James Marusek

I am 3 years post-op RNY gastric bypass surgery. About a month before surgery, I received almost a day of training that went into great detail about all the requirements. So I think that some of these questions are driven by: 1. Individuals in the beginning part of pre-op who have not received the training yet and were trying to get up to speed. 2. The level of training especially those undergoing weight loss surgery in other countries (where training may be is lacking). 3. Confusion. There are many types of surgery. For example there is RNY gastric bypass and then there is mini-bypass. They are different operations and I suspect have different requirements. After all someone with a lapland has a different set of requirements than gastric bypass. Think of gastric balloon!

After surgery I lost my ability to swallow medium to large size pills. I bought a pill splitter and a pill crusher and made do. After about 2 months I regained my ability to swallow again. Generally the prescription meds that I took before surgery, my PCP wrote those prescriptions after surgery. But if it was surgery specific like the blood thinner, then the surgeon's office wrote those prescriptions. This is not necessarily a bad thing because my PCP is 5 miles away whereas my surgeon is 100 miles.

Not sure what an intake appointment is. Have you met with the psychologist, done the extensive pre-op testing, done the half day training session?

Hiccups and sneezing are signs of being full, just a bit away from dumping syndrome. But at 8 days post-op and on a liquid diet, I doubt this is the cause.

I am 3 years post-op RNY surgery and this is the approach that I use in the Maintenance phase. http://www.breadandbutterscience.com/Surgery2.pdf

Google translate says that "cottage cheese" in English corresponds to "cottage cheese" in French. Then under translation it reads "le format blanc" is cottage cheese, cream cheese, curd.

In general, your weight loss will begin to slow down and level off and you will quite naturally slide into Maintenance phase. It is a very natural thing. I am 3 years post-op RNY and I leveled off around my 6 or 7th month. Sleeve patients lose weight at a slower pace but the weight loss phase is longer.

After surgery, I discussed the issue of weight gain with my nutritionist. Her recommendation for those that have reached maintenance phase is to eat a balanced meal of Protein, carbs and fat. Immediately after RNY gastric bypass surgery, the part of your stomach that processes fats and sugars was cut away. Therefore if you ate fats or sugars, it would pass through your new rerouted stomach and into your intestines and you could experience dumping syndrome. But after about the first year, your intestines realize something is amiss and evolve to process fats and sugars. I feel fats are important in the maintenance phase because the goal in the maintenance phase is hunger control. One of the properties of fat is to satisfy hunger cravings. http://www.breadandbutterscience.com/Surgery2.pdf

This is a link to the shelter construction. It is a one of a kind. http://www.breadandbutterscience.com/Shelter.pdf

Mini-gastric bypass is a different operation than gastric bypass, so the rules to follow may be different. And although we are trying to help you some of our advice may be incorrect. There are different types of Protein supplements. In general they fall into three categories, protein shakes, protein add in powders and Protein Bars. Generally you need to be several months post-op before protein bars are an acceptable alternative because you need for your body to heal. There are several types of protein shakes, some are powders you mix with either milk or Water. Others are premixed. There is at least one type with a lot of protein called Isopure. It is very different than the rest. I hated the taste but my wife liked it. So you might give that type a try. You can use milk as protein. Some take milk and fortify it buy adding powdered milk. Experiment until you find a good way of getting more protein in your diet.

I am a little confused. You lost 13 kg (29 pounds) in the first month and think you will reach your goal weight by losing another 9 kg soon. That means your goal weight is a loss of 49 pounds. Many individuals loose a significant amount more than that. Goal weight is an artificial number. I think between I and my surgeon, we set my goal weight initially at 190 pounds (86 kg). That was a number that I would be satisfied with and consider the surgery a success. But I lost a lot more than that. At one point I dropped all the way down to 143 pounds (65 kg). Eventually, some flavor will return to your meals. Your taste buds will recover somewhat. I found that mixing food groups together such as in chili and Soups gave the food more flavor. It is important for you to resolve your issues with using Protein supplements (protein shakes, powders).

Immediately after surgery your body is in a major heal mode. Don't be too concerned about reaching your daily Protein requirement in the very beginning. Just keep working towards it and you will get there.

The best of luck on your continued journey.

In general, they are looking at whether there is a psychological component to your weight gain over the years. They are more about trying to treat any conditions that might interfere with your weight loss after surgery. So just answer their questions honestly.

The sleep study can confirm if you have sleep apnea. If you do, they generally prescribe a CPAP machine and request that you use it when you sleep. I believe your surgeon will want you to bring in the CPAP during your time in the hospital and will request that you continue to use it after surgery. In my case, there was a good chance that I had sleep apnea, because for several years prior to surgery my wife could not get any sleep at night because I snored and she was a light sleeper. As a result because of this condition, they scheduled a second round of pre-op testing with a specialist. I met with a neurologist who examined me and recommended a sleep study. I declined and told him that I understood that RNY gastric bypass surgery is known to affect this condition for the better and if I still had a problem after surgery, I would make an appointment and see him for the study. Based on that he passed me for the surgery. Within a few weeks after surgery, my snoring stopped. I would wake up in the middle of the night and find my wife standing, hovering over me. I was sleeping so quietly that she thought I might have died and was trying to determine if I was still alive.

