James Marusek

The guidance I received was 3 meals per day. Also the guidance said that I should consume 75-90 grams of protein which worked out to 3 protein shakes per 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. As time went on and as my meal volume increased, because I concentrated on consuming high protein meals, I was able to offload this requirement for protein supplements. I was able to go from 3 protein shakes per day, to 2, to 1 and then at a year and a half, I was able to get off them all together.

According to my Bariatric Discharge Instructions one of the conditions in which you should contact your surgeons office is "New onset of upper back or left shoulder pain."

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. So make sure you are following the program requirements. Part of what you are experiencing is recovery from the surgery, but if you fall short on any of these three requirements, this can lead to the condition you are experiencing.

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. At 6 weeks post-op, I wouldn't be in panic mode yet. Just remember to meet your daily protein, fluid and vitamin requirements and do not exceed the meal volume directed by your surgeon. At 6 weeks this should be around 2 ounces per meal.

After RNY gastric bypass surgery, I completely lost my hunger. This experience did not last forever. It lasted about a year and then my hunger returned except it was not as strong as pre-surgery. Generally this experience of losing hunger begins once you enter the solid stage. So if you are not experiencing this from day one, give it a little time. If you are allowing too many carbs into your diet, that may be the cause of the hunger. I do not know if this loss of hunger is solely experienced by those with RNY gastric bypass surgery or if sleeve and duodenal switch patiences also experience this condition. Perhaps those who underwent that type of surgery can chime in with their experiences.

Welcome and let us know if we can be of any help or if we can answer any of your questions.

The rate of weight loss depends on the type of surgery. I had RNY gastric bypass and my weight dropped very quickly and I leveled off and went into the maintenance phase at around 7 months. Sleeve patients lose weight at a slower pace, experience many stalls along the way but can lose weight sometimes for up to 2 years after surgery and maybe more. I have no knowledge of the rate that DS patients experience. I also believe that BMI plays a role in the length of the weight loss phase. Those with very high BMI will lose weight for a longer period of time after their operations, provided they follow their dietary guidance from their surgeon.

I followed my discharge instructions. These read: "Wear your TED hose until activity is back to normal. Wear your binder for at least 2 weeks. Your binder is for comfort." The compression stockings (TED hose) was to prevent blood clots from forming. An abdominal binder serves many important functions, especially in the early postoperative stages of an abdominal surgical procedure. An abdominal binder provides compression and support to both the upper and lower abdomen. It helps to improve blood circulation and oxygen levels at the operative site, increases healing and reduces swelling. With all these improvements, the patient is able to get out of bed sooner and walk around more easily. This further improves breathing and promotes the healing process and a speedy recovery. I found that most of the pain was gas pain and walking significantly reduced the level of this pain.

Congratulations.

Since you are pre-op, I would recommend the following 3 steps: 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. After surgery, I was pleased with my body image. It was horrible prior to surgery and improved significantly after surgery. This is a pre-op compared to 6 month post-op photo of myself.

I had RNY gastric bypass surgery almost 4 years ago. I had Type II diabetes prior to surgery and took 2 prescription medicines daily but these were still not keeping my diabetes under control. My doctor was recommending that I transition to insulin shots but I refused. I had the surgery instead. I was in the hospital for 2 days. When I left, I was off all my prescription medicines for diabetes and I have not taken any since. I periodically (around once per month) check my fasting blood sugar levels and they are fine. The surgery does not solve everyone's diabetes. For some, they only see a reduction in the amount of medication they take. This seems to be a function for how long they were diabetic. I had diabetes treated by medication for around 5 years prior to surgery. It seems that from reading past threads, that individuals that suffered for many years with diabetes and transitioned to insulin did not experience complete remission from this disease. So the sooner that your get this problem under remission the better.

After surgery, I found that I was not able to swallow medium to large vitamins. Therefore I had to crush the calcium tablets in order to take them. I mixed the powder with Crystal Light and drank them. Because the powder quickly turned into paste, I had to repeat the process several times in order to get them to go down. After a couple months I found that I could swallow again. It has been very easy to manage them after that.

