Born in Missouri

I had a bypass on June 13, 2018. I have had virtually no appetite since day one. Appetite Zero. I'm not even close to meeting my protein and fluid requirements. Dismal levels of both, really. I probably take in fewer than 250 calories per day as well. This is not on purpose. The only thing I am able to maintain with any regularity is my vitamin regime. And because I have more malabsorption issues as a bypass patient, I take the risk of deficiencies very seriously. Taking vitamins is effortless. Eating not so much. I've been told not to worry, so I am not stewing about my protein, fluid, or calorie deficiencies any longer. I've been assured that this is temporary. How long is temporary? How many more days, weeks, months? My "problem" is not about gagging or restriction or any of the other reasons suggested. It is only my appetite. Food is an afterthought. I only think about it in terms of "I guess I should probably try to eat something today." It's not that I've forgotten the look, taste, and enjoyment I received from certain foods in the past... Chipotle's hard-shell chicken tacos with tomatoes/cilantro, sour cream, and extra cheese come to mind... but I just don't have the craving to follow through with cooking favorite foods or seeking them out (like Chipolte's where my daughter has always offered me with an endless supply of gift cards for an occasional eating-out treat.) I'm a scratch cook. I can cook just about anything I put my mind to... but I have little interest in cooking anything now. I have an empty nest which means fewer mouths to feed. It's just my husband and me, so I mainly cook enough to satisfy his primitive "need to eat", but, for me, it's become a mindless chore and a bore. I have replied to other posts on this forum with pretty much the same words... mainly because very little changes from day to day. I know there are those who struggle with something at the other end of the spectrum: intense hunger. I can understand the frustration with that problem, too. Perhaps I should feel "lucky" that I have no appetite. I don't actually feel lucky, but I'm willing to accept my lack of appetite as temporary and a version of normal.

The Society for Metabolic and Bariatric Surgery estimates that 18 million adults in the U.S. qualify for weight-loss surgery, but only about 1 percent actually do it. The length of recovery and cost concerns are the main reasons more people don't have such procedures. Endoscopic Sleeve Gastroplasty is a non-surgical weight loss procedure that is commonly referred to as ESG and also known as the incisionless gastric sleeve or the accordion procedure. Instead of incisions, stapling and removing parts of the stomach, a tiny camera and tools go down a patient's throat with a needle and thread. Specialized tools mark out guidelines in the stomach, sutures are placed in triangular patterns and the area is cinched together. Stomach size is reduced by 70 to 80 percent. ESG works by reducing the space inside your stomach and by slowing down the rate at which food empties from your stomach. Unlike the band, sleeve, and bypass, however, which are surgical procedures, the ESG procedure is non-surgical. Access to the stomach is gained not through incisions in the abdomen but endoscopically, i.e. through the mouth. Like the surgical procedures, the ESG is performed under general anesthesia, and it takes about 1 hour to complete. A device called the 'Overstitch' is inserted into the stomach and reduces the stomach capacity from the inside by stitching the stomach together with a series of approximately 6 stitches. https://www.healthierweight.co.uk/non-surgical-gastric-sleeve/esg-or-gastric-sleeve/ https://www.mooremetabolics.com/weight-loss/endoscopic-sleeve-gastroplasty/ http://bmiclinic.com.au/endoscopic-sleeve-gastroplasty/

Most of the bariatric literature on thiamine deficiency surrounds gastric bypass, but it seems sleeve gastrectomy is not immune to this problem despite that, theoretically, sleeve gastrectomy experiences fewer malabsorption issues. https://www.soard.org/article/S1550-7289(18)30222-3/fulltext Nutritional deficiencies are a recognized complication of bariatric surgery. Thiamine deficiency has been reported as a possible consequence of both restrictive and malabsorptive bariatric procedures. Most of the reported cases occurred after Roux-en-Y gastric bypass (RYGB) surgery; fewer were described after biliopancreatic diversion, vertical banded gastroplasty, or duodenal switch. Adults who have a high carbohydrate intake derived mainly from refined sugars and milled rice are at greater risk of developing thiamine deficiency because thiamine is absent from fats, oils, and refined sugars. https://www.soard.org/article/S1550-7289(05)00726-4/fulltext Thiamine was the first vitamin B to be discovered. It is absorbed in the proximal jejunum and is mainly stored in muscle as thiamine pyrophosphate. It has a biological half-life of 9-18 days. Patients who experience persistent vomiting after bariatric surgery are at risk of developing thiamine deficiency. Mild deficiency should be suspected if patients complain of apathy, anorexia, restlessness and generalized weakness. Prolonged deficiency leads to beriberi and/or Wernicke’s encephalopathy. The most common presenting symptom of thiamine deficiency is a pins-and-needles feeling in one’s extremities despite normal vitamin B12 and folate. The average time from surgery to onset of thiamine deficiency symptoms was 9 months. Persistent vomiting, alcoholism, and non-compliance with vitamins are all contributing factors to thiamine-B1 deficiency. Treatment for those suspected of thiamine-B1 deficiency: 50-100mg of thiamine twice daily. https://www.soard.org/article/S1550-7289(11)00050-5/fulltext

