If you experience any of these symptoms, contact our Bariatric Surgeons

• Fever (101°F or above).
• Redness, swelling, increased pain and/or pus-like drainage from your wound.
• Chest pain and/or shortness of breath.
• Nausea and/or vomiting that last more than 12 hours.
• Pain, redness, and/or swelling in your legs.
• Urine output fewer than four times in 24 hours.
• Pain that is unrelieved by pain medication.

Swelling and Bruising

• Moderate swelling and bruising are normal after any surgery.
• Severe swelling and bruising may indicate bleeding or possible infection. Notify your surgeon if this occurs.

Discomfort and Pain

• Mild to moderate discomfort or pain is normal after any surgery.*If the pain becomes severe and is not relieved by pain medication, please contact your surgeon.

Numbness

• Small sensory nerves to the skin surface are occasionally cut when the incisions are made or interrupted by undermining of the skin during surgery. The sensation in those areas gradually returns, usually within 2 to 3 months as the nerve endings heal spontaneously.*Because of some post-operative numbness, it is best to avoid heating pads until you heal.

Itching

• Itching and occasional small shooting electrical sensations within the skin frequently occur as the nerve endings heal. These symptoms are common during the recovery period. Ice, skin moisturizers, vitamin E oil and massage are often helpful.

Redness of Scars

• All new scars are red, dark pink or purple. The scars take about a year to fade. *We recommend that you protect your scars from the sun for a year after your surgery. Even through a bathing suit, a good deal of sunlight can reach the skin and cause damage. Wear a sunscreen with a skin-protection factor (SPF) of at least 15 when out in sunny weather.

• Nausea
• Vomiting
• Dehydration
• Bowel Habits
• Dumping Syndrome
• Flatulence
• Transient Hair Loss / Skin Changes

Nausea
Nausea can be related to insufficient chewing, fullness, sensitivity to odors, pain medication, not eating, post-nasal drip or dehydration. Nausea that occurs in the first days after surgery can be suppressed with medications called anti-emetics. In unusual cases, the nausea can be so severe that it prevents patients from taking in adequate amounts of liquids. If this happens you need to come back to the Medical Center to receive intravenous fluids. Call the office if nausea is lasting more than 12 hours. Persistent vomiting can lead to dehydration, electrolyte imbalance, and vitamin deficiencies.

Nausea can also occur after bariatric surgery due to changing hormone levels. Nausea may be alleviated with a short-term supplementation of low dose estrogen patch. Note: Estrogen should not be used by patients with known or suspected pregnancy, breast cancer, estrogen dependent neoplasia, undiagnosed abnormal genital bleeding, active thrombophlebitis, or thromboembolic disorders. Estrogen has been reported to increase the risk of endometrial carcinoma.

Odors can sometimes be overwhelming after surgery. Many former patients found that putting a few drops of peppermint essential oil, available at many health-food stores, on a handkerchief can be very helpful if odors bother you. Avoid perfumes and scented lotions. If food odors bother you, try to have someone else prepare your meals or prepare bland foods.

• Learn to recognize when you are full. This will not happen immediately, but by eating very slowly, it will become easier.
• Should you have difficulty drinking you may want to try ginger, peppermint tea, fennel tea, decaffeinated green tea or water with lemon (hot or cold.)
• Suck on a cinnamon stick.
• Take your nausea medicine as prescribed by your surgeon.
• If you believe that your pain medication is the cause of your nausea, please call your surgeon's office to have the prescription changed.
• Stay hydrated – fluids should be continuously sipped all day long to prevent dehydration. You need a minimum of 64 oz of fluids per day. Increase this amount by 20% if you are sweating.
  

Vomiting
Vomiting is often times associated with eating inappropriately. It is very difficult to gauge in the beginning how little food will satisfy your hunger. Chew your food well, keep it moist and eat only half of what you anticipate eating. If there is still space, and you still feel hungry, you can always eat a little more. Chances are that you are going to feel full with very little. A couple of teaspoons may be all that you can take in at one time.

Sometimes fullness occurs quickly. Allow yourself time to recognize the feeling of fullness. Typically, a profound feeling of satisfaction follows the fullness within a few minutes, and makes you uninterested in eating more.

What Causes Vomiting?

• Eating too fast
• Not chewing food properly
• Eating food that is too dry
• Eating too much food at once
• Eating solid foods too soon after surgery
• Drinking liquids either with meals or right after meals
• Drinking with a straw
• Lying down after a meal
• Eating foods that do not agree with you

If vomiting continues throughout the day, stop eating solid foods and sip clear liquids (clear and very diluted juice, broth and herbal tea.)
Should you have difficulty swallowing foods or keeping foods down, please call your surgeon. Vomiting may indicate that the stomach pouch is blocked. If vomiting continues for more that 24 hours, contact your surgeon, since vomiting can lead to severe dehydration, a situation that needs to be taken seriously.

