Common Problems & Their Solutions

Discomfort & Pain
Mild to moderate discomfort or pain is normal after any surgery. 

•  If the pain becomes severe and is not relieved by pain medication, please contact your surgeon.  Note: you should avoid NSAIDS such as Advil, as these types of pain relievers can be irritating to your stomach after surgery. 

Nausea
Nausea is often related to fullness, sensitivity to odors, pain medication, not eating, post-nasal drip and/or dehydration. During the first few days to weeks, another kind of nausea may follow the gastric bypass from delayed function of the Y-limb; this spontaneously resolves with time.

•  If a person experiences this type of nausea, we feel it is very important to suppress it with medications, called anti-emetics. Persistent vomiting can lead to dehydration and electrolyte imbalance, and can cause vitamin deficiencies to occur, since one cannot take the required supplements.

Vomiting
Vomiting is often times associated with eating inappropriately. After gastric restriction, if one gets a full feeling and continues to eat, chances are an episode of vomiting will result. Most patients have this happen several times, and most quickly learn to follow instructions to eat slowly, chew food well, and avoid the last bite when fullness occurs. Typically, with Gastric Bypass, a profound feeling of satisfaction follows the fullness within a few minutes, and makes further eating a matter of indifference.

•  If you experience vomiting that continues throughout the day, stop eating solid foods and sip clear liquids (clear and very diluted juice, broth and herbal tea). Should you have difficulty swallowing foods or keeping foods down, please call your surgeon. Vomiting may indicate that the stomach pouch is blocked. If vomiting continues for more that 24 hours, contact your surgeon, since vomiting can lead to severe dehydration, a situation that needs to be taken seriously.

Dehydration
Dehydration will occur if you do not drink enough fluids.  Symptoms include fatigue, dark colored urine, dizziness, fainting, lethargy, nausea, low back pain, and a whitish coating on the tongue. 

•  Contact your surgeon if you believe that you may be dehydrated. In some cases you need to be admitted to the hospital so that fluids can be given intravenously. If you have difficulties drinking due to nausea, suck on ice chips, popsicles or protein drinks.

Bowel Habits
It is normal for you to have one to three bowel movements of soft stool per day.  It may be foul smelling and associated with flatulence.  Some patients have diarrhea for a few months.  Most of these changes resolve within the first year after surgery as the intestines adapt.  Lactose intolerance and high fat intake are generally the culprits of loose stool and diarrhea. 

•  Avoid all high fat foods and discontinue the use of all cow milk products.  Yogurt is okay.  Look at what you are eating.  If loose bowel movements continue, eliminate fruits and juices.  Adding Metamucil® (un sweetened) to your diet will add bulk to your stools and keep you regular.  If cramping and loose stools (more than 3 per day) or constipation persist for more than two days, please call your surgeon’s office.  After restrictive surgery, the amount of food consumed is greatly reduced, and the quantity of fiber or roughage consumed may be much smaller.  Correspondingly, the amount of bowel movements will be diminished, causing less frequent bowels activity, and sometimes constipation.  If this becomes a problem, a stool softener such as Colace® may be indicated to avoid rectal difficulties. 

Flatulence
It is important to remember that everyone has gas in the digestive tract. Gas comes from two main sources: swallowed air and normal breakdown of certain foods by harmless bacteria that is naturally present in the large intestines. Many carbohydrate foods cause gas; fat and protein cause very little. The foods that are known to cause more gas are beans, veggies, some fruits, soft drinks, whole grains/wheat and bran, cows milk and cows milk products, foods containing sorbitol and dietetic products.

•  Eat your meals more slowly, chew food thoroughly, avoid eating chewing gum and hard candy, eliminate carbonated beverages. If you are still having symptoms try remedies such as Acidophilus, Gas X®, and Gaviscon®. Devrom® can help eliminate offensive odors. You can order Devrom® factory-direct at (800) 453-8898.

Lactose Intolerance
Lactose intolerance is a set of symptoms resulting from the body’s inability to digest the cow milk sugar called lactose.  Gastric bypass surgery can unmask lactose intolerance, but not cause it.  Lactose is commonly found in dairy based foods and beverages, and is digested in the intestines by the enzyme lactase.  Lactase breaks down lactose so it can be absorbed in the blood stream.  When the body does not produce enough lactase, lactose cannot be digested which may result in lactose intolerance.  Depending on the individual, the symptoms may vary, including cramping, diarrhea, bloating, gas and nausea. 

•  Although there are supplements such as Lactaid® that you can take, elimination of dairy is the best approach to solving the problems associated with lactose intolerance. 

Hernia
A hernia is sometimes felt as a bulge under the skin of your abdomen where the bowels are not being contained due to a weakness at the site of the incision. You may feel pain when you lift a heavy object, cough, or strain during urination or during bowel movements. The pain may be sharp and immediate, or the pain may be a dull ache that gets worse toward the end of the day or after standing for a long period of time.

•  Minimize the risk of developing a hernia by avoiding heavy lifting for three months after surgery. Surgery is the only fix for a hernia. If the hernia comes out and will not go back in when you lie down and is associated with severe pain and vomiting, it can result in an emergency. Call your surgeon’s office or your primary care physician on an emergency basis.

Yeast Infections/Thrush
You may notice that after surgery you may have a white, cottage cheese-like coating on your tongue.  The tongue could also be very red and inflamed.  Most likely you have a yeast overgrowth in your mouth known as thrush.  Oftentimes this is due to large amounts of antibiotics taken around the time of surgery. 

•  Call your primary care physician if you have an oral or vaginal yeast infection or a rash on your skin.  You can reduce this problem by taking lactobacillus acidophilus in addition to the prescribed regimen post-operatively. 

Anemia
Signs of anemia include pallor, weakness, fatigue, dizziness and shortness of breath. 

•  We recommend that all menstruating woman take an iron supplement in order to prevent anemia. 

Transient Hair Loss
Hair thinning or loss is expected after rapid weight loss since calorie intake is much less than the body needs, and protein intake is marginal.  This is a transient effect and resolves when nutrition and weight stabilize.

•  You can minimize the loss of hair by taking your multivitamin daily and making sure that you consume at least 60 grams of protein per day.  Additional supplements of zinc and biotin may also be helpful. Your doctor will recommend these as needed.  We advise patients to avoid hair treatments and permanents.  If symptoms persist you may use Minoxydil® cream in the men’s strength as directed on the box.  

Swelling & Bruising
Moderate swelling and bruising are normal after any surgery. 

•  Severe swelling and bruising may indicate bleeding or possible infection. 

Numbness
Small sensory nerves to the skin surface are occasionally cut when the incision is made or interrupted by undermining of the skin during surgery.  The sensation in those areas gradually returns – usually within 2 to 3 months as the nerve endings heal spontaneously. 

•  Be especially careful not to burn yourself when applying heating pads to numb areas.   

Itching
Itching and occasional small shooting electrical sensations within the skin frequently occur as the nerve endings heal.  These symptoms are common during the recovery period. 

•  Ice, skin moisturizers, vitamin E oil and massage are often helpful. 

Redness of Scars
All new scars are red, dark pink or purple.  The scars take about a year to fade. 

•  We recommend that you protect your scars from the sun for a year after your surgery.  Even through a bathing suit, a good deal of sun light can reach the skin and cause damage.  Wear a sunscreen with a skin-protection factor (SPF) of at least 15 when out in sunny weather.