“It is also well known that obese individuals face weight-bias job discrimination compared to non-obese individuals.” “This positive change is more obvious for women, who are more discriminated against than men for work, because of their obesity." “It’s possible that losing weight helps people find work by improving their physical or mental health, or by making them less likely to experience weight-based discrimination when seeking employment.” https://www.reuters.com/article/us-health-obesity-employment/weight-loss-surgery-linked-to-better-job-prospects-idUSKBN1L1299 Have you experienced what you felt deep down was weight-related discrimination? What about after your surgery and after you lost weight? Any difference?

Which are sprays and which are in liquid form? What about those waxy around-the-clock deodorizers? I'm guessing the products Alex tested are made for five-alarm poos.

I narrowed my decision to two programs. One at a larger hospital with a very structured in-house program that required participants to use their nutritionist, physiologist etc. The other program had no structure. It offered a list of possible nutritionists and psychologists to contact for pre-op evaluation. You were basically on your own in deciding what to do. The only requirement the second program had was attending a one-hour talk about bariatric surgery and nutrition with a Q&A afterward. It was very basic information and a waste of time to attend. I chose the second program. I don't like hovering professionals telling me what to do. I dislike rules and oversight and heavy-handed regimes. When I was told that I "had to" use their nutritionist (that the nutritionist I had already seen wasn't acceptable for their program), I knew that they would be sticklers every step of the way. I know some people thrive on structure and feel safe and cozy being told what to do and what not to do. I can't function that way. Even if it's for my own good, I don't like the idea of someone monitoring my behavior. While I feel as though I was tossed out on the curb sometimes, I'm doing okay. I have my primary doctor. I have my own kids (a pharmacist and two medical doctors) to look out for me, and I have myself. I'm not a clueless person waiting to be told what to do next or what I shouldn't be doing. If I ever find myself in a position in which I need help, I know how to ask for it. I just don't want "help" imposed on me. Does any of this resonate with anyone?

I had a huge hematoma on one side. Actually, my entire belly was black and blue. It was tender but it didn't hurt. I remember cushioning my belly with a soft pillow while sleeping on my side. I also found that sleeping somewhat upright (pillows piled high) was more comfortable than sleeping relatively "flat". I was tempted to sleep on my belly (something I was eager to do after giving birth), but I decided no.

Your username says it all. apositivelife4me . Keep being positive, keep sticking to your diet/exercise and more positive things will happen. I am genuinely happy for you and for anyone who is losing weight. It's something everyone here can understand and celebrate. Woo-hoo!

So why do patients face longer wait times to receive bariatric surgery compared with surgeries to treat other life-threatening conditions such as cancer and heart disease? . One big reason: Many insurance companies (including Medicaid) require those seeking bariatric surgery to lose weight before their surgery, even though there's no data or evidence to prove preoperative weight loss affects long-term success. Patients with complex medical histories enrolled in Medicaid experienced the longest delays. Nonwhite patients also waited longer... Smokers and patients with high cholesterol or psychological disorders also had longer wait times for bariatric surgery. https://www.sciencedaily.com/releases/2018/07/180730090141.htm How long did it take before you had your surgery? How long did you wait calculated from your first visit to your date of surgery? What requirements or obstacles did your insurance carrier impose? Supervised weight loss attempts? Were you told that you had to lose weight during those attempts… and that any weight gain would impede your path to surgery? Did you have to meet with a psychologist, nutritionist, and attend required bariatric surgery classes before your surgery was submitted to your insurance for surgery approval? For those who were self-pay… did you circumvent your insurance carrier because of the obstacles/delays imposed by your carrier, because your BMI or other insurance mandated requirements did not make you “eligible” or because you had no bariatric benefits?

