James Marusek

My surgeon's office recommended taking 3 Flintstone vitamins daily. I encountered no problems with taking these. They were readily available and cheap. My blood workups showed they were effective. I am over 5 years post-op. I use to pick these up by large bottles at Sam's club. But for some reason, it seems like they transitioned to Flintstone gummy vitamins. And as a result the large bottles are no longer available. I was warned by my surgeon's office to not use gummy vitamins because they would not be absorbed properly. I tried using other children's multivitamins, but I was dissatisfied with them. They tasted bad. And also they changed color from light to very dark over a few months. Around the second or third year I transitioned to taking normal multivitamins.

Generally on your hospital discharge directions, there is a list of conditions that describe when to call your surgeon's office. On my list there is one that says "Uncontrolled or increased abdomen pain". So your idea about calling your surgeon's office tomorrow is a good idea. (Why not today?) I used an abdominal binder for a few weeks right after surgery. This helped to minimize abdominal pain. Most of the pain I experienced after surgery was gas pain. Walking helped to relieve this pain. Also generally in a hospital one is administered antibiotics. This kills off not only the bad bacteria but also the good gut bacteria. These colonies of good gut bacteria need to be reestablished after the antibiotic treatment ceases. This is done by taking probiotics. It will help your colon work properly.

Generally when you are released from the hospital you are given Discharge Instructions. This includes a list of symptoms for which you are to contact your surgeons office and report. In my list, one of the items was "uncontrolled or increased abdomen pain" It sounds like you have uncontrolled pain and it sounds like your pain is increasing. But you indicated it was on your left side which I normally wouldn't associate with abdominal pain. Anyways it might be prudent to contact your surgeons office and let them know what is going on.

The guidelines that I received 5 years ago from my surgeon was weekly for DS patients. I am a RNY gastric bypass patient, and my guidelines were B1 daily. After the first year, my surgeons office modified my requirement to weekly.

The following are the guidelines for Duodenal Switch patients from the office of the surgeon who performed my surgery: * Four children's chewable complete multivitamin's daily. * 1800-2400 mg calcium citrate daily. * a total of 5000 international units of Vitamin D3 daily. * 1000 micrograms of sublingual B12 weekly or a B12 injection monthly. * 100 mg. Thiamin (Vitamin B1) weekly.

Dumping syndrome is a condition that can develop after surgery to remove all or part of your stomach or after surgery to bypass your stomach to help you lose weight. The condition can also develop in people who have had esophageal surgery. Also called rapid gastric emptying, dumping syndrome occurs when food, especially sugar, moves from your stomach into your small bowel too quickly. Signs and symptoms of dumping syndrome generally occur right after eating, especially after a meal rich in table sugar (sucrose) or fruit sugar (fructose). Signs and symptoms might include: Feeling bloated or too full after eating Nausea Vomiting Abdominal cramps Diarrhea Flushing Dizziness, lightheadedness Rapid heart rate Source: https://www.mayoclinic.org/diseases-conditions/dumping-syndrome/symptoms-causes/syc-20371915 So the ability of sugar to cause dumping syndrome in gastric bypass patients is correct but not necessarily fats.

Good luck. I am sure it will give you some relief.

If you have RNY gastric bypass surgery, then the part of the stomach that normally processes fats and sugars has been cut off. Therefore if you consume fats and sugars it can lead to dumping syndrome. After about a year, your intestines will figure out something is wrong and adppt this function. Therefore for Gastric Bypass patients, this restriction will go away. So generally when you reach the maintenance phase, fats are reintroduced back into the diet because fats are important in hunger control. So in the maintenance phase, my nutritionist recommended a diet with equal levels of fats, carbs and protein. But protein always comes first. If you had sleeve surgery, I am not sure of this requirement.

It is a little common for individuals to develop a stricture after weight loss surgery. Generally this condition is treated by endoscopic dilation. Also be aware that some patients will require this procedure a few times. According to the internet: Formation of stricture is another potential complication occurring after LSG [Laparoscopic Sleeve Gastrectomy]. It could present either acutely after surgery due to tissue edema or more commonly in a delayed fashion. Presenting symptoms include food intolerance, dysphagia or nausea and vomiting. Although kinking of the stomach following LSG has been reported, the most common site of stenosis is at the incisura angularis. An upper gastrointestinal study or endoscopy is usually diagnostic. Treatment options depend on the time of presentation. A stricture diagnosed acutely after surgery can sometimes be treated conservatively with bowel rest (nothing by mouth), rehydration with intravenous fluids and close observation. In the absence of other pathologies (e.g., abscess, leak), these strictures will spontaneously resolve with no need for further intervention. Failure of conservative management warrants endoscopic dilation. In contrast, chronic strictures usually require further intervention. These include either endoscopic or surgical treatments. Treatment options depend on the length of stenosis. Endoscopic dilatation is an invaluable tool used in this setting of a short segment stenosis. Successive treatments in 4- to 6-week intervals are adequate to treat stricture and ameliorate patient symptoms. In contrast, long segment stenosis and failure of endoscopic management demands a surgical intervention. Options include laparoscopic or open seromyotomy or conversion to Roux-en-Y gastric bypass. Dapri and colleagues26reported their experience with laparoscopic seromyotomy in patients who had LSG. These investigators reported successful results with this treatment. Parikh and colleagues reported an incidence of 3.5% of symptomatic stenosis following LSG in their series of 230 patients; 2 patients required conversion to a Roux-en-Y gastric bypass owing to failure of endoscopic management. Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3788014/

Right after surgery, many people sleep on recliners instead of their beds.

