Dr. Husted’s and Dr. Anderson's Support Group Please call the office (615) 284-7960 If interested in starting a support group in your area, please call Jamie at the office.
Facilitators: Jamie Carr, RN and Jennifer Ginnings, RN (615) 284-7960
Cumberland Center for Obesity Surgery office of John Husted, M.D. and Bill Anderson, M.D. 2021 Church Street Suite 602 Nashville, TN 37203
INFORMATION ON GASTRIC BYPASS SEMINARS
Dr. Husted an Dr. Anderson, requires all patients to attend a seminar prior to consultation. The seminars are free of charge and are open to patients, family members and friends. The seminar will cover all aspects of gastric bypass surgery, including the history of the surgery, the procedures performed, the entire process from the consult to the hospital discharge, risks of surgery, complications, follow-up visits, medications and diet.
We update the seminars on a monthly basis. Please call the office prior to the seminar to verify the time and date.
Preparing for Surgery
Preoperative Testing. Approximately two weeks before surgery, you will be required to have preadmission testing. The testing is done at Baptist Hospital. Janet in our office will arrange the testing for you and will send you written instructions for the testing. The standard tests that Dr. Husted orders are as follows: blood work, a urinalysis, chest x-ray, EKG, and an upper gastrointestinal series (an x-ray of your stomach). For most patients, these are the only tests required, however, for our patients with more complex medical problems Dr. Husted may require additional testing.
If you live more that two hours from the Nashville area, Baptist Hospital offers a courtesy suite for you to stay in the night before surgery. If you are interested in this service, please tell Janet so that she can make the arrangements for you.
Start taking a high potency multivitamin once a day to improve your overall health. If possible, begin walking everyday to increase your lung capacity and increase circulation. Start taking two showers per day three days before admission to the hospital. You should shower with an antibacterial soap. Pay close attention to skin folds and areas that are difficult to reach. Proper hygiene is necessary and may help in preventing skin irritation.
We also suggest that you purchase the necessary items that you will need upon discharge from the hospital. We recommend the following: gauze pads, paper tape, a thermometer, Tylenol®, high potency multivitamins, calcium citrate + D (Citracal®), natural fruit juices, Gatorade®, foods that are easy to prepare such as soups, and non-fat yogurt, an over the counter anti-gas agent such as Gaviscon® or Phazyme®.
Do not have anything to eat or drink after midnight before surgery! Your stomach must be empty at the time of surgery to avoid aspiration.
Medications. If you are taking aspirin products, do not take them seven days prior to surgery. You may take Tylenol® for aches and pains. In addition, if you are on a blood thinning medication, Dr. Husted will give you specific instructions about those medications. The anesthesiologist will inform you during the preadmission testing what medications to take the morning of surgery.
Tobacco Products. I will not address this issue. If you have not stopped at this point, we will know it after your general anesthetic.
Hospital Necessities. Do not bring more than $20.00. Please leave all valuables at home. You will need a small bag with your toiletry items: toothbrush, toothpaste, comb, shampoo, and lotion. Most patients bring their favorite slippers and robe. Having one comfortable item of clothing usually makes you feel better. The hospital will provide a gown that will fit you comfortably. Bring a pillow with you to assist you on the ride home. Bumps and sneezes can be uncomfortable without a pillow. Bring this information packet with you. You do not need to bring your medications; Dr. Husted will write the order for you to receive mediation while in the hospital.
Morning of Surgery
Be sure to shower. Remove all jewelry and do not wear nail polish. If you have long hair, please tie it in an elastic band. Contact may not be worn. Bring your glasses instead. If you wear dentures, you will be asked to remove them before surgery. The nurses will take care of them and return them to you after surgery. Brush your teeth; pay close attention to not swallow any water while rinsing.
If you are driving in that morning, make sure that you arrive two hours before your scheduled time. Janet will assist you with the times. Park in the Mid-State parking garage located on 20th Avenue. You will report to the seventh floor early morning admissions area. The nurse will check you in and take you down to the fourth floor area where you will change you clothes and put on a hospital gown. You will also sign the consent for your surgery. We realize that you have signed consent in our office. This consent is for the hospital. You will remain there until surgery calls for you. I will come by to see you to inquire if you have any remaining questions for me. When surgery calls for you, you will be taken via a stretcher to the holding area suite. At this time, your family members will be asked to report to the fourth floor waiting area.
The Holding Area. While awaiting surgery, Dr. Husted will see you to inquire about last minute thoughts. Your anesthesiologist, the nurse anesthetist, and the nurse that will take care of you in the operating room will ask you many questions. A peripheral intravenous line (IV) will be placed in your arm, and a central line will be placed in your neck. We understand that this will be a high anxiety time for you. Surgery is not a normal experience. Fear and anxiety is normal and the staff that will be taking care of you is sensitive to these issues.
The Operating Room. The operating rooms are generally cold and the staff will do everything possible to make you comfortable and ease your anxiety. At this point, you will be moved from the stretcher to the operating room table. The anesthesiologist will place a mask over your nose, you will breath in the air and you will go to sleep.
While you are asleep in the operating room the anesthesiologist will place a tube in your nose (nasogastric tube). The nurse in the room will place a urinary catheter in your bladder. Dr. Husted will insert a gastrostomy tube (g-tube) in the downstream part of your stomach. The surgery will take anywhere from 2-5 hours. As soon as the surgery is completed, you will be taken to the recovery room until you are alert and then taken to the intensive care unit (ICU).
Pain Control
Pain. You will be kept as comfortable as possible. We cannot take all of the pain away. Most patients experience soreness at the incision site. The first few days after surgery, you will be able to medicate yourself with a patient controlled analgesia (PCA) pump. As soon as you are able to tolerate liquids, Dr. Husted will change you to oral pain medications. Be sure to tell the nurses if you are experiencing pain.
Epidural Catheter. This option is for patients weighing 350 pounds or less. An epidural catheter is used for localized pain control without the systemic sedation that can be associated with the PCA. We find patients that opt for the epidural, generally experience less pain, are discharged from the hospital sooner and usually do not require pain medication at the time of discharge from the hospital. You will speak with an anesthesiologist before surgery for additional information about the epidural catheter for pain relief.
This surgery is performed under a general anesthetic. Regardless of your choice for pain control, Dr. Husted will give you medication to keep you as comfortable as possible.
The Hospital Stay
The typical hospital stay is 3-4 days. The time in the hospital will increase if there are complications. All patients spend the first night in the ICU. You will be asked to get out of bed the night of surgery. The first time out of bed is usually the most difficult. The nurses will assist you. We find that patients that walk at least four times daily recover faster. Walking will decrease the chance of blood clots and pneumonia. You will also be asked to deep breathe and cough. The nurse will educate you on how to use a incentive spirometer. This will assist you in expanding your lungs, thereby decreasing the risk of pneumonia.
The morning after surgery, Dr. Husted will see you and determine if you are ready to be transferred to a regular hospital room. If transferred, you will be sent to a regular hospital room and at that time a family member may stay in the room with you.
