James Marusek

The first few days home after surgery can be a little rough when it comes to bedtime and sleeping. Many people sleep on a recliner during the first couple days. Swallowing vitamin can be difficult at first, so it might be wise to have a pill crusher or pill splitter handy. A complete set of measuring spoons. Your taste buds may change after surgery. So what you find agreeable may taste simple awful after surgery. So it is good to have a variety pack of various protein shakes to try until you can downselect a type you like. Sometimes you can find these sample packs at places like GNC or over the internet. I made my own protein shakes from powder. One needs a blender such as a Ninja blender to do this effectively. They give me a small plastic spoon when I left the hospital. I do not like plastic but I searched around and found one that was the same size as the plastic spoon and I use that even today when I eat. Most food that you buy in preparation for the surgery will go to waste. Buy some crystal light to make the fluids go down easier. Also frozen sugar free popsicles are really good during the first month after surgery.

One of the possible side effects of rapid weight loss after undergoing weight loss surgery is orthostatic hypotension or orthostatic intolerance. These terms describe a significant drop in blood pressure upon standing from a seated or reclined position. Drip in blood pressure causes a decrease in blood flow to the brain. There are several studies discussing this after RNY gastric bypass and sleeve gastrectomy. However, this can also be an issue post Duodenal Switch. The process is still not completely understood but can be due to several factors. Rapid weight loss, sympathetic nervous system dysfunction, dehydration, electrolyte imbalance, malnutrition, thyroid issues, cardiac issues, post prandial hypotension (blood pressure lowering after meals due to blood flow shifting to the gut) or medications are all suspected as possible cause for orthostatic hypotension. Source: https://www.dssurgery.com/orthostatic-hypotensionintolerance/ Prior to weight loss surgery I had high blood pressure and I was taking 2 types of prescription meds for that condition. A few weeks after surgery, this condition went into remission and I stopped the medication. If you are in a similar situation, perhaps a readjustment or elimination of your prescription may be in order. Also meeting your daily fluid requirement is very important and if your body gets dehydrated, it can cause this problem.

Bad breath is one of the most under-expected concerns that frequently develops after weight loss surgery. While it is not something that impacts every weight loss patient in the same way, it is something that should be recognized following your bariatric procedure. There are several primary causes that can cause bad breath to develop following your bariatric procedure. These include: * Dehydration * The inability of food to exit the stomach pouch * Ketosis caused by rapid weight loss While bad breath may not be as severe a health issue following surgery as other potential concerns, it is something that can interfere with your quality of life and general comfort level, and therefore is worth addressing. Luckily, bad breath is usually preventable or treatable by understanding the precise cause of the issue, and taking several basic preventative steps. Source: https://www.flowersbariatriccenter.com/patient-resources/health-issues-after-weight-loss-surgery/bad-breath-after-weight-loss-surgery/ Ketosis can cause dry mouth. One of the solutions is to rinse you mouth with Biotene Mouthwash. Here is an article about the subject. https://ketoconcern.com/dry-mouth-keto-diet/

Reactive hypoglycemia is low blood glucose (sugar) that occurs within four hours after eating. Symptoms of reactive hypoglycemiamay include anxiety, fast heartbeat, irritability (feeling very stressed or nervous), shaking, sweating, hunger, dizziness, blurred vision, difficulty thinking and faintness. But, reactive hypoglycemia post–gastric bypass generally can occur in patients one year or more after their bariatric surgery. ... The further out from surgery you are, the more tuned in to your body and reactions to food you become. Since you are 9 days post-op, I suspect this is not the problem. Another possible explanation is that you were diabetic prior to surgery. If that was the case and you were taking blood sugar medicine, it might be time to reduce the amount of medicine your were taking. So you might want to check with your doctor and reset your prescription. I was diabetic prior to surgery and I went off all my prescription medicine the day I left the hospital after surgery. Another possibility is that it is not a blood sugar problem but rather an electrolyte imbalance. Common electrolytes include sodium, calcium, magnesium, and potassium. ... When the amount of electrolytes in your body is too high or too low, you can develop dizziness, cramps, and problems with an irregular heart beat (heart rhythm) or symptoms of mental confusion. This may happen if you don't take in enough fluids daily. Another possibility is dizziness can be caused by a blood clot. Embolism can occur when an embolus, or blood clot, forms around a heart valve that is not working properly, or is released within the arteries to the brain, causing a stroke. The effects of a stroke may include temporary dizziness. However, if the embolus travels to the vestibular system, it can cause severe dizziness. This is a very serious condition. Or there are other possible causes for dizziness and fainting. I would refer to your hospital discharge directions. There should be a page that describes when to contact you surgeon's office. On my discharge directions it states: Chest pain, rapid heartbeat and/or dizziness. Better to be safe than sorry!

