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I am not a doctor, but... (post-op diet progression)



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Over the last few weeks, I've seen a number of posts about "cheating" on the diet plan in the days and weeks immediately following surgery, and I am very concerned about this trend.


I am not a doctor, I do not play one on TV, and I am not dispensing medical advice.


However.


I am a registered nurse, and what I'm about to say is an informed and educated opinion.


Surgeons tend to give VERY detailed instructions about what to eat after a stomach surgery, and for VERY good reason.


Even when the surgery is arthroscopic and looks to be a very tiny surgery on the outside, it's a VERY BIG surgery on the inside. The VSG surgery leaves a staple/suture line the entire length of the stomach. That incision has to heal, and if you could see it, it would look like raw beef. If the incision were on the outside, we would be very careful with it, keeping it clean and bandaged while it healed. Of course, it's on the inside, so we can't do that. But we need to keep in mind that it needs to heal in the same way.


We have to eat, and that food will be against that raw incision. At the same time that we have to protect the healing stomach, we also have to get in plenty of fluids and nutrients, specifically Protein, in order to support healing. Protein is the primary building block for tissue, so it's critical to healing. Carbs are mainly just energy sources, so they're not as important, especially given that people having bariatric surgery have plenty of energy in their fat stores. This is why protein is stressed so heavily over carbs in the diets.


Additionally, the stomach is now in a new shape, and it basically has to learn how to function as a slender tube instead of a big bag. There's a learning curve. Kinda like a newborn baby's stomach. We don't dump steak and salad into a newborn's stomach for good reason - it doesn't know how to deal with it. Similarly, we don't want to do that to our new sleeve. We start off with stuff that's easy on the suture line and easy to digest, and as the suture line heals and the sleeve learns its job, start working our way up to "real" food.


So over the years, doctors have learned what foods are best for a healing stomach, and that translates into the post-op diet progression instructions.


Typically, that looks like this: Clear liquids, then full liquids, then pureed foods, then soft foods, then slowly move into a "full" diet beginning with high moisture content foods first. When moving from one stage to the next, it's typically advised to add just one food at a time, in small amounts, and see how it's tolerated. A food that's not tolerated well can be tried later on as well. If an entire stage is not being tolerated, back up to the previous stage for a while, and then try again more slowly.


Surgeons tend to specify how long to stay in each of these stages, what types of food make up each stage, and how to transition to the next stage. Every surgeon's instructions are a little different, and it's based on their experience and sometimes changes based on the patient's specific medical case.


The general idea in the very early weeks is to eat foods that will not stress the healing suture line, and do not have particles that are known to cut into the raw tissue or get embedded into the suture line. If a cut or embedded food particle gets infected, it can become an abscess and develop into a leak. A leak can be life threatening, and at the very least cause the patient to have to be hospitalized and possibly have more surgery to correct it. Foods that are particularly known to cause issues are those that swell up like rice, have seeds like strawberries, or have rough hard edges or hard to digest fibers like wheat crackers or raw vegetables.


There are people who eat all sorts of things against their doctor's orders and have suffered no ill effects, but this should not be used as an argument that the doctor's orders are not important. Similarly, you will find some people who smoke a pack of cigarettes every day and drink a pint of whiskey every day but live to 100. They are not representative of most people, and should not be used as the example other people follow.


The reality is that some people will develop abscesses and leaks because they ate things before they were cleared to by their doctors, and there is no way to predict who will have the complications and who will not. And the consequences can be as severe as death. It's not common, but that's how bad it can get. That's why the doctors give the instructions they do. They're not just testing you or trying to make your life hard. They are giving you the best information they have to keep you safe.