Discharge
While in the hospital, a clinical nutritionist will see you to educate you on your diet. You will be given medications, discharge instructions, and wound care instructions as well. Upon discharge, if you live more than 30 minutes from the hospital Dr. Husted will expect you to get out of the car every thirty minutes, walk around the car three to four times. You are still a risk for developing blood clots; therefore this will be necessary every 30 minutes.
Restrictions
You may not drive for two weeks. You may not lift anything heavier that 10 pounds for eight weeks. Your incision needs time to heal. Lifting before the eight weeks can increase the risk of hernia. If you follow the weight restrictions, it will decrease the likelihood of hernia. We cannot guarantee that this will prevent a hernia. Climbing stairs is acceptable; pace yourself.
Returning to Work
If you have a sedentary job, you may return to work after the two-week postoperative office appointment. Most patients that return to work at the two-week mark do not have the stamina to work an entire day. Please remember that you undergone major surgery and it takes your body time to bounce back. If you have a job that requires lifting, Dr. Husted will ask you to remain out of work for eight weeks.
Exercise
The only exercise that is allowed for eight weeks is walking and swimming. Walking can be done as soon as you return home. We ask you to walk as much as you can tolerate. Swimming is allowed as soon as your staples and g-tube are removed and the incision is healed. At the end of this packet, we have included tips on walking and how to get started.
Wound Care
You will have a midline incision that begins at the sternum and extends downward. The incision is closed with staples. The g-tube is secured with a single stitch that is attached to your skin. The staples and the g-tube will be removed in the office at the two-week mark after surgery. You will need to shower with the incision covered with plastic wrap for five days after surgery. After the fifth day, the incision is watertight and you may shower without covering it. The g-tube site should be covered every time that your shower the entire time that it remains. We recommend changing the dressing after your shower; patting the area dry and applying a fresh dressing. The staples tend to catch on clothing therefore most patients prefer to keep a light dressing over the incision until the staples are removed. Despite careful handling on the incision and the g-tube area, they can become infected. Here are signs of wound infection to be aware of: increased redness, drainage from the incision, fever above 100º, red streaks, swelling of the area or increase tenderness. If you experience any of these symptoms, you should call the office immediately.
G-tube
The g-tube placed in the downstream part of your “old” stomach. It prevents your stomach from becoming very bloated following surgery. The stomach is stressed by the surgery and can take a few days to begin working properly again. The g-tube remains in the stomach for two weeks and is removed in the office with your staples. In most cases, when you are discharged from the hospital, the nurse will remove the bag that is attached to the tube and replace it with a plug. Should you begin to feel full and bloated that area, you may walk to the sink, unplug the tube and drain it over the sink. Do this only if you experience this feeling of fullness. If you do not experience this, leave the tube plugged.
Normal Occurrences After Surgery
Nausea
Nausea is common in the first few weeks after surgery. The usual causes are increased sensitivity to odors, going to fast with foods, and increased acid in the stomach. We recommend that you take your acid blocker as prescribed by Dr. Husted. Sometimes herbal tea (chamomile) will assist in easing the nausea. Odors after this surgery can be a bit overwhelming at times. We find that some patients after this surgery become highly sensitive to odors. This is temporary and will improve over time. We recommend to patients to purchase spearmint or peppermint oil, place a few drops in a handkerchief and carry it with them. They will hold it to their nose when the odors become overwhelming. Patients do report that this is helpful in those times. Remember that you must take your time with foods and fluids. Go slowly.
Hair Loss
Hair loss is common with rapid weight loss. The hair loss is temporary and reversible. It usually begins about the three- month mark after surgery and lasts until about the nine- month mark. At this time be certain that you are taking in 70-80 grams of protein a day. Some patients will take ZBEC® or hair supplements that you may purchase over the counter. Most patients that experience hair loss find that cutting the hair shorter makes the hair loss less noticeable. We do not recommend perms or coloring in this time period as it can further create stress to the hair.
Bowel Activity
It will take time for the bowel to adapt to all of the changes that surgery creates. Constipation can occur due to the decrease in intake. If you experience constipation, we recommend Milk of Magnesia® to alleviate constipation. If you experience loose stools, they are usually caused by high fatty foods and lactose intolerance. Notice your dietary habits and make the necessary changes. You may notice that gas will increase as well. Watch those foods that cause gas. If dairy products increase gas, diarrhea and cramping, you are most likely lactose intolerant. Purchase Lactaid Tablets® and take before eating dairy products. You may reduce gas by watching your diet and if necessary take an anti-gas agent. One product that will significantly reduce the odor of stools and gas is Devrom®. You may purchase this product where ostomy supplies are sold or order direct from the company at 1-800-453-8898.
Make sure that you drink at least 1-2 liters of fluid a day. Take water with you everywhere you go. You should sip water all day long. This will prevent dehydration. Monitor you urine. If it is dark, increase your fluids.
Lactose Intolerance
Many patients who tolerated milk products before surgery find that after gastric bypass surgery that milk products cause abdominal cramping, nausea and diarrhea. This occurs because of the stress to the bowel created by surgery itself. Lactose is a sugar found in milk products and requires a particular enzyme found in the intestine. The intolerance of lactose can be treated with Lactaid, an over the counter tablet that patients may take prior to eating milk products. The bowel will adapt over time and most patients can resume having milk products without the Lactaid within 6 months.
Diet After Surgery
Please understand that you have an active role on your healing process. You have undergone a major change in your life both physically and emotionally. Take an active role to take good care of yourself. We expect the patient to take responsibility for controlling the types of foods taken in during the first eight weeks as well as throughout their life. You must learn to work with the surgery instead of viewing it as a “magic” procedure that will create weight loss without your involvement. Dr. Husted can only do his part; we need for you to do yours.
Pureed Diet
A pureed diet is to provide the appropriate time for the proper healing of your gastric pouch. To allow proper healing please remember that the following must be strictly adhered to in order to prevent possible complications of the newly banded area. While the tissues of your surgically altered stomach are healing, you must minimize the stress on those tissues. The area where your band is placed is fresh tissue. If you eat solid foods earlier than the eight-week period prescribed by Dr. Husted, one of two problems may occur. The first is a marginal ulcer. The banded site may become irritated and will produce ulceration at the area. At that point, you will be placed on medication and will be required to remain on a pureed diet for approximately three months. Secondly, the area may become irritated and scar down, closing off the opening to your stomach. If this happens you may be required to have additional surgery.
The First Eight Weeks
During the first eight weeks of surgery all foods must be pureed. You will need a blender for this diet. The foods must be able to pass through a straw however, we ask you not to use a straw due to the air that is sucked into your “new” stomach. A pureed diet is a diet that involves blending everything that you eat. You may have regular table food, however, it must be in the consistency that you can draw it through a straw. You must blend the food into a liquid form without lumps. You may include ground meats. Use broths, gravy, or soup to obtain proper consistency. Soups should be strained or blended until there are no lumps. Eggs may be blended with skim milk. Fruits and vegetables may be pureed. You may need to add natural fruit juice or vegetable juice to maintain consistency. Smoothies can be made by blending fruit with non-fat plain yogurt and skim milk. Frozen dinners may also be blended with broths.
