A nurse is caring for a client who is 2 days postoperative following a gastric bypass

Exercises to speed recovery

The single most effective way to shorten recovery time is to get active right away. Simply walking short distances and even changing positions in bed promotes circulation. Good blood flow enhances healing and discourages the formation of blood clots.

Perform the following exercises at least once every hour after surgery. It's also a good idea to practice these movements before surgery to promote lung function and agility.

• Beginning the first night after surgery, sit up and dangle your feet, then stand at your bedside with the help of your nurse or physical therapist. This may hurt but will become easier each time. Your strength will return and your pain will lessen every day.
• The day after surgery, you'll be asked to get out of bed and walk. After that, walk at least three times per day and perform leg and breathing exercises hourly. You may not feel well enough to go for a walk, but try to do as much as possible.
• Your nurse will teach you how to cough and breathe deeply, and you'll be shown how to use an incentive spirometer to help expand your lungs. Coughing and deep breathing loosen secretions that may accumulate in your throat or lungs and can help prevent pneumonia. Deep breathing also increases circulation and helps your body eliminate the anesthetics that were used for surgery.

How to breathe deeply:

1. Inhale as deeply as you can, letting your belly – not just your chest – expand.
2. Hold your breath for two seconds.
3. Exhale completely.
4. Repeat three times.

How to cough:

1. Inhale deeply.
2. Cough from your abdomen, not your throat. Hold a pillow against your abdomen for support.

How to exercise your feet and legs:

1. While lying on your back in bed, push your toes toward the end of the bed, as if you're pressing a gas pedal.
2. Pull your toes toward the head of your bed, then relax.
3. Circle each ankle to the right, then to the left.
4. Repeat three times.

Recovery at home

Leaving the hospital

Your surgeon will decide when you're ready to go home, based on your progress. Prior to discharge, you'll receive specific dietary and activity instructions, along with precautions and information on issues that warrant contacting your surgeon. If you have concerns about returning home, discuss them with your nurse or discharge coordinator.

When you return home, take it easy for a while. Your body is healing from major surgery and the weight loss that occurred during the initial recovery period.

Follow-up appointments

We care about your progress. Stay in communication with your bariatric surgery team, so we can do our best to help your recovery go smoothly.

We schedule an initial follow-up video visit for two to three weeks after surgery. Your discharge instructions will include information about this visit. After that, you'll see your care team regularly – usually three, six, nine and 12 months after surgery. Then you'll have an annual appointment.

It's also important to keep your primary care provider informed of your progress.

Activities to avoid

For three to six weeks post-op, strenuous activity is not recommended. Avoid lifting anything heavier than 15 to 20 pounds for the first six weeks.

Recommended activities

During the first few weeks after surgery, you may feel weak and tire easily. However, frequent nonstrenuous activity, such as short walks, is recommended. Gradually increase the distance of your walks. The more physically active you are, the better for your recovery. Following these recommendations will help you get back to your baseline energy level more quickly.

Continue walking at least four times a day, so that you're walking 30 to 45 minutes per day by the sixth week. If you have specific problems with your weight bearing joints (such as the ankles, knees and hips), you can perform water exercises once your abdominal incisions have healed, typically three to four weeks post-op.

Staying hydrated

You may be nauseated or experience vomiting the first weeks after surgery. To control these side effects, maintain your fluid intake by taking small, frequent sips of water. Drinking 1.5 to 2 liters of water daily is recommended.

Travel

You can resume traveling short distances as soon as you feel strong enough. Don't drive a motor vehicle until you're no longer taking prescription pain medication, which is usually about one week after surgery. If your planned trip involves a long flight, wait at least four weeks after surgery.

Personal hygiene

During the first several days after discharge, most patients like to have someone at home with them for moral and physical support. You may shower upon returning home.

Wound care

Your incisions will have sutures (stitches) deep in the skin and surgical glue on top. The sutures dissolve over time, and the glue begins to peel one to two weeks after surgery.

It's safe to let the incisions get wet during a shower, but don't submerge them in water until they're completely healed. As the glue peels off, apply Vaseline or Aquaphor to the incisions to keep the skin moisturized. This prevents scabbing and speeds healing.

A small amount of yellow, pink or clear fluid draining from the incision is normal. If an infection develops at the wound site, it usually occurs three to 10 days after surgery. Watch for symptoms of infection, which include:

• Increased redness or foul-smelling fluid coming from the incision
• Severe pain at the incision site
• A fever of greater than 101.5 degrees Fahrenheit

Contact your bariatric surgery team if you experience any of these symptoms.

