James Marusek

Frankly I was too busy to feel anxiety. I would recommend three things to begin with. 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.

It can be a little overwhelming at times. I am 4 years post op RNY gastric bypass and the following two articles give you my experiences thus far. http://www.breadandbutterscience.com/Surgery.pdf http://www.breadandbutterscience.com/Surgery2.pdf

Stricture is a complication occurring post RNY gastric bypass, Sleeve Gastrectomy and Duodenal Switch. At least for gastric bypass patients, this can occur at 4 to 8 weeks out from surgery. I do not know if the same timeframe also applies to duodenal switch patients. Since you are 1 month post-op it appears you are probably within this time window. So you may want to discuss this issue with your surgeons office. An endoscopy or an upper gastrointestinal study can help with this diagnosis.

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. One thing to do now at your stage of 3 1/2 months post-op 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. As a result, 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. Your lack of bowel movements could be caused by not drinking enough fluids.

Vitaminwater is High in Liquid Sugar, and May Contain Just as Much Fructose as Coca-Cola. One 20 oz (591 ml) bottle of Vitaminwater contains about 120 calories and 32 grams of sugar, just about 50% less than a regular Coke. However, it differs between countries which “type” of sugar is used. After RNY gastric bypass surgery the part of your stomach that processes sugars and fats can be cut away. Therefore consuming sugar can produce dumping. Not all people are affected the same way by the surgery so that may account for your lack of dumping.

It might be a little too soon to transition to protein bars. It wasn't until the 3rd or 4th month that my nutritionist recommended them. Your stomach may still need a little extra time. A protein bar is probably too dense at this point. I used Quest protein bars. These bars were good in that they had high protein, minimal sugar and also contained fiber. They also came in a lot of different flavors. Some protein bars are almost similar to candy bars, so be careful. So check for protein content, sugar content and fiber content. Protein bars are good when you are on the go and can't drag along a blender in order to mix a protein shake. A Quest protein bar contains 220 calories and provides 21 grams of protein. A Muscle Milk Light protein shake [2 scoops of powder in a 16 ounce glass] contains 210 calories and provides 25 grams of protein. So they are comparable.

After RNY gastric bypass surgery, you are required to take many vitamins for the rest of your life. This is because you body no longer synthesizes vitamins from food. That part of your stomach has been cut away, so this daily requirement is extremely important. 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. So in my case I found that what works best for me is to take the iron supplements just before bedtime. I put my vitamins in a weekly pill container. I have one container for the morning and one for the night. And I use a very small glass bowel for my calcium supplements. I put my calciums in the bowl in the morning and take them throughout the day. If I am up and about I put my calciums in a ziplock bag and carry them with me. The directions I received after surgery was: Three Flintstone complete chewable multivitamins daily. Additional 65 milligrams elemental iron daily for menstruating women. 1500 to 1800 milligrams calcium citrate daily [this can be tricky because the dosage rate is per 2 capsules - therefore this can mean around 5-8 capsules per day depending on the size (petite or regular)]. 500 to 1000 micrograms sublingual B12 daily or 1000 microgram injection once monthly. 100 milligrams Thiamine (vitamin B1) daily for the first year and then weekly thereafter.

I had RNY gastric bypass surgery. I lost weight quickly. Those who have sleeve surgery generally lose weight at a slower pace and encounter many stalls along the way. [Someone on the board even created a slogan for it called "Embrace the Stall"]. My weight loss came to an end around 7 months and I transitioned into a maintenance phase. Sleeve patients can achieve the same degree of weight loss but it is over a longer time period. Many are still losing weight after 2 years. It took me around 6 months before all the problems that I encountered after surgery seemed to melt away and I entered a Happy State. So do not expect the problems to disappear overnight. It will take time.

Hi Simon What type of surgery did you have? From you IP address it looks like you are from Western Australia around Perth. There are several different types of surgery for weight loss and the reactions may vary by type. Generally, I would say that memory being hazy is not due to anesthetics at 3 1/2 weeks post-op. If you have been taking prescription pain medicine, that might be the cause. Also if you were diabetic prior to surgery and are still taking your meds, the meds may need to be adjusted. Some of the conditions of low blood sugar are unexplained fatigue and trouble thinking clearly or concentrating. http://www.healthline.com/health/hypoglycemia?m=0#overview1 It took many months before the surgery wounds healed up. For me it was about 6 months.

