Category: Klinik Obezite

Categories
Klinik Obezite

KO-E-065 Medication adherence

Drugs after surgery

Anti-reflux drugs

Following surgery, your health team will prescribe antireflux medication for at least 3 months. These drugs support optimal healing, prevent gastric reflux, and anastomotic ulcers after gastric bypass surgery. After 3 months, your health team will evaluate your symptoms and your type of surgery to determine whether you should continue to take this medication or not.

Prevention of the gallstones

If you still have a gallbladder, your health team can prescribe ursodeoxycholic acid for 6 months to prevent the formation of gallstones.

If you have diabetes mellitus

As you will not eat many meals in the following days after surgery, your DM treatment will be adjusted according to your capillary glucose value. As a rule, the insulin dose is cut in half and the oral agents are taken only if needed. Please be in contact with your diabetes specialist during your follow-up to determine how your diabetes treatment should be adapted in the long term.

If you are using diuretics

If you had taken diuretics before surgery, you should avoid these drugs after surgery, as you will consume very little liquid and the dehydration risk will be increased. Your health team will inform you about the protocol you should follow.

If you are using CPAP

While you are applying for surgery, please do not forget to bring the CPAP (continuous positive airway pressure) device with you to the clinic. You will need this device the night before surgery and a few weeks after surgery. After you have lost a significant amount of weight, your health team will evaluate whether you still need treatment with this device.

Introduction to vitamin intake

Bariatric surgery may significantly change your body’s ability to absorb vitamins, minerals, and nutrients. Furthermore, the small amount of food you can eat will provide these components much less compared to the time before surgery. Vitamin and mineral deficiencies may lead to serious medical consequences. Therefore, it is very important that you take daily multivitamins and mineral supplements for the rest of your life. Your healthcare team will prescribe a supplement suitable to your needs.

Your physician will perform regular blood tests to control the nutritional deficiencies during your follow-up period. Some of the most common vitamins and minerals are as follows. If you forget to take your supplements, the risk of developing related symptoms will increase.

  • Iron

Iron deficiency is one of the most common deficiencies. Iron is most abundant in red meat, but eggs, beans, nuts, and apricots also contain iron in small amounts. Women regularly lose iron during menstruation. Your health team will probably prescribe iron supplements (80-120 mg/day) for you.

The symptoms of iron deficiency are:

  • Fatigue,
  • Irritability, and
  • Anemia – As the iron depots of the body can be measured (ferritin concentration), blood tests may show early signs of iron deficiency.

The more serious iron deficiency becomes the more problems related to the structure and functions of the tongue, nails, mouth, and stomach will start to develop. The skin may appear pale, and the inner side of the eyelids may become pink. The nails become thinner and flatter and they curve like a spoon over time. The patient may feel a burning sensation in the tongue and/or the tongue may appear red, flat, and soft. Heart failure may develop in untreated severe anemia cases.

Vitamin B1

Vitamin B1 is a very critical nutrient after bariatric surgery. It supports the oxidative metabolism of glucose, in other words the energy generation from glucose.

When the patient vomits or receives glucose perfusion, vitamin B1 deficiency worsens, which leads to glucose deficiency in the nervous system. Under these conditions, serious neurological symptoms may aggravate so-called sequels, which originate from a previous disease or injury. If vomiting lasts more than 12 hours, contact your physician.

  • Vitamin D

Pre-operative vitamin D deficiency is very common and usually worsens after all types of bariatric surgery. Vitamin D deficiency impairs bone health and is considered responsible for muscular dysfunction. Vitamin D deficiency may decrease bone density (osteopenia and osteoporosis) and may lead to bone fractures. Other problems related to vitamin D deficiency include muscular weakness and fatigue and falls in the elderly.

  • Vitamin B12 (Cobalamin)

Severe vitamin B12 deficiency may induce several neurological disorders such as cognitive dysfunction, depression, urinary incontinence, and polyneuropathy. If such complications emerge, B12 supplementation does not always reverse the symptoms. Blood B12 levels should be regularly monitored to prevent this critical deficiency.

The symptoms of B12 deficiency include numbness, tingling and burning sensations in the feet, muscle stiffness and general weakness in the legs. Anemia is common and can be diagnosed at an early stage with blood tests. Following the restriction of natural vitamin sources, the development of deficiency symptoms may take 5-6 years.