Symptoms of concern

Serious problems are not common after this surgery. However, if you experience any of the symptoms below, contact your surgeon immediately:

• Fever of 101.5 degrees F or higher
• Redness, swelling, increased pain or pus-like drainage from your wound
• Chest pain or shortness of breath
• Nausea or vomiting that lasts more than 12 hours
• Pain, redness or swelling in your legs
• Inability to urinate lasting eight hours
• Pain that persists after taking pain medication

Normal side effects

You may experience some of the following postsurgical issues, which are considered normal:

• Moderate swelling and bruising. Notify your surgeon if you experience severe swelling and bruising, as these may indicate infection or internal bleeding.
• Mild to moderate discomfort or pain. Notify your surgeon if your pain becomes severe or persists after your pain medication should have taken effect.
• Temporary numbness. This is caused by the cutting of small sensory nerves near the surface of the skin during surgery. Sensation usually returns as the nerve endings heal, typically within six months. Be careful not to burn your skin when using heating pads on areas of the body that may be temporarily numb.
• Shooting electrical sensations within the skin, which often occur as nerve endings heal. This is common during the recovery period, especially with activity. Wearing an abdominal binder can help minimize this symptom.
• Red, dark pink or purple scars in the first weeks to months after surgery. Scars take about a year to fade. It's important to protect your surgery scars from the sun for a full year, even when covered by a bathing suit, as sunlight can still reach the skin and cause damage. Apply a sunscreen with a sun protection factor (SPF) of at least 30 before any sun exposure.

Nausea

Nausea may occur as a result of insufficient chewing, stomach fullness, sensitivity to odors, pain medication, going without food for too long, postnasal drip or dehydration. During the first days after surgery, nausea usually can be treated with medications called antiemetics. Take your nausea medication only as prescribed by your surgeon.

Rarely, nausea becomes so severe that it prevents a person from drinking adequate amounts of liquid. If this happens, you'll need to receive intravenous (IV) fluids at the hospital. Persistent vomiting may lead to dehydration and electrolyte imbalance.

Odors can sometimes be overwhelming after surgery. If you experience dry heaving, try sniffing a few drops of peppermint essential oil on a handkerchief. Avoid perfumes and scented lotions. If food odors bother you, try having someone else prepare your meals or stick to bland foods.

Learn to recognize when you are full. This will not happen immediately, but by eating very slowly, it will become easier.

If you have difficulty drinking due to nausea, try peppermint tea, fennel tea, decaffeinated green tea, or hot or cold water with lemon. Sucking on a cinnamon stick may also alleviate nausea.

If you believe your pain medication is causing nausea, call your surgeon's office to discuss a prescription change.

Vomiting

Vomiting is often caused by eating inappropriately. Initially, it can be difficult to adjust to your new anatomy. One to two tablespoons may be all you can eat at one time.

Possible causes of vomiting include:

• Eating too fast
• Not chewing food thoroughly
• Eating food that's too dry
• Eating too much food at once
• Eating solid foods too soon after surgery
• Drinking liquids with meals or right after meals
• Drinking with a straw
• Lying down after a meal
• Eating foods that don't agree with you

To prevent vomiting:

• Chew food well.
• Keep food moist.
• Measure portions. Eat small amounts every one to two hours in the early postoperative period.
• Follow the "Dietary Guidelines After Bariatric Surgery" education guide recommendations for diet progression.

If you experience prolonged vomiting, stop eating solid foods and instead sip liquids, such as protein shakes and water. If you have difficulty swallowing food or keeping food down, call your bariatric surgery team.

Vomiting may indicate that food isn't passing successfully through your stomach. If vomiting continues for more than 24 hours, contact your bariatric surgery team. Also, be aware that vomiting can cause severe dehydration, which requires treatment.

Dehydration

Dehydration occurs when you don't drink enough fluids. Symptoms include fatigue, dark colored urine, fainting, nausea, low back pain (a constant dull ache across the back) and a whitish coating on the tongue. If you experience these symptoms, blood tests will be needed to establish the severity of your dehydration. Dehydration also increases the risk of bladder and kidney infections.

Contact your bariatric surgery team if you're concerned about dehydration. You may need IV fluids.

To prevent dehydration:

• Buy a reusable bottle, bring it everywhere, and sip water all day.
• Drink at least 1.5 to 2 liters of fluids per day. Increase this amount if you're sweating a lot.
• Avoid caffeinated beverages because they act as diuretics – increasing the amount of water expelled from your body. Unsweetened herbal tea – hot or iced – is fine.
• If nausea is making it difficult to drink water, suck on ice chips.

Bowel habits

Bowel movements vary greatly after bariatric surgery. Stools may be foul smelling, associated with flatulence, or a different color than normal. Taking iron supplements, for example, will make your stools dark or black. Until you're eating more solid food, your stools will be soft. Most of these changes resolve as the body heals and adapts to changes. Please call your bariatric surgery team if you have persistent diarrhea.

After bariatric surgery, you'll consume much less food and fiber. As a result, you may have bowel movements less frequently and experience constipation. If constipation persists, try adding a powdered fiber supplement to your daily routine.

