Escape_Pod

WE can develop due to thiamine deficiency. I'm particularly interested in this topic because my 1-year labs came back showing very low thiamine levels, despite faithful multivitamin supplementation, so I've added a B complex to my routine. I know others on the boards have also seen this development. Unfortunately, the full text of the study requires a subscription or article purchase, but you may be able to obtain through a local library. Just for the record, I did not experience persistent vomiting (or, actually, any vomiting at all) - noted as a major determinant here. Wernicke Encephalopathy in Subjects Undergoing Restrictive Weight Loss Surgery: A Systematic Review of Literature Data AbstractThe use of weight loss surgery is progressively increasing, and in recent years, restrictive bariatric surgery procedures have been more often used. Although thought to be associated with a lower incidence of post-operative side effects than malabsorpitive surgery, some cases of micronutrients deficiency have been reported because of an acquired thiamine deficiency; in this clinical setting, some cases of Wernicke encephalopathy (WE) have been described. Major determinants and predictors of this major neurological complication are currently unknown. The aim of this systematic review was to analyse literature data in order to address this issue. The main result of our systematic review was that persistent vomiting is the major determinant of WE in patients undergoing restrictive weight loss surgery. In addition, early thiamine supplementation can rapidly improve the clinical conditions, avoiding permanent deficiencies. On the other hand, given the wide variability of clinical and demographic characteristics, definite prognostic factors of WE occurrence and of clinical outcome cannot be identified. In conclusion, although our results are suggestive, further ad hoc prospective studies evaluating changes in micronutrients levels according to different types of surgery are needed. Copyright © 2014 John Wiley & Sons, Ltd and Eating Disorders Association.

Can you incorporate Protein powder without drinking shakes? I love my morning protein mocha (Click mocha, almond milk / hot Water, and a Starbucks via packet), but there's a lot you can do with Protein Powder. I mix protein powder into plain greek yogurt - I like Casein protein powder better than whey for this, as it's thicker and less gritty. I also make protein muffins with a bit of oatmeal, egg, vanilla protein powder, chopped apple, cottage cheese and cinnamon. I know it sounds weird, but it makes a surprisingly convincing muffin. I've found some great protein recipes online.

I don't have any experience with what you're describing, but I wondered if you're taking a probiotic? I started on one because my surgical nutritionist told us studies showed patients taking a probiotic had better weight loss (no idea why, but I figured it couldn't hurt!). I still take a daily probiotic, and I haven't had even a case of the sniffles in years (I'm sure now that I've said that I'll come down with a cold tomorrow). But if you're prone to stomach issues, a probiotic might be worth a try. I try to switch to a different brand every few months. (And on a mostly unrelated note, I still love my Protein shake in the morning (it's actually more of a protein hot mocha.) Hope you're feeling better!

Lisa, I have also gotten way off track, it's a recurring issue with me, and I know what I need to do, it's just a matter of not letting myself "forget" it once my weight gets back in my comfort zone. For me, personally, I cannot handle sugar in moderation. I know lots of folks can, and being able to have the occasional treat is key to staying on track. For ME, those treats have to be sugar-free, or I get sucked back in and get totally out of control, and it takes ages to drag myself back on track. I've got coming up on 4 weeks sugar-free under my belt, and it's SO much easier to stay on track once I get myself there. I'll second the suggestion for Click, I love the mocha flavor. You can order it from Amazon, I'm not sure I've ever seen it in a store. Jane's response is awesome on so many accounts. It truly is about being brutally honest with yourself about what will work for you, vs what's an excuse not to give up something you've become attached to. I think if you can get 2-3 solid weeks of good eating habits behind you, you'll begin to really feel a difference, and it won't be such a struggle, but the key is to arm yourself with every possible tool you can think of for those 2-3 weeks. MyFitnessPal helps me, journaling helps sometimes, checking in on WLS sites like this one, or blogs that inspire me help keep me focused. Another strategy that's worked for me before is to join a challenge of some sort. MyTinyTank runs 6-week challenges every few weeks on a private Facebook page. Unfortunately you just missed the start of one (Nov. 29), but check out her website for more info (just search for MyTinyTank). If you're on MyFitnessPal, send me a PM if you'd like to connect there for daily checking-in and support. I'm walking the same path, I'd be glad of some company in getting my weight back under control.

