Post Op Sleeve Stage One Two Three Diet

Yesterday was my birthday.  I’m now 56 years old and I went to Denny’s for my free Grand Slam Breakfast! Yea, as if.  My daughter ate the Grand Slam, I had one scrambled egg white, which was delicious.  However, when I announced this in my private weight loss surgery support group on Facebook, I was questioned about what stage I am in my “diet”.

Of course I had read my paperwork and I know what stage I’m on. But I wanted to reassure everyone that I knew what I was doing and quote the paper.  I won’t repeat what I wrote in the group post, because I want google to like me, but the point is I’m confused.  I know two weeks is 14 days, so what are days 15-20 considered?

*DIET PROGRESSION & MEAL PLANNING AFTER BARIATRIC SURGERY*

This is the anticipated diet progression after your bariatric surgery. Keep in mind that tolerance/intakes will vary on an individual basis depending on the healing process. It is important not to progress too soon from stage to to stage to allow for proper digestion and absorption of diet consistencies. Adherence to this new eating plan is necessary to ensure one’s nutrition status and weight loss progression are optimized.

Day 1- Post Operative: First 24 Hours–Nothing by mouth-NPO

Day 2- Post Op: after upper GI series (x-ray test) & clearance by surgeon to initiate oral diet, stage 1: Bariatric Sugar-Free Liquid diet will be ordered.

*FIRST TWO WEEKS AFTER SURGERY*

(Stage 1) SUGAR-FREE LIQUIDS ONLY (*start with CLEAR LIQUIDS first*)

Foods Allowed:

  • Water, Crystal Light, Decaf Tea
  • Unsweetened Juices or Sports Drinks (dilute 50:50 with water)
  • Sugar Free Jello
  • Clear Broth
  • Sugar Free Ice Pops/Sugar Free Ices
  • Protein Liquid or Powder (You will receive a protein supplement on the meal tray during your hospital stay)

Instructions:

  • Sip fluids at a rate of 1 ounce at a time every 10-15 minutes.
  • Do not drink out of an open cup/bottle or use a straw, and no carbonated beverages.

Recommended intake at this stage =2oz-4oz./Meal (may take longer to consume initially, allow 1 hour for meals)

If tolerating above fluids/consistency, gradually introduce:

(Stage 2) SUGAR-FREE, LOW FAT FULL LIQUIDS

Add the following foods:

  • Skim Milk, Skim Milk Plus (*Light Soy Milk or Lactaid Milk can be substituted)
  • Blended Low Fat Soups and Broths (*Cream Soups should be strained)
  • Fat Free, Sugar Free Puddings and Custards.

Instructions:

  • Keep serving sizes small (NO more than 4oz per meal)
  • Continue to sip liquids between meals, following fluid intake guidelines (aim for at least 32oz.)
  • Continue to consume protein supplement drinks (8oz) between meals to aid towards meeting 60-80g protein/day.

Recommended intake at this stage =2oz-4oz/Meal

___________________________________________

*Weeks THREE & FOUR after surgery:*

(Stage 3) Sugar-Free, Low-Fat Belnderized/Pureed

Introduce the following foods slowly if tolerated stage 1 & stage 2 consistencies:

  • Fat-Free. Low-Sugar smooth yogurts (ie: Dannon Light & Fit Vanilla) -4oz
  • Farina and oatmeal -4oz
  • Low-Fat Cottage Cheese/Ricotta Cheese -4oz
  • Soft chopped egg (suggest starting with scrambled egg white first) 1 egg
  • Mashed Potatoes/Sweet potatoes – 1/4 cup
  • Pureed/blenderized meat 1 1/2 oz
  • Unsweetened blended fruit (ie: unsweetened applesauce) 1/4 cup
  • Pureed/blenderized vegetable 1/4 cup

Instructions:

  • Keep portion sizes small (*see Recommended Intake Guidelines below)
  • Chew food very well to a mushy consistency before swallowing
  • Eat slowly (at least 30 minutes+ for meals)
  • Consume fluids in between meals following fluid intake guidelines (aim for at least 48 oz)

Recommended intake at this stage = 4 oz/Meal (1-1/2 oz Protein +1/4 cup Veg/Fruit) If tolerating well after a few weeks, can gradually progress to no more than 6 oz/Meal (2oz Protein + 1/3 cup Veg/Fruit meal)

14 Days Post Operative Sleeve

Wow, it’s been an incredible two weeks.

I remained hospitalized 5 days after my surgery with my Hbc blood counts teetering on the low end.  I guess the doctor wanted to keep me to make sure that I’d start going up on my own, and I did.

So, I get home and I’m feeling pretty good.  I’m finding myself tolerating pretty well. My pain was tolerable, again, most of the pain was in my lower back.

I felt good enough to walk 1/8 mile to the park and then proceed another 1/8 mile to the corner store with my grand kids. And then repeat the walk back.