This advice was directed at Bootscraper's case. It wasn't meant for the VirginiaRN's PA/staff case. Two different scenarios. I saw absolutely no point in confronting the PA/staff. They needed the "guidance" of a higher up. Confronting them would have done about the same as confronting the elevators.

That worst part of this is that you have to keep reliving the impact of their comments and kicking yourself for not saying anything. The lesson everyone on this forum should be hearing is SPEAK UP. Don't let the comments slide. Report, confront... but "do" something. When we do nothing, we essentially are telling ourselves that we don't matter. That our feelings don't matter. And that others are free to speak about us as they please. I am looking forward to future posts here in which someone was so moved by the stories and advice here that they spoke up. Everyone: be a self-advocate. You matter.

You are a classy lady. I have not been moved by another story on this board as much as this one. You have a gift of speaking from your heart, which gave everybody here a front-row seat to your pain. I applaud you for that courage. It's not easy to put your hurt on display. Your son learned more that day about you and your strength than you realize. Your restraint in reverse-shaming your PA/and staff was not a weakness in my view. You are a consummate professional. You behave as a professional with your patients and in your everyday life. Lucky are the patients who have you as their care-guide. It's easy to admire people who do "great things", but it's people that go through everyday struggles, survive them, and keep moving in a positive direction that I look to for inspiration. Being big (and former big) people, we've all tasted some of the pain that was unceremoniously dished out to you that day. We've all had to figure out how to process that pain. By sharing your story, I believe you gave those (here) who are not as gifted at expressing their inner feelings, a voice. You mentioned the idea of writing a letter to the head of practice. I would start drafting a letter now while your thoughts are still fresh in your mind. Composing such a letter in itself would be therapeutic for you. Whether you decide to send it is another matter for you to consider. If you do send the letter, however, I would NOT send it anonymously. As a self-advocate and a role model for your children, it is important for you to stand behind your words. It would be too easy for the head of practice to dismiss a letter written anonymously. The PA/staff would not be able to deny the words that came from an actual person as easily as words coming from a ghost. By signing your name, you also leave the door open for a response. If one receives a letter like this from an actual person, there is an obligation to follow up. If you send it anonymously, you will always wonder whether it was intercepted and destroyed before reaching the head of practice, whether it was read and acted on, etc. Just as you were placed in the position of having to process the hurt they caused, let them now defend their unprofessional patient-shaming. By writing this letter, you are not only helping to correct a wrong done to you, but to future patients who would be at their mercy. This PA is young. She obviously still has some important lessons to learn about being a compassionate caregiver. While it might have felt good to lambaste that PA/staff directly (in front of your son), I think being shamed professionally by her superior is a far better lesson. Just my two jellybeans....

Great tip, Kitty.

@Sosewsue61 Let's keep each other in the loop. Our symptom overlap is striking. I'm most intrigued by your scar-tissue supposition. I'm thinking that my reason is probably mechanical rather than a deficiency. As far as I know, keloids and hypertrophic scars don't occur under the skin. I know when I had an umbilical hernia repair, though, the scar tissue that formed under my bellybutton has been uncomfortable at times.

I'm not looking forward to Bony-Butt Syndrome. I don't even want to think about not having enough booty to cushion my body. The idea of my tailbone being compressed while seated is not what I signed up for!

The hardware and the way my knees were configured has to be of some relevance... yes?

I'm starting to suspect that the cramping I've been experiencing (in my left calf) for the last few weeks might be related to my knees. A blood clot was ruled out. The pain radiates up and down my entire left leg at times. It feels numb and tingly sometimes, too. I had both knees replaced when I was at my heaviest (303lbs). Now that I've lost a little under 50lbs, I'm wondering if my "new" knee isn't the source of that pain. Has anyone one else had knee replacements and then experienced pain in one or both legs after losing weight? Anyway, I'm planning to see my orthopedic surgeon and find out his take on this theory. The frustrating thing for me is that my pain meds don't even touch this pain. With the amount of morphine I take daily (for a chronically bad ankle), I'd normally not even notice pain elsewhere unless it was off-the-charts. This pain is severe.

