Bariatric follow-up

Post-sleeve bloods (note that if CRP > 20, vitamin levels are hard to interpret)

De-emphasise weight loss at this point
Refocus on getting the basics right
- If feeling hungry, distract yourself with a different activity
- Minimise alcohol and carbonated drinks
Introduce smooth puree diet - weeks 3 and 4
- 4-6 small meals per day, with protein at each meal
- 30 min for each half cup of food. Stop when satisfied or after 30 minutes.
- Stop fluids 10 minutes before eating and restart 30 minutes after eating
- Aim 1.5-2L low calorie drinks
Soft moist diet - weeks 5 and 6
- Still need 4-6 small meals per day
- Soft enough to easily mash or break up with a fork
- No more than 1 cup for each portion
- Serve on a small plate and use small utensils
- Allow 30 minutes for each meal - chew well and put down utensils between mouthfuls
- Still avoid breads, baked goods, meats, carbonated beverages, raw vegetables, hard fruits, dried fruits, anything with sharp edges
Wounds, pain
Bowels - if constipated, add fibre
Look at medication management for comorbidities and encourage involvement of GP
Check multivitamins - should be on it for life

Emphasise correct eating - eat slowly, chew food well, be mindful of portion size

Dumping syndrome - see gastrectomy topic
Nausea - often occurs early after sleeve. Manage medically and keep drinking.
Vomiting/regurgitation - should not occur with liquid/pureed phase. If this is occurring with solids, slow down, have smaller mouthfuls and portions.
Constipation - usually need more fibre such as Benefibre. Add prune juice and ensure hydrated.
Hair loss - can occur about three months post-op - normal reaction to physiological stress of weight loss. Usually stops within another three months with hair regrowing. Ensure eating balanced diet and taking multivitamins.