James Marusek

Many people who undergo bariatric surgery suffer from a type of hypoglycemia (low blood sugar) called Reactive Hypoglycemia. This article will explain the condition. https://www.ridgeviewmedical.org/services/bariatric-weight-loss/enewsletter-articles/reactive-hypoglycemia-postgastric-bypass/

Generally setting a weight goal is an arbitrary number. Generally morbidity studies show that individuals that are underweight or overweight have a higher mortality rate. Those people who are in the normal weight category with a BMI of between 18.5 to 24.9 live longer. But when you get a serious illness or accident, you may lose weight and this can lead to death. Therefore I have set my goal near the 24.9 BMI which gives me a little bit of energy reserve (in the form of fat) should I have a major illness or accident.

Many times during surgery you are administered antibiotic to prevent you from getting an infection in the hospital. These antibiotics kill not only the bad bacteria but also the good bacteria in you body. Therefore it is a good idea after surgery to take probiotics for a week or so to restore the lost good bacteria.

Congratulations on the 37 pounds that you lost thus far. It is common to encounter stalls. It appears that you are about 1 to 2 months post-op at this point. If you are encountering nausea frequently and find it difficult to consume even small volumes of food, it may be because of a stricture. Otherwise, just continue to follow the requirements of the program (Protein, fluids, Vitamins and meal volume). As your meal volume increases, if you concentrate on consuming high protein meals, you will be able to begin to drop off your protein supplements. These supplements do contain calories. Your daily protein requirement is the sum of the protein you consume from meals combined with the protein from supplements (Protein shakes, protein bars). Reducing you dependency on supplements can kick-start your weight loss from a stall.

Your body is in a heal mode at the moment. Do your best to follow the daily recommended Protein, Fluid and Vitamin requirements and things should get better. It took me around 6 months to reach my "happy state" when all the minor problems were resolved.

The goals of the "Weight Loss" phase and the "Maintenance" phase are different and they require different approaches. Perhaps this article can explain. http://www.breadandbutterscience.com/Surgery2.pdf

I never heard of schizoaffective disorder so I looked it up. It is referred to as a combination of schizophrenia and mood disorder - either bipolar disorder or depression. Several individuals with those types of mood disorders have undergone WLS and have posted on this website. As others have already said, talk to your surgeon, be open, and see what they recommend.

My nutritionist recommended Quest Protein bars. One of the advantage of Quest, other than the fact that they come in a variety of flavors, is that they contain fiber. I was having issues with constipation at the time. This is a good approach.

Congratulations

Stay calm. It is common to take a few weeks before you begin to lose weight. Your body is in a major heal mode and allowing it to heal is the prime goal at 10 days post-op. For one thing most patients gain weight while they are in the hospital because they are pumping fluids into you. So you have to first lose this added weight before you begin to see a weight loss. So stay calm, follow the directions (meal volume, Protein, fluids and vitamins), relax and let the magic happen.

I had a problem with scales too. I would step on it in the morning and then again a few minutes later and get two entirely different set of numbers. Sometimes the numbers would vary by several pounds. Couldn't believe the numbers, so I literally threw the scale out and began looking for something a little more consistent. I found a scale that gave readings in increments of 0.2 pounds and was repeatable. It was a Beurer Model Number BF66. I bought it at Bed, Bath and Beyond. [it has an upper weight limit of 330 pounds.] I have used it for 3 years now and am happy with it. Your weight can vary by as much as 5 pounds during the day. I weigh myself naked first thing in the morning. This is generally my lowest weight. Adding clothes, watch, wallet, shoes can add around 4 pounds. [That is why the scales in the doctor's office can add a few pounds to my weight.] When I eat, I can add some more. The main thing I am looking for is consistency and accuracy.

Congratulations on your weight loss thus far. I had RNY and transitioned from the "Weight Loss" phase to the "Maintenance" phase around 6 or 7 months post-op. Gastric Sleeve patients tend to lose weight slower but over a longer period of time than RNY patients. Generally I don't track calories but rather food volume. This article describes my experience with RNY. http://www.breadandbutterscience.com/Surgery2.pdf I am older and less active, so my caloric intake is substantially lower than yours. Immediately after RNY surgery, my caloric intake was around 400 calories per day for several months. So long as I met the Protein, Fluid and Vitamin requirements, I was fine. So when I hear that "1700-2500 calories to lose weight safely", that is not my experience.

Generally, the health insurance companies are the ones that dictate medically supervised diet and exercise programs as a prerequisite. Surgeons are more focused on the success of the surgery. This means Psychological testing, Pre-Op testing, the ability to follow the program requirements after surgery, a training class that lays down the program requirements in great detail, also some pre-op weight loss to make your stomach a little looser so the surgeon can perform the operation effectively. This can all take time. It gives you the opportunity to attend some Bariatric Surgery Support Group meetings and get in the habit of exercise. Thirty minutes of walking each day will make the recovery process go smoother and less painful.

In my experience with RNY surgery, my weight loss slowed and stopped and I smoothly transitioned into the "Maintenance" phase. This happened around 6 or 7 months post-op. In general, my goal was to maintain my weight at the high side of normal BMI. Generally normal weight is defined as 18.5-24.9 BMI. I personally believe that it is good to have a little extra fat on my body so I can survive a major illness or injury when one has a tendency to lose weight. So my goal is close to 24.9. I have dropped as low as 23.1 just as an experiment. With a BMI of 20.3, you are still within "Normal". Sometimes I find it difficult to eat food even at 30 months post-op. If I consume too much volume, it can lead to dumping. I mentioned this to the nurse of my surgeon. She said my surgeon has a tendency to make the pouch small and that they can perform a simple procedure to enlarge it slightly. I am happy where I am at and didn't pursue the subject any further. I think it is the same procedure for dealing with strictures.

