Common problems after sleeve gastrectomy and how to deal with them

Every day in the clinic and out here in social media world, I hear people talking about problems after sleeve gastrectomy. Problems after a sleeve are common as you are going through huge physical and psychological changes, but you shouldn’t put up with them in the long term. In this post I’m not going to talk about the major complications. There is so much information already out there on these. The problems I’m going to talk about are those that are more annoying, the things that catch you by surprise, the niggly things that no-one tells you about before surgery.

These complaints can be everything from the big ones like deciding whether or not to tell people about your surgery, to smaller things like feeling nervous & guilty about throwing out clothes or even getting used to the new eating habits such as learning to slow down. The most common of all these struggles are below, plus what you need to do to improve them so life after a sleeve is much much brighter.

So here goes…

Eating out

Eating out can be tricky on a number of fronts… It can be hard to decide where to go, what to choose from the menu and then to eat slowly and drink either side of your meal while everyone else around you is guzzling their wine and taking huge mouthfuls finishing in 5 minutes flat!

To make eating out easier:

• Choose a restaurant that involves sharing dishes so you can pick and choose what and how much you want and bit a little more ambiguous, rather than leaving a relatively untouched main meal on your plate. Good places to try are Thai, Vietnamese, Lebanese, Indian and Tapas.
• Always pick only from the entree menu and try to go for something that you’ll like but isn’t too far away from what you’ve tried before, just in case it doesn’t agree with you.
• Start a glass of wine when you arrive, then stop drinking when you order your meal. After you’ve eaten, wait about 20 minutes before you start drinking again (often this is when everyone else is having dessert).
• For more tips and trick for eating out see my FB Live video here.

Telling people

This is a tough one! And such a personal one. Some people are very open and happy to share and have discussions, but others are more private, so telling work colleagues or extended family sounds like the last thing you want to do. If you’re more private, there are lots of concerns that I hear all the time: people worry that it will change relationships, or that those that they do choose to tell will tell others that you hadn’t planned, or that they just want to move on and not talk about it all the time!

If you’re not going to tell anyone (or only select few) then you need to have some quick and easy responses prepared for those times when people question why you’re not eating much, how you’ve lost so much weight or why you had that time off from work. It’s really frustrating that we feel, as a society, that it is completely fine to comment on a persons weight and changes in weight, but it is something often talked about so you need to feel like you’re ready with a couple of quick excuses to change the subject!

Taking supplements

After surgery, it’s essential that you take certain supplements every day. Sometimes taking supplements is a pain because it’s annoying to remember, but sometimes this is a pain because the tablets are just too hard to swallow.

If your problem is remembering to take them: try linking them to something else you do every day. For example, taking them after you clean your teeth or while you’re driving to work, or first thing when you turn your computer on in the morning.

If your problem is swallowing the tablets, talk to your dietitian about an alternative option such as liquid or chewables or speak with your pharmacist about the possibility of crushing or cutting them up. There is always a way around this – it  just might take a little bit of experimenting to come to a routine that works for you.

Initial pain

You’ve had a big surgery, so there will be pain although the degree to which you have pain varies so much. The best way to prepare for this is to prepare mentally, and expect it. If you don’t have much then it will be a bonus! Also be sure to ask for pain relief when you are in hospital and upon discharge, so you’re not going home with pain that you can’t manage.

If you do have pain, usually it will settle down by 2-3 weeks after the surgery at the latest. If your pain is getting worse, or doesn’t seem to be improving, or if it is too much to manage, then please please please see you surgeon again asap. Don’t leave it for days in case it is something more sinister.

Getting used to your new eating habits.

Having a sleeve means a HUGE change in your eating habits and this is one of those problems after sleeve gastrectomy that every single person struggles with. You are not alone if you still sometimes eat too fast or have trouble leaving food on your plate. All I can say is that it does get easier as time goes on.

The best thing you can do to solve this one is to be more mindful around food:

• Before you eat, ask if you’re actually hungry. If yes – what do you feel like, and if no – why do you want to eat and what else can you do?
• Serve yourself a smaller portion that you think you need (our eyes often deceive us and you can always go back for more if you’re still hungry at the end of your meal)
• Focus on how you eat: take thumb-nail sized mouthfuls, rest between each mouthful so you’re taking 20-30 minutes to eat your meal.
• DON’T EAT IN FRONT OF THE COMPUTER OR TV! You will be distracted and find it more difficult to determine when to stop eating.
• For more tips watch this FB Live video on eating after a sleeve.

Cooking smaller portions

People mention that getting used to cooking smaller portions is one of their biggest problems after sleeve gastrectomy. After years of cooking big portions, it can be really tough to find recipes that work for 1 cup portions.

My biggest advice here is to eat what the family eats! Don’t feel like you need to make a separate meal for you while you cook something else for the family. A sleeve should be flexible and you should be able to eat most foods, but perhaps just need to pick and choose a selection from the family meal. For example, if having pasta, you would choose to have more of the meat and veg sauce, and less of the pasta itself.

If you’re cooking for one, look for recipes that freeze well. Australian Healthy Food Guide has great healthy and easy recipes made for one (single serve) and these will often feed you for two or three meals. Their search function allows you to search for freezable meals, too. Other great places to look for bariatric-friendly recipes include Food Coach Me and Bariatric Cookery. It takes time to find what works for you – but it will happen! You’ll get used to shopping for less food and also get used to being really creative with leftovers!

Throwing food out

Lots of us have been brought up with the old “you have to eat all the food on your plate”, or ” you can’t waste food, there are starving children in Africa!” The truth is that now, after your sleeve, you will have to get used to leaving food on your plate or throwing away leftovers. If you don’t, you’re more likely to eat more than you need and eventually regain weight. Over time you’ll realise that if you do over eat, you’ll feel uncomfortable and perhaps even make yourself sick, so negative reinforcement tends to work in your favour here, too, and often a few months after surgery, people are feeling much better about throwing food out.

Practical things you can do to help with this urge to not waste food include:

• serve smaller portions to begin with, so you have less leftover
• if you do have leftovers, you can always put them back in the fridge to eat later.
• cook smaller portions (see my point above)
• feed someone else in the family (dogs are man’s best friend!)

Changes within the family

This is actually going to be a blog post all of it’s own in upcoming weeks, as it can be a big problem after sleeve gastrectomy. Having a sleeve is a big adjustment for you, but it’s just as big of an adjustment for your family. Whilst most family members are really suppportive,  Often family members will worry that you’re not eating enough, or worry that you’re losing weight too fast, or even just struggle with the fact that you take so long to eat a meal.

My biggest piece of advice here is to talk with them. Be open and honest with them, try not to get frustrated and defensive. Bring them along to appointments with the surgeon and dietitian so they can ask all of their questions and feel reassured that everything is okay. If you need to, see a family counsellor – it can really help to air everything with a supportive person in the room.

I’d love to hear from you now… Is there anything else that you really struggled with that’s not on the list?