It is normal in the first eight weeks to have no appetite. The usual calorie intake is between 400-600 calories per day. The focus is on fluids and one of the main challenges will be to maintain hydration. Your body needs the same amount of fluid as it did prior to surgery, yet your “new” stomach is limited to 1-2 ounces at a time. This does not mean your meal size should be limited to 1-2 ounces, as liquids may pass through fairly swiftly; most patients take 6-ounce liquid meals, but no more than that at a single meal. You should carry water with you everywhere that you go. Liquids should be free of calories and preferably free of caffeine. Patients who drink high calorie juices will not obtain the desired weight loss. Carbonated drinks will cause gas and the gas will create a very uncomfortable feeling. If you must have a carbonated beverage, allow it to “go flat” before drinking.
The fluid intake requirement is one quart of water per day (32ounces). Sip slowly. Do not force fluid. Drinking too fast or gulping will create pain, discomfort and possibly vomiting. Most patients find that warm water goes down easier than cold water. This will be a new concept and it will take time to adjust to it. It will be a new eating pattern for you until you know what that full feeling really means.
Soft Foods
At the eight-week mark your diet will be advanced to a soft diet. You will no longer be required to blend your food. You should concentrate on foods low in calories and high in protein. The purpose of soft foods is to allow your system to adjust to this new eating pattern. Soft foods include oatmeal, mashed potatoes, yogurt, saltines, eggs, soup, rice and beans, seafood with the exception of crustacean shells, cottage cheese and peanut butter. You will eat soft foods for a total of four days.
Regular Foods
After eight weeks of a limited diet, we advance patients to regular foods. Do not be afraid to try new foods. Just remember to eat small amounts. Your diet at this point is going to be trial and error. Bread, pasta and steak are three common foods that most patients cannot tolerate.
Regular Gastric Bypass Diet
At approximately 9 weeks after your surgery you should be completely transitioned from the soft diet to a regular gastric bypass diet. Your dietary restrictions at this point will be limited to low sugar, low fat foods. As your diet advances remember to introduce one new food at a time. If a certain food does not agree with you make sure that you can identify it for the future. If you experience a problem with a particular food, it does not mean that you cannot ever eat it again, just wait awhile before trying it again. Your main purpose now should be proper nutrition and weight loss. To maximize weight loss and maintain nutrition, solid foods should be eaten almost exclusively. Soft calories such as yogurt, mashed potatoes and gravy, and chips should not be eaten.
Now is the time to begin eating the same foods as the rest of the family; however, you will eat smaller portions. We recommend that you eat on a salad plate instead of a dinner plate. The portions will look more normal for you. Over time you will feel comfortable with your eating habits and they will become a way of life for you. Be patient. You will adjust. There are three very important things to remember when eating solid foods:
· Chew your food completely! · Set your utensil down between bites! · Cut your foods into small bites!
As you may expect, the diet that immediately follows gastric bypass surgery is very specialized. One good way to understand the diet after surgery is to compare you with four-year-old child. Small children eat small amounts of food. They have a small amount of stomach space to fill. A patient that has undergone gastric bypass surgery is no different. The space is limited so make sure you fill it with healthy, nutritious foods.
Fluids should be consumed on an almost continual basis. However, we ask that you do not drink fluids during meals and not within an hour after foods. If you drink during your meals, you will wash the foods through your pouch too quickly and will generally consume more food than necessary. This will be a new habit for most patients and will take some time to become familiar with.
Remember that your pouch will fill up quickly! It is important to recognize that sometimes one bite of food will create that feeling of fullness. If this occurs stop eating. The second bite of food can distend your pouch creating an uncomfortable feeling. Over time you will learn to recognize these feelings and will train yourself to eat smaller amounts. If you overeat or if you eat a food that does not agree with you, your stomach will be irritated. An irritated stomach stays irritated for a day or so. It will be less tolerant of food and liquids and can create a more exaggerated feeling of fullness. If this occurs, allow your pouch to recover by consuming liquids for the next meal or two.
Dumping Syndrome
Your “new” pathway for food intake involves the emptying of the foods into the small intestine. This pathway is created to decrease the body’s ability to tolerate foods high in concentrated sugars whereby decreasing the calorie intake. Sweating, weakness, heart racing, and cramping abdominal pain characterize dumping syndrome. Rapid emptying from the stomach into the small intestine is the cause. Most patients state that it feels terrible and will simply have to lie down until the feeling passes. Dumping syndrome is not dangerous; it just creates a very temporary uncomfortable feeling.
Medications and Supplements
Multivitamin
As stated earlier, begin a multivitamin as soon as you decide to have surgery. You will need to take a multivitamin for the rest of your life. However, during the first eight weeks, we ask you to chew two children’s chewable vitamins a day. There are many on the market such as Flintstones, Bugs Bunny, and Centrum. It is very important to chew these supplements due to the fact that your nutritional intake is reduced. After the eight weeks, you may purchase a high-potency adult multivitamin. Take one per day.
Trinsicon
You will be given a prescription for Trinsicon. You will also be required to take this medication for life. It is a vitamin B-12, intrinsic factor and iron supplement. Your “new” stomach will not absorb B-12 as before, therefore you will be required to take the medication or have a B-12 injection monthly for the rest of your life. Vitamin B-12 and iron are essential in preventing anemia. Following gastric bypass, regular untreated vitamin B-12 and iron supplements taken by mouth do not pass through the main body of the stomach required for iron processing, nor through the downstream part of the stomach where a substance known as intrinsic factor is made. Intrinsic factor is needed to bind to vitamin B-12 for absorption to occur. Without this, proper processing and binding of iron and vitamin B-12, a low blood count - anemia - may occur. The supplement will significantly reduce the risk of the condition occurring. Initially, the medication tends to create nausea in some patients. Consequently, most patients do not take the medication for about 6 weeks after surgery.
Calcium
Calcium is the most abundant mineral, and the fifth most abundant substance in the body. Calcium plays a vital role in blood coagulation, and enzyme activation; it gives firmness and rigidity to bones and teeth, and is essential to nerve and muscle function, including the heart. The body’s ability to absorb calcium is diminished following gastric bypass, but can usually be overcome with supplements. Calcium citrate is the most easily absorbed calcium. It dissolves regardless of the acid content of the stomach, and can be taken with or without food. We ask all patients take a calcium citrate + vitamin D supplement everyday for the rest of their life. The recommended dosage is 1,200 mg per day. You may purchase the calcium supplement at most grocery stores or a local pharmacy.
Proteins
Proteins are the most plentiful substance in the body next to water. Protein breaks down into amino acids that are necessary for the construction of body proteins, which are vital for the growth and maintenance of muscles, blood, internal organs, skin, hair and nails. Protein is also vital to the formation of hormones, enzymes, and antibodies. Common sources of protein are lean meats, poultry, fish, eggs, cheeses beans and nuts. It may be very tempting to eat a salad and potato, however, you must eat the protein first and then the complex carbohydrates.
Protein is also available in powder, liquid and bar forms. They may be purchased in most health food stores. These forms are an excellent way to add to the protein to your diet. Remember, it is necessary to take in 80 grams of protein a day.