  • Calcium

Calcium is required for the proper functioning of many organs. The most important outcome of calcium deficiency is its negative impact on bone health (osteoporosis, decrease in bone density, and occasional bone fracture). The daily requirement is approximately 1000-1500 mg.

Tetany – Very low calcium blood levels may lead to muscular spasms in the legs such as cramps due to the increase in the sensitivity of the nerve fibers and neural centers. This condition is known as tetany.

 

  • Folic acid

Folic acid (vitamin B9) is important for the proliferation of red blood cells, healthy growth and functioning of the cells. In addition, folic acid has a critical role in decreasing cerebral and spinal birth defects in the early stages of pregnancy. The recommended daily dose for adults is 0.4 mg. Adult women, who plan a pregnancy or are pregnant, should take daily 400-800 mcg of folic acid.

The following symptoms of folic acid deficiency are usually mild:

  • Fatigue
  • Grey hairs
  • Oral wounds
  • Swelling in the tongue
  • Growth disturbances
  • Magnesium

Magnesium is a mineral and has the following functions:

  • Protects the normal nerve and muscle functions.
  • Supports a healthy immune system.
  • Contributes to the maintenance of a normal heart rhythm.
  • Contributes to bone health.
  • Regulates blood glucose levels and contributes to energy generation and protein production.

Magnesium deficiency leads to significant adverse symptoms like muscle pain or spasm, impaired digestion, anxiety, and sleep disorders.

Your physician will ask for regular control of your vitamin and mineral levels. If you have questions about your vitamin and mineral needs, deficiency symptoms or blood tests, please do not hesitate to contact our health team. 

A whole blood test is performed in the 1st, 3rd, and 6th months of surgery.

 

Categories
Klinik Obezite

KO-E-052 My surgery details: Gastric Sleeve

Categories
Klinik Obezite

KO-E-051 My surgery details: Omega loop gastric bypass

 

Categories
Klinik Obezite

KO-E-088 Exercising after surgery

Exercise after surgery

After surgery

For 6 months after surgery, you will follow a comprehensive physical activity program under the supervision of a coach. At discharge, you will receive more detailed information. İmportant issues are emphasized below.

1 day to 3 weeks after surgery

Right after surgery, your body will be in recovery mode. We recommend light mobilization exercises for the first week. The aim at this stage is to keep your joints mobile and your muscles active in order to maintain your muscle mass. Daily walking and breathing exercises are also recommended. Focus on listening to your body and step by step increase your activity level. Do not forget to follow the recommendations of your health team.

3 weeks to 6 months after surgery

In this period, you will include certain basic aerobic and strength training activities in your exercises. Continue to focus on your breath and listen to your body. Increase your activities gradually over time. The aim is to reach and maintain a basic physical fitness level.

At the end of this stage, your routine exercise will be so to say your best friend. You will wish to spend some time on your exercises every day and you will miss them if one day you cannot do them for any reason.

Rest of your life

This is the time for strengthening; let your exercise routine take root.

Categories
Klinik Obezite

KO-E-085 My physical activity for the long run

 

How to maintain physical fitness?

How to set goals for long-term fitness?

 

Introduction to long-term follow-up

Approximately 6 months after your surgery, you should be continuing a more powerful and strong exercise program with higher self-confidence. You should be able to push your endurance level to achieve more in each exercise.

The main challenge you may face at this stage is to return to your old habits. Studies have shown that many bariatric surgery patients start to sit up to 9 hours after 6 months and only walk about 60% of the daily number of steps recommended by the World Health Organization (WHO). Now that you have lost some weight and you are aware that you can do certain activities, eating some food you used to eat before surgery, eating the same way when you are out with your friends and your family may look attractive.

 

It is important to remember what you have learned during your journey and stick to the diet and exercise program prescribed by your health team. Even though you have had great success so far, there is still a long way for you to go before you convert your new behaviors into life-long habits.

Maintaining your fitness level

If you have stuck to the program so far, it means that you have already created a strong exercise regimen based on endurance and overall strength. Congratulations! As your follow-up programs continue, it is important that you find ways to change your exercise routine and focus on the activities you enjoy the most. This will keep you motivated in the long term. You can also use health monitors, pedometers, or exercise applications to record your progress and enjoy your exercise workouts.

Do not forget to develop your endurance with aerobic activities to maintain your body weight. Strength workouts are still important. Therefore, free weights, gymnastics, or yoga exercises, which can help you to improve your strength, can be added to your exercises. Cardio-fitness, group exercises or interval exercises like CrossFit can be perfect for this phase (if you do not have cardiovascular problems). Please do not forget that it is best to start these activities under the supervision of a professional trainer.

