Heading Home

The vast majority of my patients are discharged the morning after their band operation, but I do not permit them to drive. For several days, the residual effects of pain medications can impair judgment and reaction times. You will need someone to drive you home, and it would be prudent to have someone remain with you for a day or two until you are able to move around comfortably and care for yourself independently.

During your first few days at home, you will likely take some of the pain medication your surgeon prescribed. As long as you are taking pain medication, driving a vehicle or operating hefty machinery or power tools is potentially hazardous. Approximately 24 hours after your last dose of prescription pain medication, you should be able to drive short distances if you feel otherwise healthy.

Guidelines for Home Recovery

Do not transport yourself home after hospitalization.

After surgery, you should have someone remain with you for a few days.

24 hours after taking your last prescription pain medication and feeling well, it is generally safe to drive. The same holds true for operating heavy equipment and power instruments.

Incisions on the skin require 48 hours to recover sufficiently so that water will not harm them. Wait two days before showering.

Take your time. Rest. Allow yourself ample time to recover your vitality.

Do not remove the butterfly ribbons that are covering your incisions. Allow them to fall off naturally, usually within a week to ten days.

• Walk, progressively building up to longer distances.

The first few postoperative days at home should be spent recuperating and relaxing. In addition to the evident physical strain, undergoing surgery can also be mentally and emotionally taxing. Allow yourself some time to regain your strength before returning to your hectic schedule. It will yield significant returns in the long term and may even convince you that it is acceptable to slow down your life. After all, lifestyle modification is precisely what you hope to achieve with the band, correct?

One of the most frequently asked inquiries after surgery is, "When can I take a shower?" I advise my patients to wait until the second day after surgery. After approximately 48 hours, the skin incisions are sufficiently mended for water to flow freely across them. This means only showers for the initial week. For the first week, and longer if there is persistent drainage from the minor incision sites, bathing should be avoided.

Typically, I use a form of suture that is designed to dissolve, and all of the sutures are placed beneath the skin. We position small sterile tapes or "butterfly" strips across each incision to help support these sutures. Additional dressings are applied to the incisions, which can be removed approximately when you take your first shower. Leave the sterile bandages in place until they begin to fall off on their own, typically a week to ten days later.

While adequate slumber is essential, you shouldn't spend all of your time in bed. This is a recipe for complications, such as blood clotting and pneumonia. You should frequently get up and move around. If the weather is pleasant, go for a stroll around the neighborhood. The fresh air will benefit you. Start out slowly and build up to walking longer distances progressively. The sooner you begin walking, the sooner you will recover your vitality.

Does it really matter what an object is called? What terms we use? If I say, "I need to eat," and you say, "It would be in my best interest to have something to eat," aren't we essentially saying the same thing? I contend that we are not.

The words we employ can and do have an impact. This is why. Some sentences imply that I have no logical options. If I use the words "should," "need," or "must," I am communicating to myself and others that I have given up my right to choose. My message is that I am being forced to do something that I do not want to do. And if I don't want to do it, I will eventually find a means to avoid it. In other words, I can generate discontent and rebellion within myself, which will ultimately lead to me making detrimental decisions, simply by using language that cedes my power.

If I say "I can," "I want to," or "It would be in my best interest to," I regain my power in my own eyes as well as in the eyes of others. Then I decide. No one is making me. And if I have made up my mind, I will not spend time and effort seeking an exit. I grant myself the freedom of choice and reclaim my authority.

Should, can't, never, always, right, and incorrect are all absolute terms that we should avoid using. Their utilization is extremely dishonest and manipulative. We use these phrases because we do not sincerely believe we can attack and solve a problem. We do not believe an honest approach is possible. We desire a ruse, a gimmick, because we lack confidence that we can or will act in our best interests.

Therefore, terminology is important. It is very important. If I am not particularly honest, I can create a negative situation for myself, such as head hunger. If I refer to my anxiety or stress as "hunger," it makes logic that I would treat it with food.