Acid Blocker
We will give you a prescription for an acid blocker at the time of discharge. You will take this medication for a total of two years. This medication will assist in preventing ulcers.
Food Labels & How To Read A Food Label
Food packaging can be very misleading. There are all types of marketing-related claims, including “reduced fat”, “lite”, “low-fat”, and many others. These labels can lure the consumer into believing the data. Let’s take whole milk for example, the label states 96% fat free - but you still get 50% of the calories from fat. 2% milk is labeled “low fat”- again you get 38% of the calories from fat. It is important that you understand food labels and how to read them.
Here are some points to follow when reading a food label:
1. Serving size - This is the most important line. All of the nutrition facts will be taken from this line. Be careful of the serving size, some labels will add more than one serving. Compare the portion that you are eating and the serving size and adjust your calories and fat accordingly.
2. Servings Per Container - This tells the number of servings per package.
3. Calories and Calories From Fat - This is the total number of calories that will be consumed in one serving. Calories from fat are the actual calories from fat per serving.
4. % Daily Serving - Again this is based on a 2000 calories per day.
5. Total Fat - This is the amount of fat in grams per serving. It is important to remember that no more than 30% of your calories come from fat calories.
6. Nutrients - These include total carbohydrates, sodium, cholesterol, protein and saturated fats.
7. Footnote on Daily Values - This recommends the current recommendations for 2000 and 2500 calorie diets. These are usually higher than your target calories and fat gram totals for the day.
Suggestions for Achieving Your Goal
Avoid high calorie foods - they will defeat your desired weight loss.
Avoid sugars - they can cause dumping syndrome and will also decrease your desired weight loss.
Stop eating when you are full - recognize that full feeling and put down that utensil when you experience it.
Take time to eat - each meal usually takes about 30 minutes to eat. Chew your food well.
Do not snack on soft calories - yogurt, chips, and sugars will inhibit your goals.
Concentrate on healthy snacks like fruits and vegetables.
At approximately one year from surgery, your calorie intake usually averages out to 1,200 - 1,500 calories per day - remember to maintain that caloric intake.
Exercise
Exercise is extremely beneficial following weight loss surgery. For the first eight weeks following surgery no strenuous exercise should be done and patients should not lift anything heavier than ten pounds. Walking however, can be done immediately following surgery and is beneficial after the first eight weeks of surgery.
Walking is one of the easiest ways that a patient can exercise. It is inexpensive; you can walk anywhere, anytime. All that is required is comfortable clothing, a good pair of shoes and motivation. Walking is easier on your joints, and will improve overall fitness. There are many benefits to walking. Walking will:
· Give you more energy · Assist you in sleeping better · Decrease stress · Tone your muscles · Increase the number of calories that your body uses · Lower your blood pressure · Improve mood and increases a positive outlook on life · Make you feel great! For these reasons and more, we promote and encourage our patients to incorporate a walking program into their lives, so let’s get started!
A Good Pair Of Shoes
A good pair of shoes is essential for walking. If a shoe is not comfortable, you will not enjoy your walk. Here are just a few suggestions when shopping for the perfect shoe.
Sports shoes are all over the market. Go to a store where the staff has a good knowledge about shoes. Look for a flexible shoe with a low, rounded and supportive heel. Make sure that you can twist and bend the toe area. A stiff shoe will not be comfortable. Look for a shoe that is lightweight and breathable. Walkers need a more flexible shoe than runners. At some point, if you want to run, you will want to invest in a stiffer type shoe made for running. If you wear a running shoe for walking, the shoe can keep the foot from rolling properly and increase the occurrence of shin splints.
The fit is very important. Be sure that your toes and your foot had enough room in the toe. You want almost a half- inch between the end of your toes and the end of the shoe. Make sure that the heel does not slip and that the shoe does not pinch or bind your foot.
Ideally you should try the shoe on at the end of the day. Wear the type of socks that you will wear with the shoes. Make sure that you try both of the shoes on. You want a proper fit.
Starting a Program
Now that you have that perfect shoe, let’s get started planning your program. There are a few things that you will want to think about before you get started. It is important that you design your program to fit your lifestyle. Arrange your program so that you will be successful. Do not make the program so rigid that you will defeat yourself. Here are a few key points that you will want to incorporate into your program:
· Choose a safe, well-lighted area to walk. · Wear those comfortable shoes, clothes that are right for the season, and a reflector if you are walking at night. · Use the buddy system to keep you motivated. · Start out slow and easy. · Work up to your goal. Slow and steady wins the race.
Stretching
Stretching is a very important start to any exercise routine. Stretching will decrease stiff, sore muscles, decrease your risk of injury and increase your muscle flexibility. Here are a few suggestions for stretching exercises that you may incorporate into your new program.
Ankle circles - hold on to the back of a chair or some type of support. Stand on one leg and lift the other foot off the ground. Make circles with your toes. Go in each direction. Do about ten circles with each foot.
Side reaches - reach one arm over your head and to the side. Keep your hips and shoulders straight. Hold for 10 seconds and relax. Repeat about five times on each side. As you hold the stretch, reach a litter further into the stretch.
Toe Points - hold on to the same chair or support. Lift one foot off the floor and point your toes toward the floor. Hold for a five seconds and flex your foot pointing the toes upward, hold for five seconds. Repeat this for each foot about 5 times.
Wall Push - lean your hands on a wall about shoulder level approximately 3-4 feet from the wall. Bend one knee and point it toward the wall. Keeping both feet on the floor. Keep your back straight with your foot flat and your toes pointed straight ahead. Hold for 10 seconds and repeat with the other leg. Do this about five times per leg.
These stretches are suggestions. You may have some of your own that you will use. Remember if your muscles feel tight or need stretching while walking, pause and stretch as needed.
The First Steps…
First of all, begin slowly. Walk out the door. Think about the direction and route that you will take. Look around you. Notice the trees, the birds, and the flowers. Walk for 5 minutes and walk back. Do this every day for two weeks. If this is easy for you, add five minutes to your walks each week. If this is too much for you, walk 2 minutes and then walk back. The goal is to walk. Do not be hard on yourself if walking to the mailbox exhausted you. You did it! Do it again tomorrow. And as you build your endurance, add distance to the walk weekly. Keep adding time until you reach your desired goal. The goal will be thirty minutes per day, walking at a “talking pace”. Do not walk so fast that you are gasping for air.
Watch your posture. Walk tall. Hold your head up and look forward. Your shoulders should be down and relaxed. Tighten your buttocks and your will begin to walk in a natural stride.
Be sure to drink plenty of water. Take your water bottle with you and drink as needed.
The toughest part of starting a program is beginning and developing a habit. There will be days that you just do not have the desire to walk. Those are the days that you will feel most rewarded if you will push yourself to step out that door.
As your walk is ending, slow down your pace and begin to cool off. You should be sure to stretch after you walk too. This stretches should be done slowly without bouncing and be sure to keep your head above your heart. These stretches should feel good and you should hold the stretches longer that before walking. Do not stretch to the point of pain. A slow, gentle stretch is all that is needed. Here are some stretches that you may want to try:
Wall Stretch - this is described in the beginning stretch before walking.
