There are those weight loss surgery patients of mine who wake up, have stomachs made of steel, and seem to have no problem eating anything from the third day after bariatric surgery. Then there are those for whom food is a very unpleasant and difficult experience, and this will continue for the first twelve weeks.
There is a whole section about nausea and vomiting, but essentially it boils down to this: if you vomit, stop eating and drinking for a while—give your stomach (pouch) a rest. Then resume a clear liquid diet.
Don’t give up on any foods. There are foods which do better immediately after weight loss surgery, but one day tuna fish may not do well, and the next day tuna fish may do just great.
Nausea is common the first few weeks after weight loss surgery. Your stomach was sutured into a pouch, it is painful, it wants to rebel, and it will. Most nausea comes from overfilling your stomach with too much food or fluid. Once the stomach distends it feels uncomfortable and you will feel nauseated. When the stomach becomes more filled it will produce more acid. The more acid in your pouch, the less your pouch likes it. Overfilling the stomach, and too much acid, both cause severe nausea. When you are nauseated you may also find certain odors bother you (cigarettes, cheap perfume, my mother-in-law’s cooking).
- Remember the size of your pouch and do not over fill it. (Simpson commandment number one).
- Take the Pepcid® or Zantac® daily (or Nexium®, Prevacid®, etc.) Pepcid Complete is a great product that allows you to have immediate relief from stomach acid as well as having Pepcid to keep acid decreased later.
- Keep something in your stomach. Some of our weight loss surgery patients have found that Matzos works well (it can be found in the international food section of most supermarkets). Matzos have little salt, and are rather bland. But every pregnant woman will tell you that a soda cracker soaks up acid and can help with nausea. Remember, this is early in the postoperative period, the first twelve weeks—we do not expect that crackers, which have high carbohydrates, will be a part of your daily food.
- Odors can cause nausea. Your husband or wife will have to smoke outside. My weight loss surgery patients refer to this as the bionic nose.
- Some herbal teas help with nausea, such as Lemon Lift, Peppermint, or Ginger. But if you overfill your pouch, you will defeat the purpose.
- Avoid all carbonated beverages. Some weight loss surgeons believe that carbonation can stretch the pouch, and even disrupt staples in the early postoperative period. There is little evidence to prove this, but unless your weight loss surgeon says it is okay, don’t do it. While carbonation seems to work well in some stomachs, you have to remember, your pouch now contains a lot less space.
- The narcotics in pain medicine can cause nausea. Codeine, Percocet® are two of the more common ones. Sometimes weight loss surgery patients have to simply avoid narcotics and use Tylenol® for pain.
- Keep drinking fluids. Your goal is 2 quarts a day (about 2 liters is fine). Sip. But remember, you do not have to drink all of this at once. Keeping a sports bottle filled with water is a good thing to do.
Vomiting is awful. Often it happens because you overeat. You have a limited amount of room, and if your pouch does not empty fast enough, you will distend it and you will vomit. So you must learn portion control. If your pouch holds four ounces, that is eight tablespoons, if you have one teaspoon too much you can feel awful, vomit, you may stay nauseated all day long, and you may not be able to hold food down.
Remember do not eat and drink at the same time early on. When you had a 50-oz stomach this was okay, but fluids fill your DS 4-oz pouch very fast and a RNY or Lap-band one-ounce pouch even faster (one medicine cup or shot glass is one ounce). If you eat a couple of ounces and then drink some water you can quickly over fill your pouch. These rules can change after a while; we are talking the first few weeks here.
Vomiting can become a cycle. If you keep vomiting, the outlet from your stomach can swell, obstructing it and so cause more vomiting. This can either be the stoma, in the case of RNY or lap-band weight loss surgeries, or the pylorus, or any portion of the pouch. Sometimes we have to put weight loss surgery patients in the hospital and give them intravenous fluids because of intractable vomiting. Often if we limit the amount they can take by mouth and go back to clear liquids we can stop the vomiting. If you are having trouble with nausea and vomiting do this:
- Stop drinking and eating for a while. If you keep drinking, or eating, and vomiting you will only cause swelling which will prevent the normal passage of fluid. After you feel better, you can gently begin clear liquids. Just like when you have the flu, it is okay to skip fluids for several hours.
- Go back to clear liquids only. Start by drinking a teaspoon full every five minutes while you are awake. This should keep you hydrated and not over do it. If you can keep hydrated, you will not need to go into the hospital. If you feel full or become nauseated with drinking, STOP.
- Protein intake is a key with weight loss operations. Isopure® and other protein drinks are clear liquids and count toward the two liters a day. But remember, protein is a goal to get to. You do not have to “stuff” protein in the first few weeks. The goal is to get your stomach working, then once it is to put protein first.
- Suck on ice cubes, or make some Popsicle (Isopure® in the ice cube tray cut with some water will help you a lot.). Do not use sugar filled popsicles.
- Keep tract of how much you drink at a time. Measure it. If you feel full, don’t drink. After your procedure, your weight loss surgeon will have measured your pouch size and will tell you how large it is. Do not exceed that amount. Often nausea and vomiting will happen if you drink too much too fast. We want you to sip water like it is fine Kentucky bourbon.
- Remember, if your stomach will not empty fast and you keep putting fluid in it, you will vomit. So drink SLOWLY. If you feel full, DO NOT DRINK—it is not worth it to vomit.
You may be given a prescription for Reglan® to help empty your stomach. Some weight loss surgery patients find that liquid Reglan works better than pills. Reglan works particularly well for those who have diabetes, as they might have a “diabetic gastropathy” which essentially means your stomach doesn’t empty well. This condition usually improves with time.
Once you are feeling better you may advance your diet gently. Remember, when you vomit, we go back to the beginning, just like in the hospital. Stop eating, wait a while, begin a few clear liquids and go from there.
Sometimes weight loss surgery patients vomit because they try something that does not agree with them. Usually this is meat. The stomach, at first, may have a difficult time digesting certain meats and vegetables. This is why we advocate that you add one thing new to your diet per day. If something does not agree with you today, try it later. Red meat takes some weight loss surgery patients three months before they can tolerate it—except for Tammy. Tammy on her fourth postoperative day was given beef tips. Sure enough, she ate them. She did very well in her postoperative period, and was able to get to her goal in a year.
If all this fails, call your weight loss surgeon. If you can only keep water down we need to know. This is usually an exaggeration, and your weight loss surgeon will want to hear what you can keep down, and what you cannot. If you can only keep water down, then it is fine to drink water for a couple of days. You will not melt away. If you truly cannot keep anything down your doctor will want you in the hospital.
Remember; just because you have had weight loss surgery does not make you immune from the flu, stomach viruses, food poisoning, bowel obstruction, or a host of other problems. Do not hesitate to talk to your family physician regarding your vomiting, especially if the flu is going around. If you are having vomiting and diarrhea, you may need intravenous fluids sooner rather than later.
Warning—preventable brain damage
Repeated vomiting episodes can quickly lead to a vitamin deficiency that can cause brain damage, a peripheral neuropathy, and muscle wasting. This can be prevented with vitamin repletion. While hospitalized, it is important to have IV fluids with the yellow stuff (multivitamins) in it, especially if you have been admitted more than two times for dehydration. If you are in another city or are being admitted by different doctors for dehydration, be sure to ask that they include multi-vitamins with their intravenous hydration.