Obesity-Related Proteins Several obesity-related proteins are being studied for their role in migraine. Two of the most important are orexin and adipokines. With orexin (which is also considered a hormone), studies in animals and humans indicate that it may be involved in many aspects of migraine. But study results have been inconsistent. Researchers, from Harvard University, now think they may have better luck with drugs that have been fine-tuned to work on orexin. Adipokines are proteins found in fat cells called adipocytes. A few studies have shown that, in some migraine patients, levels of certain adipokines (e.g., adiponectin, leptin, and resistin) are elevated during and between attacks. ------- Currently, migraine is not an appropriate indication to pursue bariatric surgery. But if you qualify for other reasons and have the procedure, three studies suggest that you may end up with fewer and less intense migraine attacks. While these findings are encouraging, more studies are needed to clarify the possible benefits of bariatric surgery in migraine patients. https://americanmigrainefoundation.org/understanding-migraine/the-skinny-on-obesity-and-migraine/ Obesity increases the risk of migraine and this risk increases with increasing obesity status from normal weight to overweight to obese to morbidly obese. Several neurotransmitters, proteins, and molecules that participate in maintaining energy appear to be involved migraine. Aerobic exercise is effective for migraine prevention, and low-fat or ketogenic diets may be effective; while not indicated for migraine alone, bariatric surgery may also be beneficial in reducing attack frequency and severity. Overall, and as for good health in general, it is important for those with migraine to maintain a healthy weight and to maintain healthy lifestyle choices in terms of both diet and exercise.

@likehasjustbegun If you like cauliflower, I think it's more important for you to have it, particularly since you are craving it. Why deprive yourself of something that is healthy? The important thing is that you are eating it according to your stage (pureed). I believe that your dietitian's recommendation is based on the idea that some people have a problem with cruciferous vegetables so they make a blanket recommendation to avoid all vegetables in this family (cabbage, collard greens, kale, Brussels sprouts, kohlrabi, broccoli, and cauliflower). \ I am post-op. I barely get 250 calories a day, very little protein, fluid intake way below optimal. I think it's great that you are doing so well. If after trying cauliflower and only if it is uncomfortable to eat, would I eliminate it from my diet.

No matter what part of the body is undergoing surgery, the process of healing is the same. Surgically “traumatized tissue” (skin, muscle, bones, cartilage, tendons, etc.) does not just magically heal; rather, the body has to rebuild and repair tissue on the cellular level. This involves energy and nutritional building blocks to support the healing process. Healing efforts surround the rebuilding of collagen, the main component in many tissues — such as skin, muscle, blood vessels, and bone. Improperly-formed collagen is associated with healing disturbances. Healing occurs in three overlapping phases. Most of one's healing occurs in the first few weeks. Inflammatory phase (up to 5 days): The body’s first response to injury involves forming a localized blood clot to stop bleeding. Infection-fighting cells (neutrophils) and debris cleaning cells (macrophages) are recruited to the traumatized area. Proliferative phase (2 days - 3 weeks): The body starts building tissue with specialized collagen-forming cells called fibroblasts. This new tissue is called granulation tissue and special growth factors to stimulate skin formation (epithelialization). Remodeling phase (3 weeks - years): The body transforms and replaces the collagen that was placed during the proliferative phase into a stronger collagen to support structure and function over the long term. It is a good idea to be as healthy as possible and nutritionally balanced before surgery to support healing. Certain vitamins and minerals are known to support the normal response to healing, and to support the normal immune system response to infection. Vitamin C: Necessary to build and rebuild collagen throughout the body. Vitamin C is also a powerful antioxidant that supports the immune response. Vitamin A: Supports immune system functioning and aids collagen strength. Also required for bone development. Zinc: An essential trace mineral used in enzymatic reactions involved in tissue and wound healing, regeneration, and repair. Vitamin K: Aids the natural blood clotting response and is important for bone health. B-Vitamins: Cellular metabolism, tissue repair and immune support. Vitamin D and Calcium: Important for bone health. Magnesium: Mineral involved in approximately 300 biochemical reactions. Amino Acids (L-Arginine, L-Glutamine): Two key amino acids for wound repair and immune function. Dietary Supplements to avoid before surgery: Vitamin E and surgery do not mix because Vitamin E is associated with increased bleeding, and this can lead to a collection of blood (called a hematoma) that could result in serious complications. The Vitamin E applied to scars is different from the Vitamin E taken orally. Vitamin E for the skin is okay. Herbal supplements, in general, should be avoided before surgery because they can cause bleeding or other operative complications. Some herbal supplements to avoid: Ginko Biloba, Garlic, Ginseng, Ginger, Dong Quai, Ephedra, Feverfew, St. John’s Wort and/or Omega 3 fatty acids. http://www.surgerysupplements.com/pre-operative-supplements-recommended-supplements-before-surgery/