Hamstring and Lower Back Stretch - stand with feet shoulder width apart. Put your arms out in front of you at waist level. Slowly lean forward (keeping head up). Slowly bend forward and reach for the ground. Bend only until you feel tension in the muscle. Hold for 10 seconds and repeat 5 times bending lower each time.
Neck Stretch - turn your head and look over your left shoulder and then the right. Keep head up straight, hold for five seconds. Tuck your chin into your chest and hold for five seconds. Next tilt head back pointing your nose upward. Hold five seconds. Repeat each of these until your feel your neck and shoulders relaxed.
Shoulder Stretch - take the left arm and cross it over your chest. Take your right hand on your upper arm and pulling the left arm into your chest. Be sure to keep you shoulders down. Do not pull at the elbow. Repeat with the right arm. Do each arm five times.
Again these are just suggestions for stretches. You may already have stretches that work for you. Just be sure that you stretch before and after any exercise to prevent injury and increase flexibility.
Motivation
Motivation is the key. You will have to find out what motivates you. It could be to lose weight, to become healthier and fit, to be able to walk in great places (hiking beautiful trails), or with your family members. Who in your life will benefit along with you when you become more fit? You will have to be the one to decide what will motivate you and keep you motivated. Choose the things that matter to you and stay focused on those things
Now, make a list of all the excuses that you have found for not becoming fit and start marking them off of your list!
You must make you and your overall well being the main priority!!
Now, get started.
*Please consult your primary care physician before beginning any fitness program
Aftercare
The first year after gastric bypass surgery is a tremendous time of change. Your body undergoes a metamorphosis and a new person emerges. It can be a time of fear, happiness, pain, pleasure, confusion, understanding and frustration. Your body is constantly changing. The range of emotions felt by most patients is normal and is to be expected. We urge you to take advantage of the monthly support group meetings provided to our patients. Most patients find the support groups very helpful in dealing with the changes that occur after surgery. See the above list of SUPPORT
Please call Dr. Husted’s office (615) 284-7960 or contact one of the facilitators of the groups for questions or directions. If interested in starting a support group in your area, please call Jamie at Dr. Husted’s office. You may also access our on-line support group www.johnhustedmd.com. For more information, call the office.
Office Visits
Office Visits. Office visits are a very important part of your aftercare. We need to see you at these scheduled times so that we may monitor your progress. We will periodically order lab tests to ensure that you are taking enough supplementation. Please be sure to schedule and make these appointments.
Office visits are as follows: 2 week visit - see Dr. Husted and Jamie 8 week visit - see Dr. Husted or Jamie 6 month visit - see Dr. Husted or Jamie, lab work done 1 year visit - see Jamie 18 month visit - see Jamie, lab work done Yearly visit - see Dr. Husted or Jamie
Dr. Husted has created a new stomach for you that will be your tool to use for weight loss control for the rest of your life. You must learn to use this as a tool to obtain and achieve your desired weight loss. Patients that learn to use this tool by using the proper diet, exercise, and dietary supplements will have the best long- term results. Set your goals early. The best time to choose new habits is early after surgery. Your motivation will be at the highest level. This is a very good time to plan your long-term success. Patients will lose weight after surgery due to the mechanical changes of surgery however; your lifestyle changes will determine your long-term success. If you have questions, please call the office we will be glad to assist you in any way that we can (615) 284-7960.
Preparing for Surgery
Preoperative Testing. Approximately two weeks before surgery, you will be required to have preadmission testing. The testing is done at Baptist Hospital. Janet in our office will arrange the testing for you and will send you written instructions for the testing. The standard tests that Dr. Husted orders are as follows: blood work, a urinalysis, chest x-ray, EKG, and an upper gastrointestinal series (an x-ray of your stomach). For most patients, these are the only tests required, however, for our patients with more complex medical problems Dr. Husted may require additional testing.
If you live more that two hours from the Nashville area, Baptist Hospital offers a courtesy suite for you to stay in the night before surgery. If you are interested in this service, please tell Janet so that she can make the arrangements for you.
Start taking a high potency multivitamin once a day to improve your overall health. If possible, begin walking everyday to increase your lung capacity and increase circulation.
Start taking two showers per day three days before admission to the hospital. You should shower with an antibacterial soap. Pay close attention to skin folds and areas that are difficult to reach. Proper hygiene is necessary and may help in preventing skin irritation.
We also suggest that you purchase the necessary items that you will need upon discharge from the hospital. We recommend the following: gauze pads, paper tape, a thermometer, Tylenol®, high potency multivitamins, calcium citrate + D (Citracal®), natural fruit juices, Gatorade®, foods that are easy to prepare such as soups, and non-fat yogurt, an over the counter anti-gas agent such as Gaviscon® or Phazyme®.
One day prior to surgery we will ask you to begin to cleanse your bowel. On the day before surgery we will ask you to have clear liquids only for that day. Clear liquids include water, apple juice, grape juice, cranberry juice, Jell-O®, broth, bouillon, and Popsicles. Increase your water intake. You will need to purchase a small bottle of magnesium citrate at the pharmacy or food market. At four pm on the day before surgery, we will ask you to drink 240cc (1 glassful) followed by a glass of water. The magnesium citrate will act on your bowels and will further cleanse your system. The onset of the magnesium citrate is generally 3-6 hours. We recommend that you remain close to home.
Do not have anything to eat or drink after midnight before surgery! Your stomach must be empty at the time of surgery to avoid aspiration.
Medications
If you are taking aspirin products, do not take them seven days prior to surgery. You may take Tylenol® for aches and pains. In addition, if you are on a blood thinning medication, Dr. Husted will give you specific instructions about those medications. The anesthesiologist will inform you during the preadmission testing what medications to take the morning of surgery.
Tobacco Products
I will not address this issue. If you have not stopped at this point, we will know it after your general anesthetic.
Hospital Necessities
Do not bring more than $20.00. Please leave all valuables at home. You will need a small bag with your toiletry items: toothbrush, toothpaste, comb, shampoo, and lotion. Most patients bring their favorite slippers and robe. Having one comfortable item of clothing usually makes you feel better. The hospital will provide a gown that will fit you comfortably. Bring a pillow with you to assist you on the ride home. Bumps and sneezes can be uncomfortable without a pillow. Bring this information packet with you. You do not need to bring your medications, Dr. Husted will write the order for you to receive mediation while in the hospital.
Morning of Surgery
Be sure to shower. Remove all jewelry and do not wear nail polish. If you have long hair, please tie it in an elastic band. Contact may not be worn. Bring your glasses instead. If you wear dentures, you will be asked to remove them before surgery. The nurses will take care of them and return them to you after surgery. Brush your teeth; pay close attention to not swallow any water while rinsing.