The most important thing at this stage of your follow-up is that you enjoy your exercises. Participate in dancing courses, push your children on the swing, or try different things. If you prefer social activities join a walking or rowing club. Make a sport that your whole family can join. If you were not able to find your favorite activities yet, let us look at a few examples together.

Introduction to physical activity

As your bariatric assessments are completed and your multidisciplinary health team has approved physical activities, let us look at the physical activity program recommended for you.

Benefits of exercise

Regular physical activity is beneficial for your whole body. During physical activities you utilize the energy coming from foods you have eaten. Movement causes metabolic changes in your body. Your heart works harder and improves your circulatory and respiratory performance and the fitness level of your muscles for the long term. Daily exercising develops your joints and contributes to healthy bone density.

In addition, exercise induces endorphin release, which decreases depression and anxiety and makes you happier and more relaxed. Exercise can also provide wonderful socialization opportunities and support better sleep.

Exercise is fun!

Believe it or not but exercise can be fun too. Once a solid daily exercise routine is established, most people find out that they are addicted to the endorphin release after a satisfying workout and the feeling of “good and energetic”. Once exercise becomes a habit, you will recognize that all your daily activities become easier, your “tight” clothes start to fit you, and you gain gradually more motivation to be more fit and healthy.

When should you start to exercise?

The earlier you start exercising after surgery, the easier you improve. Evidence shows that regular physical activity is an important indicator of the long-term maintenance of weight loss before and after surgery.

Adaptation to a new and active lifestyle

The aim of surgery is to enable you to adopt a healthy lifestyle for the rest of your life. This means that you add more activity to your daily routine. For this, you do not need to go to the gym every day, although it can be done. You can walk more, play with your grandchildren and do more dynamic activities like walking in the woods instead of sitting and watching TV.

It may be difficult at the beginning but once you add more activities into your life, you will become more confident in your ability to adopt a more active lifestyle. Do not forget that an active lifestyle should be combined with a healthy and balanced diet to achieve your weight loss goal.

 

Categories
Klinik Obezite

KO-E-021 Eating after surgery tips and tricks

Tips for a healthy lifestyle

Be active: Physical activity may improve your health. You do not need to exercise at a gym for hours to be active. There are many ways to add more activity into your daily life. For example, while you are returning home from work, try to get off the bus one stop earlier or to use the stairs instead of the lift.

Do not stay dehydrated: Drink water regularly to avoid dehydration. We recommend drinking at least 1.5-2 liters of water every day. All non-alcoholic drinks count. However, normal water and skimmed milk are more healthy options. Try to avoid non-alcoholic beverages and carbonated drinks, as they contain high amounts of sugar and calories and are bad for teeth.

Do not skip breakfast: A healthy breakfast is an important part of a balanced diet. A bowl of whole-grain, low-carb cornflakes with sliced fruits is a tasty and nutritional breakfast.

Recommendation Before Before and after
Do not forget to eat three meals a day x  
Eat the equivalent of five handfuls of fruit and vegetable every day. X  
Add vegetables to every meal X  
Make your vegetable intake easier by choosing seasonal foods that require little preparation, such as bananas, small tomatoes, and carrots. X  
It may be useful to eat in a quiet environment.   X
Start by working on portion control. Smaller plates like saucers may be useful.   X
Digestion starts with chewing. Chew your bites well and slowly.   X
Eat at regular intervals. Avoid snacks and do not miss meals.   X
Drink plenty of water a day long (at least 8 glasses)   X
Leave your fork and knife on the table between two bites.   X
Cut food in small bites.   X
     
Take vitamin and mineral supplements.   x
Prefer food containing unsaturated fats like vegetable oils, fatty fish, and avocado. Avoid food containing saturated fats like ripened cheeses, cakes, sausages, cream, butter etc.   x
Do not consume sugar.   x
Consume less salt – maximum 6 g per day.   x
Your daily diet should contain 60 g of protein for females and 80 g for males.   x
Eat fish twice a week.   x
OH   x

 

Categories
Klinik Obezite

KO-E-094 Tips for staying motivated

Tips to maintain motivation

  1. Learn to focus on what you feel during exercise instead of on the activity itself. Observe what is going on around you; notice the sky, humans, sounds etc. This will help you to become aware of your progress.

a. How do you feel when you are active and participating?

b. How do you feel after exercising?

c. Was the exercise easier yesterday? Did you feel more or less tired?

