Monthly Archives: December 2017


diet_what_dietI used to participate on a particular WLS support board, and we had an absolute deluge of people posting about “cheating” on their post-operative diets.  Some of the netizens would respond “oh, honey, that’s okay… we’re all human.”  Discussions about how impossible it is to fight food addictions would ensue.  As a nurse, I was horrified that these people did not seem to understand the critical importance of following the post-operative diet instructions from the surgeon.

In case this post runs on too long and you need the TLDR; (too long, didn’t read) version here it is:  STICK TO YOUR SURGEONS POST-OP INSTRUCTIONS TO THE LETTER.  IT IS NO LESS THAN YOUR LIFE ON THE LINE.

Understand your surgery

Most bariatric surgeries today are performed arthroscopically.  That means there are only a few tiny holes that you can see from the outside.  You need to understand that the surgery on the inside is HUGE.  If you’ve had the vertical sleeve gastrectomy (VSG) there is a suture line running the entire length of your stomach.  If you’ve had Roux-en-Y (RNY) also known as the gastric bypass, there are multiple suture lines throughout your digestive tract.  There are other surgeries, but those are the main ones, and the principles hold for all of them.

If you had a long cut on your arm, you’d (hopefully) know that you need to keep it clean, keep out dirt and other stuff that can get stuck in the wound, and how important it is to protect the area while it heals.  You can’t see the wounds that are on the inside, but they require the same kind of protection and support while healing.  But we can’t put bandages on them, or keep from eating.  So food is going to be in contact with those healing wounds.

Also, whichever surgery you had, your stomach has a new configuration and doesn’t know how to manage food easily just yet.  Your digestive system has to re-learn how to do its job with the new configuration, just like a newborn baby’s.  It’s important to start easy and work up to harder to digest foods.

A diet for healing

Any food you eat while the suture lines heal (about 6-8 weeks) will be in contact with a healing wound.  Most surgeons give very detailed instructions about what to eat after WLS, and it’s all designed to protect that suture line and ease the newly configured stomach into its new way of working.

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, full liquids, pureed foods, soft foods.  Each phase typically lasts a week or two.  Only after those phases are complete will they have the patient slowly move into a "full" diet beginning with high moisture content foods first.  The surgeon will specify what foods belong in each phase, and how long to stay in the phase.

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 life-threatening leak. 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.

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.  For example, eggs were on my soft foods list, but I couldn’t tolerate them until after I was eating moist proteins.  My surgeon said that was common, and many food intolerances early on will clear up later after more variety of foods is well tolerated.

A very real risk

Just as there are people who smoke a pack a day while drinking a pint of whiskey and live to be a hundred, there are people who eat all sorts of things against their doctor's orders and suffer no ill effects.  This is not a justification to ignore your surgeon’s instructions, it’s pure luck on their part, or possibly some amazing genetics.  You shouldn’t count on either.

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.

I don’t say this to scare you away from WLS.  These complications are very rare.  But you increase the risk significantly when you ignore your surgeon’s post-op instructions.  The doctors are not testing you or trying to make your life hard. They are giving you the best information they have to keep you safe.

It’s incredibly difficult to deal with cravings or “head hunger” as some of us call it, or wanting desperately to chew real food.  It’s very hard to be on liquids only for weeks.  Acknowledge that it’s hard, and seek support in getting through it, but understand how vital it is to muscle through.  Violating these orders is not "cheating" on a diet. It's risking your life.

Trust your surgeon

If you spend any time talking to other WLS patients, you’ll find that every surgeon has a slightly different protocol.  Some skip entire phases listed above, or shorten them dramatically.  Some seem to be completely radical and start patients back on solid food in just days after surgery.  This is not a case of right or wrong.  Each surgeon operates based on what they were taught combined with their personal experiences.  They may even make modifications for an individual patient based on that patient’s health and history.

If you are trusting this surgeon to operate on you, then you need to have trust in their protocols.  The time to make sure you fully understand the protocols, have documentation about the specifics of the protocols, and that you agree to the protocols is BEFORE SURGERY DAY.  If you don’t trust everything your surgeon advises, get a new surgeon.  If there’s a particular concern about part of a protocol, sort it out before you schedule the surgery.