If you are driving in that morning, make sure that you arrive two hours before your scheduled time. Janet will assist you with the times. Park in the Mid-State parking garage located on 20th Avenue. You will report to the seventh floor early morning admissions area. The nurse will check you in and take you down to the fourth floor area where you will change you clothes and put on a hospital gown. You will also sign the consent for your surgery. We realize that you have signed consent in our office. This consent is for the hospital. You will remain there until surgery calls for you. I will come by to see you to inquire if you have any remaining questions for me. When surgery calls for you, you will be taken via a stretcher to the holding area suite. At this time, your family members will be asked to report to the fourth floor waiting area.
The Holding Area. While awaiting surgery, Dr. Husted will see you to inquire about last minute thoughts. Your anesthesiologist, the nurse anesthetist, and the nurse that will take care of you in the operating room will ask you many questions. A peripheral intravenous line (IV) will be placed in your arm, and a central line will be placed in your neck. We understand that this will be a high anxiety time for you. Surgery is not a normal experience. Fear and anxiety is normal and the staff that will be taking care of you is sensitive to these issues.
The Operating Room. The operating rooms are generally cold and the staff will do everything possible to make you comfortable and ease your anxiety. At this point, you will be moved from the stretcher to the operating room table. The anesthesiologist will place a mask over your nose, you will breath in the air and you will go to sleep.
While you are asleep in the operating room the anesthesiologist will place a tube in your nose (nasogastric tube). The nurse in the room will place a urinary catheter in your bladder. The surgery will take anywhere from 2-5 hours. As soon as the surgery is completed, you will be taken to the recovery room until you are alert and then taken to the intensive care unit (ICU).
Pain Control
You will be kept as comfortable as possible. We cannot take all of the pain away. Most patients experience soreness at the incision site. The first few days after surgery, you will be able to medicate yourself with a patient controlled analgesia pump (PCA). As soon as you are able to tolerate liquids, Dr. Husted will change you to oral pain medications. Be sure to tell the nurses if you are experiencing pain.
The Hospital Stay
The typical hospital stay is 5 days. The time in the hospital will increase if there are complications. All patients spend the first night in the ICU. You will be asked to get out of bed the night of surgery. The first time out of bed is usually the most difficult. The nurses will assist you. We find that patients that walk at least four times daily recover faster. Walking will decrease the chance of blood clots and pneumonia. You will also be asked to deep breathe and cough. The nurse will educate you on how to use a incentive spirometer. This will assist you in expanding your lungs, thereby decreasing the risk of pneumonia.
The morning after surgery, Dr. Husted will see you and determine if you are ready to be transferred to a regular hospital room. If transferred, you will be sent to a regular hospital room and at that time a family member may stay in the room with you.
You will not be allowed to eat or drink until an upper gastrointestinal series (UGI) is performed at the three-day mark. The UGI will allow visualization of your stomach and inform Dr. Husted if you have a leak. If the test results are negative, the tube (NG) will be taken out and you will begin clear liquids. Your diet will be advanced to full liquids and you will be discharged on a pureed diet. Most patients are discharged on the following day.
Discharge
While in the hospital, a clinical nutritionist will see you to educate you on your diet. You will be given medications, discharge instructions, and wound care instructions as well. Upon discharge, if you live more than 30 minutes from the hospital Dr. Husted will expect you to get out of the car every thirty minutes, walk around the car three to four times. You are still a risk for developing blood clots; therefore this will be necessary every 30 minutes.
Restrictions
You may not drive for two weeks. You may not lift anything heavier that 10 pounds for eight weeks. Your incision needs time to heal. Lifting before the eight weeks can increase the risk of hernia. If you follow the weight restrictions, it will decrease the likelihood of hernia. We cannot guarantee that this will prevent a hernia. Climbing stairs is acceptable; pace yourself.
Returning to Work
If you have a sedentary job, you may return to work after the two-week postoperative office appointment. Most patients that return to work at the two-week mark do not have the stamina to work an entire day. Please remember that you undergone major surgery and it takes your body time to bounce back. If you have a job that requires lifting, Dr. Husted will ask you to remain out of work for eight weeks.
Exercise
The only exercise that is allowed for eight weeks is walking and swimming. Walking can be done as soon as you return home. We ask you to walk as much as you can tolerate. Swimming is allowed as soon as your staples are removed and the incision is healed. At the end of this packet, we have included tips on walking and how to get started.
Wound Care
You will have a midline incision that begins at the sternum and extends downward. The incision is closed with staples. The staples will be removed in the office at the two-week mark after surgery. You will need to shower with the incision covered with plastic wrap for five days after surgery. After the fifth day, the incision is watertight and you may shower without covering it. The staples tend to catch on clothing therefore most patients prefer to keep a light dressing over the incision until the staples are removed. Despite careful handling on the incision, the incision can become infected. Here are signs of wound infection to be aware of: increased redness, drainage from the incision, fever above 100º, red streaks, swelling of the area or increase tenderness. If you experience any of these symptoms, you should call the office immediately.
Normal Occurrences After Surgery
Nausea
Nausea is common in the first few weeks after surgery. The usual causes are increased sensitivity to odors, going to fast with foods, and increased acid in the stomach. We recommend that you take your acid blocker as prescribed by Dr. Husted. Sometimes herbal tea (chamomile) will assist in easing the nausea. Odors after this surgery can be a bit overwhelming at times. We find that some patients after this surgery become highly sensitive to odors. This is temporary and will improve over time. We recommend to patients to purchase spearmint or peppermint oil, place a few drops in a handkerchief and carry it with them. They will hold it to their nose when the odors become overwhelming. Patients do report that this is helpful in those times. Remember that you must take your time with foods and fluids. Go slowly.
Hair Loss
Hair loss is common with rapid weight loss. The hair loss is temporary and reversible. It usually begins about the three- month mark after surgery and lasts until about the nine- month mark. At this time be certain that you are taking in 70-80 grams of protein a day. Some patients will take ZBEC® or hair supplements that you may purchase over the counter. Most patients that experience hair loss find that cutting the hair shorter makes the hair loss less noticeable. We do not recommend perms or coloring in this time period as it can further create stress to the hair.
Bowel Activity
It is normal to have 3-4 soft stools a day. You will notice that the stools will increase in odor. Some patients will experience diarrhea for a few months after surgery. It will take time for the bowel to adapt to all of the changes that surgery creates.
Loose stools are usually caused by high fatty foods and lactose intolerance. Notice your dietary habits and make the necessary changes to reduce stool consistency. You will notice that gas and flatulence will increase as well. Watch those foods that cause gas. If dairy products increase gas, diarrhea and cramping, you are most likely lactose intolerant. Purchase Lactaid Tablets® and take before eating dairy products. You may reduce gas by watching your diet and if necessary take an anti-gas agent. One product that will significantly reduce the odor of stools and gas is Devrom®. You may purchase this product where ostomy supplies are sold or order direct from the company at 1-800-453-8898.
Make sure that you drink at least 1-2 liters of fluid a day. Take water with you everywhere you go. You should sip water all day long. This will prevent dehydration. Monitor you urine. If it is dark, increase your fluids.
