Patient Instructions Before and After Your TIF Procedure This brochure is intended to give you a general overview of the TIF® Procedure instructions. ALWAYS follow your doctor’s pre-procedure and post-procedure instructions. Pre-Procedure Instructions Post-Procedure Instructions Make sure you inform your doctor about all medi- Your doctor will determine whether it is necessary cations you are currently taking and provide a full for you to spend the night in the hospital after history of your medical conditions. your procedure. For the first few days, you will DO NOT take any diet aids or herbal supple- experience some pain and/or discomfort in your ments that contain ginkgo, garlic, or St. John’s chest and shoulder and you may have a sore Wort for 10 days prior to surgery. throat, and/or some discomfort swallowing. These DO NOT take any aspirin, blood thinners, anti-in- symptoms should resolve within the first week after flammatory (arthritis) medications, vitamin E or your procedure and appropriate medication will be fish oil for 7 days prior to your procedure. provided as needed. If symptoms do not resolve or if discomfort becomes more severe, notify your Your doctor will give you additional instructions doctor immediately. regarding medications you are currently taking. Continue to take your GERD medication after your DO NOT smoke or drink alcohol for 48 hours procedure as recommended by your doctor. prior to your procedure. Occasional heartburn is normal in healthy people DO NOT eat or drink anything for at least and may depend on diet and other factors such 12 hours before your procedure (or longer if as stress. If GERD symptoms recur, you should instructed by your doctor). The TIF procedure contact your doctor. cannot be performed if there is food in your stomach.Take the medications your doctor Even though the TIF® Procedure is incisionless, it is has approved for you to take with a small still surgery. Like any surgical procedure, success amount of water. is dependent on how well you adhere to post- procedure instructions including: Dietary guidelines Physical activity, driving Medications Return to work Follow-up Avoid foods with coarse texture: nuts, raw fruits, and raw vegetables. Try not to vomit, cough, retch or strain. This can significantly affect the healing and effectiveness of your new antireflux valve. During the healing process, avoid foods and drinks that triggered your reflux in the past. You may reintroduce them slowly after Dietary Guidelines healing. To avoid chest pain take small bites, chew for The strength of your new antireflux valve is largely 30 seconds and gradually thicken the texture determined by how well it heals. What you eat and of your food. drink can dramatically impact the durability of your Remain in an upright position for 1 hour antireflux valve. You will be asked to follow a liquid after eating. diet followed by a mashed and soft food diet as Do not eat for at least 2 hours your newly reconstructed valve heals. before bedtime. If you experience heartburn, write down the food that gave you heartburn and avoid eating it. Talk Do not drink carbonated beverages to your doctor at your next visit about your food- or alcohol. associated symptoms. Remember, its normal for Avoid spicy foods. some people (non-GERD patients) to occasionally Avoid foods and drinks that are very hot experience heartburn from specific foods, and this or very cold. may mean that your valve is functioning correctly. Follow your doctor’s instructions to wean If your symptoms persist, contact your doctor yourself off antireflux medications. immediately. Do not smoke. During the 6-week post-procedure period, it’s important that you adhere to the following Avoid gas-forming, acid producing foods, guidelines: or foods that slow gastric emptying such as tomato-based products, peppermint, black pepper, caffeinated drinks, alcohol, onions, Eat 4 to 5 small meals consisting of soft green peppers, fatty foods, beans, spicy foods throughout the day. foods, citrus fruits, and fiber supplements. Take small bites and chew your food Taking over the counter anti-gas medications thoroughly for 30 seconds to avoid may be helpful. swallowing a large bolus of food. Weeks 1 and 2: Liquid Diet The fi rst 2 weeks after your procedure are extremely important. That’s why we ask you to be particularly cautious with your diet. You will stay on clear liquids for the fi rst 1-3 days after your TIF procedure. This diet contains only Be sure to drink a minimum of 4-8 oz of fluids that are clear and very low in sugar. However, water between each meal. it is not nutritionally balanced and will only be used a few days. Do not take large gulps. Sip clear liquids and rest between sips. Allow 20 minutes to Avoid beverages with alcohol, caffeine, drink ½ cup. You may sip on fluids all day if carbonation (soft drinks), or acidic drinks (tomato, you wish but at least 6-8 times per day. grapefruit, and orange juice). Take your