Most weight loss surgeries today are performed using minimally invasive techniques (laparoscopic surgery). This is how my surgery was done, I had 7 incision points. The one area where they did the most work produced a large knot. It took around 6 months for that knot to go away. In general most of the healing takes place in the first few weeks, but it does take awhile for it all to go away completely. Since you had 3 surgeries at once, you will have a longer recovery time. Over my lifetime I have had 2 hernia operations. One was done where they opened me up and the other was done laparoscopically. That made quite a difference in recovery times. I think when they opened me up, for around the first month, I could hardly even get up without help. In the laparoscopic operation, I was up and about in a weeks time.

It has been a long time since I went through the Psych Eval. As I recall the two outcomes of the eval are: You are cleared to go forward with the surgery, or You need to resolve your psych issues first before you can proceed.

According to the Internet: Side effects of using phentermine are dizziness, dry mouth, difficulty sleeping, irritability, nausea, vomiting, diarrhea, or constipation may occur. If these effects persist or worsen, notify your doctor or pharmacist promptly. This medication may raise your blood pressure.

I only had the gastric bypass without the other operations. In my case it took 6 months to fully recover. But each day it got a little better.

You're sleeve is a tool. It is still there. I talked to my nutritionist a few years ago about this subject. She said individuals that experience this can reverse the trend. But she said the weight loss doesn't happen overnight. Essentially the amount of time that you were binging is approximately equal to the amount of time to shed the weight again. So if you are bingeing for the last 6 months, it might take you 6 months to lose that 40 pounds regain. So be patient and persistent.

RNY Gastric bypass surgery should help with GERD and sleep apnea. It does not fix a hiatal hernia. That will need a separate operation to correct. But I suspect that operation may be done at the same time as the gastric bypass surgery.

Generally if you develop an ulcer, you will find it difficult to keep food down and experience incessant nausea and vomiting. But these symptoms can also happen if you develop a stricture. 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.

Two other thoughts passed through my mind. 1. It is important to take a regiment of probiotics anytime you were treated with antibiotics. Antibiotics not only kill the bad bacteria but also destroy your good gut bacteria. It is important to restore these colonies and you accomplish this with probiotics. 2. You may also be suffering from the effects of GERD. You are taking proton-pump inhibitors so that should help to keep that under control. There are various types of proton-pump inhibitors and some patients respond better to one form of treatment than another. Pantrozole vs. omeprazile vs. protonix vs. others. Work with you doctor and find the best fix for you.

So it sounds like you are meeting your daily requirements for protein, vitamins and fluids. So that is the important thing. From what you said I do not think you have a stricture. A main part of the problems that you experienced was due to the blood clot that made its way to your lungs, a pulmonary embolism. This was a life threatening condition. You experienced bronchitis twice and got pneumonia. This would be my main focus. According to the Internet: Your treatment for a pulmonary embolism depends on the size and location of the blood clot. If the problem is minor and caught early, your doctor may recommend medication as treatment. Some drugs can break up small clots. Drugs your doctor may prescribe include: - anticoagulants: Also called blood thinners, the drugs heparin and warfarin prevent new clots from forming in your blood. They can save your life in an emergency situation. - clot dissolvers (thrombolytics): These drugs speed up the breakdown of a clot. They’re typically reserved for emergency situations because side effects may include dangerous bleeding problems. Surgery may be necessary to remove problematic clots, especially those that restrict blood flow to the lungs or heart. According to the Mayo Clinic, some surgical procedures your doctor may use in the case of a pulmonary embolism include: - vein filter: Your doctor will make a small incision, then use a thin wire to install a small filter in your inferior vena cava. The vena cava is the main vein that leads from your legs to the right side of your heart. The filter prevents blood clots from traveling from your legs to your lungs. - clot removal: A thin tube called a catheter will suction large clots out of your artery. It isn’t an entirely effective method because of the difficulty involved, so it’s not always a preferred method of treatment. - open surgery: Doctors use open surgery only in emergency situations when a person is in shock or medications aren’t working to break up the clot. Source: https://www.healthline.com/health/pulmonary-embolus#treatment So I suspect that you were on medicine to dissolve away the blood clot. Once it has been taken care off they probably put you on some medicine to prevent new blood clots from forming. The article also mentioned two other things that are critically important for you. These are wearing compression stockings and exercising (such as walking 30 minutes per day). Now back on the food issue. In my case I went for over a year with minimal food intake. I lost almost half my weight in 7 months. My body converted my stored fat into the energy that drove my body. So long as I met the other requirements fluids, vitamins, and protein, my body was just fine with the minimal food intake. That was over 5 years ago and I am just fine. From my perspective, I found the transition to solid foods (such as chicken and steaks) to be difficult so I relied on softer foods (such as soups and chili) and still do to a large extent. These are not normal chili and soups but rather home made ones that are doubly fortified with protein. As a result I reduced and stopped the protein shakes almost 4 years ago when I could obtain my protein from my meals. I have provided recipes for these at the end of the following article about my journey. http://www.breadandbutterscience.com/Surgery.pdf

I had RNY gastric bypass surgery whereas you had the sleeve. There are some similarities. 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. So how are you doing on meeting your daily protein, fluid and vitamin requirements? Generally when you eat a minimal amount of food, the protein requirement is met by protein shakes. I was consuming around 3 per day for the first several months after surgery. 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. So this has 3 parts to it. From what you said you are taking a proton pump inhibitor (omeprazile). Have you restricted yourself from using NSAIDs? Aspirin and Excedrin are just a few common items that are NSAIDs. Have you ever been checked for Helicobacter pylori infection. It is fairly common. About fifty percent of the people in the world have this infection and it is a hard one to kill.

