Post Surgery/Treatment Diet

Post Surgery/Treatment Diet

For Non-operative Patients

Various treatments and options other than surgery are available. Every individual’s circumstances are different and the Clinical Team will offer their best and tailored advice for each person. Depending on how successful a treatment plan has been, usually after cycles of chemotherapy and or radiotherapy, patients generally find they can eat reasonably normally, which is a great and well-earned relief.

The section on Meal Ideas provides some suggestions that should help you to establish a varied routine of foods to enjoy.

If no further treatment can be offered and swallowing becomes more difficult, it is best to speak with your Consultant Surgeon and Dietitian for their most pragmatic and expert advice. In more advanced cases, options are still available, such as stents and feeding tubes to help continue nourishment and energy for an active life.

For Post-operative Patients

Waking up from surgery is a surreal experience, surrounded by monitors, bleeping noises, tubes and sensors, people milling around wearing protective suits and face masks. It can be an emotional moment too, a deep sense of relief knowing that the surgery itself is over. With strong pain relief and intensive care, the whole experience is a bit of a blur.

Oesophageal and stomach surgery is so incredibly effective that sipping water is possible within just a few hours, and a hot cup of tea or coffee isn’t far away. Whilst a feeding tube (jejunostomy - JEJ tube) may have been inserted into the small intestine supplying the body with much needed liquid nutrients, it won’t be too long before pureed and fork mashable foods are on offer, almost as soon as the patient feels comfortable to eat.

Most patients remain in intensive care for only a day or two, before being moved to recuperate on the Upper GI ward for typically 6 or 7 days prior to discharge. Dietitians work with patients to provide bespoke dietary plans before they return home. A plan might include continuing with supplementary liquid feeds through the JEJ tube for a period of a few weeks, combined with a pureed diet of small regular meals each day. The aim being to adjust to a more normal eating pattern whilst ensuring sufficient daily calories are provided. The JEJ tube will normally be left in place for around 2 months until the lead Consultant and Dietitian advise it is time to remove it.

Getting home

There will be mixed emotions returning home, from a great sense of relief and determination to get better, to some degree of trepidation having been released from the care of such fantastic professionals. Even with a number to call, it can be daunting in the first few days. But rest assured, having a dietary plan in place and a simple-to-use feeding tube it won’t be long before more normal meals are part of the routine again and the JEJ tube can be removed.

Tips for the first 4 weeks at home

To ensure you don’t miss a meal, set a ‘meal alarm’ on your phone or other device for every 2 hours between 8am – 6pm, or simply use a notepad to tick off small meals as you have them.
As you tick off your meals, record what you eat highlighting with a star * the foods you like. This will help you to fine-tune your meal plan and help identify foods you haven’t yet tried.
Record how much you eat – it is encouraging to know week by week that you are able to gradually eat a little more, this can also help identify if you are eating too much of something.
Make a note of how you feel after meals, especially if you experience trips to the loo or mild aches and pains after eating – this will help you refine the foods that you find either problematic or trouble-free.

Meal portion size

Because of reconstructive surgery your new stomach will be smaller than before and in a different position, higher up in the chest area. In many cases, five or six small portions a day will be the new norm. A ‘small portion’ for most of us is approximately a third of what we would normally eat. For some, over a number of years, the stomach can stretch a little, allowing for slightly larger portions, but the long-term side effects of this are relatively unknown.

Managing weight

Small portions make it inherently difficult to attain sufficient calories to offset weight loss, so it is vitally important to eat regularly. Initially, we recommend six small meals a day with snacks between! Absolutely focus on the foods you like the most, especially those high in protein and fats and some carbohydrate, all of which help to reduce weight loss. This harps back to our pre- treatment ‘eat what you like’ regime, but following major surgery it is important to combat weight loss by eating what you like the most, and most often.

