AFTER WEIGHT LOSS SURGERY

It is perfectly normal to experience nausea during the first few days after weight loss surgery. It may continue to bother you for weeks or even months on and off. Pay attention to the precise timing of symptoms and try to identify the reason (they are various). This way you may be able to prevent discomfort in the future.

The most common causes of nausea are:

1. Dehydration. This is typical during early recovery stages. The stomach swelling doesn`t allow you to drink sufficient amount of fluids.

2. Acid reflux. Stomach acid irritates it causing pain, heartburn, and nausea. It is extremely important not to skip antacids and take PPI medication every 12 hours for at least 2 months post-op.

3. Taking vitamins on an empty stomach. Do not take more than one pill at a time to avoid nausea. Take vitamins after having a meal such as yogurt, protein shake, soup, etc.

4. Artificial sweeteners. Consider preparing your own protein shakes or savory options (add protein powder to chicken or vegetable broth). Learn more at Homemade Protein Shake Recipes.

5. Drinking or eating too much too quickly. It will take time to learn your new stomach preferences. Avoid gulping water, and large bites. Chew very well until food becomes pureed in your mouth.

6. Progressing through the post-op diet stages too fast. It is a matter of tolerance. Some are able to move on to the next food stage a few days sooner than others. We highly recommend to never skip or rush through the post-op diet stages. This may cause not only nausea but serious complications, such as bowel obstruction, for example.

Vomiting can be expected after weight loss surgery as the stomach is reduced in size, it is traumatized. And it will take time to learn what it likes and dislikes and how many ounces of liquids or food it can take at one time.

The most common reasons for vomiting are:

• Eating or drinking too much too fast;
• nausea (due to severe dehydration);
• stomach irritation by medication or certain foods.

How to prevent vomiting:

• Make sure to sip fluids very slowly (especially during the first days post-op).
• Chew very thoroughly once you start the solid food stage.
• If you are experiencing discomfort while progressing from one stage to another, continue with the previous stage without progressing for 3-5 days until you feel more confident to move on. Certain foods may not be tolerated well for months post-op, everyone recovers differently.
• When you start feeling a little pressure in your chest, you should stop eating. Burping, hiccupping, sneezing, yawning, or runny nose are signs of fullness. Listen to your body when you experience these symptoms; one more bite and you may have to vomit.

When to be alarmed?

If vomiting continues for more than one day. If you are vomiting everything you consume, including water and your own saliva. If vomiting is accompanied by other symptoms such as strong abdominal pain, fever, tachycardia (fast heartbeat), dizziness – please reach out to your patient coordinator or your bariatric surgeon directly, or go to the nearest ER.

Not able to vomit?

It is very common after weight loss surgery wanting to vomit  but not being able to. For example, after eating something that doesn`t feel right, perhaps your stomach was not ready for a certain type of food yet, and you wish to empty it. Learn about the reasons why you may no longer be able to vomit at Can`t Vomit After Weight Loss Surgery?

Cause

Reflux is a partial return of stomach content/gastric acid into the esophagus. This symptom is quite common after weight loss surgery, among gastric sleeve patients in particular. Normally, the lower esophageal sphincter is strong enough to prevent stomach content from traveling up the esophagus. But as the pressure inside of the stomach chamber increases significantly after sleeve gastrectomy, the sphincter no longer copes with its role. As a result, some stomach content gets pushed into the esophagus. Acid reflux may be temporary and slowly resolve as you lose weight and the pressure on your stomach decreases, or it may become permanent.

Prevent acid reflux symptoms

• At early recovery stages reflux appears when you eat or drink too rapidly. To prevent gastro esophageal reflux, you have to drink and eat staying straight.
• Avoid lying down immediately after eating, wait for at least 30 – 60 minutes after your last intake.
• At any recovery stage avoid foods and drinks that are acidic (coffee, citruses, ketchup and tomato soup/juice, spicy, greasy, deep fried foods.)

Reflux is rare among RNY Gastric Bypass patients, but may also appear.