I am not familiar with the term intussusception, so I looked it up. According to the internet: In adults, intussusception is usually the result of a medical condition or procedure, including: A polyp or tumor Scar-like tissue in the intestine (adhesions) Weight-loss surgery (gastric bypass) or other surgery on the intestinal tract Inflammation due to diseases such as Crohn’s disease So I thing the first step is to localize the root cause of the condition and then have that condition treated.

There are two phases to weight loss surgery. These are the weight loss phase and the maintenance phase. The strategy for these two phases are different. I am almost 4 years post-op RNY gastric bypass surgery and this is the approach that I am using in the maintenance phase. http://www.breadandbutterscience.com/Surgery2.pdf

After my RNY surgery I was no longer able to take large or medium size pills because I could not swallow them. But after about 2 months I found that I was able to swallow them again. So I was wondering if you have tried recently. 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.

I am sorry you are experiencing problems. I would recommend that you review your discharge instructions. The first two concerns that you expressed caused me to believe that you need to contact your surgeons office and let them know what is going on. My discharge instructions read: Contact your physician when: Uncontrolled or increased abdomen pain. Persistent diarrhea beyond the first week after discharge or more than 6 diarrhea stools in a day. [Having a bloody diarrhea -shooting blood - for 2 days should mean that you immediately let your surgeon know this.] So based on this, I suspect you have a complication that needs to be resolved sooner than later. As far as your third concern about bruising. This is normal. Also you have probably been taking a blood thinner to prevent blood clots after surgery. Blood thinners will make major bruising problems. You site of incisions will look very bad for around a month but then it should get better.

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

Soup will do fine but I would avoid the pasta and rice. After my RNY gastric bypass surgery I found that softer foods (such as chili and soups) went down much easier than harder foods (such as steaks). So I made my own meals from scratch and fortified them with extra protein. I have included some of the recipes at the end of the following article. http://www.breadandbutterscience.com/Surgery.pdf

Dr. Mark Hamer from Loughborough University, Loughborough, England and colleagues combined data on physical activity from iterations of the Heath Survey for England and the Scottish Health Survey which were obtained between 1994 and 2012. The data in the present study came from 63,500 participants who were aged 40 or more, 46 percent of whom were male. The goal of this study was to look at how the level of physical activity compared with mortality rates. Essentially they broke the data into four groups: Inactive at baseline — 63 percent Insufficiently active — 22 percent Weekend warriors — 4 percent (about one-half took part in one, and one-half in two exercise sessions weekly) Regularly active — 11 percent. Then they compared the bottom 3 groups with the inactive at baseline. There conclusions were "The present study suggests that less frequent bouts of activity, which might be more easily fit into a busy lifestyle, offer considerable health benefits, even in the obese and those with major risk factors. A particularly encouraging finding was that a physical activity frequency as low as 1 or 2 sessions per week was associated with lower mortality risks, even in the insufficiently active." So it is extremely important to get some physical exercise even if this is minimal because it can dramatically decrease your risk of dying early. This reduction is in the order of 30% to 35%. [On the upside, this analysis had a large sample size - 63,500 participants. On the downside, this analysis was based on self reporting. Another weakness in the study was that the Individuals in the inactive group tended to be older and were more likely to be smokers, to be in unskilled occupations, and to report long-standing illnesses. But they did adjusted their analyses for factors such as smoking which could also affect the outcomes. So it is a little like a mixed bag.] http://acsh.org/news/2017/03/08/you-dont-have-run-marathons-benefit-physical-activity-10957

Many insurance companies require a body mass index of 40 or greater (or 35-40 when there is at least one co-morbidity related to obesity) in order to qualify for bariatric surgery. So the first thing to do is review your health insurance plan booklet and check their requirements. If you don't meet the plan's requirements, there are generally two options that you may want to consider: self-pay and changing your health care insurance provider.

I had RNY gastric bypass almost 4 years ago. The surgeon's office directions on vitamins were: * Three Flintstone's complete chewable multivitamins daily * 65 milligrams elemental iron daily for menstruating women * 1500 to 1800 calcium citrate daily. [be careful on this one because cited dosages on the bottles are generally by two tablets not on a single table] * 500 to 1000 micrograms sublingual B12 daily or 1000 mcg IM injection once monthly. * 100 mg Thiamine (vitamin B1) daily for one year following surgery and then weekly thereafter. 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.