Don’t be disheartened if you continue to lose weight. Being persistent and following a routine of small, regular, nutritious meals, adjusting to what suits you, will eventually help you stabilise weight loss and reverse the trend. We all have our own natural weight range we feel most comfortable with. This is a good target to aim for, and once there, it is possible to tailor your diet towards a much healthier regime for the long term.

Supplements

We advise all patients to take an A to Z multivitamin and minerals tablet. Most chemists and supermarkets will sell own brands, which are cost effective, however contents do vary and you should look for 14 milligrams of iron and 2.5 micrograms of B12.

Because of the nature of the surgery, your body will not necessarily absorb all the vitamins and nutrients as well as it did before. In particular, your levels of B12 might be affected. B12 is an important component in the body's 'energy generation cycle', so a lack of B12 can leave you feeling lethargic and tired. Through simple routine blood tests, conducted either at the hospital or your GP, your B12 can be monitored. If your levels are low, you may be offered regular, 3-monthly B12 injections.

Poor or ‘mal-absorption’

Again, because of the nature of the surgery, food isn’t always digested fully or absorbed as well as it was before. Poor absorption is typified by oily stools that usually float. Strangely however, sometimes digestion works well after surgery, and other times flips over to poor absorption for maybe a week or two before returning to near normal. Poor absorption can lead to weight loss, so if it persists you should consult your dietitian for advice. There are remedies, such as Creon supplements taken before each meal, which aid digestion.

Drinks, pureed and soft foods

After surgery, it is prudent to stick with pureed and soft foods for a few weeks, allowing surgical reconstructions time to heal, and for intestinal movements and gut fauna to recover.

The pureed and soft food ideas sections of Meal Ideas and the Eating well with swallowing difficulties booklet provide some suggestions in this area.

Dumping Syndrome (feeling tired and diarrhoea)

Normally the stomach controls the release of food into the bowel. After an operation to remove all or part of the stomach or oesophagus, the loss of this slow and steady release can result in a number of symptoms called Dumping Syndrome..

There are two types of dumping syndrome:

early dumping.
late dumping.

Late dumping syndrome is more common after an oesophagectomy.

Early dumping syndrome

This can happen within 30 minutes of eating a meal. You may:

feel dizzy and faint.
your heart might beat faster.

These symptoms may last for about 10 to 15 minutes. You may also have:

tummy cramps.
diarrhoea.

When food is delivered too quickly into the bowel, either due to the loss of the stomach or the loss of its reservoir function, fluid is drawn into the bowel from the surrounding organs and tissues, which causes your blood pressure to drop.

Many people find early dumping syndrome gets better on its own in time. After a few months, symptoms can get less severe and happen less often.

Late dumping syndrome

Late dumping occurs 1 -3 hours after eating a meal, or when you have missed a meal. You may suddenly feel:

faint.
sick.
shaky.

This happens when the food delivered into the bowel is absorbed more quickly than usual and the body releases insulin as a response, a hormone which causes blood sugar levels to drop. If you feel the symptoms starting, you can lie down and rest until you feel better or you could try eating a sugary snack.

Controlling dumping syndrome

For most people, the symptoms of dumping syndrome slowly reduce over time. Tell your cancer doctor or dietitian if the symptoms do not stop. If your symptoms continue or are severe, your cancer doctor may give you medicine to help.

You can help prevent or reduce the chances of having early or late dumping syndrome if you:

eat slowly.
eat small, frequent meals.
drink fluids slowly between meals, rather than at mealtimes – try to leave 15 to 30 minutes between eating and drinking.
eat foods that are high in protein, such as fish, meat and eggs.
avoid having foods or drinks that have a lot of added sugar, such as sugary cereals, sweet drinks and desserts – if you have them, eat slowly and only have small amounts.
rest for 15 to 30 minutes straight after eating a meal.

Some patients find that taking a couple of dextrose tablets can help quickly alleviate the symptoms, whilst taking sugar is counter intuitive it seems to work well for many patients. Alternatives to dextrose are sweet things like orange juice or bread-and-jam, though energy gels are not a good idea.