I didn’t have any problem walking around Walmart letting my granddaughter try on gymnastic outfits.

It felt good to get out in the sun and take a short walk at the beach and sit down and relax for a few minutes.

And I was feeling great having left the hospital at 268# and getting up this morning to put on my bathing suit, on postop day #8, at a number I hadn’t seen for a decade 240!

Postop day #9, I woke up even more jazzed to see the scale showing me at 238!! And that, my friends, is where the rest of the day is a blur.  I remember getting up from a nap and feeling like I’d been dropped from the roof, confused and overall not well.

My daughter took me to the emergency room where I remember the doctor asking me questions, but I don’t know what happened after that I was in a cubby in the ER – for 2 days!!!

I remember one point hearing the nurse telling Erica I had a temperature of 103, and she repeated that to the doctor, who responded, “You mean 100.3, only children have high temperatures like that.” And then I was given bags and bags of fluids. Asked to drink about 20 oz of whatever for a CT scan. Mind you, it takes me about 15 minutes to drink 2 oz. when I’m feeling great.

Forgot to mention that my granddaughter smashed her finger in the storm door, breaking her nail, the previous afternoon.  She was crying and scared to go to urgent care. Erica couldn’t pick her up, but I’m not going to let my sweet little baby suffer and be scared, be damned not lifting anything over 20#, and I picked her 70# up and carried her down the stairs and helped her into the truck. Thus, CT to check if I split my gut open. Nope, everything was intact.

I finally get into a room around 3:30 Tuesday morning where the nurse starts asking me about previous hospitalizations and she mentions that I was hospitalized for “end stage renal failure”!? I protested that I’ve never had any organ failures, and I was corrected that as of the previous night, I was hospitalized for end stage renal failure, along with urinary tract infection, dehydration, low blood pressure and blood count, oh yea, and pneumonia.

It took a couple of days to find out that the “end stage renal failure” was code for severe dehydration!  Well, why don’t they just say that? Geez.

About 24 hours into my stay in the ER I’m weighed in at 160#! Seriously? The hospital loads me up with fluid that turns into rocks once it hits my system.  So now I’ve gained about.

I spent my 5 days in the hospital feeling uncomfortable and restless. I felt ok on discharge. My main complaint is weakness.  I certainly don’t feel like going to the beach and walking to the kitchen is a major accomplishment for me.  However, I’m down to 148# on day 14.

Surgery Date Laparoscopic RNY Bypass or Sleeve

July 8, 2016 was the date I had surgery.

I had been having some problems at “home” and ended up spending 2 days before surgery in a hotel, which really wasn’t a bad thing. It gave me an opportunity to spend fun time with my grandkids in the pool and fitness center.

I called Good Samaritan Hospital, the night before, to get the time that I needed to arrive, which was 11:00 a.m.

I dressed comfortably in a pair of shorts, sports bra and over-sized t-shirt, and a pair of granny panties. My son-in-law and the kids dropped me off.

I brought a bag with my neck pillow, which I’m glad that I brought with me.  It made me more comfortable, as the gurney was terribly uncomfortable, as well as the bed and the chair.

I went to take a selfie of me smiling to reassure my grandchildren that I was in good spirits, not to worry, as well as to remind myself.  However, Linda, Good Samaritan Hospital’s Surgical Nurse Liaison, couldn’t have brought more attention had she yelled “FIRE!”  As I lay in my enclosed on 3 sides cubby, grinning ear-to-ear as I adjusted for a good overhead angle, Linda yelled from across the patient and visitor packed room “Ma’am! You can’t take pictures in here!”

I was startled and dropped my arm from over my head and I could see the people in the rooms behind her look at me with disdain as they probably thought I was taking their pictures! After all why would such a big deal be made out of someone taking their own picture?

Humiliated and feeling awkward, I began to cry.  I wanted to leave.  I felt so stupid and alone.  I didn’t need anyone with me going in. I was confident and happy and ready – now, I just want to go find a hole to crawl into and die.  This was my present, it felt like every day of my past was once a present of humiliating awkwardness.

Several minutes later I asked my nurse who the nurse was that said that to me.  I had thought I was over reacting, after all isn’t that what I’ve been told every time I reacted to anything?  The nurse looked at me as though really didn’t want to tell me, and didn’t want any of the nurses to hear her talk to me about it.  She told me her name was Linda and her title was “Liaison”. My nurse looked at me choking on my tears, and assured me that if she knew that I was so upset she’d be devastated. My response was along the lines of “Good, then make sure that she knows, because I AM devastated!  I wasn’t worth the effort to take a few steps forward and ask me not to take pictures?”

I was taken up to surgery around 12:45.  I put all my effort into adjusting back into a positive spirit.  Joked a little with the doctors, making sure that Dr. Bridges knew the procedure that I was most wanting was a laparoscopic RNY gastric bypass and only if all else failed did I want the sleeve.

