Life after surgery
The days and weeks after surgery
The day that your doctor discharges you is dependent on your progress and decided by your surgeon. Before that, you will be given instructions about your diet and the activities you need to do. These will be gone over with you. You will also be told how to be safe and careful and the situations that could arise that require a call to wither your physician assistant or surgeon.
Planning Your Recovery at Home
Think about your environment at home. Do you have a lot of stairs? How easy is it to access your bathroom? Let the hospital staff know what your home environment is like so that they can work that into your plan for going home, including your individual needs. It’s helpful to have items like a shower hose with a hose, tongs, or a sponge stick and a toilet lift.
Following Up with your Surgeon’s Office:
- The medical team caring for you wants you to have progress. Stay in touch with the team, and they will work to ensure that you are taken care of.
- After surgery, you will have an appointment with your surgeon that occurs anywhere from 10 to 14 days later.
- The discharge instructions from your surgeon will let you know when that appointment will be.
- You will keep seeing your surgeon periodically after that first follow-up appointment.
- You will likely be seen three months after your surgery, then six months, then nine months, at 12 months, and then at 18 months. You will need to be seen once a year after that.
- If you have any concerns in between those appointments, call the surgeon’s office.
- Stay in contact with your primary care physician as well, and reach out to him if you have medical concerns. After your discharge from the hospital, you should see him about two to three days later, as you may need your regular medications adjusted.
Specific Recovery Instructions
Once you are at home, there are several things that will happen to you. At home, take things easy as you begin to heal. You are recovering from major surgery, as well as some weight loss during this period. You will have your activity restricted and will have to put off any strenuous activities for at least three and as many as six weeks after your surgery. You can walk around and do light chores around the house if you can tolerate them.
In the first few weeks after the surgery, you might experience weakness and get tired more easily after doing activities. But it’s better to be as active as you can.
Short and frequent walks are often tolerated better than fewer, longer walks that will fatigue you. Get up and walk, but increase the distance of your walking gradually. The more active you are, the better. Activity will help with your recovery and give you much more energy. Keep walking four or more times every day so that the combination of your walks gives you about 30 to 45 minutes of walking each day at the six-week mark. When you have your six-week appointment, you should regularly be walking about two miles every day or even more, unless you are having joint problems. If you do, going to water exercises is an excellent way to stay active. It’s safe to start water exercise for about three weeks post-op.
In the first weeks after your surgery, you may be nauseated, weak, fatigued, or vomiting. Be sure to stay hydrated by taking small sips of fluid when you can. It’s recommended to take in about 1.5 to 2 liters of fluid every day.
Keep traveling for short distances when you feel up to doing so. However, you cannot drive until you have finished your pain medicine. This is usually about a week after your surgery.
Avoid sitting still or standing still for long periods of time. It would help if you changed your positioning often while you are sitting, and instead of standing still, walk around. This will give you a lower risk of developing blood clots in your legs.
It’s encouraged for you to climb stairs.
Don’t lift objects that weigh more than about 10 to 15 pounds. Also, avoid any pushing or pulling motions, like vacuuming, in the three weeks after you have had surgery.
Don’t do any heavy lifting, pushing heavy loads, or carrying heavy items for the initial three months post-op.
It’s helpful to have someone else at home with you in the first days after your surgery to lend both physical support and moral support. Because of the way abdominal surgery is done, it’s normal to need help when you go to the bathroom.
Using flushable wipes can be a gentler way to tend to personal hygiene, or you may use a peri-bottle. It’s helpful to use a small water bottle with a sports top. Having a long sponge stick is also an excellent way to practice your hygiene.
You will only need minimal care for your wounds. If your surgeon used sutures, they are likely the kind that dissolves, so you will not have to remove your stitches.
There may be tape on your incision. These are called steri-strips, and over time they will fall off by themselves.
If your surgeon used staples, he would have to remove them. This usually occurs about 14 days after your surgery. The removal is painless and is done in the surgeon’s office.
