James Marusek

I would recommend three things. 1. Take a good before photograph of yourself, so that you have something to compare to after surgery. Many times we are blind to our obesity. We do not see ourselves. Therefore when the weight begins to drop off rather dramatically, we question if this is really happening. Photographs are a good visualization of our success. Many people carry a before and after photo with them, just to remind themselves of their success. 2. Walk 30 minutes each day, every day until surgery (or equivalent exercise). Walking helps the recovery process go smoothly and minimized the pain levels from surgery. 3. Wean yourself from caffeine and carbonated beverages now. After I gave up my 6 diet coke a day habit, I suffered from a week of severe withdrawal syndrome consisting of severe headaches and body aches. I was miserable. You don't want to combine the effects of caffeine withdrawal with the effects of surgery. I also lost 20 pounds pre-op on this change alone.

If this is a security clearance issue, generally my impression is that Mexico is not a restricted country and generally should not be a problem to visit that nation. The fact that you might be having surgery there might generate some vulnerability red flags. So you may want to consult your security office just in case.

It might be related to low blood sugar, especially since you drank some orange juice and it stopped. If you had diabetes prior to surgery and were taking prescription medicine prior to surgery, it may be time to scale back the use of this medicine. It might be signs of a condition called reactive hypoglycemia. Here are a couple links. https://www.stjoes.ca/patients-visitors/patient-education/f-j/PD 7972 Reactive Hypoglycemia after Bariatric Surgery.pdf https://www.ridgeviewmedical.org/services/bariatric-weight-loss/enewsletter-articles/reactive-hypoglycemia-postgastric-bypass/

Several months after RNY gastric bypass, you will transition from the Weight Loss phase to the Maintenance phase. Eventually your weight loss will diminish and you will slide quite naturally into the next phase. I went through this transition at around 7 months post-op. Being successful in the Maintenance phase requires a different strategy than the Weight Loss phase. The following article describes my experience in the Maintenance phase. http://www.breadandbutterscience.com/Surgery2.pdf

There are two phases to weight loss surgery. I had RNY gastric bypass surgery and I transitioned from the Weight Loss phase to the Maintenance phase at around 7 months. But it also depends on the type of surgery. Some individuals with the sleeve generally get there in up to 2 years. And it depends on who much weight you have to lose and your own body chemistry. For those with gastric bypass, you body changes physically. After surgery, the part of your stomach that process fats and sugars has been cut away and these substances will quickly pass out of your stomach and into your intestines which does not know what to do with them. That is why your surgeon restricts your diet to eliminate or minimize these. But after several months, you intestines change and learn how to process these substances. Around this time hunger returns. It is not as strong as before surgery, but the honeymoon period is over. Anyways if you had gastric bypass, you may be transitioning into the Maintenance phase. The strategies are different between these two phases, so you must adjust accordingly. Anyways this is my impression of the Maintenance phase. http://www.breadandbutterscience.com/Surgery2.pdf

