James Marusek

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

Before surgery, I had several bouts of acid reflux (GERD). Because of this the answer was clear, gastric bypass (RNY) was the only good choice and the sleeve was not. Gastric bypass has been around for several years and has a good track record. In comparison the sleeve is a newer option. But from what I can tell, the sleeve is rapidly taking over as the primary gastric bypass surgery option selected.

The key is experimentation. Try many things and then stick to those that work for you. I found that chili and Soups went down smoothly so I stuck with that. I made my own so I could use twice the Protein than found in store bought soups. I have included a few recipes in the following article. http://www.breadandbutterscience.com/Surgery.pdf Your protein requirement is the sum of the protein you get from meals combined with the protein you get from supplements (Protein shakes and protein bars). So as your meal volume increases, if you concentrate on high protein meals, you can reduce the number of protein shakes you need to take each day.

I suspect a pre-operative surgical plan at a Center of Excellence includes more than dieting. Mine also included an exercise program and attendance at bariatric surgery support group meetings. Then after you completed the program, according to your insurance, you must have the surgery within a 3 month window, or all that work goes to waste. "Naomi H" is right. Work this through your surgeon's office. They have specialist that deal with insurance issues.

I also hit a plateau. I looked at my calorie intake. As my meal volume increased, I concentrated on eating high Protein meals. That way I was able to reduce the number of Protein shakes I consumed each day. Your protein requirement is the amount of protein you get from your meals combined with the amount of protein from your protein supplements. I was able to reduce the number of protein shakes, which in turn reduced the total number of calories (meals, protein supplements, fluids). Then I began to lose weight again. As you progress, you will need to adapt and change continually until you pass the weight loss phase and transition into the maintenance phase.

I didn't have any problem with it. Just answer the questions truthfully. They are looking for any existing problem that might prevent the surgery from being successful. Why did you gain the weight in the first place? For most people it is a lack of exercise combined with eating the wrong types of food.

Your weight loss seems a little on the light side. But your starting weight was 235 pounds. Some people start with much higher starting weights. You meal volume should be minimal. I would look at the calories in the Protein shakes or the fluids that you drink. In my case, as I began to increase my meal volumes, I concentrated on eating high protein meals, that way I was able to begin to decrease the number of Protein Shakes I consumed each day. When I did this, my calories dropped and my weight loss picked up.

I have heard that undergoing plastic surgery is more painful than weight loss surgery. So that might be a good question.

Based on the sugar and calories, I have permanently given up shakes (at Steak and Shake), salad and breadsticks (at Olive Gardens), pizzas (all types), ice cream, coffee (at Starbucks). But that still gives me a lot of choices.

It might help if you defined the acronym. SIPS stands for Stomach Intestinal Pylorus-Sparing Surgery. The procedure is described as a modified duodenal switch. The new procedure involves the formation of a sleeve gastrectomy that is slightly larger than the usual sleeve combined with a shortened amount of intestine that is attached below the pyloric valve, the natural outlet controlling the emptying of solid food from the stomach. So no I haven't heard about this procedure until I looked it up. Since it is new, it has a very minor track record and it is not possible to tell how many patients have this procedure and the results.

Some of the symptoms you are describing could be due to low blood sugar. Some people suffer from low blood sugar (hypoglycemia) after surgery. This occurs in people who were diabetic or were not diabetic prior to surgery. You may be experiencing reactive hypoglycemia. Reactive hypoglycemia (postprandial hypoglycemia) is low blood sugar that occurs after a meal — usually within four hours after eating. Low blood sugar (hypoglycemia) usually occurs while fasting. Signs and symptoms of reactive hypoglycemia may include hunger, weakness, shakiness, sleepiness, sweating, lightheadedness, anxiety and confusion.

In my case, I monitored my blood pressure daily. When my BP dropped, I cut my BP medicine dose in half. Then when it dropped some more, I went off the BP medicine completely. This all occurred within the first couple weeks after surgery. I generally took my blood pressure readings first thing when I got up in the morning so I would have some consistency with the readings. Without daily readings it would be hard to make that decision. I suspect your BP readings might have been slightly elevated in the doctor's office.