prescribed medications. PPIs should be taken for at least 2 weeks and wean off according to physician Foods that are allowed: recommendation. If pills/capsules are Water, plain or lightly flavored larger than a peanut, discuss with your (non-carbonated) pharmacist if they can be halved, crushed Milk, decaffeinated tea, caffeine-free or if there are liquid options available to drinks minimize hard swallowing. Diet decaffeinated drinks Take vitamin/mineral supplements every (non-carbonated) day being mindful of pill/capsule size as Diluted electrolyte drinks noted above. This will help prevent vitamin Strained soups and mineral defi ciencies. Diluted, light, or diet apple or white It’s helpful to eat a very low fat diet to grape juice minimize heartburn symptoms. Non-acidic fruit or vegetable juices Restaurant foods are not recommended (without chunks) during the fi rst few weeks. Liquid puddings and creams Sherbets or Ice-creams (without chunks) The following protein supplements can be Milkshakes used starting on day 4: Baby food Protein-enriched commercially available shakes. You can also add one scoop of concentrated protein powder to your bowl of soup or glass of juice. During week 2, a liquid diet is still Shopping list weeks 1-2 recommended but you may add very liquid, potato-based and non-stringy vegetable mashes. Water, plain and lightly flavored (non-carbonated) This diet consists of high-protein full liquids and Milk, decaffeinated tea, blended solids. The portions should remain small caffeine-free drinks and not exceed ½ cup to help prevent vomiting and Diet decaffeinated drinks proper healing of your newly reconstructed valve. (non-carbonated) Your meals will be only liquid or blended. They may Electrolyte drinks include milk, vegetable or diluted fruit juice. Sip Apple juice or white grape juice Non-acidic fruit or vegetable juices liquid meals very slowly. Drink 4 oz (½ cup), over (without chunks) 20-30 minutes. Strained soups Eat 4-6 small meals each day. The amount you Liquid puddings and creams will be able to eat at one time is very small and Sherbets and ice-creams should not exceed ½ cup. Eat foods high in protein (without chunks) because they help your body heal from surgery. Milk-shakes Baby food Tips on how to blend foods: Cut foods into small pieces Recipes Place food into blender or food processor Protein Fortifi ed Breakfast Drink ½ packet Carnation Instant Breakfast Add liquid such as broth, juice, or milk ½ scoop of whey protein powder Blend or puree until smooth 4 oz skim milk Amount per serving (½ cup): 120 calories, Strain foods that do not blend in a 15 g protein completely smooth consistency Season foods to taste PB Protein Pudding 1 packet sugar-free pudding ¼ cup dry milk ¼ cup peanut butter 2 cups skim milk Amount per serving (¼ cup): 100 calories, 6 g protein Eggnog ½ cup skim milk ½ package Carnation Instant Breakfast ¼ cup liquid egg substitute Amount per serving (½ cup): 110 calories, 13 g protein Food Guide Day Day Weeks Weeks Yes No Post Procedure 0-3 4-14 3-4 5-6 Water (non-carbonated) Milk, decaffeinated tea, caffeine free drinks Diet and decaffeinated drinks, diluted electrolyte drinks Broth of any kind, strained soups (not tomato based) Diluted, light or diet apple or white grape juice low in sugar Non-acidic fruit or vegetable juice (without chunks) Clear liquids, Liquid puddings and creams Sherbets, ice-creams, milk shakes (without chunks) Drinkable yogurt (no chunks) Protein-enriched commercially available shakes Very liquid, potato-based mash Non-stringy vegetable mash Full liquids Full Baby food Cottage cheese Oatmeal Well-cooked & pureed vegetables (mashed potatoes Canned fruit (without skins) Bananas, melons, berries low fat food Soft texture, Soft eggs, tofu Moist, mashed boneless fi sh Well-cooked lean ground food (e.g. turkey) Small soft noodles Non-sticky rice food Cereals (softened in milk) texture Medium Soft cheeses Shopping list weeks 3-4 Weeks 3 and 4: Soft Diet Milk, fruit and vegetable juices This diet consists of blended foods with one new Tea, coffee solid food added daily. Portions should be small and not exceeding 1 cup to help prevent vomiting Potatoes and/or vegetables to mash and proper healing of your newly reconstructed Oatmeal valve. Puddings, ice-creams, sherbets Foods that are allowed: Butter and margarine Water, milk, fruit juices and Soups (without chunks) vegetable juices Tofu Tea and coffee (in small quantities) Well-cooked ground food: slowly Mashed vegetables and/or potatoes introduce fi nely ground fi sh Oatmeal or turkey Puddings, ice-creams, sherbets Butter and margarine Soups (without chunks) Shopping list weeks 5-6 Tofu Slowly introduce well-cooked, fi nely ground food such as fish or turkey Pasta (small noodles) and non-sticky rice Food to avoid: Thicker soups or soups with small Raw or undercooked food pieces of vegetables Alcoholic and carbonated beverages Sauces Pasta, bread Bananas Cakes, pancakes, waffles, cookies, etc.