  1. Motivate yourself in a positive way. Remind yourself how good it feels to be outdoors or active. Appreciate yourself when you overcome a moment of low motivation and complete your exercise. Realize how good it is to achieve your goal, particularly when you thought about giving up at some point for that day.
  1. Do not forget that physical activity improves your mood. This not only alleviates stress but also helps to fight against sadness and depression. If your motivation is down because you are bored, remind yourself how you will instantly feel better after exercising.

Every time you achieve your goal for that day, reward yourself with an activity you really enjoy such as watching a new episode of your favorite TV show. After a while, your exercise will be the reward itself. For instance, after you have spent a long day in front of your computer monitor, you will want to reward yourself with a walk in the park.

 

Categories
Klinik Obezite

KO-E-025 Post-op nutrition protocol: general suggestions

Diet protocol after surgery: General recommendations

During your stay at the hospital, your health team trained you about the diet program you have to follow in the following months and for the rest of your life. Sticking to this program is the key to a successful weight loss. To be sure that you eat the correct food and to avoid adverse effects, you must follow these instructions.

The Get Ready application will provide all the information you need. If you need further information, do not hesitate to contact your health team.

Some general recommendations to help you change your behavior and be healthier, are given below:

 

  • Eat very slowly. Do not forget to put the fork on the table after each bite.
  • Chew well. This is important to prevent food from getting stuck in the trachea.
  • Always take more time for meals. Approximately 45 minutes for a small meal.
  • Stop eating when you feel full. Do not force yourself to finish a portion or do not exceed the quantity that can be tolerated by your stomach.
  • Drink regularly fluids between meals. Minimum 2 liters per day. Stop drinking fluids 30 minutes before the meal and continue drinking fluids 30 minutes after the meal.
  • Liquor and carbonated water are not recommended.
  • Divide your diet program: Plan snacks between the main meals and divide your daily diet into 6 to 7 meals.
  • Never miss any meal.
  • Avoid sugar: Sugar, honey, desserts, chocolate, jams, fruit purees, sugared composts, cookies, fruit syrups, packaged desserts, industrial beverages, ice cream etc.
  • Avoid hidden fats: Pastry, popcorn, chips, pommes frit etc.
  • Do not eat mayonnaise, cream, ham, cold cuts, dried fruits, avocado, and oily food like olives.
  • Do not consume large quantities of rigid vegetables (carrots, celery). These vegetables can easily stuck to your airway or alimentary tract.
Categories
Klinik Obezite

KO-E-020 Eating after surgery

Healthy diet after surgery

Especially in the first 8 weeks after surgery, you should change your eating habits to avoid pain, vomiting and wound dehiscence in certain conditions and of course lose weight.

Changing eating habits may also help to prevent gastric obstructions. Swallowing large bites may hinder the passage of food through the intestines. To decrease the risk of intestinal obstruction, it is important that you eat slowly and swallow after good chewing. Your new slogan should be: “slow, small, moist and easy”.

Stop eating when you are full

 

Just one more spoon may lead to vomiting and stretching of your stomach wall. Focus on the signals of your body not the food on your dish. The signs of satiety may be different from the signs before surgery. Some signs – even though less obvious – showing that your stomach is about to be full are: Pressure or feeling of fullness just under your chest cage in the middle of your abdomen.

  • Nausea, vomiting or heartburn. A few minutes after you are really full, you start to feel satiety. You may try the following to find the right portion size: Measure 30 cc of water and drink it and wait a couple of minutes. If you feel full with this volume and you are comfortable, measue your meals similar to this volume. This will prevent the dilatation of your stomach sac and the emergence of discomfort due to overeating.

Tips for general mealtimes

  • Take 30-45 minutes for each meal. Take your time to chew your bite well. If you use a dental plate, you have to eat purees or soft foods. Learn to eat more slowly and consciously to allow your body to feel satiety and digest food better. If you eat too fast, you may overeat and not chew sufficiently, and this may cause vomiting.
  • Explain to your friends and family why you should eat slowly: Thus, they will not expect you to eat faster.
  • Take small bites. You may use a saucer as a visual aid instead of a regular plate for portion control.
  • You can use small forks and spoons to determine the correct portion.
  • Only eat at mealtimes recommended by your health team. “Snacks” between meals, which are not recommended by your health team, or eating small “snacks” here and there will have a negative impact on your weight loss process and prevents you reach your targeted weight.
  • Do not consume fluid while eating solid food. Do not drink fluids 30-45 minutes before and after solid food intake. Taking liquid and solid food together may cause nausea and push food faster through the stomach and lead to overeating.
  • Just eat the best food. After all, if you must eat less then eat the best, isn’t it? 

