James Marusek

Good luck on your recovery.

There have been a few people on this board who have had that type of surgery. It is still somewhat rare.

If you drinking Protein shakes are you counting the calories of the shakes with your calories per day? As your meal volume increases, you have the option of deriving more protein from your meals and as a result you need less protein supplements (Protein Shakes and protein bars). Dropping some of the protein supplements can reduce you total calorie intake and start you losing again. In my case I concentrated eating high protein chili and Soups. So at 1 cup per meal, I was consuming 65 grams of protein from my meals alone. So now I don't take any protein supplements any longer.

Eight miles a day seems a little extreme. When I was young I began jogging and worked myself up to 10 miles per day and actually began to get heavier because I was replacing fat with muscle. Also 300-600 calories per day seems a little on the low side. Are you counting the calories in the Protein shakes in that number. The important thing in the weight loss phase after surgery is meeting the protein, Vitamin and Fluid requirements. It is important to get around 30 minutes of walking exercise per day. Beyond that you might give it a rest for a while. I definitely would not use a weight gainers shake, it kind of defeats the purpose.

The latest research shows obesity beginning to decline in the U.S including children. The greatest change seems to have been a decrease in soda and sugar-sweetened beverage consumption by children — down by 79 daily calories between 2004 and 2012. Unfortunately, calories from Desserts went up by 20 in that period, while those from fruits and vegetables increased by only 16. Overall, their daily intake dropped by about 185 calories. http://acsh.org/2015/07/data-suggest-were-seeing-a-real-decrease-in-americans-calorie-consumption/

During surgery, they pump you body with fluids and that adds weight. So it takes a weeks or two to get back down to the weight that you had going into surgery. It is great that you lost 72 pounds since March. The pre-op weight loss adds to the post-op weight loss. It gives you a good start. I don't think I would be too concerned at this point that you only lost 27 pounds post-op. Just remember the basics - Vitamins, Protein and fluids. food is only secondary because your body is converting stored fat into the energy that drives your body and thus you lose weight.

What type of surgery did you have? In the beginning, food is relatively unimportant because your body is converting stored fat into the energy that drives your body. The important elements are Protein, fluids and Vitamins. After surgery I found that I no longer liked to drink Water because it tasted very chlorinated. I found that Crystal Light worked for me but in your case you seem to be having problems with that. Later I stumbled into using fine English teas. Experiment and find out what works for you because the Fluid requirements are important. The fact that you are having problems with Protein shakes is also of concern. I did some experimentation. There are many different types of protein shakes. Some are powder and some are premixed. Some are in powder form that you add to your meals. There is a great amount of variation and the key here again is experimentation. Try one and if you don't like it try another. For me Muscle Milk Light (vanilla Cream) worked well. Originally I tried to mix it by hand by using a shaker. That did not give the right consistency so I went an bought a blender (Ninja blender with a individual size mixing cup that after you mix it you attach a sippy lid and you are good to go.) With the blender I found that I could also blend it other ingredients (in my case a half a banana) to make the drink more palatable. If you feel weak and dizzy, it might be due to vitamins. If you are not taking the right ones or in the right forms or in the right quantity, it can cause weakness and dizziness. For example B12 seems to give people a lot of problems. For RNY patients, it needs to be taken daily if you are taking them sublingual (under the tongue).

There were a few people who had revision surgery in our bariatric support group meeting. One man had a lap band. His band started eroding into his stomach so he had to have it removed. He had a RNY which he was happy with. Because of the erosion, his RNY had to be a smaller pouch which limited his food intake more so than a normal RNY patient.

0. Type of Surgery? RNY 1. How long have you been in maintenance mode? 20 months 2. What's your current height and weight? 5' 7", 150 lbs 3. How many calories do you eat daily (on average) to maintain your weight? around 1500 4. What kind of focus do you put on Protein -- number of grams or anything else you want to say? around 65 grams of protein per day derived from meals. 5. What kind of focus do you put on carbs - number of grams or anything else you want to say? I avoid like a plague processed sugar (including sugars with calories, such as honey. The exception being sugars found in fruits and milk.) Instead I use artificial sweeteners (Splenda), artificial sweeteners (Stevia and sugar alcohol) and the sugars found in fruits and milk. I try and limit my complex carbs (bread, Pasta etc.) to about one meal a day. 6. What other nutritional tips / tricks are working for you that help you maintain? I rely on fats to avoid hunger. As a result I eat real butter, whole milk and cream, meat other than lean meat. [in the weight loss phase my stomach was cut away and fats caused immediate dumping but after the first year my intestines took up the function of processing fats and I was able to incorporate it into my diet again.] 7. Which foods, if any, do you avoid altogether? Milk shakes, ice cream, any foods with more than 5 grams of processed sugar per serving. 8. What exercise regimen (exercise types and frequency) do you follow? I rely on normal physical activity (manual labor). For example last year I moved 100,000 pounds of gravel by hand and 50,000 pounds of concrete landscaping blocks. 9. What role, if any, has counseling or therapy played in your WLS success? None 10. What advice would you offer WLS patients to help them be successful? The approach to succeed in the weight loss phase is different than the maintenance phase. They need to adapt to the transition or if they follow the same rules, they may begin to put the weight back on.