I have no idea how long the surgery was, nor do I know how long I was in recovery, seemed like only minutes that I was there screaming “Please make it stop” as I felt the relentless pain that was identical to the pain I vividly remember in the ER, years before, when a woman tried to kill me by running me over with her Tundra pick up truck.  That’s another story for another time.

I remember the nurses telling me that they were giving me everything they could, they must’ve given me some good stuff because I don’t remember anything until they had brought me up to my room.  I’m doing my best not to hold my breath.  You know when you hear people telling someone to “breathe!”? I learned decades ago that if you want the pain to lessen, you MUST relax.  I found myself in an argument with myself and the nurses – I know I was outside my head trying to breath and saying I’m going to hold my breath, don’t let me hold my breath – I knew I was my worst enemy.

Thank God, Erica was there rubbing my lower back. I know that it helped more than anything they gave me to calm me down and alleviate the pain that I was having.

I don’t recall any incisional pain and gas pain was nominal for the most part.  Though people who have had the sleeve or bypass surgeries insist the back pain I was having was gas pain.  However, for me it was a recreation of the pain I had when I was, literally, hit by a truck.

 

Weight Loss Surgery Preoperative Diet

Today I start my 7 day, bariatric postop diet.

SUGAR-FREE/FAT-FREE LIQUIDS to include:

  • Strained Cream Soup (made with skim milk)
  • Sugar-Free/Low Fat Frozen Yogurt
  • Sugar-Free/Fat Free Pudding
  • Smooth Fat-Free Yogurt (i.e. Dannon Light & Fit Vanilla)
  • Skim or 1% Milk
  • Light Soy Milk
  • Original or Light Almond Milk
  • Unsweetened or Diluted Juices (dilute at least 50/50 with water)
  • Clear Broths
  • Sugar-Free Jello
  • Sugar-Free Ice Pops/Ices
  • Coffee
  • Tea with Lemon

PROTEIN SUPPLEMENTS should be used during this time.

Yes, that’s exactly what my diet list shows! I can’t get over that it says protein supplements “should be” used during this time.  My insurance doesn’t pay for a nutritionist, but I have paid for a couple.  Which gets me to thinking, I really should call and get in an appointment before surgery.

I’m so afraid of these changes.  I know that I can do it, I’m just afraid that I’m going to do something wrong and I’ll mess myself up and have more discomfort than being fat.  I’ve talked to my therapist, and I’ll talk to her again the day before surgery.  I’m overthinking things.

It reminds me of jumping from the waterfalls, as I did my mikveh.  Leaving the house, driving there, walking the path, stepping to the edge, the whole way, I was nervous.  I’d behave as though I were fearless, when in my head there was a conversation of sorts, which I now can see me be drug, kicking and screaming, by my alter-ego, who gets me to the edge and simply pushes me in.  I come bobbing up and she says “See, that wasn’t so bad now, was it.”

Weight Loss Surgery Date

After 4 months, I finally received my surgery date!  July 8, 2016.

Back in January, when I committed myself to the idea of weight loss surgery, I was confident.  So now that it’s June, and the
“wait period” is over and I received approval for the surgery by Fidelis, my anxiety level is up there.

When all of Fidelis’ “Customer Support” staff had responded to me that there was no wait period, once I received all of my clearance letters the bariatric surgeon’s office could request approval I was relieved and had everything done before my second visit with my surgeon.  I knew, the quicker surgery happened the sooner I could recover and get into a routine for my “new” life.  But that was all BS!

I had intended to go to Florida with my daughter and grandkids for a week; but I’m not taking any chances, getting some travel bug, though Air Born is incredible.  And, I’ve gotten blood clots from traveling, so I’m just not going to risk doing something that may cause my surgery being postponed.

How to Take Body Measurements

Video and instructions on how to take body measurements to track weight loss.

Six Month Body Measurement Tracking Chart
Printable chart (one page) to track measurements of weight, chest, waist, right arm, left arm, right thigh, left thigh and hips for 24 weeks.

Here are the body parts you should always measure and how to measure them properly:

  • Neck – Measure around the smallest part of your neck.
  • Chest– Measure around the fullest part of your bust, under your armpits and around your shoulder blades, include your nipples.
  • Arms – Measure around the largest part of your arms (flexed or not flexed, just make sure to do it the same every week.)
  • Waist – Measure around the smallest part of your waist, if you don’t have a pronounced wasistline and you’re fairly straight, measure just above your belly button.
  • Hips – Measure around the widest portion of your hips. Making sure the tape is level back there isn’t easy, try to do it in front of a mirror.
  • Thighs –  Measure the circumference of the the fullest part of your thigh, usually about three inches from your crotch.
  • Calves – Measure around the largest part of your calf (flexed or not flexed, just do it the same each time).

