There are those patients of mine who wake up, have stomachs made of steel, and seem to have no problem eating anything from the third day after weight loss surgery. Then there are weight loss surgery patients for whom food is a very unpleasant and difficult experience, and this will continue for the first twelve weeks. After weight loss surgery your stomach is reduced in size and is referred to as a pouch
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 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 pouch was sutured, it is painful, it wants to rebel, and it will. Most nausea comes from overfilling it with too much food or fluid. Once the stomach distends it feels uncomfortable and you will feel nauseated. When it becomes more filled it will produce more acid. The more acid in your pouch, the less it likes it. Overfilling the pouch, 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 to much acid as well as having Pepcid to keep acid decreased later.
- Keep something in your pouch. 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 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
- Friends will say drink some seven-up or ginger ale. Avoid these and all carbonated beverages. Avoid these well meaning people; they are evil and trying to destroy you (just kidding). 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 pouches, you have to remember, your stomach 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.
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 people who have diabetes, as they might have a “diabetic gastropathy” which essentially means your pouch 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 pouch, 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 bariatric 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 weight loss surgeon will want you in the hospital.
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.