Right after surgery, I could no longer physically swallow large pills. So I used a pill splitter and a pill crusher to take my Vitamins. After 2 months that condition changed so I was able to swallow even the largest pills such as the Citrical and life became much easier. Generally I have to space out the Calcium supplements (Citrical) otherwise it will not be absorbed properly. Also I need to space out the Iron from the calcium by 2 hours for the same reason, absorption issues. I am 26 months post-op RNY surgery and I currently take the following: 5 Citrical (Calcium Citrate) tablets daily - total 1575 mg 2 Flintstone Complete Multivitamin chewable daily 1 Iron pill (65 mg) daily 1 Vitamin B-12 sublingual (methylcobalamin) (1200 mcg) daily 1 D3 (5000 IU) Vitamin softgel daily 1 B1 (100 mg) vitamin tablet weekly The vitamin regiment will vary a little between one individual and the next. I have blood work performed yearly and the doctors and nutritionist will fine tweet the regiment based on the results of the blood work. Also there are many choices in the types of vitamins. For example, I was taking my B12 vitamins with a once a month injection for the first year.

I did not experience this and I do not think it is common. Some people experience a blockage in the plumbing. In some cases, scar tissue or inflammation can narrow the new connection between the stomach and intestine. This is called a stricture. Strictures usually develop four to six weeks after surgery, and affect less than five percent of bariatric surgery patients. Patients with strictures will notice that they are progressively less able to take in fluids and food. Strictures can be treated with an endoscope, which is a thin, flexible tube with image sensors and special tools at the tip. A doctor will use an endoscope with a tiny inflatable balloon at its tip to open the stricture.

Right after surgery, your body is trying to heal itself. Many people find it difficult in the beginning to get the required fluids down. In a few weeks it should get better. For me I found that flavored Water (Crystal Light) went down easier than water. Later I found out that fine English teas tasted good. Experiment until you find something that works for you.

My tastebuds definitely changed after surgery. I could't even drink the Water in the hospital because it tasted extremely chlorinated. Protein shakes tasted bad after surgery. Most foods were very bland after surgery.

I too purchased a bottle of Nature Made 1000mg timed release B-12 Vitamins. I asked my nutricianist if it was O.K. to take these in place of the sublingual B-12. She said NO. I think it has to do with the type of B-12. There are 2 types. One is called methylcobalamin. This is the type that should be taken. You might switch to the sublingual for a week (take it daily) and see if it makes a difference to your energy levels.

I had RNY gastric bypass surgery 26 months ago. I lost 115 pounds and maintained the weight loss. Before surgery hunger was constantly gnawing at my bones. While I was eating a meal, I was thinking about what I would eat for my next meal. After surgery my hunger was gone. It was not easy to lose weight when you are not hungry. This is very much different than a diet experience. There was no willpower involved. Not everyone who has a RNY loses appetite but many do. This may not be the case for those that undergo Sleeve. By consuming more food you can stretch you stomach and thereby eat more and regain the weight back. I asked my nutritionist why some people lose weight after surgery only to gain most of it back afterwards. She said grazing which I interpret as another way of saying snacking. I do graze but I have not gained weight. I think the secret is what you graze on. I graze on Protein and fats. Fats take away hunger. So essentially I am never hungry. I strictly stay away from all processed sugars. I satisfy my sweet tooth with artificial sweeteners (such as Splenda, sugar alcohol), non-nutritive natural sweeteners (such as stevia), natural sugars (found in fruits and milk). At 26 months out, I have a cup of coffee each morning with a large scoop of whip cream. I make the whip cream myself using Splenda so it has no sugar. I have around 3 Adkin's treats a day. I consume whole milk, real butter and real non-lean meat. I was diabetic before surgery. That went away right after surgery. I periodically check my blood sugar levels and they are normal. The weight is off and all my prior medical conditions are in remission: high blood pressure, diabetes, GERD, sleep apnea, frequent urination. I think why some people gain the weight after RNY is that they are confused. After surgery you body (stomach) can no longer process fats and sugars. If you take too much it causes dumping. But as the months go by your body adapts and your intestines change and begin to take up the role of the stomach and start to absorb fats and sugars. There are 2 phases to weight loss surgery. These are the losing phase and the maintenance phase. The same rules do not apply for the two different phases. I personally wouldn't pay $20K for the operation because I do not have that amount of disposable income. The 12 months would better be spent by preparation. Attend Bariatric Surgery Support Group meetings. Do exercises. Walking each day is very important. Cut out all carbonated beverages and caffeine. Prepare yourself for this important step in your life.

