– Hi, my name is Michelle Stelter, certified bariatric nurse and today, we will be discussing the Bariatric Discharge Class. [Bariatric Discharge Class] [What You Need To Know For The First Weeks At Home] Topics that we will be discussing today will be your diet, including protein [drinks], medications at home, home oxygen, constipation and diarrhea, pain, nausea, we’ll talk about your incisions [Wound Care], activity, follow-up classes and appointments, virtual online classes and then we’ll go over some essential no no’s after bariatric surgery. So the number one complication after any bariatric surgery is dehydration. So, we cannot stress enough how important it is that you go home, continue to drink and continue to record how much you’re drinking.
It’s wise to have a system in place at home where you will be tracking your drinking. So you won’t have us at home coming in and waking you up and making sure you’re drinking, at home, this goal is all on you and you can fall behind really, really fast. So, we can pretty much guarantee, if you’re not tracking how much you’re drinking, you’re not drinking enough. So, ways that you could track your drinking at home would be pen and paper, you drink it, you write it down, just like we had you doing here.
You can pick some sort of drinking receptacle at home, figure out how many ounces it is, how many of those you need in a day and set small goals for yourself throughout the day based on the size of your drinking bottle and then lastly, you can use apps on your phone such as water tracking apps, MyFitnessPal or Baritastic is a really popular app and the nice thing about the apps is that, you can set reminders to help you to remember to drink if you’re really sleepy. So we definitely recommend you do that. The number one sign of dehydration that you’re gonna be looking for at home is your urine. So, if your urine is really dark or you haven’t urinated in six to eight hours, that’s a huge red flag that you’re probably already dehydrated.
If you find yourself in that situation, we want you to focus on your drinking for a solid six hours and if you cannot get the four ounces an hour in, you’re calling your doctor. It is not normal to go home and not be able to drink and be vomiting. So if you cannot drink, then you need to let your doctor know. Your diet this week is divided into two categories.
So you have a hydration goal and you have a protein goal, and so, we’ll talk about protein next but from a hydration standpoint, the things that you’ll be drinking are water and you can do flavored waters as long as they’re sugar free or no-calorie. You can do the broth, decaf coffee and tea and sugar-free jello and popsicles, like you have on your tray here. If you’re struggling to get four ounces an hour in, I do recommend switching to the warm liquids. They oftentimes will go a lot better.
Sometimes, the cold drinks can cause pain, nausea and cramping and jello is probably the least well-tolerated of everything. So, if you are doing well, have jello and feel awful, that’s pretty common. You don’t ever have to have jello or you can wait a few days and try it again. Things that you do need to avoid, no carbonated drinks, no straws, no sugary drinks like juice unless it’s diluted way down.
No caffeine, no alcohol, and if you’re going to sweeten something at home, try using Splenda or Stevia instead of the other artificial sweeteners. So really, the only difference between what you’re doing here today and what you’re doing at home for the next week is here, before you leave for home, we need you to drink four ounces an hour for four hours in a row. That lets us know that you can go home and drink enough to stay hydrated. At home, if four ounces an hour is easy, you may have five ounces an hour.
If five is easy, you can have six and so on. So right now, you have a lot of swelling around your stomach. As that starts to go down, the fluids are gonna go through a lot faster. So you’re going to notice that you can drink a lot more.
That being said, if you drink too much too fast, you can get what’s called overload symptoms. So what happens is, I took too much all at once, my stomach is now full and there’s nowhere for the extra fluid to go, so it just sits up in your chest and if you have overload, you will know it. It causes pain, nausea, heartburn and sometimes a shooting pain through to your back. So the first thing you’re gonna do if you have overload is stop drinking and do not go lie down.
So, we need gravity to help this fluid go down. So I want you to get up, walk around, take some deep breaths, try to relax. If you’re really over full, you can spit into a cup, but at the very least, I want you to sit up in a chair. Once you stop drinking, you’re gonna feel better in about 15 to 30 minutes and then you probably would wanna stop for a whole another hour or two, just let everything totally empty out and start over.