Lactose Intolerance
Many patients who tolerated milk products before surgery find that after gastric bypass surgery that milk products cause abdominal cramping, nausea and diarrhea. This occurs because of the stress to the bowel created by surgery itself. Lactose is a sugar found in milk products and requires a particular enzyme found in the intestine. The intolerance of lactose can be treated with Lactaid, an over the counter tablet that patients may take prior to eating milk products. The bowel will adapt over time and most patients can resume having milk products without the Lactaid within 6 months.
Diet After Surgery
Please understand that you have an active role on your healing process. You have undergone a major change in your life both physically and emotionally. Take an active role to take good care of yourself. We expect the patient to take responsibility for controlling the types of foods taken in during the first four weeks as well as throughout their life. You must learn to work with the surgery instead of viewing it as a “magic” procedure that will create weight loss without your involvement. Dr. Husted can only do his part; we need for you to do yours.
The purpose of this surgery is not to allow you to increase your eating habits, it is to reduce your weight without creating too many restrictions. Remember that after surgery you will not be allowed to have anything by mouth until the UGI test is negative. You will be advanced to clear liquids, and then to pureed foods. You will remain on pureed foods for a total of two weeks, will be advanced to soft foods for two weeks and then finally to a regular diet.
Pureed Diet
The purpose of a pureed diet is to provide appropriate time for the proper healing of the staple line of the stomach. While the tissues of your surgically altered stomach are healing, you must minimize the stress on those tissues. A pureed diet is a diet that involves blending everything that you eat. You may have regular table food, however, it must be in the consistency that you can draw it through a straw. We ask you to refrain from drinking through a straw due to the fact that it will increase gas. You must blend the food into a liquid form without lumps. You may include ground meats. Use broths, gravy, or soup to obtain proper consistency. Soups should be strained or blended until there are no lumps. Eggs may be blended with skim milk. Fruits and vegetables may be pureed. You may need to add natural fruit juice or vegetable juice to maintain consistency. Smoothies can be made by blending fruit with non-fat plain yogurt and skim milk. Frozen dinners may also be blended with broths.
Soft Foods
At the two-week mark your diet will be advanced to a soft diet. You will no longer be required to blend your food. You should concentrate on foods low in calories and high in protein. The purpose of soft foods is to allow your system to adjust to this new eating pattern. Soft foods include oatmeal, mashed potatoes, yogurt, saltines, eggs, soup, rice and beans, seafood with the exception of crustacean shells, cottage cheese and peanut butter.
Regular Foods
After four weeks of a limited diet, we advance patients to regular foods. Do not be afraid to try new foods. Just remember to eat small amounts. Your diet at this point is going to be trial and error. What does not work one day, may work the next. Avoid raw fruits and vegetables. They may cause gas. Maintain a high level of protein.
Proteins
Proteins are the most plentiful substance in the body next to water. Protein breaks down into amino acids that are necessary for the construction of body proteins, which are vital for the growth and maintenance of muscles, blood, internal organs, skin, hair and nails. Protein is also vital to the formation of hormones, enzymes, and antibodies. Common sources of protein are lean meats, poultry, fish, eggs, cheeses beans and nuts. It may be very tempting to eat a salad and potato, however, you must eat the protein first and then the complex carbohydrates.
Protein is also available in powder, liquid and bar forms. They may be purchased in most health food stores. These forms are an excellent way to add to the protein to your diet. Remember, it is necessary to take in 80 grams of protein a day.
For the first three months you will notice some restriction with foods. Do not expect to eat large amounts. In the beginning, your intake will be limited. You may take three or four bites of food and be full. Be patient. Over time your stomach will stretch and you will become comfortable with your eating habits. By six months, most patients are back to eating normal food volumes.
Sugar
You will still be able to absorb sugar. You must moderate your sugar intake. If you eat simple sugar it will slow down your weight loss. Filling up on concentrated sweets can prevent the weight loss and decrease your ability to take in the required amount of protein necessary. Read foods labels for the sugar content. Avoid those foods that have high sugar contents.
Medications and Supplements
Vitamins
As recommended earlier, begin taking a high potency multivitamin. You will be required to take a multivitamin for the rest of your life. Take one a day. This surgery can cause vitamin deficiencies and taking a multivitamin can make up for the deficiencies.
Calcium
Calcium is the most abundant mineral, and the fifth most abundant substance in the body. After Biliopancreatic Diversion with Duodenal Switch (BPD/DS), the body loses some of its ability to absorb calcium. For this reason, we recommend that all patients take calcium replacement. We ask our patients to take calcium in the form of calcium citrate + D for the rest of their lives. The recommended dosage is 1200 mg.
Iron
There is diminished absorption of iron following surgery due to the decreased stomach volume. Dr. Husted recommends that you take one tablet per day of ferrous fumerate. This type of iron may be purchased over the counter.
Acid Blocker
We will give you a prescription for an acid blocker at the time of discharge. You will take this medication for a total of two years. This medication will assist in preventing ulcers.
Food Labels & How To Read A Food Labels
Food packaging can be very misleading. There are all types of marketing-related claims, including “reduced fat”, “lite”, “low-fat”, and many others. These labels can lure the consumer into believing the data. Let’s take whole milk for example, the label states 96% fat free - but you still get 50% of the calories from fat. 2% milk is labeled “low fat”- again you get 38% of the calories from fat. It is important that you understand food labels and how to read them.
Here are some points to follow when reading a food label:
1. Serving size - This is the most important line. All of the nutrition facts will be taken from this line. Be careful of the serving size, some labels will add more than one serving. Compare the portion that you are eating and the serving size and adjust your calories and fat accordingly.
2. Servings Per Container - This tells the number of servings per package.
3. Calories and Calories From Fat - This is the total number of calories that will be consumed in one serving. Calories from fat are the actual calories from fat per serving.
4. % Daily Serving - Again this is based on a 2000 calories per day.
5. Total Fat - This is the amount of fat in grams per serving. It is important to remember that no more than 30% of your calories come from fat calories.
6. Nutrients - These include total carbohydrates, sodium, cholesterol, protein and saturated fats.
7. Footnote on Daily Values - This recommends the current recommendations for 2000 and 2500 calorie diets. These are usually higher than your target calories and fat gram totals for the day.
Suggestions for Achieving Your Goal
Avoid sugars - they will decrease your desired weight loss.
Do not snack on soft calories - yogurt, chips, and sugars will inhibit your goals.
Concentrate on healthy snacks.
Exercise
Exercise is extremely beneficial following weight loss surgery. For the first eight weeks following surgery no strenuous exercise should be done and patients should not lift anything heavier than ten pounds. Walking however, can be done immediately following surgery and is beneficial after the first eight weeks of surgery.
Walking is one of the easiest ways that a patient can exercise. It is inexpensive; you can walk anywhere, anytime. All that is required is comfortable clothing, a good pair of shoes and motivation. Walking is easier on your joints, and will improve overall fitness. There are many benefits to walking. Walking will:
· Give you more energy · Assist you in sleeping better · Decrease stress · Tone your muscles · Increase the number of calories that your body uses · Lower your blood pressure · Improve mood and increases a positive outlook on life · Make you feel great!
For these reasons and more, we promote and encourage our patients to incorporate a walking program into their lives, so let’s get started!