Whether your surgeon used staples or any other method to close your wound, you must keep the area clean and dry to help it to heal. Unless your surgeon says differently, you need to shower with soap, rinse your skin and then thoroughly dry it. If your wound begins to ooze or it starts to catch on your clothes, you can put a light dressing over it. Otherwise, it’s better to leave it uncovered to lower the risk of infection.
At about the three-week post-op mark, your wound can be immersed in water. Before you take a bath, however, talk to your surgeon to make sure you’re ready. Then, you can swim and sit in the bathtub.
Even if you have the best care possible, an infection can happen to any wound. If your incision looks red or swollen, has red streaks around it, oozes pus, drainage that smells bad or looks yellow-green, or your temperature gets to higher than 100.5, you need to tell your surgeon about it immediately.
Unless your surgeon or other members of your medical team tells you to. Do not put antibiotics or other ointments on your wound.
We do not expect that you will have any severe complications after surgery, but there may be a few symptoms that need to be taken care of right away. If you have any of these symptoms, you need to call your surgeon immediately.
- Shortness of breath or chest pain
- A temperature of 100.5 or higher
- More than 12 hours of nausea or vomiting
- Pain that is not alleviated by pain medicine
- Urinating fewer than four times every 24 hours
- Swelling, increased pain, redness, or drainage that looks like pus oozing from your incision
- Redness, swelling, or pain from the incision
Typical symptoms will include:
- Some bruising and swelling can happen after any surgery. However, if they are severe, this may mean that there is an infection or some bleeding.
- Pain that is not heavy or extreme- if your pain is severe and is not helped by your pain medicine, call your surgeon.
- Numbness- there are small nerves that may have been cut as the incision was being made, or they may be interrupted by the surgery. The feeling in those numb areas will likely return two to three months after your surgery as your nerve endings can heal. If you apply heating pads to the area, be sure that you do not burn your skin due to the area’s numbness.
- Itching may occur. You may feel itchy or get the sensation like electricity shooting through your skin, as your nerve endings heal. This is a common occurrence as you recover. If you have these symptoms, it can help get a massage or use oil, moisturizers, ice, or vitamin E to the wound.
- Your scar will likely be red. New scars are always either dark pink, red, or purple. It takes about a year for them to fade. It is recommended to keep your wound out of the sun for about a year after the operation. Even if you wear a bathing suit, quite a bit of sunlight can get through the fabric and damage your wound. Use sunscreen with an SPF (sun protection factor) of 15 or more when you go out into the sun.
Recommended Home Pharmacy Supplies
- Cotton balls
- Gauze pads
- Bandage tape
- Heating pad
- Hydrogen peroxide
You may have nausea related to fullness, not enough chewing, pain medicine, elevated sensitivity to smells, not eating, dehydration, or a postnasal drip.
When the first few days after your surgery brings nausea, it’s usually kept under control with specific medicines that are called antiemetics.
There are rare cases when the nausea is severe enough to prevent you from getting enough liquids into your body. If this occurs, it’s essential to go back to the hospital to be put on IV fluids. If your vomiting is persistent, it can cause an electrolyte imbalance, dehydration, or vitamin deficiency.
It’s common to be more sensitive to odors after your surgery. Many patients find that using a little bit of peppermint oil on a piece of cloth can help suppress dry heaving. Don’t wear any scented lotions or perfumes. If you are bothered by food odors, ask someone else to make your meals, or you can make bland meals.
Start to notice when you’re full. This is not something that happens right away, but recognizing fullness will get easier if you eat slowly.
If your nausea makes it difficult for you to drink, try making fennel tea, water with lemon, peppermint tea, or decaf green tea.
Nausea can be alleviated by putting a cinnamon stick in your mouth.
If you think your pain medicine causes nausea, call the surgeon and ask for a change in your prescription.
Keep hydrated. You should sip on fluids throughout the day to keep you from becoming hydrated. You need to drink at least 1.5 to 2 liters each day of fluids. If you sweat, increase your intake.
You should have nausea medicine that your surgeon prescribed, so take that medicine.
Eating inappropriately can cause vomiting. It can be challenging right after your operation to tell how much food will keep you satisfied. Generally, very little food should make you feel full. It may be that you can only take in a few teaspoons of food at a time.