The three most important elements after RNY gastric bypass surgery are to meet your daily protein, fluid and vitamin requirements. Food is secondary because your body is converting your stored fat into the energy that drives your body. Thus you lose weight. Weight loss is achieved after surgery through meal volume control. You begin at 2 ounces (1/4 cup) per meal and gradually over the next year and a half increase the volume to 1 cup per meal. With this minuscule amount of food, it is next to impossible to meet your protein daily requirements by food alone, so therefore you need to rely on supplements such as protein shakes. Many experience problems drinking protein shakes. I hated them. But in the beginning I drank them, three 16-ounce protein shakes a day, in order to meet my protein requirements. You do not have to like protein shakes only tolerate them. There are many varieties of protein shakes available today. Experiment until you can find one you can tolerate. I used Muscle Milk Light (Vanilla Creme) powder blended with water and a half a banana. That worked for me. But on the opposite end of the spectrum, you might try premixed Isopure. Without sufficient protein, your body will scavenge protein from other areas of your body, such as your muscles. Protein is extremely important after surgery as its job in the body is to build and maintain tissues including your body's major organs and skeletal muscles. Protein deficiency, when continued over a long period of time can cause a disease known as protein caloric malnutrition. Common symptoms are poor healing, fatigue, hair loss and muscle wasting. Immediate post op, protein promotes healing of the staple line and incisions.

I had gastric bypass. For the first 4 weeks I was on full liquids and the next 4 on pureed foods. It wasn't until I reached week 9 post op that I was allowed to transition to solids. The transition to solids can be rather difficult. There is no need to rush this transition. I found that softer foods (such as chili and soups) went down much easier than hard foods (such as steak and chicken) therefore I stayed with these for a long time. After surgery, I lost my hunger. This occurred at my transition to solid foods. When I was in liquid and pureed stage, I did not feel this effect. I didn't feel full. After surgery, your stomach is the size of a fist. If you put more food onto your stomach than it can hold, it will produce dumping, vomiting in this case. This is very noticeable in the solid food stage. The experience is quite awful. But your body will produce pretriggers such as sneezing, instant loss of appetite, mucous formation, hiccups to warn you when you are close to this point. If you stop eating when these pretriggers first appear, you will avoid dumping. Just become attuned to your body and when a pretrigger occurs, do not eat even one more bite. I have included some chili and soup recipes at the end of the following article. http://www.breadandbutterscience.com/Surgery.pdf

After my gastric bypass surgery, I had several incision point. I think it was 7. Over the first year or so they all disappeared. There was one in particular that produced a large bump. This was the last one to disappear. I asked my surgeons office about this. They said this is the point where most of the surgery was performed within my body. That is the reason why there was a hard bump.

According to the internet: A stricture is when the opening to or from the stomach becomes inflamed and/or blocked preventing all or some of the food from properly entering the stomach or intestines. Strictures can be either acute or chronic (very quick onset or an ongoing issue after surgery). What to look for? Nausea or vomiting. Difficulty swallowing. Food intolerance. When to call your doctor? As always call your doctor if you think something is wrong. If nausea and vomitted is present every time you eat, or you are having difficulty swallowing, contact your doctor immediately. How common is a stricture? According to this study, strictures were present in about 3.5% of patients after surgery. However, while a stricture can be serious, often they are treated with a simple endoscopic dilation (inserting a camera down your throat under anesthesia to widen the stricture). How are they treated? If the stricture is diagnosed shortly after surgery, it can usually be treated with rest, nothing by mouth, and intravenous fluids. If the stricture is diagnosed a few weeks or more after surgery then the treatment will depend on the length of the stricture. For short stenosis (narrowing of the stomach) the physician will typically perform an endoscopic dilatation. Multiple treatments every 4 to 6 weeks will typically clear the stricture. For longer stenosis, the phsyician may have to intervene surgically and convert the patient to gastric bypass. Source: https://www.obesitycoverage.com/uncomplicating-gastric-sleeve-complications/ Your body needs time to heal, so there is no reason to accelerate the transitions between liquid/puree/ solid food stage. Just take your time with these transitions.

The transition from liquids to pureed food to solid foods can be difficult. There is no need to rush things. Just take your time with these transitions.