The following abbreviations are commonly used on this website: ACL = Anterior cruciate ligament AGB = Adjustable gastric banding AMRAP = As Many Rounds As Possible (crossfit) BB = belly button bc = because BCBS = Blue Cross/Blue Shield BED = Binge Eating Disorder bf = best friend BM = bowel movement BMI = Body Mass Index bp = blood pressure BPD = Borderline Personality Disorder or Biliary Pancreatic Diversion bs = blood sugar btw = by the way C25K = Couch Potato to Running 5K CBT = cognitive-behavioral therapy CC = common channel c diff = clostridium difficile cos or cuz = because CPAP = continuous positive airway pressure CRNP = certified registered nurse practitioners cw = current weight CXR = Chest X-Ray DDD = degenerative disc disease Dr. = doctor DS = Dumping Syndrome or Duodenal Switch EGD = Esophagogastroduodenoscopy EKG = Electrocardiography ff = fat free GERD = gastroesophageal reflux disease GI = gastrointestinal GNC = General Nutrition Corporation store GP = general practitioner or family doctor HBP = high blood pressure hr = heart rate hw = highest weight ICU = Intensive Care Unit Idk = I don’t know IMHO = in my humble (honest) opinion IMO = in my opinion IUI = Intrauterine insemination LAP Band = Laparoscopic Adjustable Gastric Band LES = lower esophageal sphincter lol = laughing out loud LSG = Laparoscopic Sleeve Gastrectomy med = medicine MFP = my fitness pal msg = message NASH = Nonalcoholic steatohepatitis nf = non fat NG = Nasogastric NP = nurse practitioner NSAIDS = Non-steroidal anti-inflammatory drug NSV = non-Scale victory (“scale” means “weight scale”) NUT = nutritionist OA = Overeaters Anonymous omw = on my way Onederland = a magical place or destination for those trying to lose weight. It might correspond to attaining a weight in the hundreds or losing a hundred pounds. op = operation OSA = Obstructive Sleep Apnea Oz = Australia PB = Productive Burps PCOS = Polycystic Ovary Syndrome PCP = Primary Care Physician PICC= Peripherally Inserted Central Catheter PM = private message (email) PMS = premenstrual syndrome POSE = Primary Obesity Surgery Endolumenal postop or post–op = post-operation or post-surgery PPI = Proton Pump Inhibitors ppl = people preop or pre-op = pre-operation or pre-surgery PTSD = Post-Traumatic Stress Disorder PVC = Premature ventricular contractions RA = Rheumatoid arthritis RH = reactive hypoglycemia RN = registered nurse RNY = Roux-en-Y RTD = ready to drink RYGB = Roux-en-Y gastric bypass SADI-S = single anastomosis duodeno–ileal bypass with sleeve gastrectomy s/f or sf = sugar free SG = Sleeve gastrectomy SIPS = stomach intestinal pylorus-sparing surgery smh = shaking my head, scratching my head SO = significant other SOB = shortness of breath sw = weight at surgery tmi = too much information TPN = total parenteral nutrition TT = tummy tuck TTC = trying to conceive Ty = Thank you. [but according to the urban dictionary “Ty” is also an abbreviation for “a total stud with a massive carrot”.] u = You UGI = Upper Gastrointestinal VSG = Vertical Sleeve Gastrectomy Vit = vitamin wks = weeks WLS = Weight Loss Surgery WOD = Workout of the Day w/o = without wt = weight

Right after surgery, your body is in a major heal mode. Many people find it difficult to meet their daily protein and fluid requirements during the first few weeks. So don't be too concerned. Just keep trying and you should soon be able to meet these goal. There are many forms of protein. Just experiment and find the one that you can tolerate the best. They all work. Just make sure it has no sugar or low sugar content.

Generally the week after surgery, you are on full liquids, therefore your body doesn't really generate poop. So constipation isn't really a problem at this stage. But it can become a problem after 2 or 3 months.

I would be concerned that you are experiencing horrible heartburn. Individuals with severe acid reflux (GERD) should opt for RNY gastric bypass instead of sleeve because sleeve surgery will only make that condition worst. So the main question is your severe acid reflux a result of the band or is it a permanent condition. Anyways this is a subject that I would consult with your surgeon about.

After surgery, it is common to experience some pain. I experienced little pain but mostly tenderness. When I tried to get up out of my waterbed, it was difficult. But pain can be a warning sign. Review your discharge instructions. My instructions indicated that the following conditions warranted contacting your physician: Uncontrolled or increased abdomen pain Shortness of breath or calf pain New onset of upper back or left shoulder pain Chest pain, rapid heartbeat and/or dizziness So if you find the pain increasing and uncontrolled, you may want to discuss it with your surgeons office.

The transition to the Maintenance phase depends upon the type of surgery you had and also how much weight you have to lose. I had RNY gastric bypass surgery and I made the transition at around 7 months. Sleeve patients lose weight at a much slower pace and encounter many stalls along the way. They can achieve almost the same weight loss as RNY patients but it takes longer. Some are still losing weight after 2 years.

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. Thus you lose weight. Weight loss is achieved after surgery through meal volume control. You begin at 2 ounces (1/4 cup) per meal and gradually over the next year and a half increase the volume to 1 cup per meal. With this minuscule amount of food, it is next to impossible to meet your protein daily requirements by food alone, so therefore you need to rely on supplements such as protein shakes. It is common for individuals to meet their protein and fluid requirements right after surgery. Your stomach is in a major heal mode. But just keep trying to reach your daily goals and you should soon be able to get there.