I personally would never stay with a surgeon, for instance, who doesn’t allow any protein drinks (even clear ones) for 2 full weeks post-op.  (Relayed by a patient online, I don’t know if it was truly in the plan.)  I know from my training that healing requires lots of protein, and a huge amount of the healing happens in those first 2 weeks.  If that were in a surgeon’s protocol, I’d get a referral to another.

In conclusion

WLS is a fantastic tool for many people in retaking control of their health.  It’s a huge commitment.  Do yourself and your surgeon a favor, and don’t risk all the time, energy, and money you’ve put into it.  Follow your instructions.  Believe me, it’s over faster than you know, and it sets you up for success in the rest of the process.

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Well, it’s that time of year again. 2016-i-was-the-most-awful-year-possible-2017-hold-my-beer

Time to look back and see how the year went, and try to decide what’s important for the upcoming year.

2017 has been a rough one, certainly.  I think the country made a mistake with the election of #45, and I find him to be a complete embarrassment.  I believe we’ll be cleaning up his mess for the rest of my natural life.  I find myself anxious and upset over politics and political maneuvers every single day.  It doesn’t help that our representatives in Congress don’t seem to care about the lives of their constituents, only the grift lining their pockets.  I know it’s been that way for a long time, but it seems to be getting worse and worse since Citizens United.  I honestly fear for my country.

On a personal level, it’s been a year with ups and downs, but mostly ups.

Since having the weight loss surgery in August of 2016, I have lost approximately 110-115 lbs.  This has resulted in vast improvements in my health overall, and likely contributed to my auto-immune condition going into remission this year.  My health news hasn’t been all good, though.  I developed thyroid nodules and a host of odd symptoms that seemed to resolve after stopping my auto-immune medication.  I also was formally diagnosed with fibromyalgia.  The fall/winter brought a string of migraines and respiratory problems, and that seems to be a seasonal pattern for me.  With all of that, plus grad school, my weight loss has stalled out about 15-20 lbs away from my goal.  I’ve been able to maintain pretty well, which is good.  Once the winter-related health issues start resolving in the spring, I’ll hopefully be able to get that last 20 lbs off.

Ah, grad school, how I loved thee… NOT.  I am happy and proud to say I slogged through my last semester of grad school, and passed with a GPA of 3.57.  I got seriously behind with the capstone project due to health complications, and lost a lot of points in my topics class due to late postings as I tried to keep up.  I seriously considered abandoning the semester and trying again in the spring, but good friends and family convinced me to push through.  My capstone professor was flexible with it and helped me catch up, which I greatly appreciate.  I am SO happy to have it done now, and so glad people who care about me convinced me to push through.

Now I have 2018 upcoming, which was the year I told everyone I’d get back into a social life.  I have so many things that I wanted to do that I had to shelve until 2018, so now I have to see which ones I still want to do and what the priorities are for all of it.  It’s strange to have free time again and not worry about assignments or reading that I’m behind on all the time.

On the homefront, the Mister and I continue to be blissfully (and annoyingly according to Munchkin) happy together.  After getting it so badly wrong a couple of times, it’s still a wonder to me that I got it completely and totally right this time.  I truly feel blessed.  All our kids are doing great.  We did gain a new fluffy member of the household when a young tuxedo tomcat invited himself in on a chilly evening.  I posted to the neighborhood boards and no one claimed him, so George became a member of the family after getting vetted and fixed.  Princess Buttercup is decidedly NOT amused, Ginny is alternately interested in playing and ticked off about him.  The dogs don’t know what to do with him, especially since he keeps trying to go into their area of the house.  But it’s fun having a young boy cat in the house again… he demands playtime or he gets truly obnoxious with the other cats, and he CLIMBS EVERYTHING.

Well, that’s most of the update for 2017.  I’m planning to do a lot more writing in 2018, so stay tuned for that.

I hope every good thing in the new year for all of you!