I suspect some of the answer may lie with the type of surgery. I asked my nutritionist "Why do some people have WLS and lose a lot of weight only to gain a major portion back later? Her answer was "grazing" which I interpret as snacking. I suspect that some people do not adhere to the Protein, Vitamin and Fluid requirement during their weight loss phase, and that also torpedoes the amount of weight they lose. Perhaps another reason is "guidance". I had a RNY. There is a great amount of detail in what foods and how much to be eaten at various stages after surgery. But when you achieve a good amount of weight loss, the guidance seems to disappear. I was in a weight loss stage for 7 months after surgery. I have been in a maintenance phase for the next 19 months. It is the maintenance phase that needs more guidance. I did a lot of experimentation and found my own way. And I am happy with it. This morning I was at my lowest weight so far. I exclude process sugars from my diet and I use fats to limit hunger. I no longer take protein supplements but rather obtain my protein from my meals.

I had RNY surgery, so the same protocol may not apply. But I suspect that the weakness is due to not meeting the Fluid, Vitamin, and Protein requirements. Also drugs may interfere with the process.

I believe there are different types of gatorade. At least one version is acceptable. I think its the one with zero calories. [As mentioned above, that version appears to be G2]. I found very fine teas from England were enjoyable to drink. Also during winter I found that hot cocoa was really good, but it must be the no sugar added variety.

I was 260 pounds prior to my RNY gastric bypass surgery. I am 5 foot 7 inches tall. At this point I am 2 years post-op and down to 148 pounds. So I don't think you are too thin for weight loss surgery. But since you have a different medical system in the U.K., it might cause you problems with financial coverage. I don't think it will negatively affect your ability to play soccer. It might actually make you better able to play, by improving your stamina levels.

Excess skin can be a problem. For me because I am a man, most of my excess skin is below the belt. I wear pants and it is hidden, so I am not really concerned. Some of the excess skin tightens up during the first year after surgery. After that, if it becomes a problem there is always the option of skin surgery (but I hear that is more painful than the gastric bypass surgery). I did find that after surgery, the skin on my face developed very fine wrinkles that made me look a hundred years old. My wife recommended I use a product called BioOil found in most drugstores. I apply it once each morning and it works fine.

I am 2 years post-op from RNY and my weight is flat-lined. As a matter of fact I weighed myself this morning and I am at my lowest weight thus far. So what am I doing. First, I am not hypersensitive about my weight loss. I weigh myself each morning but I use the scale only as a tool, not something to beat myself over the head with. It only tells me if I am making the wrong decisions on my experimentation with food. Second, I am getting most of my Protein from meals. I consume high protein meals and do not take protein supplements any longer. Third, I strictly stay away from processed sugars. I use low calorie sweeteners (such as Stevia), no calorie artificial sweeteners (such as Splenda), natural sugars (found in fruits and milk) and sugar alcohols. I had diabetes prior to surgery and have been in remission since the surgery and periodically monitor my blood sugar levels. And the testing shows this approach works. Fourth, I consume fats. Fats have the power to take away hunger. So generally, I am rarely hungry. Generally, I have a cup of coffee in the morning with a giant scoop of home made whip cream. I make it myself and use Splenda in place of sugar. I use whole milk and real butter. I might have 3 Adkins treats during the day which also have fats and no processed sugar. They take the edge away from hunger. I asked my nutritionist "Why do people have surgery only to gain some or all of their weight back over the years?" Her response was "grazing" which is probably synonymous with snacking. I will be the first to admit that I snack, but I think it is important to understand what is appropriate to snack on. I snack on protein and fats and exclude processed sugar. Fifth, I do not drink carbonated beverages anymore. I believe it is the carbonation that causes weight gain. It is like generating miniature explosions in my stomach that over time expand it out and allow it to grow and as a result, I gain weight. Six, I am aware of the conditions that cause me to loose additional weight and will sometimes take advantage of these conditions to capture and achieve additional long term weight loss. These fall into two categories. I have found that when I get the stomach flu, I will lose weight. I have also found that when I travel and am forced to eat out, I generally lose weight.