In general, the fact that you are experiencing constant nausea indicates that there is a condition that should be looked at. According to the internet: Nausea and vomiting are the most common complaints after bariatric surgery, and they are typically associated with inappropriate diet and noncompliance with a gastroplasty diet (ie, eat undisturbed, chew meticulously, never drink with meals, and wait 2 hours before drinking after solid food is consumed). If these symptoms are associated with epigastric pain, significant dehydration, or not explained by dietary indiscretions, an alternative diagnosis must be explored. One of the most common complications causing nausea and vomiting in gastric bypass patients is anastomotic ulcers, with and without stomal stenosis. Ulceration or stenosis at the gastrojejunostomy of the gastric bypass has a reported incidence of 3% to 20%. Although no unifying explanation for the etiology of anastomotic ulcers exists, most experts agree that the pathogenesis is likely multifactorial. These ulcers are thought to be due to a combination of preserved acid secretion in the pouch, tension from the Roux limb, ischemia from the operation, nonsteroidal anti-inflammatory drug (NSAID) use, and perhaps Helicobacter pylori infection. Evidence suggests that little acid is secreted in the gastric bypass pouch; however, staple line dehiscence may lead to excessive acid bathing of the anastomosis. Treatment for both marginal ulcers and stomal ulcers should include avoidance of NSAIDs, antisecretory therapy with proton-pump inhibitors, and/or sucralfate. In addition, H pylori infection should be identified and treated, if present.

As I was losing weight, some people commented that they were concerned that I was losing too much weight. That wasn't really the problem. It was that since I lost my weight, my clothes no longer fit properly and I looked like I had lost too much weight. The sleeves of my shirts and jackets fell well below my fingertips. I replaced my clothes with some that fit properly, and the comments went away.

Immediately after my RNY gastric bypass I became lactose intolerant. So anytime I drank milk or dairy or anything that contained lactose it resulted in an immediate trip to the restroom with diarrhea. This condition disappeared after a couple months. Be forewarned some protein shakes contain lactose.

"Kidneys filter 200 liters of blood a day, help regulate blood pressure and direct red blood cell production," states the National Kidney Foundation. "But they are also prone to disease; 1 in 3 Americans is at risk for kidney disease due to diabetes, high blood pressure or a family history of kidney failure. There are more than 26 million Americans who already have kidney disease, and most don’t know it because there are often no symptoms until the disease has progressed." Prior to my RNY gastric bypass surgery around 4 years ago, I had high blood pressure and diabetes. After surgery these diseases quickly went into remission. Which will positively affect the condition of my kidneys. I came across an article today that describes the do's and don't to inhibit the development of kidney disease. Many of these fell into line with the directions I was given after my surgery. They included: Drink plenty of Water daily Avoid drinking tea or coffee to excess Limit one's intake of sugar-sweetened drinks and alcohol Exercise regularly More than 661,000 Americans have kidney failure. Of these, 468,000 individuals are on dialysis, and roughly 193,000 live with a functioning kidney transplant. Each year, kidney disease kills more people than breast or prostate cancer. In 2013, more than 47,000 Americans died from kidney disease. http://acsh.org/news/2017/03/23/caring-your-kidneys-essential-often-forgotten-11042

I am sorry that you went through these difficulties. But I am a little confused. Are you saying that you are following the daily requirements for vitamins, protein and fluids and ran into these problems? After RNY gastric bypass surgery, you are required to take many vitamins for the rest of your life. This is because you body no longer synthesizes vitamins from food. That part of your stomach has been cut away, so this daily requirement is extremely important. 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.

After RNY surgery, you are required to take many vitamins for the rest of your life. This is because you body no longer synthesizes vitamins from food. That part of your stomach has been cut away, so this daily requirement is extremely important. 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. So in my case I found that what works best for me is to take the iron supplements just before bedtime. I put my vitamins in a weekly pill container. I have one container for the morning and one for the night. And I use a very small glass bowel for my calcium supplements. I put my calciums in the bowl in the morning and take them throughout the day. If I am up and about I put my calciums in a ziplock bag and carry them with me.