Congratulations.

It is common to experience constipation after surgery. Sometimes it is a sign that you are not meeting your daily fluid requirements. Generally if you are constipated for more than 3 days, it means that you are really bound up and normal stool softness will not work. That happened to me and the only relief was to use a glycerin suppository. You have to insert this into your rear end, but it does unbound you. But you do not want to use this approach forever. You need to find a long term solution. I found that if I eat an apple just before bedtime, this normally meant that I had a good bowel movement when I got up in the morning. But the important thing is you not only need to eat the flesh of the apple but you also must eat the skin. [For those in the pureed stage, an apple can be blended into an apple sauce, but you may have to add a little water to make the blender work properly]. When you get to the stage where you can substitute protein bars for protein shakes, it is important to look for a protein bar with a lot of fiber. Quest protein bars work good. Here is a list of things people use to combat constipation derived from former threads on this site: Smooth Move Herbal Tea Prune Juice (warmed) Prunes (4 in the morning and 4 at night) Magnesium citrate Insoluble fibers (Garden of Life Raw Fiber or Renew Life Triple Fiber). Haribo Sugar Free Gummy Bears Aerobic Magnesium 07 Ground Flax Seeds (but don’t try to grind it yourself). Use 2 tablespoons per glass of water every night before going to bed. Bowel Clear (herbal blend) Low Fat Bran Muffin (recipe). 80 calories each 1 cup flour 2 teaspoons baking powder ½ teaspoon baking soda ½ teaspoon cinnamon 2 cups bran cereal 1 ¼ cups milk 1 egg ½ tablespoon applesauce optional: banana, berries, mini chocolate chips Bake 400° F for 22 minute

Some individuals find it difficult to meet the daily requirements after surgery. This is because your stomach needs time to heal and this can take a couple weeks or more. But just keep trying and you should be able to get there. Be willing to experiment. After surgery, my taste buds changed dramatically. Even Water changed. In the hospital it tasted excessively chlorinated and I could not drink it. So I experimented. sugar free popsicles became my best friend. Some individuals find hot or cold can help with fluids. For me, I found that I could tolerate flavored water. So I began using Crystal Light. I also found a new drink Bai which I liked cold. In the winter, I found that I tolerate Hot drinks such as piping hot cocoa. But you have to use the "No Sugar Added" variety. Also fine English teas were very good. Your daily Fluid requirement is more than just the water you drink. It includes the water in Protein shakes, the water component of Soups, milk, the water you use to take your daily Vitamins, the water in tea and decaf coffee.

First off, I do not think this is necessarily related to your weight loss surgery. But 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. So the general advice from above avoid NSAIDs (such as Aspirin, Ibuprofen, Diclofenac, Naproxen, Meloxicam, Celecoxib, Indomethacin, Ketorolac, Ketoprofen, Nimesulide, Piroxicam, Etoricoxib, Mefenamic acid, Carprofen, Aspirin/paracetamol/caffeine, Etodolac, Loxoprofen, Nabumetone, Flurbiprofen, Salicylic acid, Aceclofenac, Sulindac, Phenylbutazone, Dexketoprofen, Lornoxicam, Tenoxicam, Diflunisal, Diclofenac/Misoprostol, Flunixin, Benzydamine, Valdecoxib, Oxaprozin, Nepafenac, Etofenamate, Ethenzamide, Naproxen sodium, Dexibuprofen, Diclofenac sodium, Bromfenac, Diclofenac potassium, Fenoprofen, Tolfenamic acid, Tolmetin, Tiaprofenic acid, Lumiracoxib, Phenazone, Salsalate, Felbinac, Hydrocodone/ibuprofen, Fenbufen]. Aspirin can be found in a number of products such as Excedrin. Use proton pump inhibitors [Omeprazole, Pantoprazole, Esomeprazole, Lansoprazole, Rabeprazole, Dexlansoprazole, Rabeprazole sodium, Pantoprazole sodium, Esomeprazole magnesium, Omeprazole magnesium, Naproxen/Esomeprazole, Esomeprazole sodium, Omeprazole/Bicarbonate ion] and/or sucralfate [Carafate] antacid. And make sure you are tested for an H pylori infection.