Abstract Long-term weight regain is a fearedcomplicationof restrictive bariatric operation. The Sleeve Gastrectomy (SG) is still in its early stages as a primary bariatric surgery and long-term data about its efficacy remains limited. From the long term studies available it seems that approximately one-fifth of SG patients might be at risk for long-term weight regain and about 5-10% of total SG patients will require surgical management forit. The possible mechanism behind this weight regain is slowly being addressed. Patient noncompliance with dietary and lifestyle regimens is the most practical factor that needs to be considered and can be prevented with a multidisciplinary team. Long-term gastric pouch dilatation and gut hormone modulation are other theories that have been proposed to explain this weight regain. Successful management strategies to combat weight recidivism include revisional bariatric surgery, performing a resleeve gastrectomy or the addition of an adjustable band in the primary banded sleeve gastrectomy. However, the safety of revisional bariatric surgery is a concern and should be performed only by an experienced bariatric surgeon. It remains that as the SG continues to grow as a popular choice for the management of morbid obesity, more concrete long term information will become available to address the how and why weight regain occurs. http://omicsonline.org/open-access/the-sleeve-gastrectomy-and-how-and-why-it-can-fail-2161-1076-4-180.pdf

Years and years ago I had a bout of really bad heartburn, or at leat that's what I was told I had. It was nothing like the mild burning, or burping stomach acid I'd experienced before. This was serious chest pain, radiated all the way through to my back. Painful enough to bring tears to my eyes - scared the bejeebers out of me. Had a couple of bad episodes, and nothing like that since. Sound familiar? So, yes, I'd say it could have been heartburn. I've also heard of esophageal spasms, but don't know anything more about them.

Congratulations, and thank you for sticking around to share your experience!

I had one or two pills I took immediately post-op that were pretty nasty, though not as bad as what you're describing. Basically, there wasn't anything that was going to mask the taste, I had to settle for not letting it ruin the 2 tablespoons of pureed whatever I was eating. I tended to crush it (or for the capsule, pour out the capsule contents) into the tiniest amount possible of something in a spoon - usually applesauce - just enough to be able to get it in my mouth, and as much as possible, swallow without letting it hit my tongue. Quick rinse with just a tiny sip of Water. Shudder, and remind myself it's only for a couple of weeks. Once I hit the two week point, I could take most pills. It really depends a lot on the pill form. Some things you can get in a smaller pill so it's ok to swallow whole. Some things you can cut in half. Capsules tend to not work so well immediately post-op anyway, because the time-release formulas don't work so well for us.

No, I don't meant to make light of the risks of untreated nutrient deficiencies, which is why I'm vigilant about taking my supplements and having blood work done regularly to catch issues early and address them. But I don't see that I have much of a choice about staying on a PPI, either. It could be worse, at least the PPI works for me, most of the time. The info on calcium tests is helpful - I'll make a note to review with my PCP when I'm in next. (My surgeon has moved to Florida, so I no longer have routine visits with a bariatric practice).

Well, I'd like not to be on a PPI long-term, but short of a miracle cure, I don't see getting off it any time soon. And having lost my mother to esophageal cancer a few years ago, I think I'd prefer to deal with nutritional deficiencies than the dangers of untreated / insufficiently managed GERD.

