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Monday, March 19, 2012

Hey Grandpa! What's for Supper?

Yes, I'm sure I just dated myself with that old HeeHaw reference, but it just seems so fitting for this post.

This question has been asked a lot "Hey Deedra!  What's for supper?" aka "What will you be able to eat after surgery?"  I thought I'd go ahead and write an entry on the nutrition section of my "Education Manual".  The section is large, so I'll probably break it down into multiple posts over the next several days.

I was almost intimidated by the realization that I will be tested by the surgeon on the information RD will provide me at the nutrition class.  Really?  An actual test?  But then I thought, that's actually a really good idea.  It means that they want to make certain that I am truly understanding this is no walk in the park.  I've got to be prepared!  So prepared that I'm even going to have to bring in a full day's menu on stage III and a full day's menu on stage IV to make sure I can do this.  

There are actually six phases that progressively add foods back to my diet after surgery.  My first 3 meals in the hospital will be clear liquids (1-2 ounces) plus 2 ounces of fluids per hour.  I then progress to strained full liquids (1-2 ounces), modified full liquids (1-2 ounces), pureed (1-3 ounces), modified soft (1-3 ounces), and modified regular (1-3 ounces) between months 2-5.  At approximately 6-7 months, I should increase the volume to about 4 ounces, and then around month eight, I'll be on regular foods - but not more than 5-6 ounces per meal and by a year post-op, I should have increased to between 7-8 ounces per meal.  Each stage also has a set number grams protein needed which is anywhere between 50 - 90 grams depending on which stage I'm in.  Looks like the optimal protein at a year post-op is 75 grams.  (Please remember that this is not recommended for anyone who has not had bariatric surgery and those not being monitored by an MD and RD!)

The Q&A section questions that stood out to me:

  • How much can I eat after surgery?  The normal stomach is approximately 40 ounces (football size).  The surgery limits stomach size to 1-2 ounces (egg size).  - This is a visual that I needed.  Wow!  What a drastic difference.
  • Can it be healthy to eat so few calories per day? (a common question I've had asked of me already... "aren't you just starving yourself?") Your health is of primary concern to our weight loss team.  You will work with the RD to ensure you are getting proper nutrition through the carefully planned diet.  Vitamin supplements are also important for your health.
  • Can I ever lose too much weight? (ha!) Your weight will level off after 12-18 months as the new pouch increases in size.  You will find the weight that is right for your body.  After surgery, lack of exercise, poor food choices, constant grazing and snacking are the main causes of not maintaining weight loss!!!

How do you measure ounces by volume not weight?  That was my question...and here's the answer:
1 ounce = 2 tablespoons = 1/3 cup = 30 cc
2 ounces = 4 tablespoons = 1/4 cup = 60 cc
3 ounces = 6 tablespoons = 1/4 cup + 2 tablespoons = 90 cc
4 ounces = 8 tablespoons = 1/2 cup = 120 cc
8 ounces = 1 cup = 240 cc


What vitamins will I be taking after the surgery (for life)?
- 2 chewable multivitamins each day (taken at separate times)
- 1500 mg daily Calcium plus Vitamin D (not taken with multivitamins)
- 500 mcg per day Vitamin B12
- An antacid will also be prescribed as a preventative method to keep the stomach pouch from developing ulcers.

 - If needed, I'll be on iron supplements - I'm hoping it's not needed!  
Reminder:  all over the counter medication like cold/cough syrups should be sugar and alcohol free.

Some of the key points to the Nutrition 101 section:(I've abbreviated most of this)

  • Protein: The body uses protein for growth, maintenance and for muscles and major organs.  It's essential for healing after surgery.  Protein is needed to maintain muscle mass, healthy skin and hair.  Eat high-quality protein every day.  Eat protein before you eat any other food group.
  • Carbohydrate:  Carbohydrate foods, especially complex carbohydrates, are a good source of energy and provide vitamins and minerals and are needed for normal body functioning.  Carbs are starches, grain foods and sugars.  After surgery, you will experience dumping syndrome if you consume high sugar foods.  Choose foods that are around 10 grams of sugar per serving.
  • Fat:  (info on good fats vs bad fats...then) Fat may be difficult to digest after surgery. Too much fat delays emptying of the stomach and may cause stomach acid to back up on to the esophagus.  It may also cause gas, stomach discomfort and nausea.  Look for foods with no more than 3 grams of fat per 100 calories (no more than 30%).
  • Vitamins (see above):  Vitamins and minerals are necessary for various body functions - over 30 vitamins and nutrients are required by our bodies.  Essential vitamins are also found in lots of vegetables and fruits as well.  Eating a variety of foods that contain a variety of vitamins and minerals is essential.
  • Water:  adequate fluid intake after surgery is necessary for important body function.  You must sip fluids throughout the day to avoid dehydration.  Water can help prevent/ease constipation (TMI for some of you).  As the body gets too little water, it siphons what it needs from internal sources (colon is one source used).  Avoid using straws - when you drink with a straw you will swallow air with each drink.  This can cause uncomfortable "air bubble" and gas pain after surgery.  If you drink too fast or take too large a gulp, it can cause nausea, vomiting and premature stretching (of the stomach).

So how can I start preparing for some of these changes?
I've already started by adding a multivitamin per day to the routine.  It's also suggest to try the pureed foods now so its not new to me after surgery. So in an attempt to not be totally shocked when I may be an emotional mess anyway, I've already bought a few jars of baby food to "test" drive.  Plus I was given a "suggested" supply list to purchase prior to surgery so I can focus on recovery not grocery shopping and running errands after ward.  Shopping list:

  • Baby spoon (will help me to remember to eat small pea-sized bites)
  • Sipper cup (small sips...no gulps)
  • Blender/food processor (got a Ninja already!  woot!)
  • Ice cube trays (to puree some food ahead of time and freeze into individual servings and store in baggies - each ice cube is about 1 ounce)
  • Ziplock bags
  • Adult liquid Tylenol (stomach won't digest pills well for a while)
  • Vitamins
  • Protein powder
I've got a few of those items already and will gradually pick up a few more.  I've got to look a bit further into the pureed stage to see what I want to try ahead of time and freeze (if it's worthy of freezing!) for later.  

I am thankful for bariatric center's approach to all of this.  I really do feel like I'm being prepared ahead of time and not just going into it blind.  Still lots of learning and work to do to get ready, but I'm excited that the day is drawing closer!

And for those of us who are old enough to remember Grandpa Jones...

"I praise you [God] because I am fearfully and wonderfully made; your works are wonderful, I know that full well." ~Psalm 139:14

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