Dehydration
Dehydration will occur if you do not drink enough fluids. Symptoms include fatigue, dark colored urine, dizziness, fainting, nausea, low back pain (a constant dull ache across the back), and a whitish coating on the tongue. Blood work should be done if these symptoms persist, in order to establish the severity of dehydration.
Dehydration may lead to bladder and kidney infections. Contact your surgeon if you believe that you may be dehydrated. In some cases you will need to be admitted to the hospital so that fluids can be administered.

Note: If your urine is dark and your mouth is dry, you are not drinking enough.

To prevent dehydration:

• Buy a sports bottle and take it with you everywhere so you can sip water all day.
• Drink at least 64 oz. of fluids per day. Increase this amount if you are sweating.
• Avoid caffeine-containing beverages – they are diuretics and can dehydrate you. Unsweetened herbal iced tea is okay to use.
• If you have difficulties drinking due to nausea, suck on ice chips.

Bowel Habits
At first, it will be normal for you to have one to three bowel movements of soft stool per day. It may be foul smelling and associated with flatulence. Most of these changes resolve as your body heals and you adapt to changes. Please call your surgeon should you have persistent diarrhea.

After weight-loss surgery, the amount of food consumed is greatly reduced, and the quantity of fiber or roughage consumed may be much smaller. Correspondingly, the number of bowel movements will be diminished, causing less frequent bowel activity, and sometimes constipation. If this becomes a problem, a stool softener may be indicated to avoid rectal difficulties.

Keeping your bowel movements regular:

• Remember that your stools will be soft until you eat more solid food.
• Lactose intolerance and high fat intake are generally the culprits of loose stools and diarrhea. Avoid all high fat foods and discontinue the use of all cow milk products. Yogurt is okay.
• Use a journal to help recognize problem foods.
• Take ¼ of the recommended dose Citrucel® (unsweetened) for regularity.
• If cramping and loose stools (more than 3 per day) or constipation persist for more than two days, please call your surgeon's office.

Dumping Syndrome
Sugar may cause “dumping syndrome” in patients who have had the gastric bypass procedure. Dumping, in short, is when sugars go directly from your stomach pouch into the small intestine causing heart palpitations, nausea, abdominal pain, and diarrhea. Symptoms may very among patients. Dumping lasts about 30 minutes to an hour. To prevent dumping syndrome, avoid foods and drinks which contain sugar.

Flatulence
Everyone has gas in the digestive tract. Bariatric patients who have had Gastric Bypass have a shortened bowel, thus causing gas to be more odorous and expelled more forcefully. Gas comes from two main sources: swallowed air and normal breakdown of certain foods by harmless bacteria that is naturally present in the large intestines. Many carbohydrate foods cause gas; fat and protein very little. The foods that are known to cause more gas are beans, veggies, some fruits, soft drinks, whole grains/wheat and bran, cows' milk and cows' milk products, foods containing sorbitol and dietetic products.

Here are some helpful hints:

• Eat your meals more slowly, chewing food thoroughly.
• Lactose intolerance can be the culprit of gas, too. Discontinue the use of all cow milk products. Yogurt is okay.
• Avoid chewing gum and hard candy.
• Avoid drinking with a straw.
• Eliminate carbonated beverages.
• Remedies include Lactobacillus acidophilus, natural chlorophyll, and simethicone.

Transient Hair loss/Skin Changes
Hair thinning or loss is expected after rapid weight loss, and is temporary. Unfortunately, that does not make it any less disheartening. During the phase of rapid weight loss, calorie intake is much less than the body needs, and protein intake is marginal. The body is in a state of starvation. One of the side-effects is hair thinning or hair loss. This is a transient effect and resolves when nutrition and weight stabilize. The hair loss usually occurs anywhere from 3 to 9 months after surgery. For the same reason, skin texture and appearance may change. It is not uncommon for patients to develop acne or dry skin after surgery. Protein, vitamins and water intake are also important for healthy skin.

For the same reason, skin texture and appearance may change. It is not uncommon for patients to develop acne or dry skin after surgery. Protein, vitamins and water intake are also important for healthy skin. You can minimize the loss of hair by taking your multivitamins daily and making sure that you consume at least 75 grams of protein per day. Nioxin® shampoo has been shown helpful for some patients, as well as Biotin (Vitamin H) tablets or powder. We advise patients to avoid hair treatments and permanents – there's no need to stress your hair from the outside, too.