I worry about folks who think that healthy eating and having VSG rather than RNY will protect them from deficiencies. I consider my intake to be very healthy, AND I take good quality bariatric Vitamins, and still ended up with deficiencies. Maybe it's just marketing hoo-ha, but I'm willing to believe it matters which brand of vitamins you take, because the source of the nutrients differs, and some are more readily absorbed than others. We were all told to take Calcium CITRATE, not CARBONATE, right? So it makes sense to me that other nutrients in a multi-Vitamin may also differ. I'm willing to pay more to take a Multivitamin that's formulated for post-ops. And while it's true that we don't have the same risks of deficiencies as RNY post-ops, we still have smaller stomachs, and many of us are on PPIs long-term, impacting absorption of nutrients that require an acidic environment. I'm vigilant, but I still ended up extremely low in thiamine and Iron. I keep up with my tests, and I focus particularly on calcium, since I can't check that with a blood test. I had a bone density scan done along with a DEXA scan a couple of years ago, but since most women in their early 40s don't have bone density scans done, my PCP tells me there's not good data to compare my results to. I'll test again in a couple of years so I can compare to my prior results.

BJs Bariatrics also sells Syntrax nectar sampler packs - 11 packets (keeps it under the max weight to ship first class) for $14.95 plus $5.12 shipping. It's more expensive than direct from Syntrax, but you get to pick your flavors in any combo you want. (Unless that's changed, that didn't use to be the case with Syntrax - you got one of each).

Sorry Jane, I intended that question about Iron for OregonDaisy! My bad... Lynda, I've heard that taking products with a stool softener long-term can cause your digestive tract to get lazy, essentially resulting in rebound constipation down the road when you stop the softener. I wondered if your program had addressed that? I'm more concerned about addressing the iron levels, but I do wonder about taking them on an ongoing basis... The FerroSequel seems to be working well for me to bring my levels back up (on top of a regular iron supplement, avoiding caffeine, timing them well separated from Calcium, and taking with Vitamin C). I'm not sure where I'd find the time to go in for regular iron infusions, so I'm glad I don't have to.

The further out you are from surgery, the more you'll find your restriction varies depending on what you're eating. A serving of chicken breast or a turkey meatball or two will fill me up and stave off hunger longer than a serving of greek yogurt or veggies, or cheese. Dense Protein is your friend. I don't see any meat products in your list of what you're eating, are you a vegetarian? You may be able to get advice from other vegetarians on how to maximize satisfaction with particular foods.

Jane, Just out of curiosity, which Iron supplement were you taking? I too battle anemia, tested with extremely low ferritin levels with last bloodwork, and have been taking Ferro-Sequel. It seems to keep me more regular than I was before starting supplements, but I'm not particularly prone to constipation.

I've been seeing more hair loss again recently, I'm going to try supplementing with Zinc - that's supposed to help, we'll see....

Awesome! Congratulations!! I don't think you look dorky, I think you look strong and skinny, and very, very happy.

Wow, some really great info here! I'm particularly glad you mentioned the birth control pill malabsorption issue - that one definitely raised an eyebrow. I see a lot of surprise pregnancies on the forums, but had attributed it to various other factors and considered it more of an issue in the first year post op.

I noticed it post-op, but things eventually returned more to normal for me. Of course, long-term, simply changing what you eat will cause your taste-buds to gradually adjust as well, so some things I use to enjoy are still too sweet, but I chalk that up to a change of eating habits. I'm rather certain if I went back to eating Reeses PB cups I go back to loving them in no time. Not going there...

I'd say you could definitely lose those vanity pounds if you want to, but that's the question - how badly do you want to? If you're already pretty much "maintaining" at your current calorie intake and exercise level, you could adjust to get those pounds off, but if you increase your calories again once you meet goal, or decide you'd rather go back to your walks, those pounds will come right back again. It's a balance, and it's a matter of deciding what your priorities are, and what you want your life in maintenance to look like. To quote one of my favorite bloggers, it's about living the healthiest life you can ENJOY.

