The most critical timeframe for complications related bariatric surgery occurs within the first 72hrs up to 6 weeks post-surgery. Symptoms of concern include:
- Fever over 101 degrees Fahrenheit
- Symptomatic low blood pressure
- Heart rate greater than 120bpm (or 40 points above baseline- whichever is higher) for 4 hours or more
- Shortness of breath or difficulty breathing
- Significantly decreased urine output
- Bright red blood via the mouth or rectum
- Dark bloody stools
- Copious/continuous bloody drainage or purulent drainage from incision site(s)
- Worsening abdominal pain lasting greater than 4 hours
- Worsening nausea and vomiting lasting over 4 hours
- Vomiting with abdominal pain.
- Worsening abdominal pain with walking or after eating
- Swollen, hot, tender extremities – lower leg, forearm
- Inability to swallow your own saliva
Although there may be some discomfort when swallowing and some minor nausea and/or vomiting post bariatric surgery, symptoms should improve with time, not worsen. Sudden onset of symptoms or worsening symptoms could indicate a potential serious problem. This could include a leak, intra-abdominal bleed, obstruction, pulmonary embolism, venous thrombosis or other complication. If you experience any of the above symptoms you should contact your bariatric office or go to the Emergency department immediately.
Additionally, there are less critical complications that warrant a follow up visit with your medical provider. This includes the monitoring your medications. Often medication doses need to be adjusted as you lose weight. These include, but are not limited to, blood pressure medications, thyroid medications, diabetic medications, and anti-depressant/anti-anxiety medications. If you have any chronic medical condition that requires ongoing medications it is best to keep regular follow ups with your primary physician so that medications can be adjusted appropriately. Never discontinue a medication without first checking with your medical provider. Listed below are a few examples. This is in no way a comprehensive list and there may other symptoms related to these medications that have not been listed:
- Too much blood pressure medications symptoms: dizziness, nausea and/or loss of balance
- Too little blood pressure medication symptom: headache, ringing ears, and/or agitation
- Too much thyroid medications symptoms: racing heart, sweating, nervousness
- Too little thyroid medication symptoms: lethargy, dry skin, fatigue
- Too much diabetic medication symptoms: hypoglycemia with extreme drowsiness, blurred vision, confusion, hallucinations, slow shallow breathing.
- Too little diabetic meds: hyperglycemia with symptoms of nausea, excessive hunger or thirst, rapid heart rate and/or vision problems.
- Too little or too much antidepressant and antianxiety medications: increased depression and/or anxiety.
There are also non medication related symptoms that warrant a follow up with your medical provider. These include but are not limited to:
- Gallbladder issues: Upper right quadrant pain that often radiates to the right shoulder or between shoulder blades. However, pain can also present in the mid upper abdomen or sometimes left upper abdomen. Often accompanied with nausea and vomiting especially after eating greasy or spicy foods. Symptoms generally worsen over time. May be accompanied with fever.
- Kidney Stones: Right or left flank (in back just below ribs) pain. Pain can be dull or sharp and may radiate into the groin area. Urination may be painful and there may be blood in urine. Can be accompanied with fever, nausea, or sweating. Some kidney stones can pass on their own while others may require medical intervention. They say passing a kidney stone is the closest thing to giving birth a man will ever experience!
- Gout: A high protein diet can sometimes exacerbate gout symptoms. Pain can be intense and is generally located in the great toe or foot but can less commonly be found in other joints. It is recommended patients with a history of gout get on and continue allopurinol or other preventive medication before having bariatric surgery. NSAIDS often used for the treatment of gout are not recommended after bariatric surgery.
- PCOS: Heavy and/or prolonged menstrual periods or sporadic menstrual periods are not uncommon with rapid weight loss. Heavy bleeding can result in anemia. Traditionally menstrual periods normalize as weight loss stabilizes. Some women find it helpful to start birth control or hormone therapy during the transition time to help control bleeding.
- Chronic Heart Failure – Fluid buildup can exacerbate symptoms of CHF including shortness of breath, fatigue, dizziness, bloating, weight gain, and chest pain.
- Vitamin Deficiencies -Can result in numbness and tingling of extremities, paresthesia, muscle weakness, or coordination issues. Labs may be needed to evaluate and treat vitamin deficiencies.
As always, any new onset of chest pain, shortness of breath, or any new acute symptom is never considered normal and warrants a trip to the Doctor. Bottom line, no one know your body better than you do. If you feel something is “just not right”, it’s best to have it checked out by your medical provider. As always, better safe than sorry!