What you have to eat after surgery

Proteins

Proteins are essential for your muscles, organs, heart, and brain. Protein is necessary for the repair and regeneration of worn or damaged tissues. In addition, proteins help to fight infections.

A small stomach sac reduces the gastric capacity to a small volume so that protein-containing food should be consumed carefully in every meal. Nevertheless, taking proteins adequate to manage body functions is critical.

The minimum daily protein intake should be at least 60 g in females and 80 g in males.

In the first 6 months, your target should be at least 60 g per day. After three weeks, if you have not taken enough protein, your body will remove protein from your muscles, which are a protein source themselves. This will lead to nausea and fatigue.

In the beginning, it is easy to follow how much protein you are taking when you are consuming protein drinks. Thereafter, while you start to eat normal food, it may be more difficult to follow your protein intake. Use the food labels as a guide. If you want to add drinks or protein bars to liquid protein mixtures, be careful. These types of products contain high amounts of sugar and calories and have a bad taste.

In certain cases, your dietitian may recommend taking more protein.

Vitamins

After bariatric surgery, the created small stomach sac will not allow you to eat enough for an adequate nutrition. In addition, malabsorption as an adverse effect of surgery reduces the capacity of the body to process vitamins and minerals. To get enough vitamins, in line with the recommendations of your health team you have to take a high-dose multivitamin and mineral supplement every day for the rest of your life. For instance, you may need to take the following supplements:

B12: B12 deficiency may develop very fast, but there are few symptoms despite its serious risks. Animal products (meat, milk, fish, poultry) contain high amounts of B12. Let your vitamin levels be checked regularly by your health team.

Calcium: We recommend that you take calcium supplements every day. Calcium is essential for bones, teeth, and neural conduction. Many individuals do not get enough calcium in their diet.

Iron: Many patients, especially females should take iron supplements to maintain an adequate iron depot and prevent iron deficiency anemia. Iron exists in many different forms. The most common form may lead to constipation. Ferrous fumarate may cause less constipation.

Additional vitamin supplements can be prescribed according to your needs. Other medications will be prescribed by your health team.

Patients who have undergone weight-loss surgery and still have a gallbladder may need to take certain medications during the period of greatest weight loss to minimize the risk of gallstone formation. Consult your surgeon to learn whether this treatment is necessary for you or not.

Liquids

You should drink 1,5-2 liters of water between meals. Among the recommended drinks you will find water, unsweetened, low-calorie, and noncarbonated beverages.

  • Avoid carbonated beverages: Following swallowing, a cold fluid warms up and releases gas, which stretches and consequently expands the stomach sac. This creates an undesired tension and causes the anastomosis to stretch.
  • Do not drink fluids 30 to 45 minutes before and after meals, as it may stretch the stomach sac and provoke vomiting.
  • Drink fluids in slow and careful sips.
  • Drink small sips regularly during the day to avoid dehydration.
  • High-calorie drinks like milkshakes, carbonated water and liquors are not allowed. High-calorie drinks usually have poor nutritional value and contain simple sugars.

NOTE: If the color of your urine is dark or you have a dry mouth, it means that you are not drinking enough fluids.

 

Categories
Klinik Obezite

KO-E-084 Breathing before surgery

Breathing exercises before and after surgery

Correct and regular breathing is very important. Everyone’s way of breathing is unique, and we rarely think about how we breathe. Optimal breathing delivers more oxygen to your blood and helps your body to function more efficiently and contributes to better physical health by lessening fatigue and muscle spasms.

Deep breathing (10 repeats)

  1. Sit straight and close your eyes.
  2. Put one of your hands on your abdomen and the other hand on your chest.
  3. Take a deep breath through your nose for 3 seconds.
  4. Hold your breath for 3 seconds
  5. Exhale through your mouth for 6 seconds like blowing on soup.
  6. Focus on the movements of your abdomen and chest during inhaling and exhaling.
  7. Repeat this breathing exercise a few times by following these steps.