Generally I had a half a banana blended in with my Protein shakes. Stalls are a common occurrence. The three most important requirements after surgery are meeting your 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. Just concentrate on meeting and not exceeding your meal volume requirements and let the magic happen. Sometimes medicines can interfere with weight loss. At 2 months post-op, your meal volume is just beginning to increase. If you concentrate on high protein meals, it means that you can begin to reduce your reliance on protein supplements (Protein Shakes, protein bars) and the calories they contain. This can help you break out of stalls. Remember your daily protein requirement is met by the protein you obtain from meals combine with the protein from supplements.

Good luck on your surgery. I basically told everyone even strangers on the street. Most people were either supportive or curious. But then again I don't suffer from the stigma of going through too many yo-yo diets. (Lose weight only to gain it back and then some.) It's your decision who to tell.

Beans!

There was an interesting study done by Dr. Guenther Boden of the Temple University Medical School in Philadelphia and colleagues recently. They confined six normal-weight men to hospital beds for a week, encouraging them to stuff themselves with food — to the tune of 6,000 calories per day. Their objective was to investigate the genesis of obesity-associated insulin resistance. This study seemed to show that increased oxidative stress was related to acute obesity onset. And the researchers suggested that a Protein, the GLUT4 glucose transporter, was affected by the excess of reactive oxygen species. This protein is produced by fat cells after insulin stimulation, and provides the means by which glucose is taken up from the blood. Obviously, if GLUT4 isn’t functioning properly, blood glucose levels will be adversely affected. Refer to http://acsh.org/2015/11/6000-calorie-diet-yields-clues-to-insulin-resistance/ Maybe, I'm a little off here but it seems to me that an interesting follow-on study should look at the opposite state. There is a large pool of individuals undergoing RNY surgery. They drop a lot of weight, they halt the progression of obesity and in many cases their diabetes goes into remission and it does so within days. Maybe tracking the GLUT4 levels in these patients might give the researchers a large pool of data to put a nail into this research.

I'm a little lost. Pre-op 304 pounds, present weight 276 pounds. That is a weight loss of less than 30 pounds. But you are showing a weight loss of 64 pounds. Did you lose over 30 pounds during the pre-op phase or is your ticker just wrong? If all you lost was 30 pounds over 2 months, I think I can understand why you would be disappointed. The only advice I can offer is to follow the meal plan (volume), take the required Protein (make sure the protein supplements have minimal calories), and be patient. Discuss your problems with the nutritionist and see if they can figure why the minimal weight loss.

Interesting discussion. Before I had WLS, I was obese and one of the problems I had was eating at restaurants. If I ate at a booth, invariably, food would find their way onto my clothing. It was messy. If I ate at a table, I didn't seem to have that problem. It wasn't an issue of feeling comfortable. It was more of an issue of whether I needed to bring along an extra set of clothes to change into after the meal or go directly home afterwards.

Strictures occur in about 5-20 percent of gastric bypass patients. They usually occur several weeks to months after surgery. They can be managed with endoscopic dilation. An endoscopy or upper GI tests will help with the diagnosis.

I am sorry to hear about your daily struggles. It seems like nowadays its the grandparents taking care of the great grandparents. Probably not something one thinks about in early life. I haven't heard of the weight loss drug "qsymia" and don't know anything about it. I am 30 months post-op RNY and have been fairly successful about keeping the weight off. I wrote a short article about the "Maintenance" phase. It is available on-line at http://www.breadandbutterscience.com/Surgery2.pdf

I'm sorry, you lost me. What is Program A and B? Both the bariatric surgeon and nutritionist should be on the same page. What is a bariatric specialist? Here is my experience. Many health insurances require conditions be met before they will approve the surgery. Some of these relate to minimum BMI limits and co-morbidities. Others relate to diet and exercise. In my case, my BMI was above the limit meaning that I was obese, also I had several co-morbities such as High Blood Pressure, sleep Apnea, Diabetes. My insurance company required that I undergo a 6 month diet and exercise program to show that I was trying to lose weight on my own and unable to do so. So in the pre-op stage, my doctor had me keep food journals to track what I ate (this highlighted where I was eating excess calories), prepare healthy meal plans, attend bariatric surgery support group meetings, perform daily exercise. All this information was eventually used in a letter that the doctor sent to my insurance company to support the need for the surgery. At the end of 6 months, I lost 20 pounds and my RNY surgery was approved by my insurance company. Since you are on a 700-800 calorie diet, you will need to take Protein shakes or your body will begin to degrade. For example you may lose hair. It probably also means that because you are consuming less food, you body does not have the material necessary to produce some of your needed Vitamins. Therefore taking a Multivitamin each day is probably an important part. I can't see that your specialist would object to this. I guess the most important part of whatever decision that you make is to keep an eye on your goal. At this point it is to obtain approval for the surgery from your insurance company.

I had severe acid reflux (GERD) for a few years prior to RNY surgery. It went into remission shortly after surgery and has not occurred since then. I am 30 months post-op.

After surgery, your taste buds may change. So if you find a Protein shake that agrees with you prior to surgery, it may taste awful afterwards or the opposite may happen. So experimentation is the best way to go. You are a lot closer to telling what will work and what will not. There is a lot of variation available out there. In my opinion all Protein shakes taste terrible. The goal after surgery for me was to find one that I could tolerate. What worked for me was "Muscle Milk Light" vanilla Creme powder mixed with Water in a Ninja blender (individual serving cup) blended with a half a banana. Since you are in pre-op, you might even try using a few cups of hot cocoa each day. But you must use the "No Sugar Added" type and low fat or no fat milk. The weather is beginning to turn colder and hot cocoa is rather enjoyable.