But if I can learn to identify my uneasy feeling, be truthful with myself, and choose to label it what it is, anxiety or stress, then I have a variety of options. Once I accurately identify my discomfort, I am given access to all treatment options for anxiety. And this shift in my perspective enables me to make a better choice for myself.

My terminology has a domino effect on my thought processes. I can use the domino effect to my advantage if I alter my language to reflect my decisions.

Medications Required

Clearly, as the incisions recover, your need for pain and nausea medication should decrease rapidly. Occasionally, a patient will inform me that they are still taking prescription painkillers a week or more after surgery, but this is uncommon. After the first week, if you still experience the need to take pain relievers, it may indicate a problem, and you should notify your surgeon. Recognize, however, that sometimes people enjoy the way their medications make them feel and continue to use "pain" as an excuse for taking dosage after dose of these potent drugs. The risk of addiction to narcotic pain relievers is real for some individuals, particularly those with a history of similar behavior. Therefore, if your surgeon refuses to refill your prescription for pain medication, it is likely in your best interest.

An addiction to pain medications is possible. Consequently, your surgeon may not wish to renew your postoperative pain medication after a certain period of time.

You will need to crush pills or open capsules and combine them with juice or water for your regular medications. Before proceeding, consult your prescribing physician and ENSURE THAT THIS IS SAFE.

Inquire if liquid alternatives to your medications are available.

If you are taking medication to reduce your blood pressure, you should carefully monitor your blood pressure. Your regular doctor may need to reduce or eliminate your blood pressure medication if your blood pressure lowers significantly after a band procedure. Be especially aware of feelings of weakness or vertigo, as they may indicate low blood pressure.

If you have diabetes, meticulously monitor your blood sugar levels. Be sure to monitor your blood sugar before giving yourself injections or taking your medication, as -band patients often need to adjust insulin or other diabetes medications downward.

Other medications you were taking prior to surgery will typically need to be resumed following the procedure. This may be problematic if the pills are sizable. Any pill or capsule could potentially become lodged in the constricted gastrointestinal area caused by the band. If feasible, you should crush or open your pills and mix them with juice or water to make them easier to swallow. However, before you do so, you should contact the prescribing physician to ensure that it is safe to do so. Your pharmacist will also be able to advise you on whether altering your tablets in this manner is safe and whether a liquid substitute is available.

Regular monitoring of blood sugar levels and blood pressure is more essential than ever for patients with diabetes or hypertension. Changes in your diet can significantly affect these measurements, necessitating adjustments to your medication dosage. This is especially true for diabetic patients. Insulin users can easily overdose if they recommence their usual dosage without frequently monitoring their blood glucose levels. Keep in mind that you are no longer consuming anywhere near the same number of calories as before, and your blood sugar will naturally decrease.

Postoperative blood pressure is frequently influenced in a comparable manner. Many patients must reduce their blood pressure medications well in advance of significant weight loss. Checking your blood pressure frequently is essential, particularly if you begin to feel weak or dizzy. If your blood pressure drops unexpectedly, you should contact your doctor so he or she can modify your medications.

Resuming Regular Activity

You will also need to progressively resume your normal physical activities and begin exercising after surgery. Walking should resume as soon as you return home, but lifting should be limited to no more than 10 pounds for the first 10 days. The limit can then be increased to 20 pounds for the next 20 days. Therefore, after approximately one month, you should be able to lift any quantity you could before surgery.

Several patients who participate in water aerobics are anxious to resume the activity, which is fantastic. However, waiting a week or so will allow the incisions to heal sufficiently to make swimming secure.

If you have a sedentary job or one that does not require a great deal of physical activity, you may be able to return to work within a few days. Patients with physically demanding occupations are typically required to take a couple of weeks off work. However, this can vary based on the patient's general health, rate of recovery, type of occupation, and other individual circumstances. The final decision rests with the surgeon.