I am 4 years post-op RNY gastric bypass surgery. I had severe acid reflux [GERD] prior to surgery. That is why I went with gastric bypass vs. sleeve; because the sleeve will only make this condition worse. I have not had a problem with GERD since surgery. I used a PPI [proton-pump inhibitor] called Prilosec [Omeprazole] to periodically treat this condition prior to surgery. I also was prescribed this drug for the first year after surgery, in order to allow my stomach to heal. But after the year was up, I could tell the this condition was in remission. You indicated that ppi medication reducing life expectancy 25 percent. GERD is a dangerous disease. It can lead to Barrets' esophagus, and many other problems. According to the internet: GERD is most often not a life limiting disease. Approximately 23 million Americans have GERD. The chances of Barret's is pretty small and even then less then 10 percent with Barrets will develop esophageal cancer. An estimated 13,000 people in the US are diagnosed with EC each year, so it is pretty rare. Everyone starts off with a normal lower esophageal sphincter and no reflux. The severity of GERD probably correlates best with the degree of damage to the sphincter, but this is not easy to determine in practice. These are the four stages of GERD: Stage 1 – Mild GERD The majority of adults today have minor damage to their LES [lower esophageal sphincter] and experience mild GERD occasionally. In most cases they either tolerate occasional heartburn or use over-the-counter acid suppressive medications with the onset of symptoms. Because their symptoms are controlled quickly, easily, and inexpensively with these drugs, their quality of life is unaffected. Stage 2 –Moderate GERD Stage 2 GERD is more difficult to control with acid suppressive drugs and reflux is more frequently accompanied by higher intensity symptoms. Damage to the LES is more extensive compared to Stage 1. Many symptoms can be satisfactorily managed long-term with acid suppressive medications. Over-the-counter medications often provide inadequate relief, so prescription strength medications are necessary to manage symptoms. Stage 3 – Severe GERD Stage 3 GERD results in a substantially lower quality of life and is considered to be a very serious problem. Prescription level acid suppressive drugs do not control symptoms to the individual’s satisfaction and regurgitation is frequent. It is also likely that one or more of the complications associated with erosive GERD may be present. Stage 4 – Pre-cancerous condition or reflux induced esophageal cancer Stage 4 is the result of many years of severe reflux. 10-15% of long-term sufferers progress to this very advanced condition. Due to long-term reflux, the lining of the esophagus has been damaged, resulting in cellular changes. Interestingly, these changes may occur in some with only minimal symptoms. Stage 4 involves the development of a pre-cancerous condition called Barrett’s esophagus, or a more severe condition called dysplasia. These conditions are not cancers, but raise the risk of developing actual reflux-induced esophageal cancer. At this stage, typical GERD symptoms may also be accompanied by burning in the throat, chronic cough and hoarseness. Strictures, or a narrowing of the esophagus, can also occur which is characterized by the sensation that food is sticking in the esophagus. This same symptom can also be caused by esophageal cancer. So perhaps it is not the use of PPI that causes the lowered life expectancy but the damage from the disease itself. Anyways from my perspective there is treatment for this condition and that is RNY gastric bypass surgery.

In general, weight loss is achieved during the short weight loss phase through meal volume control. The two operative words here are short and volume. So if you want to maximize your weight loss during this phase, you need to adhere to the program guidelines. I slid into the maintenance phase at 7 months. One suggestion at your stage is to assess your protein intake. Your daily protein requirement is met by a combination of the amount of protein you obtain from food combined with the amount of protein from protein supplements (protein shakes, protein bars). Right after gastric bypass surgery, the volume of food you consume is minuscule (2 ounces) per meal. But as you get further along, the meal volume increases. Therefore you have a very important option available to you. If you concentrate on consuming high protein meals, you can begin to reduce your reliance on protein shakes. I went from 3 a day, down to 2, down to 1 and eventually none when I reached 1 cup per meal at a year and a half post-op. This is important because protein shakes contain calories. If you can reduce your caloric intake, then you can end a stall. At least that was the approach that I used and it worked for me. There are two phases to gastric bypass surgery. These are the Weight Loss phase and the Maintenance phase. The strategies for the Maintenance phase is dramatically different than the Weight Loss phase. Your body changes over time (post-op) and that means that you need to change too. When you talk about eating a Hershey's Kiss or a Cookie, that seems to signal that you might be near the Maintenance phase. You can still lose weight in the Maintenance phase but you must accept this transition when it comes. Here is my perception of the Maintenance phase. http://www.breadandbutterscience.com/Surgery2.pdf

Congratulations.