Violating these orders is not "cheating" on a diet. It's risking your life. I am not being overly dramatic with this statement, it is a fact that it has happened. You are risking your safety and your health if you violate these orders. It's not about "being human", it's not about "food addiction". It's about your safety and your health. It's hard to be on liquids only for 2 weeks (or more). Some people have huge cravings, or "head hunger" as we tend to call it here. Or just want desperately to chew something. No one is saying it's easy. But it's necessary. Distract yourself. Eat/drink anything that's allowed on your plan - freeze it, heat it up, try something that's opposite of what you've been having to shake it up. Walk around the house or the block. Suck on an ice cube. Count to ten or a hundred. Post about how hard it is, and ask people to help you get through it. But muscle through. It's nothing less than your health and safety.


As for why one surgeon will have his patients on Clear Liquids for 2 weeks while another only does 2 days? Or why one will skip a phase entirely? Each surgeon has different experiences that inform his practices. One is not right and the other wrong. They are each operating out of what they were taught and what they have seen in their own patient groups. They may have even modified the plan because of a specific health concern in your specific case. As a patient, you need to fully understand what your surgeon expects, and if you have a problem with the protocols get it straight with your surgeon and team BEFORE you go under the knife.


If you don't trust your surgeon and his protocols, find another surgeon. I personally would question a surgeon who doesn't allow any Protein drinks including the clear ones for 2 full weeks post op (saw that in one patient's instructions on this site) and likely wouldn't work with that surgeon, given what I know about the needs of protein for healing. But after surgery is not the time to be questioning the surgeon's protocols. Get those questions asked and answered to your satisfaction well before the surgery date.


If you are having surgery, and you have not been given your post-op instructions, at the very least for the first 2 weeks post-op, do not proceed with the surgery until you have that information. We have people posting here stating that they were sent home without clear instructions as to what they were supposed to eat or drink, just a vague statement about "full liquids". That is not sufficient information, and instructions should be given WELL BEFORE the surgery, not after. You should fully understand what will be expected in the weeks after the surgery before consenting to the surgery, or your team is not doing their job.


(This ends my sorta rant about post-op diets and "cheating")


Good luck to everyone!

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Applause

Sent from my iPhone using the BariatricPal App

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Thank you for this! I definitely needed to read this point of view. I was sleeved on 12/20. I had a few rough days with trying to get my liquids in. I also think I am "mourning" food. I had a meltdown and am slowing picking myself back up. I know with each passing day, it will get better.

Sent from my SM-G920V using the BariatricPal App

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Thank you for this! I definitely needed to read this point of view. I was sleeved on 12/20. I had a few rough days with trying to get my liquids in. I also think I am "mourning" food. I had a meltdown and am slowing picking myself back up. I know with each passing day, it will get better.

Sent from my SM-G920V using the BariatricPal App

A friend of mine recently used those same words to describe her experience after her recent sleeve. It WILL get better. it's like basic training in the army. ;) It's hell the first couple of weeks, it's a head game, but each day gets better .

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@theantichick My mom is an RN. Registered Nurses are some of the smartest, in-tune medical professionals. Maybe I'm a bit biased. ;) thank you for saying this. Yes, our incisions are tiny. we can't see what's on the inside. I think your analogy of a baby's stomach is spot-on. All us recent sleevers, let's work hard to keep this investment in ourselves intact.

And I've said this before here on the forum...my dad died after a gastric bypass in 1982. THIS IS A SERIOUS SURGERY, Y'ALL. And sure, it was a different time, the tech is much better...but the danger is still there. My daddy never left the hospital. Everyday I succeed with this, I dedicate to him and his struggle with weight.

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Thank you for your post.It needs to be said to wake us up to what might happen if the new diet is not followed.

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@@theantichick Well said! Or well written anyway. I am quoting one line you wrote:

"They are not representative of most people, and should not be used as the example other people follow."

Remember, no one is completely useless. At the very least, they can serve as a bad example. :D

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malin-so sorry to hear about ur dad. we can do this together!

Sent from my iPhone

Thank you. He went septic while he was in the hospital somehow. I was only 8, I don't remember all the details. But it has given me a healthy respect for WHAT can go wrong. Both of my parents are/were obese. I didn't make this decision lightly. I know most of us feel that way. :)

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