sure that you are splinting your abdomen with a pillow to make
moving a little more easier for you.
-Some patients will feel tired, depressed, tearful, irritable and not like their normal
self following surgery. They also may have problems with sleeping at night.
These things are normal following surgery. They are related to you receiving
anesthesia and medications that your body is not use to receiving. It will take
several weeks for you to start feeling more like yourself.
Bath and Showers
-You will be able to take daily showers as you did before surgery. Wash over
every incision with soap and water and pat the areas dry when you are one with
your shower. You do not have to keep them covered unless they are draining.
You can wash your hair as you normally would.
-Please avoid taking tub baths.
Sexual Relations
-Sexual Relations can be resumed as early as 2 weeks following surgery. The
best rule is to resume when it is comfortable for you.
-For females, it is very important that you are using some type of method to
prevent pregnancy. You should not become pregnant during the first 12 to 18
months following surgery.
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Medications
-You should not take any medications unless your surgeon has said that you can.
-You will be given a prescription for a liquid pain medication when you are
discharged from the hospital. You may also use Tylenol that is crushed or cut
into very small pieces for pain control as well.
-At this point in your recovery, all medications should be liquid, crushable,
dissolvable or able to be cut into very small pieces. You will not be able to take
capsules. Not all medications fit into these categories. You will need to follow
this rule for the first 6 months to a year after surgery.
-You will need to contact all of your doctors that see you regularly and have
prescribed any medications for you and let them know that you have had bariatric
surgery. They can help you determine if you need to continue taking the
medication and they can make sure that the form of medication is acceptable for
you to take. If any of your doctors have any questions, they can contact our
office.
-Do not take any of the below listed medications unless approved by your
surgeon. They can irritate your new stomach and create ulcers.
Examples: Ibuprofen, Advil, Motrin, Naprosyn, Aleve, BC Powders,
Goody’s Powder, Non-Steroidal Anti-Inflammatory
-You will start taking vitamins per our program’s protocol following discharge from
the hospital. Your Nutritionist has reviewed this protocol with you. Please refer
back to the information that was given to you at the time of your Nutrition
evaluation. Vitamins are available to you in several different brands in order for
you to be able to choose which type is better for you.
Our office recommends:
-Bariatric Advantage: Available at Medical Park Pharmacy
-Optisource: Available at Medical Park Pharmacy, Health Wise Pharmacy and
Wal-Greens
-Opurity: Available at Medical Park Pharmacy
-Buying your vitamins and minerals at your local pharmacy
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Your New Diet
You were given an additional packet of information regarding your diet and
progression through the stages at your Nutritional Evaluation. The typical
progression of your diet will be in stages. You will need to see your nutritionist
one month following surgery for an appointment to evaluate how you are doing
with your new diet. You can make this appointment by calling Physicians East at
(252) 413-6683.
Gastric Bypass/Sleeve Gastrectomy Diet:
-Stage I:
1 to 14 days after surgery (one to two weeks)
-6 liquid protein meals a day (2 ounces at each meal)
-60 to 80 grams of protein required daily
-(Example: 8am, 10am, noon, 2pm, 5pm, 8pm)
-Sip on water, non-carbonated, artificially sweetened
beverages in between meals
-Stage II: 14 to 28 days after surgery (two to four weeks)
-Full liquid and puree diet
-No chunks of food. Smooth, soft consistency requires no
chewing
-60 to 80 gram of protein required daily
-6 meals a day (2 to 4 ounces at each meal)
-Sip on water, non-carbonated, artificially sweetened
beverages in between meals
-Stage III: 28 to 42 days after surgery (four to six weeks)
-Soft foods (should be tender, soft and moist, no tough or dry
foods)
-Three meals a day with one to two snacks
-4 to 6 ounces at each meal
-Start adding meats to your diet and discontinue the protein
powder
-60 to 80 grams of protein required daily
-Sip on liquids as in previous stages
Gastric Band Diet:
-Stage I:
1 to 14 days after surgery (one to two weeks)
-Full liquid and puree diet
-No chunks of food. Smooth, soft consistency requires no
chewing
-60 to 80 gram of protein required daily
-6 meals a day (2 to 4 ounces at each meal)
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-Sip on water, non-carbonated, artificially sweetened
beverages in between meals
-Stage II: 14 to 28 days after surgery (two to four weeks)
-Soft Diet
-60 to 80 grams of protein required daily
-Three meals a day with one to two snacks
-4 to 6 ounces at each meal
-Be sure that you are not consuming liquid calories
-Start adding meats to your diet as tolerated
-Sip on liquids as in previous stage
*One month after surgery you can introduce salads, fresh fruits and vegetables to
your diet.
Return Appointments
It is very important that your keep all of your scheduled follow-up appointments.
Bariatric surgery does on affect everyone in the same way. Important signs that
may signal a problem may be missed if you do not keep your appointments. If
you need to miss an appointment, please call our office and we will be glad to
schedule a more convenient time for you.