A Good Pair Of Shoes
A good pair of shoes is essential for walking. If a shoe is not comfortable, you will not enjoy your walk. Here are just a few suggestions when shopping for the perfect shoe.
Sports shoes are all over the market. Go to a store where the staff has a good knowledge about shoes. Look for a flexible shoe with a low, rounded and supportive heel. Make sure that you can twist and bend the toe area. A stiff shoe will not be comfortable. Look for a shoe that is lightweight and breathable. Walkers need a more flexible shoe than runners. At some point, if you want to run, you will want to invest in a stiffer type shoe made for running. If you wear a running shoe for walking, the shoe can keep the foot from rolling properly and increase the occurrence of shin splints.
The fit is very important. Be sure that your toes and your foot had enough room in the toe. You want almost a half- inch between the end of your toes and the end of the shoe. Make sure that the heel does not slip and that the shoe does not pinch or bind your foot.
Ideally you should try the shoe on at the end of the day. Wear the type of socks that you will wear with the shoes. Make sure that you try both of the shoes on. You want a proper fit.
Starting a Program
Now that you have that perfect shoe, let’s get started planning your program. There are a few things that you will want to think about before you get started. It is important that you design your program to fit your lifestyle. Arrange your program so that you will be successful. Do not make the program so rigid that you will defeat yourself. Here are a few key points that you will want to incorporate into your program:
· Choose a safe, well-lighted area to walk.
· Wear those comfortable shoes, clothes that are right for the season, and a reflector if you are walking at night.
· Use the buddy system to keep you motivated.
· Start out slow and easy.
· Work up to your goal. Slow and steady wins the race.
Stretching
Stretching is a very important start to any exercise routine. Stretching will decrease stiff, sore muscles, decrease your risk of injury and increase your muscle flexibility. Here are a few suggestions for stretching exercises that you may incorporate into your new program.
Ankle circles - hold on to the back of a chair or some type of support. Stand on one leg and lift the other foot off the ground. Make circles with your toes. Go in each direction. Do about ten circles with each foot.
Side reaches - reach one arm over your head and to the side. Keep your hips and shoulders straight. Hold for 10 seconds and relax. Repeat about five times on each side. As you hold the stretch, reach a litter further into the stretch.
Toe Points - hold on to the same chair or support. Lift one foot off the floor and point your toes toward the floor. Hold for a five seconds and flex your foot pointing the toes upward, hold for five seconds. Repeat this for each foot about 5 times.
Wall Push - lean your hands on a wall about shoulder level approximately 3-4 feet from the wall. Bend one knee and point it toward the wall. Keeping both feet on the floor. Keep your back straight with your foot flat and your toes pointed straight ahead. Hold for 10 seconds and repeat with the other leg. Do this about five times per leg.
These stretches are suggestions. You may have some of your own that you will use. Remember if your muscles feel tight or need stretching while walking, pause and stretch as needed.
The First Steps…
First of all, begin slowly. Walk out the door. Think about the direction and route that you will take. Look around you. Notice the trees, the birds, and the flowers. Walk for 5 minutes and walk back. Do this every day for two weeks. If this is easy for you, add five minutes to your walks each week. If this is too much for you, walk 2 minutes and then walk back. The goal is to walk. Do not be hard on yourself if walking to the mailbox exhausted you. You did it! Do it again tomorrow. And as you build your endurance, add distance to the walk weekly. Keep adding time until you reach your desired goal. The goal will be thirty minutes per day, walking at a “talking pace”. Do not walk so fast that you are gasping for air.
Watch your posture. Walk tall. Hold your head up and look forward. Your shoulders should be down and relaxed. Tighten your buttocks and your will begin to walk in a natural stride.
Be sure to drink plenty of water. Take your water bottle with you and drink as needed.
The toughest part of starting a program is beginning and developing a habit. There will be days that you just do not have the desire to walk. Those are the days that you will feel most rewarded if you will push yourself to step out that door.
As your walk is ending, slow down your pace and begin to cool off. You should be sure to stretch after you walk too. This stretches should be done slowly without bouncing and be sure to keep your head above your heart. These stretches should feel good and you should hold the stretches longer that before walking. Do not stretch to the point of pain. A slow, gentle stretch is all that is needed. Here are some stretches that you may want to try:
Wall Stretch - this is described in the beginning stretch before walking.
Hamstring and Lower Back Stretch - stand with feet shoulder width apart. Put your arms out in front of you at waist level. Slowly lean forward (keeping head up). Slowly bend forward and reach for the ground. Bend only until you feel tension in the muscle. Hold for 10 seconds and repeat 5 times bending lower each time.
Neck Stretch - turn your head and look over your left shoulder and then the right. Keep head up straight, hold for five seconds. Tuck your chin into your chest and hold for five seconds. Next tilt head back pointing your nose upward. Hold five seconds. Repeat each of these until your feel your neck and shoulders relaxed.
Shoulder Stretch - take the left arm and cross it over your chest. Take your right hand on your upper arm and pulling the left arm into your chest. Be sure to keep you shoulders down. Do not pull at the elbow. Repeat with the right arm. Do each arm five times.
Again these are just suggestions for stretches. You may already have stretches that work for you. Just be sure that you stretch before and after any exercise to prevent injury and increase flexibility.
Motivation
Motivation is the key. You will have to find out what motivates you. It could be to lose weight, to become healthier and fit, to be able to walk in great places (hiking beautiful trails), or with your family members. Who in your life will benefit along with you when you become more fit? You will have to be the one to decide what will motivate you and keep you motivated. Choose the things that matter to you and stay focused on those things
Now, make a list of all the excuses that you have found for not becoming fit and start marking them off of your list!
You must make you and your overall well being the main priority!!
Now, get started.
*Please consult your primary care physician before beginning any fitness program
Aftercare with BPD/DS
The first year after a Biliopancreatic Diversion with Duodenal Switch (BPD/DS) is a tremendous time of change. Your body undergoes a metamorphosis and a new person emerges. It can be a time of fear, happiness, pain, pleasure, confusion, understanding and frustration. Your body is constantly changing. The range of emotions felt by most patients is normal and is to be expected. We urge you to take advantage of the monthly support group meetings provided to our patients. Most patients find the support groups very helpful in dealing with the changes that occur after surgery. We have a support group in Nashville as well as other locations in Tennessee, Kentucky and Alabama. The list is above:
Dr. Husted has created a new stomach for you that will be your tool to use for weight loss control for the rest of your life. You must learn to use this as a tool to obtain and achieve your desired weight loss. Patients that learn to use this tool by using the proper diet, exercise, and dietary supplements will have the best long- term results. Set your goals early. The best time to choose new habits is early after surgery. Your motivation will be at the highest level. This is a very good time to plan your long-term success. Patients will lose weight after surgery due to the mechanical changes of surgery however; your lifestyle changes will determine your long-term success. If you have questions, please call the office we will be glad to assist you in any way that we can (615) 284-7960.
My Favorite Web Sites
Dr. Husted
Gastric Bypass Information, Links & Recipes
Victoria's Recipes for Gastric Bypass Patients
My Weight Loss Before & After PICS