Treatment

• All bariatric patients must take PPI medications daily (Nexium or Omeprazole 20 mg every 12 hours taken 30 min before meals) during the first 2 months post-op.
• Your doctor may recommend antacids (Maalox, Mylanta) in addition to the PPI`s (1 spoonfull every 8 hours before meals) during the first 2-3 weeks after weight loss surgery. 
• After 2 months it is safe to try slowly reducing the dosage and wean off the medication, of course provided acid reflux does not persist. Otherwise,  you may have to continue taking antacid medication daily or as needed for as long as symptoms persist.

In severe cases, when reflux becomes unbearable and uncontrolled by PPI medications, revision from gastric sleeve to RNY bypass is the only solution.

Learn more at Permanent Acid Reflux After Gastric Sleeve Surgery.

Cause

It is one of the most common and unavoidable symptoms after any bariatric procedure. Remember that your caloric intake has decreased significantly. Therefore your body lacks energy and you will feel tired and sleepy early in the day. Dehydration, which is very common at early recovery stages, contributes to constant fatigue. This is the most difficult part of recovery. You have to power through it and be patient. All patients report regaining their energy levels back to normal at 8 – 12 weeks post-op. The reward for all your suffering is rapid weight loss. This is a so-called honeymoon period after weight loss surgery when you will be losing weight relatively quickly. It will not last for a long time. Usually, around 6 months post-op, weight loss slows down drastically.

Decrease fatigue

You cannot avoid it, but you can control it by taking vitamins (resume vitamins at 1 – 2 weeks post-op), probiotics, staying hydrated (use IV therapy if needed), taking probiotics, sleeping well (at least 8 hours). Do not resume any serious workouts until 2 months post-op. Eat a well-balanced diet. Meat your daily protein goal. Keep track of your food/liquid intake with the help of bariatric apps (Baritastic, Fitness Pal, etc.). Take it easy, this stage will pass and pay off by producing great weight loss results. Focus on the health benefits, remember the rewards! Work on your mental and emotional health during this stage. Rapid weight loss will trigger mood swings (due to drastic hormonal changes your body is going through), feelings of regret, sudden irritation, sadness, anger. This too shall pass.

Cause

Dumping syndrome is typical for gastric bypass patients although it may develop after gastric sleeve as well. High intake of carbohydrates and simple sugars is the reason for this phenomenon that causes several unpleasant side effects. The intestine gets a load of carbohydrates that causes a cascade of hormonal changes.  This, in turn, causes diarrhea, abdominal pain, nausea, dizziness, tachycardia, fainting, sweating, and fatigue. Basically, you feel like you are going to pass out. These symptoms appear within the first 30 minutes after a high sugar intake. A small percentage of patients develop this syndrome later, up to 3 hours after ingestion. These patients tend to develop hypoglycemia, sweating, tachycardia, and fatigue.

Prevent dumping

Avoid high intake of sugars or foods high in simple carbs (white bread, pasta, tortillas, rice) at one time. Dumping is a desirable effect of malabsorptive surgeries, as it motivates patients to avoid unhealthy foods in order to avoid unpleasant symptoms.

Consider the following resources for more information:

Dumping Syndrome After Gastric Bypass Surgery

Dumping Syndrome, by Mayo Clinic

Dumping Syndrome, by National Library of Medicine

Cause

Drastic changes in your diet after weight loss surgery will affect your digestive habits. Absence of bowel movements for 4-5 days post-op is perfectly normal as you are on a liquid diet and very little solid matter forms along the intestines. Dehydration contributes to further constipation, as well as a diet rich in protein and low in fiber.

Treatment

If you do not have any bowel movement for more than 4-5 days, take any laxative or stool softener that you like. Some may need to try several brands before they find one that works best. For example, you could try OTC medications like MiraLAX, Colace 2 in 1, Dulcolax, Senokot, Milk of Magnesia. Additionally, it is recommended drinking Smooth Move tea daily. Such laxatives can be used on a regular basis until your diet progresses to the stage where you can tolerate raw fruit and veggies with much more fiber that will produce regular bowel movements.

Learn more tips on how to fight constipation at Constipation & Hemorrhoids After Bariatric Surgery.