Adventures in Bariatric Surgery

So nine weeks ago I had a Roux-en-Y Gastric Bypass. Thought it might be worth writing a bit about the experience and a few of the things I would have done in preparation knowing what I know now.

Disclaimer: I am not a medical professional. This article is opinion from a lay person. Advice here may or may not work for you.

The story so far: A bit over four years ago I had a Lapband installed. It had the attraction of being reversible whereas the bypass is permanent. While it was effective and I lost about thirty kilograms, after four years weight loss had completely stalled and I started having other issues with it – mainly reflux and heartburn. It turns out in the four years since I got my lapband the prevailing wisdom on the subject has decided lapbands generally last about four years then start having problems, and help the recipient loses about thirty kilograms, but no more. Nice to be inside the curve I guess.

So, still wanting to be alive in twenty years or so, I needed to do something else. The bypass seemed like the logical option to pursue. It’s been around for a fair while and seems to have a pretty good track record (you always hear the horror stories, but they are the exceptions).

So, here’s the rough order of events leading up to and the weeks after the surgery:

  • Two weeks before, you’ll start a very low carbohydrate diet, consisting mainly of protein shakes and soups like Optifast plus a cup or two of veggies per day. The purpose of this is not to enlighten you to the virtues of a Ketogenic diet, but to shrink the size of your liver so it is not in surgeon’s way while they meddle with your other internal organs.

  • Surgery. Don’t be a hero, take the pain medication.

  • All things going well, you’ll spend four or five days in hospital.

  • For the first week after surgery you will be on fluids only. This is basically anything that you could suck through a straw. So soups, shakes… more soups. Expect that you will have a very low tolerance for anything with sugar in it (more on that below).

  • Weeks two and three you upgrade to mush! Anything that can be run through a blender to become puree. This can include casseroles, pasta, risotto and thicker soups. If you can run it through a blender without burning it out, than it is probably fair game.

  • Week four you actually get to use your teeth, kinda. Soft foods. Mostly what you’ve been eating for the last two weeks but without having to blend it first. More casseroles and pasta, but also poached eggs, mince dishes and chunky soups.

  • Week five, all things being well, you’re onto your quote long-term eating plan unquote. Eat sensibly and all that.

Post surgery you want to be pretty kind with yourself. Not only has some of the internal plumbing been rearranged, but the surgery itself is pretty big. Your body will spend a few weeks going, “What the hell just happened?” I found even five weeks later I would be going fine for four or five days then completely conk out and want to sleep for a day, then be fine again. It’s a big adjustment.

Another thing I found post-surgery was a high sensitivity to sugar, called Dumping syndrome. Basically the stomach valve is no longer there to regulate the release of food into the bowel, so the sugar gets dumped into your intestines all at once. Among other things, your body responds by producing an excess of insulin. Symptoms can include a rapid heart beat, sweats, nausea and can even trigger an anxiety attack. Basically you feel like the sky is falling on your head for twenty to sixty minutes.

Initially, even the lactose in milk was enough to make me feel unwell. Even the protein shakes from the pre-surgery low-carb diet had enough sugar in them to trigger episodes, which nixed my plan to use the left over shakes during the first week as part of my fluids.

Fortunately around week four or five, when I started eating substantial food again, the sensitivity started to lessen. While if I were to eat half a family block of chocolate it would make me feel like I was dying, I can enjoy a couple of pieces with only a mild flutter. More importantly, although lactose free milk was okay, I can use regular milk in my coffee again, so life goes on.

For me, this negative buzz if I eat too much sugar was one of the more distressing changes. Not so much because I want to eat more chocolate, but because of how ill I feel if do eat something that disagrees with me. Discovering that peanut butter really does not agree with me any more was a rude surprise that wiped me out for a good hour. On the other hand, as a incentive to eat a bit healthier it is certainly effective. I’ve convinced a bypass is two parts changing the way your body processes food and one part aversion therapy.

With the rearranged internals, you have to get use to different sensations around eating and hunger. Feeling hungry is usually a mild thing that only pops up if I haven’t eaten or drunk anything for half a day. When sitting down to a meal it is also quite easy to eat too much and be over-full. You don’t get the feeling of a full stomach in quite the same way. Also, you’ll be surprised how little food you end up eating at a meal. Having lived with the lapband previously was probably good preparation so I adjusted pretty fast. Looking at the last couple of bites of food on your plate and thinking, “I’ll just polish that off,” can be the difference between thinking, “That was a satisfying meal,” and, “Oh, why did I eat so much?” You adjust in time. When eating out at a restaurant I now take a plastic container in my bag to bring the leftovers home for lunch the next day. Unless you spend the rest of your life ordering entrées you’ll never finish a restaurant meal.

So, things to do in preparation for having a bypass? Figure out as much of the foods you can eat for the first few weeks after surgery in advance. Especially if, like me, you hate soup. Figure out and test the options well beforehand. Assume anything sugary is going to make you feel sick. Even the lactose in milk. Prior preparation will help you resist the temptation to rush the schedule and move onto the next phase sooner. Don’t do that, you might bust a seam.

After the surgery, your body wants lots of protein to help it heal. So beforehand, find a sugar-free, lactose free, maybe even gluten free protein powder that you think you’ll be able to put up with drinking daily for a while. You’ll probably want to avoid anything that tastes sickly sweet. (Pro tip: A drop or two of peppermint essence can really help.) First week home I went down to the local body building supplements store and explained what I needed and why. I wasn’t their first customer in this situation and they were very helpful.

You’ll also have been pumped full of antibiotics for a couple of days, so taking some sort of probiotic is probably a good idea too. Think yoghurt, kombucha, kefir, kvass or other fermented foods. (Flavoured yoghurt usually has too much sugar. A couple of big spoonfuls of plain yoghurt blended up with some almond milk and half a banana or some frozen berries can work well.)

Be prepared to supply your own food while in hospital, in case their idea of a good post-surgery bariatric fluid menu is milk shakes, fruit juice, sustagen and a thin soup that tastes like a doormat. Having not figured out the dumping syndrome thing, and being completely out of it for a couple of days after three hours of surgery, I thought feeling absolutely crap after eating anything was normal. It wasn’t.

Check with your surgeon what medications you may need to be on and for how long after the surgery. In my case I need to be on pariet for about six months to minimise stomach acid production while things heal and the body adjusts. You may need to go back to your GP to get a prescription with repeats.

It is good to find a surgeon that is part of a larger team that does follow-up and looks after you both before and after the surgery. You get to talk to a dietician that will tell you some of what to expect, and make sure you’re set with the proper vitamin supplements and such. Go over the types of food to eat and what can be problematic. You can ring the nurse when the larger laparoscopic incision on your left side starts really hurting after four weeks and they can tell you that is normal and what to do about it. They’ll field weird questions like, “My lips have been really, really dry since the surgery, is that normal?” (It isn’t, but it cleared up after about four weeks, and you can steal the moisturising stick out of your partners handbag to deal with it in the meantime.) They’ll assure you that you’re not being a bother and they would far rather you ring and ask instead of worry.

If all this sounds painful and a hard and a big thing, well it is. But remember the end goal is still being alive in twenty years. I’ll be around too.