Possible causes of vomiting:
- Bot chewing your food enough
- Eating too quickly
- Eating too much at a time
- Drinking through a straw
- Having food that is very dry
- Eating food right after your surgery
- Lying down after you eat
- Drinking during your meal or right after it
- Eating things that don’t agree with you
Possible ways to prevent vomiting:
- Eat moist foods
- Chew your meals thoroughly
- When you think about how much you want to eat, eat just half of it. You can eat more later if you still have room for it
- Follow your post-surgery diet exactly
- If you have vomiting for a prolonged period, don’t have solid foods and only sip on clear liquids like broth, highly diluted broth, or herbal teas. If you have trouble with swallowing or vomiting too much, contact the surgeon.
- If you are vomiting, it can be an indication that something has blocked your stomach. If you vomit for longer than 24 hours, you need to call your surgeon, as vomiting can cause you to become severely dehydrated, which is a serious problem.
If you don’t drink enough, you will become dehydrated. Dehydration symptoms are fainting, low back pain, dark urine, and the tongue becoming coated. If these symptoms are persistent, you need bloodwork to find out how dehydrated you are.
When you are dehydrated, it can lead to kidney infections and bladder infections. If you think you are dehydrated, be sure to call the surgeon. Some patients need to return to the hospital to get intravenous fluids.
Here’s how you can help to prevent dehydration:
Use a sports bottle that is easy to carry with you and sip water from it throughout the day.
Drink 64 ounces or more of fluids every day. If you sweat, increase this number.
Don’t drink drinks that have caffeine. Caffeine is a diuretic, and it can cause dehydration. It’s better to drink unsweet herbal tea.
It can help to suck on ice chips when you have nausea that prevents you from drinking.
It’s normal to have soft bowel movements anywhere from one to three times every day. It might smell bad and cause you flatulence as well. As you heal, these symptoms will resolve themselves, and your body will adapt to its changes. If you have persistent diarrhea, contact the surgeon.
After you have had restrictive surgery, you will eat far less than you did before, and the amount of fiber you take in will also be less. This can cause you to have bowel movements less often and can cause some constipation. If this bothers you, you can take a stool softener to help with your bowel trouble.
Here’s how you can keep your bowel movements regular:
Keep in mind that you will have soft stools until you can take in a lot of solid food.
Diarrhea and loose stools are often signs of taking in too much fat and being lactose intolerant. Don’t eat foods that are high in fat and stop drinking products made from cow’s milk. It is ok to continue eating yogurt.
Look up the foods you ate in your pocket journal so you can identify foods that caused problems.
If you have loose stools and cramping more than three times a day, or if you have persistent constipation for longer than two days, contact your surgeon.
There is gas in everyone’s digestive tract. However, after bariatric surgery, you have a shorter bowel, and this can make your gas come out more forcefully and to smell worse than before. There are two main ways that we get gas- by swallowing air or by foods being broken down by the bacteria that live in the large intestine.
You can also get gas from carbohydrate-heavy foods. Eating foods that are high in protein or fat does not cause much gas.
Certain foods cause people to have more gas. These include veggies, soft drinks, beans, certain fruits, cow’s milk, and products made from cow’s milk, whole grain wheat and bran, dietetic foods, and any food that incorporates sorbitol.
Here are a few ways you can help prevent flatulence:
- Chew each bite thoroughly and slowly eat your meals.
- Gas is often caused by lactose intolerance, so stop eating cow’s milk products except for yogurt.
- Don’t eat hard candy or chew gum
- Don’t drink through a straw
- Cut out all carbonated drinks
- Use products made with natural chlorophyll, lactobacillus acidophilus, or simethicone.
You can reduce the risk that you will have a hernia by doing no heavy lifting in the initial three weeks after your operation.
If you have a hernia, you will probably notice a bulge on your abdomen. This bulge is your bowels that are not in the abdomen where they belong and are instead protruding through a weak spot in your abdominal wall at the incision site. If you try to lift something heavy, strain when going to the bathroom, or cough, you may have pain. It can be a sharp pain that happens immediately, or it may be a duller ache that gets more painful over the day or after you have been standing a long time. If you suspect that you have developed a hernia, contact your surgeon.