Sometimes the fluid just comes right back up. We don’t want you to force it up, but if it does happen, don’t panic. Usually once the fluid comes up, you’ve eliminated the problem and you feel better quickly and hopefully, if you’ve had overloaded once, you will not have it again because you’ll kind of know what that threshold feels like, I’m getting full, I need to take a break. Okay, let’s talk about the protein goals.
So your protein goal this week is measured in grams. So, you’re shooting for a minimum of 35 grams a day. All protein sources are different. So you have to read the label of whichever one you’re drinking to figure out how many ounces you need.
So for instance, here after surgery, oftentimes, we will start with a clear protein because the clear proteins tend to be more thin and more well-tolerated after surgery when you have a lot of swelling. The clear proteins, however, are quite diluted as far as protein goes, so you have to drink a lot more of them. However, because they tend to be low or no carb, we let them count towards the hydration goal and the protein goal. So if you have a clear protein at home, it counts for both goal.
You may start the milk based proteins today. You can start the pre-made shakes, like the Premier protein ones we use here or you can use a protein powder that you mix with water, skim or 1% milk and you can use non-dairy milks as long as they’re unsweetened. Be aware that the milk based proteins are thicker, they might take longer to go through, you might not tolerate them as well, especially right after surgery when you still have a lot of swelling. The bottom line this week is that, we care more about hydration than protein.
So if you cannot drink enough to hit both goals, make the hydration goal your priority. One of the major ways people get dehydrated this week is they’re drinking way too much protein and not enough water. So this is basically your diet until you have class next week, that you either do over the phone or online and then, when you do your class next week, you can use your book that you got prior to surgery to go through the next diet progression. Let’s talk about one of the biggest complaints people have who are going home today and that is gas pain.
Gas pain can be a really sharp pain that comes and goes, it’s usually felt up high on one side of the other and sometimes you get a referred pain up to your shoulder and unfortunately, the gas pain can be worse than your incision pain sometimes and pain medication really doesn’t do anything for it. So, things that you can do to help with the gas pain, walking relentlessly, you can try a hot pack, you can try a cold pack, you can try Gas-X but ultimately what you need is time and you need a few days for the swelling to go down around your stomach to reabsorb the gas they used in surgery and to start passing the gas from below. So, we know how hard it is, just keep doing the best you can, hang in there, keep walking, keep sipping and you’re going to feel like a new person in a few days. So in your bariatric surgery handbook, it tells you all of the vitamins and supplements that you will need at home.
The only two you need to start this week is the multivitamin and the B12. If you are doing bariatric specific vitamins, I just want you to follow the instructions on the package as far as how many to take in a day. Also, if you’re taking a bariatric vitamin, your B12 might be included in your multivitamin, so you just need to verify that. If you are doing over-the-counter vitamins, you may do a pill that you chop in half, you can do a liquid or you can do a chalky chewable or a melt but no gummy vitamins.
If you had the sleeve procedure, you will take whatever it says to take on the bottle for the over-the-counter vitamin. If you had a bypass, you are going to double the recommended dose and then you also need to get a B12 tablet that dissolves under your tongue. As far as home medications, your nurse will review everything in your room. You will have instructions on all of your new medications and any current medications that are going to be changing or discontinued.
Keep in mind that if you are on medication for your blood pressure, or if you have diabetes, those medications could be changing and you could be given parameters for adjusting those meds at home and then following up with your primary care provider about a week after surgery. As far as pain medication, you will be sent home with a prescription pain pill, but Tylenol is always your first choice for discomfort. If you become constipated after surgery, it’s probably from your prescription pain pill. You can pretty much take anything to relieve constipation except fiber.
Fiber, you will use in six weeks as part of your regimen but you cannot handle that yet. So you can do a stool softener, you can do milk of magnesia, you can even do an enema or a suppository but no fiber. Most people do not have constipation this week. For most people, you have liquid coming in, you have liquid coming out for at least a few days.
