Supplements
Sustagen: Milk based supplement with added vitamins and minerals. Can be purchased from most supermarkets.
Ensure: Soy based supplement, which is lactose free. Comes in a variety of flavours. Available at most supermarkets.
Resource: Fluid drinks that are lactose free. Available at selected pharmacies.
Resource Protein Powder: A high protein powder, which has no taste. This can be added to foods and drinks to help increase your protein intake. Can be purchased at most large pharmacies.
Enriched Milk: Add 1-2 tablespoons of full cream milk powder to every cup of milk and stir.
After major upper gastro-intestinal surgery it is common for patients to experience one or more of the following symptoms. It is important to notify your doctor if these symptoms persist. Most symptoms will not last for a long period of time and they should generally get better with time rather than worse.
Loss of Appetite
You may experience a degree of decreased appetite following the operation as your stomach has been partly or fully removed. This is a common problem. It is important to have six small meals a day to improve your appetite. You can also substitute some of these meals with high protein drinks. Some patients experience a change or loss of taste, which usually resolves after a period of time
In the beginning it may be difficult to work out how much food to eat. Everyone is different and you will found out by trial and error. If you overeat you may develop some abdominal pain that usually settles after a short period of time.
Weight Loss
You may encounter a change in your weight after your operation as your body begins to heal itself. Most patients will lose around 10% of their initial weight. It is important to try to eat food and fluids that are high in protein and to eat every couple of hours. Most people’s appetite returns after two to three months.
Reflux
Some patients may experience a degree of reflux. You can minimise the severity of reflux by using medication and by following some of the suggestions below.
- Avoid lying down for at least 30 minutes after eating
- Avoid foods that are known to aggravate reflux, eg. Spicy or acidic foods.
- Eat small meals often rather than 2 or 3 large meals.
- Don’t lie flat, use 2 to 3 pillows to prop yourself up.
- Try not to lie on your left-hand side, lie on your right or back.
Dumping Syndrome
Normally there is a muscle at the bottom of the stomach that controls the amount of food it lets into the small bowel. Sometimes this muscle is removed or doesn’t work as well following a gastrectomy. This can cause “dumping syndrome” where food moves too quickly from the gullet into the small bowel.
The symptoms that you may experience include nausea, vomiting, bloating, cramps, diarrhoea, sweating, weakness, tiredness and your heart may race. Eating six small meals each day and avoiding foods and drinks high in sugar will help in reducing these symptoms.
Nourishing Milk Drinks
Milkshake:
1 cup of milk
1 scope of ice cream
1-2 tablespoons of Sustagen or Ensure powder
Add flavouring to taste.
Egg Flip:
1 cup of milk
1-2 tablespoons of Sustagen or Ensure powder
1 egg
Vanilla to taste
Smoothie:
1 cup of milk
1-2 tablespoons of Sustagen or Ensure powder
1 banana or other desired fruit
1 scoop of ice cream or yoghurt
Fruit Flip:
1-cup fruit juice (preferably not citric based)
1 egg
1 scoop of ice cream or yoghurt
Fruit Shake:
1-cup fruit juice (preferably not citric based)
1-2 tablespoons of Sustagen or Ensure powder
1 scoop of ice cream, yoghurt or cream
The following is an example of a 7 day meal plan:
| Supper | Evening Meal | Afternoon Tea | Lunch | Morning Tea | Breakfast | |
| Creamy Rice Pudding | Lamb Casserole with Vegetables | Moist Chocolate Cake | Chicken Soup | Egg Flip | Weet Bix | Monday |
| Baked Egg Custard | Spaghetti Bolognaise | Fruit Shake | Vegetable Pancakes | Banana Smoothie | Omelette | Tuesday |
| Cheesecake | Salmon Fillet with Mashed Vegetables | Cheese and Crackers | Egg and Lettuce Sandwich | A glass of Ensure | Baked beans on toast | Wednesday |
| Ice Cream and Jelly | Shepherd’s Pie | Fruche | Vegetable Soup | Milkshake | Poached Eggs on toast | Thursday |
| Chocolate Mousse | Beef Stew with Vegetables | Bubble and Squeak | Quiche Lorraine | Yoghurt | Porridge | Friday |
| Lemon Meringue Pie | Tuna Bake with Boiled Vegetables | Ensure Pudding | Macaroni Cheese | Fruit Smoothie | Scrambled Eggs | Saturday |
| Junket | Vegetable Lasagna | Stewed Fruit and Custard | Tuna and Mayonnaise Sandwich |
Banana | Melted Cheese on toast | Sunday |
Diarrhoea
If diarrhoea occurs 15 to 30 minutes after eating, you may be experiencing “dumping syndrome”. It is important to drink plenty of fluid, especially between meals and to eat six small meals a day. Most commonly, bowel changes will settle within a month or two, if your diarrhoea persists, seek medical advice.