The video below shows how to measure results during a weight loss program.

Bariatric Support Group

We’re required to attend 3 bariatric surgery support groups before surgery is scheduled.  At first, I thought this would be a waste of time, what could they possibly provide me with, since I already know several people who have had it done.

I realized that having the surgery will create monumental changes in my lifestyle and it’s important to have access and be surrounded by people who will also be living within the confines of these changes.

I know that it’s been difficult for me to have compassion for those who have been going through these changes because I could not relate to them.  I had an uneducated prejudice, I felt that I knew more than they did about the adjustments that they were required to make.  In retrospect, perhaps it was an endeavor to be relevant.  I think it was my attempt to deal with an underlying envy that I couldn’t identify within myself.

I’ve been to 2 groups, thus far.  It’s exciting to hear their successes.  To hear someone who had surgery 6 weeks ago and has lost 45 pounds, 65 pounds in 2 months, at the time of their first “surgiversary” they’re down 150 pounds. To think, that will soon be me!

My current anxiety about after surgery is sipping water.  I love my water.  It’s my favorite fluid.  As a child, I hated water, “it has no taste” I would complain.  Now, I find myself carrying a container of water with me everywhere, enjoying the the flavor and the appreciation of chugging down a pint during a break in housework, during a walk, sitting in a hot car, etc.

It was reassuring to know that I’m not the only one who thinks about this.  There are dozens of people in the group who are post surgical, many have been so for several months or years.  They are quick to assure that it’s an issue which they all have overcome.

The group that I attend is guided by the bariatrics nurse coordinator and/or a social worker who also specializes in bariatrics.

It’s run like an AA or OA meeting, in that who said what stays in the room.  Friends and family are welcomed attend, ask questions and participate in discussions.

Since it is a presurgical requirement, there are a number of people who are waiting for a surgical date.  Many are newly recuperated.  There are a few who are years out there to support new friends and family members. And then, there are those who are coming in for revisions, or have gained weight and looking for support or coming back for a revision.

It isn’t unusual for people to remain actively involved in the surgical support groups years postoperatively.

No Drinking With Meals After Weight Loss Surgery

Why no water with meals after weight loss surgery?

Having a drink of water during a meal, is another luxury I must avoid.  My understanding is two fold, one is food can settle in your stomach, taking up space like a layer of thick sand that won’t immediately absorb fluid, thus the fluid has nowhere to go and you will throw it up.

Second reason not to drink fluids with meals is that it dilutes the food which hastens digestion creating room for more food diminishing the purpose surgery was performed, as illustrated in the video below.

Gastroenterologist Consultation

I arrived by cab, at 9:15 a.m., my insurance provides me with 24 round trips per year.  My appointment was for 10.  When I sat down, I was alone in the waiting room, but there were a few people on the other side of the partition who looked busy enough.

Around 9:50, I was called up and provided paperwork, which took me 15 minutes to fill out.  And at 10:15 I was put into an exam room.

At 11:00 I started getting antsy.  I had scheduled an 11:30 pick up for my 1:00 appointment across town, thinking I arrived early enough to provide plenty of time for filling out first time paperwork, and 90 minutes provided plenty of leeway.  and I went to the nurses station, where they assured me it wouldn’t be long, there  were only 3 more people ahead of me!

True to  their word, the doc got to me at 11:20.  I told him I needed an endoscopy as part of my prescreen for gastric bypass surgery.  He inquired if I had a cardiology consult.  I told him I had seen my cardiologist the day before.

“Did he do an echocardiogram, ekg, and a stress test?” the inquisition continued. I said yes, wanting to get the appointment and get out of there, but he wasn’t going to let me off easy and he repeated his question. ‘Okay, officer, I confess’.  I reluctantly told him that he hadn’t done the stress test.

“You’re going for the whole ball of wax.  If it were me, I’d want to be sure that I was getting off the table, and I’d demand a stress test. But that’s between you and me.”

He went on about all the stress my heart has been through damages the heart.  Guess he doesn’t  believe in the old adage, “what doesn’t kill you makes you stronger.”

He scheduled the procedure for early next week. “I want to see cardiology clearance when you walk in the door.  Pick it up and carry it in with you.  I will not perform the endoscopy without seeing clearance from your cardiologist.”

I rushed out, no cab.  I called the cab company, who claim not to have me scheduled to go to another appointment and they were going to take me home.  I called my insurance company, they called the cab company, and they weren’t going to be able to get me across town in time. I ended up rescheduling my next appointment.

My 11:30 pickup came for me at  2:20!

When I arrived home, I called my cardiologist and had them fax over my clearance.  I also asked that he call me, and remind me why he felt that I didn’t need a stress test.

I then called the gastro’s office to verify they received the fax and informed them that the doctor wants to see it before my procedure next week.