The First 30 Days General Guidelines

The first 30 days post-op DS (duodenal switch) will be different than the first 6 months or even the first year post-op. After surgery there are a lot of physiological changes going on in patient’s newly rearranged intestinal tract. Along with weight loss there will be emotional changes as well. Below are some guidelines that may help patients during this important recovery time during the first 30 days.

Physical Recovery from Surgery:

The patient just had major surgery, this means giving the body time and patience to heal, along with the proper fuel (water & nutrition) as well as rest. Always follow a personal bariatric surgeon’s guidelines. Drinking water daily will be a difficult task at first, but try to aim for 2 liter’s a day. Fill a 2 liter jug up in the refrigerator and try to SIP, SIP, SIP, throughout the day. It is important to drink the water or a patient can easily become dehydrated and that leads to fatigue, nausea, depression, feeling irritable and sometimes a trip back to the emergency room for IV hydration. Watch urine output too! After emptying the bladder in the morning, the color of urine should be clear, light yellow, 4-5 times a day. The best fluid to drink is water, but this tends to get boring. Add slices of fresh lemon, lime, or any fruit, to add some taste to help drink more often. By rotating the temperatures of water such as warm water, or cold water can help as well. Ginger or peppermint teas and even coffee (occasionally) are often well tolerated. Stay away from any sugar substitutes, carbonation and sugary sodas. Focus should be on protein at all times! It will take a significant effort to get enough protein, 50-80 grams a day, before moving to other foods. It is another challenge, but with protein drinks in the first month it can be done. Remember that protein drinks can count as fluid so this can be helpful the first 30 days when the stomach is small. It gets easier to eat protein as the “newly” operated stomach’s swelling is subsiding. We often say, eat “soft and slippery” protein this first month. Real food is more desirable and tolerated: fish, eggs, soups, yogurt-get creative! Limited seasonings and mayonnaise needs to be in moderation and can help immensely. Eating in restaurants this first month is a challenge, so learn to take a personal little bag of protein (deviled eggs, tuna fish, cottage cheese, yogurt – with a little ice pack to keep cold) then order a nice tall “Arnold Palmer”. This drink combination of iced tea and real lemonade can be very satisfying! A little bit of sugar is OK! The second month of eating gets much easier as long as a patient is able to tolerate the “soft” protein and the surgeon/dietician updates the diet to a regular, high protein, low sugar, and lactose free. Supplements will be added slowly, one at a time, as the patient learns to tolerate them.

Physical Activity:

Hopefully before surgery the patient has concentrated on walking or doing whatever type of “increased activity”. The only activity that the patient has had is walking in the hospital; now keep that up- gradually adding time and distance to the daily walk. Walking also reduces the chance of serious complications that can happen with any major surgery. The first month will feel tiring a lot of the time, but walking every day, just a little, will help immensely with depression, circulation, healing, weight loss and just plain “feeling stronger and better.” Patients want to preserve their muscle mass and focus on losing fat mass. This can be done by moving muscles with activity, which will help maintain strength. When the surgeon clears a patient they will start adding upper body strength training with gentle weights and resistance bands at first.

Emotional Recovery:

The postoperative phase has often been called an “emotional roller coaster”……get ready for the ride! Sometimes the patient will feel jubilant, and other times very low, depressed, “why did I do this to myself?” syndrome. This is very NORMAL. This is all a part of recovery process; the body is healing, there is fatigue and the loss of tremendous amounts of weight. Hormones are stored in fatty tissue and no matter what a patient does, there is going to be some emotional “ups and downs” especially the first month. We try to prepare our support people/family for this part of the journey. They can be helpful in reminding a patient this is only temporary, to drink some more fluid, and walk some more distance. Go to local support groups and share experience and feelings. Everyone in the room has been through the same thing. Taking pictures of oneself monthly is a great way to help document the weight loss that is happening because often times the weight loss does not communicate with the brain. Next year, when all of this is over, help someone new through this process; it feels good to help other people. Most of all, a patient must be kind to themselves this first month, follow the guidelines perfectly, expect some bumps and enjoy the new health.

Barbara Metcalf RN, CBN

Day to day life after Duodenal Switch mainly involves ensuring adequate protein intake and daily vitamin and mineral supplementation. You will also be required to have your blood work monitored to check your levels and adjust your supplements as necessary.

Knowledge is power. Many DS veterans will encourage you to learn all you can and become your own advocate. This is especially important if you have to travel a long distance to see your surgeon as many family doctors aren’t familiar with Duodenal Switch.

Soon you will find detailed information on post-op diet, recipes, exercise and blood work.