The only repair for a hernia is surgery. If when a hernia begins, your bowels will not go back to their correct space when you are lying down, and you have vomiting and pain, it may be an emergency. Call either your primary care physician or the surgeon and let them know about your emergency.
After your surgery, you may develop a white tongue coating that looks like cottage cheese. Your tongue may also be inflamed and red. If this has happened, you likely have developed thrush- an overgrowth of yeast in the mouth. When this happens, it often was caused by a lot of antibiotics being used during your surgery. If you have any symptoms of an infection of your mouth or a skin rash, call your primary care physician.
You can make this condition better by taking in Lactobacillus acidophilus as well as your other medications.
Candida albicans is a type of yeast that causes vaginal yeast infections. These tiny organisms generally live on the skin in small numbers and the vagina and on the vulva. It can cause a white discharge that looks like cottage cheese, as well as swelling. If you get these symptoms, contact your gynecologist or your primary care doctor.
There are many things you can do to reduce the risk of a yeast infection, including avoiding synthetic clothing and anything tight-fitting. Only wear cotton underwear and don’t wear pantyhose daily. Do not douche or use any feminine spray products. You can also ingest Lactobacillus acidophilus as well as your other post-op medications.
All women who menstruate are recommended to take iron supplements to keep them from developing anemia. Talk to your doctor and ask about the iron supplement that is right for you specifically.
If you have an iron deficiency, you may have symptoms like being pale, feeling weak, having worse job performance, dizziness, fatigue, have a hard time regulating your body temperature, or shortness of breath.
You can also develop an iron deficiency from having too little vitamin A. This vitamin helps iron to be used from its storage sites, so a vitamin A deficit keeps the body from using all of the iron stored within it. This makes it look like you have an iron deficiency because the iron in your blood is lower, though your body keeps enough iron stored within.
Transient Hair Loss/Skin Changes:
After you have lost weight, having some hair loss or hair thinning is normal. It is only a temporary process, but it can be easy to be upset by it.
While you are experiencing fast weight loss, you will be taking in much fewer calories than your body needs, and you won’t have much protein intake. There are different ways your body will react to this food deprivation, and hair loss and hair thinning are just two of those reactions. When your weight and nutrition eventually stabilize, the hair effects will stop. When you do have hair loss, it will likely be anywhere from three to nine months post-op.
You can lower the amount of hair you lose by taking in a multivitamin every day and eating a minimum of 75 protein grams every day. Using Nioxin shampoo has also been helpful for many patients, as have biotin powders or tablets.
It’s best not to have any hair treatments such as perms to avoid putting even more stress on your hair.
The look and feel of your skin might change after your operation. Patients commonly develop either dry skin or acne after their surgery, as water intake, vitamins, and protein are all critical to keeping skin healthy.
After any operation, it is expected that you will have scars. How big your scars are will depend on the specific type of surgery you have, which type of sutures you had, and how well you heal.
You can make your scars smaller if this is something that concerns you. After your incisions have healed completely, you can use scar creams and silicone pads to soften the scars and make them flatter, smoother, and more like your natural skin color.
Avoid getting sunlight on your scars to allow them to heal.
When your body and your emotions are stable, you can resume your regular sexual activity.
After bariatric surgery, women need a mechanical type of birth control instead of oral contraceptives. This is because the weight loss will increase your fertility and cause oral birth control medications not completely absorbed.
Many women who are severely obese become infertile, as a large amount of fat will soak up some of the women’s hormones and make some hormones of its own. This is a strange signal for the uterus and ovaries, and it can cause the ovaries not to ovulate. When you lose weight, this can reverse the course rapidly.
After your weight loss has stabilized, you can begin to plan a pregnancy. But it’s important not to get pregnant in the 18 months after the operation, as it’s not good for your baby’s health and safety and you. If you get pregnant, you will need more vitamins, protein, and blood tests. You can contact your surgeon or your OB/GYN. They can talk about your surgery so that specialists can coordinate with their efforts.