Many experience problems drinking protein shakes. I hated them. But in the beginning I drank them, three 16-ounce protein shakes a day, in order to meet my protein requirements. You do not have to like protein shakes only tolerate them. There are many varieties of protein shakes available today. Experiment until you can find one you can tolerate. I used Muscle Milk Light (Vanilla Creme) powder blended with water and a half a banana. That worked for me. But on the opposite end of the spectrum, you might try premixed Isopure. If you tried all the various varieties and still are unsuccessfully, then there is the fallback of fortified milk. 32 ounces of 1% milk fortified by adding 1 cup of dried milk provides 56 grams of protein. It also takes a dent out of meeting the fluid requirements. Mix up a pitcher and drink a little throughout the day. Without sufficient protein, your body will scavenge protein from other areas of your body, such as your muscles. Protein is extremely important after surgery as its job in the body is to build and maintain tissues including your body's major organs and skeletal muscles. Protein deficiency, when continued over a long period of time can cause a disease known as protein caloric malnutrition. Common symptoms are poor healing, fatigue, hair loss and muscle wasting. Immediate post op, protein promotes healing of the staple line and incisions.

If you have GERD it is important to have the bypass because in many cases the sleeve will only make this condition worse. Several sleeve patients had to undergo revisions because Gerd became a significant issue. I had high blood pressure prior to surgery and I was taking two types of prescription medicine to control the condition. Within a couple weeks after my gastric bypass surgery, I was off all my high blood pressure meds and I haven't taken any since. I had surgery over 5 years ago. I also had severe acid reflux (GERD). That condition also went into remission after surgery.

Right after surgery your body is altered. Your stomach will no longer accepts many foods and as a result one experiences dumping syndrome. But over time, your intestines will detect that something has changed and will alter itself and allow you to accept these types of food again. So right after surgery I became lactose intolerant. But then a couple months later this problem disappeared. During the weight loss phase I avoided fats. But then when I reached the maintenance phase, I found that my body could accepts fats again into my diet without any adverse affects. So you might retest yourself and see if you are still lactose intolerant and see if fats produce dumping syndrome.

Congratulations. 😀😊😎☺️

I had RNY gastric bypass surgery over 5 years ago. I have documented my experiences in the following two articles: http://www.breadandbutterscience.com/Surgery.pdf http://www.breadandbutterscience.com/Surgery2.pdf From my experience, there are two phases to weight loss surgery. These are the weight loss phase and the maintenance phase. I feel the medical community pretty much has the guidance for the weight loss phase down pat. But they seem at a loss in the maintenance phase. Better guidance is needed here. Much of this transition has to do with the change in dieting routine between the two phases.

Many patients find it difficult to meet their daily protein and liquid requirements during the first couple weeks after surgery. This is because your body is in a major heal mode. Just keep working towards those goal each day and you should soon be able to meet them.

According to the internet: Nausea and vomiting are the most common complaints after bariatric surgery, and they are typically associated with inappropriate diet and noncompliance with a gastroplasty diet (ie, eat undisturbed, chew meticulously, never drink with meals, and wait 2 hours before drinking after solid food is consumed). If these symptoms are associated with epigastric pain, significant dehydration, or not explained by dietary indiscretions, an alternative diagnosis must be explored. One of the most common complications causing nausea and vomiting in gastric bypass patients is anastomotic ulcers, with and without stomal stenosis. Ulceration or stenosis at the gastrojejunostomy of the gastric bypass has a reported incidence of 3% to 20%. Although no unifying explanation for the etiology of anastomotic ulcers exists, most experts agree that the pathogenesis is likely multifactorial. These ulcers are thought to be due to a combination of preserved acid secretion in the pouch, tension from the Roux limb, ischemia from the operation, nonsteroidal anti-inflammatory drug (NSAID) use, and perhaps Helicobacter pylori infection. Evidence suggests that little acid is secreted in the gastric bypass pouch; however, staple line dehiscence may lead to excessive acid bathing of the anastomosis. Treatment for both marginal ulcers and stomal ulcers should include avoidance of NSAIDs, antisecretory therapy with proton-pump inhibitors, and/or sucralfate. In addition, H pylori infection should be identified and treated, if present. 1. So generally the advise here is to avoid NSAIDs such as aspirin and excedrin. 2. Use a proton-pump inhibitor or sucralfate which is a gastric acid inhibitor. [My surgeon directed me to use Omeprazole (OTC - Prilosec) for the first year after surgery so that my stomach would heal properly. After that to discontinue use. I did. I am now over 5 years post-op.] 3. Make sure you are tested for H Pylori Infection. This is a very common infection. About half of the world population has it. And it is very difficult to kill. It may take several treatments of antibiotic cocktails to kill it.

Yes it is common after surgery. Lovenox (Enoxaparin) is an anticoagulant that helps prevent the formation of blood clots. Lovenox is used to treat or prevent a type of blood clot called deep vein thrombosis (DVT), which can lead to blood clots in the lungs (pulmonary embolism).

I had RNY gastric bypass surgery over 5 years ago. It was probably one of the best decisions I ever made. Here is a link to my experiences with the surgery. http://www.breadandbutterscience.com/Surgery.pdf

Many times there are pre-triggers that will occur warning you if you are about to exceed the amount of food your stomach will hold. These will vary between individuals. Some common ones are sneezing, excess mucus, hiccups, the taste of food radically changing taste. Most times if I stop eating when I hit a pre-trigger, I will not dump. So if you are afraid of dumping, learn your body pre-triggers.