First month after Surgery

The first day will be water sips to ensure tolerance and give the pouch time to adjust.

Once you're home you will start on carbonation-free, caffeine free clear liquids for 3 days, emphasizing 100% juices diluted with water.

All Lap-Band Patients must keep a weekly weight diary to bring in to each appointment to access the need for an adjustment.

The Lap-Band patient will be assessed for an adjustment at the 6-week appointment. An assessment for an adjustment will be done every 6 weeks until the 6-month appointment and then every 3-6 months thereafter.

If an adjustment is done follow the clear liquid list below for 48 hours and slowly advance back to pureed and then to regular consistency food as tolerated.

GROCERY LIST       10 Calories or less per serving drinks Examples are: * Crystal Light * Diet Snapple * Fruit 2o * Fruit Refresher * Diet V8 Splash * Minute Maid Light * Sugar-free Kool-Aid with a sugar substitute * Aquafina flavored waters * Diet SOBE * Propel Waters * Sugar-free Popsicle's * Low-fat vegetable, beef, and chicken broth's * Decaffeinated tea/coffee with sugar substitutes such as Splenda, Equal, Sweet One, Twin, Sweet-N-Low and so forth. * Sugar-free Jell-O * 100% juice's diluted with water (1/2 cup water + 1/2 cup 100% juice)

NOTE : The first 3 days drink the clear fluids listed above throughout the day to get the minimum of 48 ounces of fluid daily to prevent dehydration. The first 3 days is the JUICE PARTY. To prevent low blood sugars and nausea make sure you drink diluted 100% juices with water throughout the day. Once the first 3 days are over discontinue all juices. They are just unnecessary calories. Drink small sips of fluids continuously throughout the day. You must drink 6 ounces an hour. In 8 hours you will have achieved the goal of 48 ounces of fluids needed. Immediately start taking all of the specified vitamins as soon as you are home. Follow the vitamin schedule provided in the vitamin section of the packet.

Introduce protein shakes

Once the first 3 days on clear liquids is finished we will begin drinking 1 protein shake every 4 hours. This will be the pattern for the remaining 11 days. (See recipes in the packet).

Drink clear fluids that are 10 calories or less per serving in-between the protein shakes.

Take 30 minutes to drink the 6-8 ounce protein shake. Whatever can not be finished in 30 minutes is to be saved for the next mealtime.

Pureed/soft food stage

Rule of thumb: (No chunks, moist, soft foods) all foods should be the same consistency.

DO NOT EAT AND DRINK TOGETHER ANYMORE

Lap-band patients must stop sipping fluids 30 minutes prior to a meal and not resume sipping fluids for 60 minutes after a meal. (30-60 minute rule)

Gastric By-Pass patients must stop sipping fluids 30 minutes prior to a meal and not resume sipping fluids for 30 minutes after a meal. (30-30 minute rule)

Continue 1-2 protein shakes as 1-2 meals a day to help with the protein intake.

Start soft protein foods listed below eating 1/3-1/4 cup every 4 hours.

	GROCERY LIST

	* Smuckers Low Carb, Skippy Natural, Smart Balance, and Natural peanut butters (5grams of sugar or less in the peanut butter). * Dannon Lite and Fit, Breyers Light Yogurt. * Eggs and egg beaters (soft boiled or scrambled) * Low-fat cheeses (eat it plain or melt it on foods) * Low-fat cottage cheese * Milk (Skim, 1%, Rice, Soy or Lactaid) watch out for hidden sugar in Rice/Soy milk. * Mashed up Tofu or Humus * Tuna/chicken/Bumblebee salmon in the can in water (Mash up with low-fat mayonnaise and season as desired) * Fresh lump crab meat (mash up with low-fat mayonnaise and old Bay seasoning) * Broil or bake any fin-fish like; salmon, tuna, flounder, cat fish, tilapia and so on. Make sure the fish is not dry or over cooked and mash with the fork. Dry over cooked fish is not tolerated. * You may puree meats in a blender or food processor. See directions on how to puree. * Soft mashed up skinless fruits like bananas, papaya, and melons. * All canned fruit in natural juices except pineapple unless it is used in the blender with a protein shake. * Oatmeal * Grits * Farina * Cream of Wheat * Instant or home made low-fat mashed white or sweet potatoes

INSTRUCTIONS ON PUREEING FOODS IN A BLENDER:

• Cut foods into small pieces about the size of your thumbnail.
• Place food in a blender/food processor
• Add enough liquid to cover the blades (broth, juice, and low-fat milk).
• Blend until smooth like applesauce.
• Strain out the lumps, seeds, or pieces of food.
• Use spices (except hot seasonings such as cayenne pepper or hot sauce) to flavor foods.
• DO NOT USE BABY FOODS
• The protein level in baby food is much lower since babies do not have the full-grown kidneys necessary to handle the protein levels adults can.

Protein is priority

The minimum goal is 60 grams of protein for-women/70 grams for men per day.

You will, most likely, need a protein supplement for the first 2-3 months, and possibly forever if your on a strenuous exercise program.

This amount of protein is required to prevent protein energy malnutrition.

The amount of protein necessary for each individual will increase as the exercise programs increase.

The Dietitian will re-access your actual protein needs based on your actual height, weight, and exercise program at your first month appointment.

Make sure you tell the secretary to schedule an appointment with the Dietitian when making an appointment with the Surgeon, otherwise they will not schedule you.
should be initially scrambled or soft boiled.

LACK OF PROTEIN CAUSES

• Protein Energy Malnutrition: This occurs when the protein storage depletes. The signs are fatigue, feeling lethargic, large amounts of hair loss, and fluid in the lower legs and feet (edema).
• Muscle Wasting: Muscle weakness.
• Fatigue/Lethargy: Patient becomes very tired and has no energy to do daily tasks.
• Delayed Healing: Slow healing from post-surgical wounds.
• Death: Without ample protein the organs where protein is stored eventually stop functioning.