As you lose weight, the chemicals and hormones stored in the fat of your body are released. As a result, many individuals feel a release of emotions during the weight loss phase. This effect should balance out when you reach the maintenance phase. One thing you can do is make sure you are meeting or exceeding your daily fluid requirements. It takes fluids to flush these hormones through your kidney or sweat glands.

Sounds a little like a stomach flu. I found that eating a banana helps with controlling diarrhea. Wish you well.

After surgery, my face developed very paper thin fine wrinkles, the kind that you see on 100 year old people. Granted I am no young spring chicken at the current age of 70 but these really fine wrinkles was disconcerting. My wife advised me to use Bio-Oil on my face and that took away the wrinkles. You can find this product in drug stores like CVS or Walmart and at other places.

Congratulations. 😊😎😀☺️😉

Good luck on your surgery and check back with us when you are on the other side and let us know how it went.

After RNY gastric bypass surgery, you are required to take many vitamins for the rest of your life. This is because you body no longer synthesizes vitamins from food. That part of your stomach has been cut away, so this daily requirement is extremely important. Vitamin chemistry is important for absorption. Calcium supplements should be calcium citrate. There are also different chemistries of B12. I use the sublingual B12 and was told to use methylcobalamin. You cannot use a time-release version of B12. If you are taking iron supplements, it must be ferrous sulfate for the best absorption. Gummy vitamins are not absorbed properly and should be avoided. It is important to put a 2 hour separation between the vitamins that contain iron and those that contain calcium. So in my case I found that what works best for me is to take the iron supplements just before bedtime. I put my vitamins in a weekly pill container. I have one container for the morning and one for the night. And I use a very small glass bowl for my calcium supplements. I put my calciums in the bowl in the morning and take them throughout the day. If I am up and about I put my calciums in a ziplock bag and carry them with me. The directions I received after surgery was: * Three Flintstone complete chewable multivitamins daily. * Additional 65 milligrams elemental iron daily for menstruating women. * 1500 to 1800 milligrams calcium citrate daily [this can be tricky because the dosage rate is per 2 capsules - therefore this can mean around 5-8 capsules per day depending on the size (petite or regular)]. * 500 to 1000 micrograms sublingual B12 daily or 1000 microgram injection once monthly. * 100 milligrams Thiamine (vitamin B1) daily for the first year and then weekly thereafter. But right after surgery, I lost my ability to swallow large pills and I had to crush them. It was like eating chalk. The only way I could down these was by mixing them with crystal light and drinking them down. Because they formed a paste at the bottom of the glass. I had to remix these and chug them down several times. Luckily my inability to swallow lasted only a couple months and then I was back to normal. The following link describes my experience with RNY gastric bypass surgery. How 
I
 Survived 
Bariatric 
Surgery

Since I snored for several years before surgery, I was required to undergo an exam by a neurologist. I arranged an interview, he examine me and came to the determination that I probably had sleep apnea. He requested that I undergo a sleep study to make sure. I declined. I said my reasoning was that in many cases, gastric bypass places this condition into remission. So why undergo the study if the sleep apnea condition will go away after surgery. I told him that if I still snore a few months after surgery, I will undergo the sleep study. He agreed and that gave me the green light to have the surgery. A few months after surgery, I would wake up in the middle of the night and find my wife hovering over me. I asked her what she was doing. She said I was breathing so quietly, she thought I had died in the night and she was checking to see if I was still alive.

One of the misconception that some individuals get during the first few weeks after surgery is that they are not seeing weight loss. When you are in the hospital they pump your body full of fluids. As a result you generally leave the hospital weighting much more than when they entered the hospital. One must first lose this water weight before your weight loss journey really begins.

I had RNY gastric bypass and after surgery my weight dropped like a lead balloon. At around 7 months I transitioned to the Maintenance phase. Sleeve patients lose weight at a much slower pace. They encounter many stalls along the way. They can achieve almost the same weight loss as gastric bypass patients. Many do not transition to the Maintenance phase for two years.

Many individuals get stressed out prior to a major operations. This stress can affect your sleep habits. You might try a warm bath before you retire for the eventing. It might help relax you.

Right after surgery, generally one drinks protein shakes. Several months after surgery, one can integrate protein bars into the mix. Later as the meal volume increases, one can transition to obtaining the required protein through consuming high protein meals. You taste buds may change after surgery so try a variety of protein shakes until you find one that is agreeable. Some stores (like GNC) sell little packets of protein shake powder so you can try a variety of flavors. Focus on protein drinks that contain a fair amount of protein and a minute amount of sugars. There are many different types of formulations on protein shakes. I would recommend that you keep experimenting until you find one that you can tolerate. You don't have to like it, just tolerate it. 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.