Because we worry more about dehydration this week, if you are going to the bathroom losing large volumes of fluid, you’re not keeping up on your drinking, your urine is starting to get dark, you can try some Imodium over the counter and if it doesn’t improve after one to two doses, call your doctor. When you go home, you can take a shower. You just can’t take a bath, soak or sit in a hot tub for three weeks. You will have laparoscopic sites covered most likely with Dermabond, which is a skin glue and some of you will have an open incision covered by gauze.
Some of you will have some old drain sites that are covered in gauze. Either way, when you take a shower, you can remove the dressings, stand with your back to the water. You can clean around the incisions with soap and water, get all the old skin prep and drainage off. Just make sure you don’t scrub the incisions directly.
When you get out of the shower, you blot everything dry and you replace any of the dressings with new dressings and you need to change the dressings every single day until those holes scab over and then you can leave them off. Look at the incisions every day. Make sure they don’t look infected, red, hot, pus, foul drainage, fever over 100.4. If they do, call your doctor.
Do not put any antibiotic ointment, scar cream, lotion, anything on the incisions, it can dissolve the glue that’s holding them together. Hopefully you are using this breathing thing that’s at the bedside. Most fevers after surgery are caused by your lungs. It hurts to cough and deep breathe.
The pain medication makes you breathe really slow and shallow, so you’re kind of holding your breath all the time. So we want you to take this home and continue to use it every hour while you’re awake until your pain is gone, you’re off pain medication and any new oxygen you’re going home on. If you experience shortness of breath or a fever over 100.4, call your doctor immediately. Your doctor will order a nighttime oxygen study that will be performed before you leave the hospital.
This is used to determine if you need extra oxygen when you go home after surgery. If it’s determined that you need oxygen at home, it’s very important that you continue to use it until you have your follow-up appointment with your doctor in the office. Oxygen is a very important part of the healing process and discontinuing it too early can hinder the healing process. If you need oxygen while you’re awake, the oxygen company will deliver a tank to the hospital before you can leave.
If you only need oxygen at night, the respiratory therapist will give you a phone number that you will call when you get home and the oxygen company will then deliver the equipment you need. Next, we are gonna talk about exercise and activity, driving and returning to work, bariatric no no’s, post-surgery follow-up and support group and online virtual classes. So for exercise and activity, your goal is to exercise 45 to 60 minutes a day, and we want you to do at home what you were doing here, six times a day, get up and take a walk for about five to ten minutes. Everyone that has surgery is at risk for blood clots.
The best way to prevent that is to get up frequently for short periods of time. If you suspect you have a blood clot, unusual pain or swelling in your calf, chest pain or difficulty breathing, call your doctor immediately, but if you think you have a blood clot, you’re going to the emergency room. Other activity restrictions that you have, no lifting over 10 to 15 pounds for six weeks, no core exercise for six weeks, which means no abdominal crunches, but you can walk on a treadmill, you can walk outside and you can do elliptical. You may drive in one to two weeks when you’ve been off pain medication for at least eight hours and you feel like you have no limitations from pain or sleepiness.
As far as returning to work, most people return to work in two to six weeks and that is something you will discuss individually with your healthcare provider and bariatric no no’s, no smoking, no alcohol, no high-calorie liquids, no carbonated drinks, no straws, no caffeine, no meat or solid food and no anti-inflammatory drugs. So, the only thing that you can do over the counter now is Tylenol. As far as post-surgery follow up, at one week, a nurse will call from the office to check in with you by phone and then your first follow-up appointment will be in two weeks in the office. Future appointments will occur at six weeks, three months, six months and one year and then annually thereafter.
You may return as often as you feel necessary to be guided and supported through your weight loss journey. I do recommend that you email your dietitian to be added to the email list for the monthly e-newsletter. The newsletter includes important topics of the month, recipes, this is where you can go to find information on classes and support group schedules. Also, if you’re interested, you can join your surgeon’s Facebook or Instagram page to see their regular postings.
If you experience shortness of breath or a fever over 100.4, call your doctor immediately. Thank you so much for listening. I hope that this information was helpful. I wish you the best on your weight-loss journey, and please know that your bariatric surgery team is here should you have any questions or concerns.
Source: Rose Medical Center
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