I did not gain as much weight as many report. I was approximately 8 pounds heavier the morning after surgery. I have a little story about that, and it dovetails with your advice to be your own advocate, which I totally agree with.
In the ICU, it is their standard practice to put all OHS patients on IV diuretic so that you start eliminating the excess fluid from surgery. A couple of hours after being put on diuretic, I went into afib. The labs showed that my potassium dropped below the safe threshold after the diuretic, as reducing electrolytes is how the diuretic works to reduce body fluid. It turns out that afib is a well-known potential side effect from diuretics.
So they took me off the IV diuretic and got me back into sinus rhythm. I get on my PC in the ICU doing my homework about diuretics after OHS. It turns out that while diuretics after OHS has a benefit for high-risk patients with heart failure and patients with kidney problems, that there is no evidence of any benefit for better outcomes for low-risk patients without kidney issues. In fact, a two-armed trial concluded no outcome benefit at all for such low-risk patients from diuretic.
So, the next morning the nurse came in to give me my meds, including an oral diuretic. Given what I had learned and given that afib is a known potential side effect from the diuretic and given that I already went into afib once from the diuretic, I decided that I wanted to follow the evidence and not use a diuretic. It was a simple risk vs reward analysis. I was very nice about it, but firm. The ICU doctor then came to talk to me about it- you know the non-compliant patient who would not take his medication.
We had a good discussion about it. I explained my risk vs reward thinking and had him read the only published trial on low risk patients for diuretics. I told him that if he could give a good reason as to why I should take the diuretic that I would be happy to, but could see no reason to risk afib again without a good reason. He actually agreed with me and said that in his view, given that I went into afib from it before, it was the right decision to not take the diuretic. At the same time, they would be watching for hypertension and signs of abnormally high fluid retention. I fully agreed that if I showed signs of either I would go back on the diuretic.
I was doing great peeing off the excess fluid. They keep close track of how much you drink vs how much you pee out, and I was peeing off about 1.5 pounds per day. It is cute how they treat you when they come and see the full urine bottle. “Wow, you filled up the bottle all the way! Good job!” Kind of like when you are first training a toddler to use the toilet. It got to the point where I looked forward to the positive affirming remarks on how good a job I did filling the bottle.
However, with every 12-hour shift comes a new nurse and a new nurse practitioner for the floor and each new shift the new nurse practitioner would prescribe the diuretic again. I was well on my way to normal weight with normal blood pressure, so I always refused. Still they would tell me that their goal was to release me from the hospital at the same weight that I came in at, despite the lack of evidence that this is necessary. Sometimes there will be policies that they have in place that might not apply to every patient from an evidence based standpoint. It's kind of like- well, a lot of OHS patients have heart failure, so lets give them all diuretics to play it safe. But, afib is nothing to take lightly and I was determined not to go into it again for a blanket policy not backed by evidence.
Anyway, I held my ground and by the time I was released I was only about 2 pounds above where I was when I checked in. I do believe that often you have to be your own advocate and sometimes that can mean digging in your heels.