Anaemia
When your stomach is removed your body is unable to absorb vitamin B12 and there may be difficulties in absorbing iron. These nutrients are important for a healthy body. Your doctor may need to give you 3 monthly injections of vitamin B12 and you need to eat foods high in iron.
Foods high in iron include meat, liver, kidneys or breakfast cereals with added iron.
Wounds
The type of wounds you have will depend on the type of operation performed. You will be discharged home with small bandaids over the wounds, which can be removed in a week’s time.
It is normal to notice some redness or swelling, as this is part of the healing process. If you develop a fever or are concerned about the degree of redness or swelling please contact your doctor. You may experience some slight discomfort at the wound, which can be controlled by some simple analgesia.
Some patient’s may be sent home with their feeding tube still in place. The tube will have been clamped by your nurse so no fluid can drain from it and covered with a dressing, which should not need to be changed. It is important not to try to remove the tube. You will need to make an appointment with your surgeon for the tube to be removed. This is an easy process, which should cause only minimal discomfort.
Pain
It is important to take analgesia on a regular basis, for example two Panadol every six hours, when you are first discharged home. Once you are feeling comfortable, you should only take analgesia, as you require. Rarely stronger medication is needed.
Fatigue
After any major operation it is common to become tired. This is your body’s reaction to the surgery. As you increase your activity this tiredness will decrease but it is important to find a balance between light activities and adequate rest. You must avoid all heavy lifting and vigorous exercise for at least eight weeks. You should not drive for at least two weeks after the operation, as your reflexes will be reduced.
The first few months after the operation can be difficult, you may remain weak and your concentration span may be decreased. Things will begin to get better but it is important to remember that this is a large operation and it can take six to twelve months to fully recover.
Sample Menu Plan
The following is an example of the types of foods you can eat which will increase your protein intake.
BREAKFAST:
Weet Bix Use full cream milk and sprinkle with sugar. If you are having problems swallowing, heat the milk.
Toast Butter while still warm, spread with jam or honey. Jam or honey can be substituted with an egg or baked beans.
Omelettes Add fillings such as mushrooms and cheese.
MORNING/AFTERNOON TEA:
Yoghurt
Nourishing drinks Smoothies, egg flips
Fruit Have fruit high in Vitamin C
LUNCH:
Soup Make on enriched milk or add cream. Try chicken or vegetable
Sandwich Use fillings such as eggs, canned fish, cheese, baked beans or bananas.
Custard Add 1 tablespoon of Ensure or Sustagen powder and use full cream milk.
EVENING MEAL:
Lasagne Add extra cheese
Vegetables Serve with extra butter or a white sauce
Rice Pudding Make on enriched milk, stir in cream or add fruit
General Diet Guidelines
As long as you use common sense you should have no problems with eating following your surgery.
Initially begin with softer foods that are easier to chew and swallow. Slowly increase the texture of your food as you begin to feel more confident with your swallowing.
It is important to remember to eat your food slowly and to chew it well. Make sure you are sitting upright when you eat. Try not to lie down for at least 30 minutes after you have finished eating.
As your body is using the protein to help repair itself following your surgery it is imperative that the foods you eat are rich in protein. Meat, fish, poultry, eggs, legumes, milk and dairy products are a good source of protein.
If you are having problems with a loss of taste you could add different flavourings to your meal or experiment with different foods. The important thing is to keep trying.
Most people will not feel hungry, but it is important for your recovery for you to eat. Try to have something to eat every two hours during the day. Try to avoid drinking fluids, which are not high in nutrients at mealtime, as you will tend to fill up on them. Try to make everything you eat or drink count.
Remember to keep your meal sizes small and frequent. If you are concerned about the amount of weight you are losing or lack of energy you have, please contact your doctor or dietician.
Depression
Some people during their recovery stage experience a degree of depression, which is usually temporary. It is important to talk to someone you trust about these feelings. Your GP should be able to help you if this becomes a problem.