To keep bowel movements regular:

• Avoid cow's milk products, such as milk and cheese, if you become sensitive to lactose after surgery. Yogurt should still be OK. Lactose intolerance and consumption of high-fat foods can cause loose stools and diarrhea.
• Use a food journal to figure out which foods may be causing irregular bowel movements.
• Add Miralax to your regimen to speed up bowel motility (movement). If your stools continue to resemble rocks (instead of soft logs) after making these changes, contact your bariatric surgery team.

Flatulence

Everyone has gas in the digestive tract. Gas comes from two main sources: swallowed air and the normal breakdown of certain foods by harmless bacteria that live in the large intestine. After gastric bypass surgery, patients have a shortened bowel, which can result in more odorous gas or more forceful expulsion of gas from the body.

In particular, high-carbohydrate foods cause gas, while foods high in fat and protein cause very little. Foods especially known to cause gas include beans, vegetables, some fruits, soft drinks, whole grains, wheat, bran, cow's milk and cow's milk products, and foods containing sorbitol or dietetic products.

To lessen flatulence:

• Eat meals slowly and chew food thoroughly.
• Discontinue eating all cow's milk products. Lactose intolerance is generally the culprit for gas. Yogurt is OK.
• Avoid chewing gum and hard candy; both can contribute to the problem.
• Avoid drinking with a straw, which can also be a contributing factor.
• Try remedies for flatulence, such as Lactobacillus acidophilus supplements (a probiotic or type of beneficial bacteria that aids digestion), natural chlorophyll and simethicone.

Anemia

Bariatric surgery reduces stomach size, which puts recovering patients at risk for decreased iron absorption and iron deficiency anemia. Signs of iron deficiency anemia include paleness, fatigue, weakness, difficulty maintaining body temperature, dizziness and shortness of breath. To prevent this problem, you will take a daily bariatric-specific multivitamin, which has added iron.

Iron deficiency may also be caused by low vitamin A levels. Vitamin A helps mobilize iron from its storage sites, so a vitamin A deficiency limits the body's ability to use stored iron. This results in what appears to be an iron deficiency because hemoglobin levels are low, even though the body can maintain an adequate amount of stored iron.

Temporary hair loss and skin changes

Hair shedding is one of the body's natural stress responses to rapid weight loss. This typically improves six to 12 months after surgery. Although the problem is temporary, patients may find it upsetting.

To minimize hair loss, take multivitamins daily and consume at least 60 to 80 grams of protein per day. A bariatric multivitamin includes the components of a hair, skin and nails supplement, so you don't need to add another supplement to your routine.

Avoid hair treatments, such as permanents, that stress your hair from the outside.

Your skin's texture and appearance may change after bariatric surgery. Some patients develop acne or dry skin, since protein, vitamins and water intake are important for healthy skin. This is another reason to carefully follow the diet and hydration guidelines.

Sexuality and pregnancy

You may resume sexual activity when you feel physically and emotionally stable.

It is strongly recommended that sexually active women use a reliable form of birth control, such as IUD, after bariatric surgery, as fertility may increase with rapid weight loss.

It is imperative to avoid pregnancy during the first 12 to 18 months after bariatric surgery. Body weight and micronutrient levels rapidly change during this postoperative period, which is not optimal for supporting a healthy pregnancy.

If you do become pregnant, please contact the bariatric surgery office, and your care team will work with your obstetrician to ensure the best possible prenatal care.

A lifelong commitment

Surgery gives you a physical tool for weight loss, but you must commit to making the mental and emotional changes necessary for long-term weight loss and maintenance.

After surgery, you need to take vitamins and supplements regularly, ingest high-quality nutrients, attend follow-up appointments with your bariatric surgery team, exercise, and participate in support groups. Your emotional and physical well-being depends on your dedication to this multifaceted plan.

Common causes of regaining weight after surgery include lack of exercise, poorly balanced meals, constant grazing, and eating processed carbohydrates and sugars. You must manage your food intake and exercise regularly for the rest of your life.

Support Groups

Support groups are an integral part of the healing process, physically and emotionally. All patients are encouraged to incorporate a support group session into their monthly schedule. UCSF offers a support group that meets over Zoom on the third Wednesday of each month. Please visit our Bariatric Surgery Support Group webpage for more information and to join our email list.

Exercise

In a reduced-calorie state, the body naturally tends to use muscle for immediate energy needs. That means following a consistent fitness program after surgery is essential. Exercising at least three times a week conserves lean muscle mass, burns fat and increases your potential for long-term success.

Supplements

Because bariatric surgery changes the digestive process, you'll take vitamins and other nutritional supplements for the rest of your life. Vitamin deficiencies are preventable and detectable, so take your supplements and see your bariatric surgery team for regular follow-up visits and lab work.