This is the approach that I am using in the Maintenance mode. http://www.breadandbutterscience.com/Surgery2.pdf I hope it can be of some help to you.

I will pray that you and your spouse can resolve this issue. I am coming up "blank" in the advice department. The only thing that comes to mind is a few months ago I was in Sam's club in the men's restroom and someone received a phone call. Nowadays, everyone have individual ring tones that tell you who is calling. In his case the ringtone was: WARNING, WARNING, WIFE IS ON THE LINE, WIFE IS ON THE LINE, WARNING, WARNING I thought it was very embarrassing, especially in the men's restroom. I imagined his wife programmed in the ringtone. Maybe if your spouse had that ringtone, he might begin to realize that you are his WIFE, especially if it is drilled into him over and over again, every time you call.

Immediately after surgery, I passed a lot of gas. Then there is the "don't trust a fart" phase. Which is really bad but fortunately it doesn't last long. Then the level of passing gas declines a little. If you are 7 months post-op, you should be in this stage. I am 3 years post-op RNY gastric bypass and I still pass gas but I generally find a convenient place to release it. I have a fair amount of control in the WHEN department. I would also agree with @ that it might be related to what you are eating. I rely on chili and chili contains Beans and beans cause gassiness.

After RNY gastric bypass surgery, the three most important daily requirements are Protein, fluids and Vitamins. In terms of protein, you need to find a protein shake that you can tolerate. You don't have to like it, only tolerate it. For many individuals, their taste buds change. Mine changed so much that I couldn't even drink the Water in the hospital because it tasted like chlorine. I could not drink milk because I became lactose intolerant after surgery. Fortunately that condition (lactose intolerant) only lasted for 2 months. Flavoring such as chocolate is O.K. so long as you can tolerate it. Be prepared to experiment after surgery until you find a supplement that you can work with. Whatever protein shake you select, it should have a good amount of protein (such as more than 20 grams per serving) and low amount of sugar. If you become lactose intolerant after surgery, be aware that some Protein shakes contain lactose. For me I used "Muscle Milk Light (Vanilla Creme) protein shake powder blended in a Ninja blender (single serving cup) with water. I blended in a half a banana to make it more tolerable. Your protein requirement is a separate requirement than your meal requirement - so the half a banana doesn't count against your meal volume. (But don't abuse this). Also your protein requirement doesn't kick in until after you begin to pass gas after surgery (normally within the first 5 days).

I mixed mine with Water because I became lactose intolerant after surgery. In the beginning it took a while to consume one Protein shake but after a few weeks, it became much less difficult.

Good luck and let us know if we can be of any help.

I had the same problem with Protein shake powder. I tried to mix it by hand. I finally bought a Ninja electric blender with a single serving cup and that made the shakes palitable.

The three most important requirements after RNY gastric bypass surgery are to meet your daily Fluid, Protein and Vitamin requirements. So it looks like you get a check mark for fluids. I agree with @@beggingtobehealthy, why have you not transitioned to Protein shakes. I know some programs will vary. My guidelines read: Protein supplements are to begin on day five following surgery. If you are not passing gas when you leave the hospital, do not start the protein supplement until you do. Once you are passing gas regularly, you may start the protein supplements Protein is extremely important after surgery as its job in the body is to build, repair and maintain tissues including your body's major organs and skeletal muscles. Common symptoms of protein deficiency are poor healing, fatigue, hair loss and muscle wasting. Immediately post-op, protein promotes healing of the staple line and incisions.

I had Type 2 diabetes prior to surgery and was on two types of medication for it. But after RNY gastric bypass surgery 3 years ago it went into remission and stayed there. But Type 1 diabetes is a different beast. I know that some individuals that undergo surgery develop a type of low blood sugar called "reactive hypoglycemia". I am no doctor but it seems that the same approach that these individuals follow with this condition may be applicable to your condition. Here is one link but if you get on the computer, I believe you can find more. http://pamtremble.blogspot.com/2010/10/reactive-hypoglycemia-after-bariatric.html So your nutritionist/surgeon staff are probably the best to answer this. It is definitely a discussion point.

Sorry to hear all about your problems. Hope things improve soon for you. It may have not done any good to try and push your friend toward surgery. My mom was diabetic and she would do the least amount of movement possible throughout the day. I tried to encourage her to get up and about more, but she refused to listen. She didn't leave her house for over 10 years unless I took her to her doctors appointments. She was the reason why I had the operation. I saw what diabetes was doing to her and decided I did not want to follow the same path. And she was the only one that made negative comments about my weight loss after surgery. And now she is in a nursing home because she has even lost that little mobility she had left. They have to use a machine to lift her out of bed and into a wheel chair.