PLEASE NOTE: The following is long, detailed and meant for those who are considering going through this process or who already are working on this process. I mention this to you now because if you do not fit into either one of these categories the information that I have put below could be VERY, VERY boring to you! IF you are want to read it just so you can have an “understanding” of what happens then feel free to read… but know that I have forewarned you that it may be very boring to you. WILL ALL of my posts be this way? No! Will ALL of my posts be this boring? NO! This one is only like this because I am providing information. Informative stuff is always boring…. unless you are the one that is needing or wanting it.
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On the morning of November 25, 2008 I arrived about 30 minutes early to St. Vincent Bariatric Weight Loss Center of Excellence at St. Vincent Hospital in Carmel, Indiana. When I get there a good amount of people are already there in the lobby. In fact the lobby is pretty well full at 8:00 am. The girl at the window is giving everyone that is there for the Pre-op Nutrition Class some paperwork… to go in addition to the paperwork that was already mailed out. I get my paperwork, sign in, and go have a seat so that I may fill out my additional paperwork. Not too long after 9 am those of us that are there for this Pre-op Nutrition Class are lead out to take the elevators up to the 2nd floor. When we get upstairs we were instructed to sit at the tables and that the 3-ring binder notebooks that are on the tables are ours to keep. I sat next to the “GPS lady” and her husband, as some of you may remember me talking about her from the November 17th Pre-Op testing. Her name is Brenda by the way.
The morning was spent going over the foods we can and cannot have during each “phase”, the beverages we can and cannot have during each “phase”, and the Vitamins and Minerals that we will need to take. I am not going to go into detail about what can and cannot be eatten or drank at this point in time. What would be the use in that? The Nurse Practitioner / Nutritionist also talked about what we can expect to be eatting during our time in the hospital, and the day before surgery diet that we will have to do. (These two I will discuss here in a bit.)
In the afternoon another nutritionist / Nurse practitioner came in and discussed a LOT of information. I could give you a long chained summary of what all she went over in the afternoon, but I think by doing so you would only become very bored with my details. I’ll save you from that. I’ll just say there was a lot of information to take in.. and surprisingly time went very quickly. They also gave us some “goodies”: a box that had a sharps container in it (for needles) as well as a DVD that discussed the LOVENOX medication, and they gave us a little lunch bag that had a little “sippy” cup, a baby spoon, and a 1 oz. cup (imagine a cup smaller than the medicine cup that comes on the Night Quill bottle… that is what one will be eating from after this surgery…. for a while anyway).
So…… what will my one day prior to surgery (Monday, December 1st) diet going to look like according to their information??? Well…. I am allowed to eat a “light” breakfast that is consistent with regular food. Woohoo! :O) For lunch… Lunch has to be a liquid lunch. Interestingly the items that they put on the list that is “acceptable include: pudding, custard, cream soups, ice cream, hot cereals, mashed potatoes, applesauce and yogurt” (St. Vincent, 2008). Talk about Carb over kill… Woohoo! :O) Then for dinner…. Clear liquids. They have listed that “[a]cceptable foods include: grape, cranberry and apple juices; gelatin, broth, popsicles, Italian Ices and Ginger Ale” (St. Vincent, 2008). Interesting thing about this… Ginger Ale is a Carbonated beverage… ahhh… okay… not too bad. No Food or Drinks should be ingested AFTER mid-night…. HOWEVER… because my surgery is not until 2 pm they did tell me that I can have clear liquids up to and no later than 9 am on the morning of my surgery (remember that is what the lady told me when I had my pre-op lab testing done). From 9 am on I cannot have any liquids what so ever. After the surgery, on day one, Clear Liquids! The other days during the time you are in the hospital you can expect to be on full liquids, which I’ll discuss later.
Some additional important points that were mentioned in the morning phase that I feel are also highly important to mention here:
A. Vitamin Supplements – In addition to the regular vitamins that one needs to take one should also be taking:
1. 1000 MCG Sublingual B12 once/week or once monthly if given as an injection.
2. 100 MCG Thiamin (AKA: Vitamin B1) should be taken weekly.
3. Multi-vitamins and calcium should be taken at least 2 hours apart.
4. Calcium tablets should be spaced out and not taken but 2 hours apart from one another.
B. Protein
1. Getting plenty of protein in can help in reducing the potential of Protein Calorie Malnutrition (PCM). According to the forms they gave us symptoms of PCM can include: Poor healing after the surgery, hair loss after the surgery, muscle loss after the surgery, and lack of energy (St. Vincent, 2008). So if you are having any of these symptoms then it would be wise to call your surgeon as you may be experiencing PCM.
2. A very good list of the types of protein supplements that can be consumed is given all over the place on ObesityHelp.com so I won’t go through that here.