Lisa, I'm sorry for everything you're suffering with right now. I know your focus and energy need to be spent on your husband at the moment, but I thought I'd mention one possibility for your esophageal spasms. When I was investigating sleeve surgery, I spoke with a local surgeon who handles some of the more challenging bariatric cases. He was concerned about VSG in my case because of my history with GERD, and in that context mentioned a patient he was treating who had developed very severe GERD post-sleeve surgery. I remember he indicated she was receiving regular botox injections (esophageal, presumably) to manage symptoms. He made it clear this was treating symptoms, not the cause, and was not a workable long-term solution. But, I thought it was worth mentioning as a possibility for treating your symptoms short-term.

So, I'm struggling with this a bit because, even though I'm a vet, I'm not exactly in maintenance, since I'm working on taking off regain. Usually I aim for under 1200 calories, 40g carbs a day, and don't eat back exercise calories, though I occasionally go a bit higher (maybe 100 calories) if my workout's over 500-600. However, the local snow pack is melting, which means my weekend hikes are getting longer these days. I do pack some trail food, but frankly the hiking suppresses my appetite somewhat, and I don't want to get a cramp, and I'm enjoying being distracted from thoughts of food. So, it's not uncommon for me to burn 2000 or even 3000+ calories (as estimated with a heart rate monitor) if I'm hiking with substantial elevation gain over a course of 5 hours or more. Combine that with a lighter Breakfast before hitting the trail, suppressed appetite, and being away from food for a large chunk of the day, and I'm often still coming out at 1200 or less intake, even if I eat a little heavier than usual in the evening. Carbs are likely to be a little higher than a normal day, though not net carbs ( A Quest bar is my go-to hike snack). In my first year post-op, I wasn't able to manage such strenuous hikes, but I'd still bonk when I got home. I'd have to take a nap, and was pretty worthless the rest of the day. Now, the rest of my day is pretty normal. Sometimes I feel a bit wobbly at the end of a hike, or develop what I think of as a low-blood-sugar headache, but mostly the lack of calories doesn't feel like it's impacting my hiking stamina. That said, I'm beginning to suspect some effects the next 1-2 days. I often find I'm unusually ravenous in the morning for a day or two afterwards, and being too hungry can lead me back into some pretty destructive eating habits. I have a long history of binge eating that I still fight (more successfully these days, but still...), and I'm definitely more prone to a binge in the day or two after a long strenuous hike. Not sure whether it's just my fat brain using the exercise as an excuse to overeat, or whether I'm setting myself up a bit. I'd appreciate some input.

Thanks for your comment, but from someone who's never been an athlete of any sort, what exactly does "recover properly" entail? I know I need to allow myself rest days (or at least alternate exercise so that I'm using different muscle groups). But beyond that vague idea, I'm a bit lost. My needs in this regard may be a bit different, because I'm not in training for a longer or more demanding event. I'm just out enjoying the trails whenever I can, and at this point my distance is limited as much by my time (and my lack of desire to haul an overnight pack) than by my physical stamina. Despite being a complete novice, I seem to have gained enough strength to accomplish my goals, and I'm still seeing improvements. I'm sure I could do better, but if I were to get serious about training it would probably be in another area. Mostly I'm worried about the mind games going on that tempt me to overeat later, or under-eat the day of a long hike.

Once I get started with sugar, it's like I'm the pre-op me. I can't get enough of it, I'm obsessed with food all day long, I'm hoarding, and sneaking, and I put on weight like nobody's business. It took me a VERY long time to come to terms with it, but I simply cannot handle sugar in moderation. I consider myself an addict. As of this morning I still have 8.5 pounds of regain to lose (and I've been working on it since just before Christmas), but I'm thrilled to be back where I am - that's how out of control things got for me. If you struggle with sugar withdrawal, you might try L-Glutamine or magnesium for a few days and see if that helps. Good luck!

I'm paying close attention today - I really believe a willingness to THINK and analyze rather than react (EAT!), is my best defense. Getting a bit more Protein today, did a midday workout to help with stress and appetite, and have a plan for after work to keep me out of the pantry. Gotta watch those mind games for sure!