After weight loss surgery as you lose weight, the chemicals and hormones that are stored in the fat cells are released into the body. This causes a hormone rush in some individuals. Once they transition from the weight loss phase to the maintenance phase, this dump of hormones should return back to normal levels.

I am almost 4 years post-op RNY gastric bypass surgery. The main reason why I went with RNY was because I had severe acid reflux (Gerd) and the sleeve will only make that condition worse. Prior to surgery I had high blood pressure and was taking 2 prescription medicines for that. I had diabetes and was taking 2 medicines for that. I had sleep apnea. When I left the hospital 2 days after surgery, my diabetes went into remission and has stayed in remission ever since. In about 2 weeks I was off all my high blood pressure medicines and haven't taken any since. My sleep apnea went into remission within a few weeks after surgery. I am pleased with the results from this surgery.

One of the great things about loosing so much weight is the experience of entirely buying a new wardrobe. It definitely gives you a new image and look. So by all means consider this option.

One thing to do now at this 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. As a result, 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.

I will pray for you and your recovery. I did a quick search on the internet [nausea abdominal pain constipation "elevated red blood cell count"] and it pointed to polycythemia vera as the cause. Then towards the end of the article it read "If polycythemia is related to kidney cancer, liver cancer, or other erythropoietin secreting tumors, the symptoms of these conditions, such as, weight loss, abdominal pain or fullness, or jaundice may be predominant." But again I am not in the medical profession and cannot adequately assess this because this condition covers so many symptoms. Another article read "Polycythemia (elevated red blood cell count) causes are either primary (aquired or genetic mutations) or secondary (diseases, conditions, high altitude). Treatment of polycythemia depends on the cause."

Weigh loss surgery can affect your blood sugar levels. Some individuals experience a condition called reactive hypoglycemia. The symptoms of hypoglycemia are: blurry vision rapid heartbeat sudden mood changes sudden nervousness unexplained fatigue pale skin headache hunger shaking dizziness sweating difficulty sleeping skin tingling trouble thinking clearly or concentrating loss of consciousness If this is the cause, it sounds like you only have a mild version at this point. But it is something to keep an eye on.

One of the guys in my Bariatric Surgery Support Group meetings completely shaved his head after surgery. It gave him a new look and he was pleased with that.

It sound a little like head hunger. Since you added sugar to your protein shake, you may have experienced some dumping. Adding sugar to a protein shake is something I would not do. Generally your loss of hunger doesn't really begin when you are in the full liquid stage. It is something that you will probably experience when you transition to solids. So don't be too concerned at this stage. Many experience problems drinking protein shakes. I hated them. But in the beginning I drank them, three 16-ounce protein shakes a day, in order to meet my protein requirements. You do not have to like protein shakes only tolerate them. There are many varieties of protein shakes available today. Experiment until you can find one you can tolerate. 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. If you tried all the various varieties and still are unsuccessfully, then there is the fallback of fortified milk. 32 ounces of 1% milk fortified by adding 1 cup of dried milk provides 56 grams of protein. It also takes a dent out of meeting the fluid requirements. Mix up a pitcher and drink a little throughout the day. Without sufficient protein, your body will scavenge protein from other areas of your body, such as your muscles. Protein is extremely important after surgery as its job in the body is to build and maintain tissues including your body's major organs and skeletal muscles. Protein deficiency, when continued over a long period of time can cause a disease known as protein caloric malnutrition. Common symptoms are poor healing, fatigue, hair loss and muscle wasting. Immediate post op, protein promotes healing of the staple line and incisions.

I have not experienced this. I had RNY gastric bypass surgery around 4 years ago and my weight loss leveled off naturally at around 7 months. I noticed that it was difficult to consume solids such as steak and chicken so I relied on softer foods such as high protein chili and soups. The fact that you are vomiting regularly may point to an abnormality. So let a specialist see if they can find a cause. And remember that you need to ensure that you are consuming an adequate amount of protein (protein shakes), during the interim until you can localize the cause.

Good luck on your surgery and check back with us when you are on the other side.