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 1^st, 3^rd, and 6^th months of surgery.