As you likely already know, the purpose of positioning a band around your stomach is to limit your food intake. The difficulty is that the degree of restriction alters over time after band placement. Initially, the stomach is compressed within the band, producing a relatively small passageway for food. Initially, therefore, only liquids will travel through the band.

However, over the subsequent weeks, the stomach wall progressively remodels itself around the band, creating a larger opening through which food can pass.

Advised Postoperative God

Days 1-2 Clear liquids (32-64 ounces per day).

Day 2 Add protein drink (40-70 grams per day).

Add complete liquids, V-8 juice, thin cream soups, and yogurt on days three and four.

Add apple sauce, pudding, smoothies, and banana on Days 5 and 6.

Days 7-8: Add mashed potatoes, cream of wheat, and well-cooked (baby food-style) vegetables, vegetable broth, and well-cooked legumes (beans) (no grits, rice, pasta, or peanut butter).

Add roasted potato, oatmeal, soft-boiled and scrambled eggs, cottage cheese, and canned pears on days 9 and 10 (try adding low-fat cheese to eggs and potatoes).

Days 11 and 12: Gradually incorporate fresh fruits; chew thoroughly and consume slowly; continue 64 oz. protein supplement drink. per day.

Add baked salmon, tuna (with fat-free mayonnaise), toast or crackers, small portions of rice, pasta, vegetables (except asparagus, celery, and corn), and whole-grain cereal (granola bars, protein bars) over the course of days 13 through 15.

Days 16-28 You are prepared to sample roasted turkey and chicken, as well as salads. Try one novel food at a time, in small portions (1-2 ounces), and chew thoroughly.

Days 29-56 You can then add ground beef, roast beef, ham, and sausage progressively. Steak should be served last, and beef is often problematic. No matter how well you digest bread, it may also be a problem.

As the aperture widens, fluids and even solid food will begin to pass through with greater ease. That does not imply that you will be able to eat steak two weeks after surgery. Some patients are more restricted than others after surgery, but the majority are initially quite restricted and gradually become less restricted. To facilitate this changing level of restriction, we place patients on a progressive diet for the duration of their treatment.

initial few weeks. Beginning with liquids, various solid foods are introduced as the opening expands. I've included the dietary reintroduction instructions that we provide to postoperative patients (page 126) in the table provided.

What you can and cannot consume in the postoperative period will likely be recommended differently by various programs. Some may be as regimented as ours, while others may be considerably less so. You must realize that the evident tightness of the band will significantly lessen during the first few weeks, allowing you to consume more food. Eventually, the band will no longer function if it is not tightened, filled, adjusted, or whatever your doctor's office calls the process.

Each of my postoperative band patients receives this comprehensive guide for introducing foods. It is provided by MASTER CENTER® for Minimally Invasive Surgery-Texas, LLP as a courtesy.

Here are the golden rules for success as you begin your new existence with the AGB. It will require some trial and error to learn to adhere to these golden principles. I'll elaborate on them later, but let me introduce them to you now. On page 131, there is also a list of ten guidelines distributed by a band manufacturer.

Checklist: Dr. Sewell's Golden Rules forAGB Patients

Eat until you are comfortable, NOT FULL!

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Choose protein first; daily protein needs range from 50 to 70 grams.

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Eat slowly and digest your food well.

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Avoid drinking 15 minutes prior to and during meals, as well as two hours after a meal.

You cannot satisfy your hunger with liquids, so you must consume.

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Daily exercise is advised.

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Conclusion

So far, we've discussed what to anticipate physically before and after surgery, but we haven't really touched on one of the most crucial aspects of the AGB procedure: adjusting the band. After surgery, the majority of patients begin to lose weight, but as they adapt to the band and the postoperative swelling subsides, their weight loss substantially slows. Adjustability is the most distinctive characteristic of the AGB. This is the subject of the following chapter.