What type of B12 Vitamin do you take and how often? Did you have a RNY gastric bypass surgery?

There are different types of weight loss surgery. The different types affect the amount of weight loss expected and the speed of weight loss. They affect the revision rate (this relates to how often one might need to have the surgery modified or corrected or adjusted or changed to another type of surgery). I choose RNY gastric bypass because it had the smallest revision rate. It also produced the quickest and deepest weight loss. Also because of a pre-existing medical condition "major acid reflux or GERD", it was the only procedure recommended for this type of condition. But it also means that I have to follow a strict Vitamin regime for the rest of my life because my body no longer synthesizes Vitamins from the food that I eat. The process of getting surgery is not simple. It has many steps. Qualifying for insurance is one of them. But then you need to undergo an evaluation by a Psychologist. There is a half day of pre-op testing to uncover any medical condition that may impact the surgery. Generally there is also a half day of classes in which almost all aspects of the surgery and meal plan and vitamin regime and exercise are covered. Many insurance plans require that you undergo a medically supervised dieting and exercise program in order to qualify.

You need to separate the calcium from the Iron and have at least 2 hours separation. The iron is probably in your multivitamin. Also you cannot take all the calciums at once. It will not properly get absorbed.

It is very common for people who have lost a lot of weight to be sensitive to cold. Before the weight loss, the body fat acted as an insulator. Before surgery, I would often drive with the car windows open even in the winter because I liked the fresh air. Now I feel the cold. When I go out in the winter and shovel the snow off my driveway, I need to use hand warmers inside my gloves to keep my fingers from freezing.

I am 26 months post-op from RNY gastric bypass surgery. I lost 115 pounds and kept it off. Almost all of my medical conditions (diabetes, high blood pressure, sleep apnea, GERD, frequent urination) have gone in remission and stayed there. Frankly the surgery was one of the best moves I ever made in my life.

I believe the best day for surgery is Monday through Thursday. I had surgery on Friday, so my recovery was over the weekend. The normal weekly hospital staff was not there during the weekend. I had a substitute surgeon generate the discharge paperwork. The whole process seemed slower. I could have been out of the hospital a half a day sooner in my opinion if it wasn't over the weekend.

The Bariatric Discharge Instructions that I received stated: Gastric Sleeve patients take 500 to 1000 micrograms sublingual B12 weekly. Roux-En-Y (RNY) & Vertical Banded Gastric Bypass patients take 500 to 1000 micrograms sublingual B12 daily. Duodenal Switch patients take 1000 micrograms B12 weekly. The RNY surgery rerouted my stomach so that it is no longer capable of synthesizing many Vitamins from foods. Whereas the other surgeries, the patients still retain stomachs that are capable of this function. Sublingual B12 passes into your bloodstream quickly and it is used up quickly. If you took your sublingual B12 within a couple days of when the bloodwork was drawn, that might indicate normal levels of B12 still within your system. Anyways it doesn't take a rocket scientist to figure this one out. Try taking 500-1000 micrograms of sublingual B12 daily for a week and see if it improves your energy levels.

I had RNY surgery, and the recommended Vitamin regiment was 500-1000 micrograms sublingual B12 daily. If you are taking the sublingual weekly, you might be deficient. A B12 deficiency could cause pernicious anemia, mood swings, paranoia, irritability, confusion, dementia, hallucinations, or mania, eventually appetite loss, dizziness, weakness, shortness of breath, heart palpitations, diarrhea and tingling sensation in the extremities. B12 deficiency has also contributed to anxiety, stress, and depression. A B12 deficiency could explain the weakness you are experiencing.

What type of meds are you taking. If you had high blood pressure before surgery and took meds for it and are still taking BP meds after surgery, it might drop your blood pressure too low and make you lethargic.

Part of the psych evaluation is to determine if you have the will to follow the program. The day I decided I wanted the surgery, I went cold turkey on Cokes. I had a 6 Coke a day habit and I knew the program wouldn't allow that. When I met with the psychologist, I told him what I did. He was pleased. The fact that you have begun exercising is a plus. It is a positive step in the right direction. Keep it up.