You will be seen for follow-up appointments following your Gastric Bypass,
Sleeve Gastrectomy and Gastric Band at:
-2 weeks
-4 weeks (1 month)
-3 months
-6 months
-9 months
-1 year
-Once a year
If you are Gastric Banding patient, your band adjustment appointments will be
scheduled as needed. You will be eligible for your first band adjustment 4 to 6
weeks following your surgery.
We will check lab work starting at your 4-week/1month appointment than at 3
months, 6 months, 9 months and yearly thereafter.
You will need to schedule an appointment to be seen by the Psychologist one
month following surgery. You may call Carolina Center at 252-757-0123 to
schedule this appointment.
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Gastric Band Adjustments
If you had a Gastric Band you will have to have adjustments to your band to
assist you in weight loss. The first adjustment usually is done 4 to 6 weeks after
your surgery. Adjustments can be done in our office or in radiology. Each
patient requires a different restriction level and adjustment schedule. Some
indicators are no weight loss for more than 3 weeks, increased appetite, feeling
hungry less than 4 hours after eating, ability to eat more food during a meal than
usual, increase in snacking and an ability to eat foods that you were unable to
eat before. If you note any of these indicators please notify our office so that we
can schedule an adjustment for you.
Common Problems That May Occur Following Your Surgery
Pain: Sometimes following laparoscopic bariatric surgery you will note an
increased soreness or pain in the left upper quadrant incision. You will notice
this more when moving. You may use Tylenol as directed to assist with the pain.
You should also use a pillow to splint the area when moving. You may use a
heating pad at the site on and off during the day. If after trying these suggestions
you do not notice any improvement you will need to call our office.
Vomiting: The most common cause of vomiting following bariatric surgery is
due to eating too fast, eating while drinking or eating foods without chewing
them appropriately. If vomiting occurs, try to eat meals over a 30 minute time
interval, chew your food appropriately and try to eat softer foods for several days
following the vomiting episode. If you notice no improvement and you are not
able to keep water or liquids down then you will need to call our office.
Diarrhea: It is not unusual to have 1 to 2 soft, semi-formed bowel movements
following surgery. Your bowel movements should become more normal once
you have incorporated solid foods into your diet.
Constipation: Medically significant constipation is defined as no bowel
movement for greater than 3 days. Typically this is not a big problem after
Bariatric surgery, but due to the altered structure of your bowel and stomach, you
many experience some constipation. If you do not have kidney problems, you
many use Milk of Magnesia as directed. You many also use Dulcolax
suppositories as directed. If you do not have results in two days after taking the
medication you will need to call our office. You many also drink warm prune juice
several times throughout the day.
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Hair Loss: Not all patients will experience hair loss following surgery.
Hair loss is due primarily to the rapid weight loss phase or 3 to 9 months
following your surgery. Please avoid coloring or your hair during this time period.
Learn to be gentle to your hair by using a wide tooth comb for combing your hair
and minimize the use of hair dryers to avoid drying out your hair. You will need to
continue to eat appropriately and to take your vitamins per our recommendation.
This usually decreases after the nine-month period.
Decreased Energy: It is very common to be very tired following your operation.
Your body is adjusting to losing weight and to getting over surgery. To help
increase your energy level, we recommend frequent, short rest throughout the
day. Rests should not last more than 30 minutes. If this persists beyond 6 to 8
weeks after surgery, you should contact our office.
Decreased Appetite: While this is the desired effect of the operation, one must
be careful that you do not completely forget to eat. You may find that you have
to encourage yourself to consume food at meal times. It is necessary that you
follow the dietary plan that has been discussed with you by our office staff.
Increase in Gas Production: The most common cause of increased gas
production following Bariatric surgery is due to a high fat intake in your diet. You
may take anti-gas medications from your local drugstore to include Beano, Gas-X
and Phazyme. You many also try adding Dannon’s Yogurt or Acidophilus milk to
your diet when you are able to do so in the diet plan. Probiotics is also a
medication that you can purchase at your local drugstore that may help with your
symptoms. These things help to change the bacterial flora in your intestine.
Bad Breath: You may notice that you have bad breath and a different taste in
your mouth following surgery. This will improve usually by the 6 months after
surgery. It is caused by your body’s response to the new way of metabolizing
foods. Things that may help to improve these symptoms are brushing your teeth
several times a day, brushing your tongue and using mouth rinse or mouth strips
such as Listerine. You many also suck on sugar-free hard candy.
Low Blood Sugar: Some patients experience episodes of low blood sugar or
hypoglycemia following surgery. You many feel dizzy, sweaty, tired and some
patients have actually fainted. If you notice any of these symptoms you many
want to try eating a high protein snack such as a scoop of peanut butter or drink
orange juice. This will help to stabilize your blood sugar level. If you notice that
this persists as a problem then you will need
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