C. Other things they make note of that I found interesting / important:
1. Daily Fluid Intake: 64-80 ounces of water (or even Fruit-2-O is okay) or low calorie fluids (such as skim milk (if you can tolerate it), Sugar-Free, Non-carbonated beverages, Decaf Tea and Decaf Coffee) is still to be consumed daily through a “sipper cup” at first and then through a sports / water bottle. They did stress that it is important to “sip” as there have been people who have actually sat down and chugged 6 oz of fluid and messed up their sutures and had to go back into the hospital for emergency surgery because of it. So, when they say “sip” they truly mean “sip” and they gave us a child’s “sippy cup” to use to re-learn how to truly “sip”.
2. NO drinking of ANY beverage DURING meals and NO drinking of ANY beverage UNTIL 30 minutes AFTER your meal. (Drinking beverages up to the moment you begin to eat is fine though.)
3. Avoid Caffeinated Beverages for the first 3-6 months!!!! You know what that means, right????? YEAH… I can have real coffee and tea again after 3 months (possibly 6 months)… I find this to be good news because I have been under the impression it was a permanent thing (Part of the reason I put this in bold)…. THIS also includes Carbonated beverages!!! YEAH… I’ll one day get to drink my diet coke again. :O) Happy, happy, joy, joy! (I will be one though that will wait until Dr. Gupta tells me it is safe to consume caffeinated and carbonated beverages again because these two things can mess with the stomach linning and cause pressure against the suture line and I do not want to mess up anything dealing with that.)
4. Alcohol is to be avoided for at least the first year (something I already knew but decided to put that here again as… well… some people may need to be reminded).
5. I heard two different conflicting opinions about exercise from the lady in the morning compared to the lady in the afternoon. The one in the morning said that “anything beyond walking on a treadmill requires that a surgeon give a release for” and the lady in the afternoon said, “any exercise other than regular walking should be given the release from the surgeon first, even if it is walking on a treadmill.” When I hear two different conflicting things…. such as in this instance…. I am just going to make a note to make sure that I ask my surgeon for clarification. With the weather getting cold and snow on its way it is going to be most likely that I will be walking on a treadmill… unless I can talk some people at the high school into letting me go over there and walk around the gym (boring) every day.
6. It was suggested that gum and candy (including sugar-free gum and candy) be avoided as it has been known that people have swallowed these whole and caused their stomach openings leading into the intestinal tract to become obstructed, and thus they needed to go back into the hospital for surgery and have them removed. (Word to the wise… do not swallow your gum and candy whole in an attempt to avoid having someone catch you with it in your mouth!)
7. IF you see the word “Sucralose” on the “ingredients” label know that this is a “Splenda” brand and is acceptable.
8. IF you see “High Fructose Corn Syrup” on the label… then the product has sugar!
9. Measure food by volume not by weight!! So… this means… NO need to use a food scale!
1 ounce = 2 tablespoons = 1/8 cup
2 ounces = 4 tablespoons = 1/4 cup
4 ounces = 8 tablespoons = 1/2 cup
6 ounces = 12 tablespoons = 3/4 cup
8 ounces = 16 tablespoons = 1 cup
10. They suggested NOT to take the Calcium Citrate Supplement: “Tropical Oasis” (which is a orange liquid)… not just because it is pricy but because they said that it lacks Iron and therefore you will need to take extra Iron supplements. You would also have to take 6 tablespoons of this a day to meet the requirements. I thought this was interesting enough to share because I have heard a lot of talk about this product on obesityhelp.com.
11. Someone pointed out… and the Nutritionist said this would be acceptable because it is sugar free… that Nestle Quick now comes also Sugar-Free. So if you like that sort of thing……
12. Step on the scale only once a week, take pictures every few weeks to once a month so that you can “see” how you are doing… you may not notice it but others will notice it first.
13. It is normal for ones stomach to not be able to tolerate one type of food one day and tolerate it the next.
14. Go to at least one support group meeting a month as they have, from what they said, found that patients who do go at least once a month have a tendency to lose 10% more than those who do not go.
15. You are suppose to walk 10,000 steps a day, on a normal typical day… get a Pedometer and see how many you walk. If you do not walk 10k steps a day then work up to that. If you do then work on going over that.
16. Wear the Abdominal binder for about 2 weeks or until the surgeon tells you that you no longer need it.
17. IF you notice some weight gain after surgery they say this is normal water gain and that it will go away.
One other thing I found interesting… but I do not know how true it is as it may have been slightly over exaggerated (not sure though). The afternoon nurse practitioner had said that in December alone all of the surgeons at their hospital that are doing just Bariatric Surgery will be performing 190 surgeries in the month. She said that December is always their busiest month because of insurance policy changes that occur at the beginning of the next year as well as because those who are either self-pay or are paying a portion of their surgery want to have the tax advantage. This does not mean that “my” surgeon is performing 190 surgeries in the month of December, but the number of ALL the Gastric Bypass (or Bariatric Surgeries, or Weight Loss Surgeries) surgeries that are scheduled to be performed by all the surgeons that do this at their hospital. To some this may seem like too many, but to those who are seriously looking at this procedure… it speaks volumes in the form of experience.
So… Well… That about does it for my update regarding the ALL DAY LONG Pre-Op Nutritional Class for this surgery.
~Tammy~
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