I told everyone about my surgery. The only person who generated negative comments was my mother. Even after all the weight loss, she was still negative. I suspect the reason why was because she was dependent on me for help in her old age and didn't want anything to interfere with that.

My weight loss phase lasted around 7 months and then I leveled off and went into a maintenance phase. I am over 2 years post-op RNY and my weight is stable and very close to my bottom weight. Around half way through my weight loss phase, I plateaued. I looked at my calorie intake including my Protein shakes and thought I could cut back a little. That was because I was gaining more protein from my meals since my meal volume increased. So I went from 3 Protein Shakes a day down to 2. I began to lose weight again. It was midway in my weight loss journey. As time went on I dropped down to 1 Protein shake a day and then none. The protein requirement is the amount of protein derived from meals combined with the amount of protein from supplements (protein shakes and protein bars). If you concentrate on eating high protein meals, it diminishes your need to consume calories and extra protein supplements.

The milder side effects come before full dumping syndrome. They are like an early warning system. Once you begin to recognize the signs, you learn quickly to just stop eating.

I took Citracal (calcium citrate). These are horse tablets. One of the problems that I unexpectedly encountered after surgery was that I was unable to swallow most of my Vitamins. I had to buy a pill splitter and a pill crusher. The Citracal tablets had to be crushed and the powder was very hard to take because it tasted like chalk. I landed up mixing it with Crystal light and drinking it. After a couple months my ability to swallow was restored and this no longer became a problem. There are a variety of options on your calcium requirements. Some I have heard are very enjoyable to take. It must be calcium citrate. So you might experiment at least until your ability to swallow is restored.

That seems like a lot of exercise. At your current weight 287 pounds, that would be equivalent to approximately: 158 minutes of low impact aerobics, or 124 minutes of moderate bicycling, or 145 minutes of cross country hiking, or 145 minutes of vigorous weight lifting. On the other side of the question, I am not too sure what you mean by starvation mode but I will assume you mean at what point the exercise vs. calorie intake might negatively affect your health. It is important to make sure you get enough Protein. In the losing phase it is critical to meet your daily protein, Fluid and Vitamin requirements. Meal intake is less important because your body is converting stored fats into the energy to drive your body (starvation mode). Thus you lose weight. If you fail to intake enough protein during this process, you will experience some signs, such as your hair falling out. It is possible to get so much into exercise that you might adversely affect your health, but the human body is fairly adaptable. I encountered one individual who picked up the bicycle riding enthusiasm after surgery. He competed in a bicycle race across the state of Indiana (160 miles). He crossed the finish line and then collapsed because of a lack of energy. After a little food and drink, he was back on his feet - no harm done.

As your volume increases, the amount of Protein you consume from meals increases. I am up to a cup per meal and derive about 65 grams a day from my meals alone. I went from 3 protein shakes a day, down to 2, down to 1 and then eventually down to none. I eat homemade high protein chili and soups. I have included some of the recipes in the attached link. These have about twice the protein content as store bought chili and soups. http://www.breadandbutterscience.com/Surgery.pdf Also in time you will be able to transition to Protein Bars as a supplement which come in handy when you are on the go.

Physical labor is a good substitute for structured exercise. Last year on my of my projects I moved 100,000 pounds of gravel by hand and 50,000 pounds of landscaping blocks. I just took my time. I have a lot more stamina (the ability to perform physical labor) since my surgery. I have a long driveway (about 800 feet) and during winter because I am in the Midwest, I need to shovel snow. This is also good exercise. Structured exercise seems more like make-work to me. It is in my opinion wasted effort. It seems like it could be better channeled into meaningful tasks.