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. Thus you lose weight. Weight loss is achieved after surgery through meal volume control. You begin at 2 ounces (1/4 cup) per meal and gradually over the next year and a half increase the volume to 1 cup per meal. With this minuscule amount of food, it is next to impossible to meet your protein daily requirements by food alone, so therefore you need to rely on supplements such as protein shakes. 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. Generally with vitamins you have a wide selection. I had RNY gastric bypass whereas you had the sleeve. I have significantly more vitamins to take than you. My general guidelines were: 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.

One of the hidden joys of weightless surgery is dropping clothing sizes. Some call it a NSV (non scale victory). I went from a size 3X in shirts down to a size Small and from a size 46 in pants down to a size 32. I think I enjoyed this more than dropping pounds on the scale. Your body responds differently as you lose weight. Sometimes you lose a few pounds, sometimes you lose a few inches - but it all adds up over time.

Good luck on your surgery.

Generally I believe there are two options. At the bottom of your post, there is a button labeled "Edit". This allows you to edit your text, such as make corrections. Or you might delete the entire post, one character at a time. At the bottom of your post, there is an "Option" button. Hit this and it will open up two options, one of which is "hide". If you hide a post, it becomes hidden or invisible.

I am not seeing any pop-up ads? [Pop-up ads or pop-ups are often forms of online advertising on the World Wide Web intended to attract web traffic or capture email addresses. Pop-ups are generally new web browser windows to display advertisements.] By definition, a pop-up ads opens a new window for the ad. That is not what I see. There is a string of advertisements along the right side but that is it. Perhaps it is because I am accessing it with a Mac. Or perhaps I have inhibited pop-up ads in my browser. It might be a function of the internet browser you are using.

After surgery my taste buds changed dramatically. Food lost its taste. I remember trying crab legs in butter - tasteless. But all was not lost. I found mixing food groups together helped to restore the flavor. Chili became really good to eat. So did soups. I am 4 years post-op RNY and food still does not taste like before surgery, but I can live with it.

Depends on the type of medicine and the type of condition you are treating. After my RNY gastric bypass surgery, I was off all my diabetes meds the day I left the hospital 2 days after surgery. Around 2 weeks after surgery, I took myself off all my high blood pressure meds. I am 4 years post-op and haven't taken any since. But I do test myself periodically to verify all those conditions are still in remission. After surgery, I found that I could no longer swallow anything large even medium size vitamins. As a result I either had to crush or split my vitamins. This condition lasted for a couple months and then I returned to normal. The approach of crushing or splitting prescription meds may not work and you may need to seek an alternative. Surgery may affect your absorption rates.

Congratulations

My wife stayed with me the two nights I was in the hospital after surgery. She slept on a reclining chair. After surgery, I was hooked up to IVs and other contraptions. As a result whenever I had to get up to walk every 2 hours, or go to use the restroom, I had to drag around a wheeled pole in which all this stuff hung on. So during the first night she helped in keeping me stable. Otherwise I might become entangled and fall down. She also helped in making sure too much wasn't showing on the back end of the hospital gown. But by the second night, most of the stuff was disconnected and it was significantly easier to move around. In the meantime, my wife would watch a little television, read magazines and just try and survive a few miserable days. So make sure that If your significant other stays with you that you make sure she/he brings along material to keep them entertained. Also I did not use pain medicine after surgery. But many patients did. This caused them to be unstable when they walked. Having someone with you during your walks is an important function, until you are off the pain medicines.

Some patients that undergo weight loss surgery experience reactive hypoglycemia. The following are a few links to this condition. https://www.ridgeviewmedical.org/services/bariatric-weight-loss/enewsletter-articles/reactive-hypoglycemia-postgastric-bypass/ http://www.todaysdietitian.com/newarchives/060415p48tip.shtml https://www.stjoes.ca/patients-visitors/patient-education/f-j/PD 7972 Reactive Hypoglycemia after Bariatric Surgery.pdf