@James Marusek Weather history, pattern mathematics, why cats naturally like to be petted, the log cabin playhouse for your grandkids, how pneumonia was the real killer during the 1918-19 flu pandemic, etc. So much to enjoy on your site. I was able to relate to your battles with your insurance carrier. In all fairness, though, I eventually received help from someone from our university system (of Missouri) who was able to jump over various gatekeepers and talk directly to the higher-ups and resolve everything in a day. Also and, of course, thank you for your service.

I wonder if strength training on my upper body or the lower body while seated is something I can do. I just need to avoid weight-bearing pressure on my right ankle. Did you mention that you have a physical therapy background once?

@Roxine. You didn't scare me... and like you said, it's only temporary. I've been taking collagen peptides (for skin, hair, nail, and joint support) for about a couple of weeks. It might help; it might not. My guess is that I'm a good deal older than you, so I'm used to my body heading South. I looked up Viviscal... I wonder what horsetail extract does? I'll ask my daughter about it; she's a pharmacist. Just curious, but did you grow up sitting on your hair? I did. Super long, super thick and straight. I've worn it shoulder length for several years now. I've never had it any shorter. I'm happy for you regarding all the weight you've lost. Your remaining weight is the about the same as the weight I've lost so far. Since my pregnancies already scared the becheezits outta me when my hair was falling out in handfuls, I'm sort of prepared. I hope it doesn't happen, but I think I'll do okay. Also, and due to my thyroid, I have very little body hair. Never have to shave my legs. No hair! If you decide to get a wig, let me know. If you get one, are you planning to go drastically different or more or less the same as your hair now?

I wasn't specific enough in my previous post. MarinaGirl is correct about taking iron and calcium at separate times. Here's information from one of the handouts from my surgeon's office: Gastric bypass patients need to take more vitamins than lap band patients or vertical sleeve gastrectomy patients because, in addition to only being able to eat a limited amount of food, part of their small intestines have been bypassed. People absorb most vitamins and minerals in our small intestines and with part of them bypassed, they end up absorbing fewer nutrients from the food they eat and the supplements they take. The vitamins you need may vary based on your individual needs and the results of your blood tests, but here's what the American Society for Metabolic and Bariatric Surgery (ASMBS) recommends you should start with: *An adult multivitamin, containing 100% of the recommended daily allowances (RDA) of at least 2/3 of all nutrients, including 18mg iron and minerals like zinc, copper, and selenium, twice daily. *1500mg to 2000mg calcium citrate (not calcium carbonate or tricalcium phosphate) divided into three to four doses of about 500mg each, taken at least two hours apart. RNY patients don't have enough stomach acid to break down calcium carbonate or tricalcium phosphate for absorption. That means supplements like Viactiv, Tums, Caltrate, and Citracal gummies aren't good choices. *An additional 18mg to 27mg iron for menstruating women *350mcg to 500mcg sublingual B12 daily or 1000mcg B12 injections once a month *B-50 complex is optional Note that the ASMBS recommends an adult multivitamin. While some surgeons and dieticians recommend children's chewable vitamins to patients, these are usually missing some key nutrients that gastric bypass patients need. Read the label of any multivitamin you are considering carefully and make sure it has 100% of the RDA of most ingredients and that it has minerals like copper, zinc, and selenium. ---- I take a multivitamin, calcium citrate, magnesium citrate, iron, Vit D-2 (doctor's prescription), and sublingual B12.

Boston-based medical researchers published an article in 2017 ( https://jamanetwork.com/journals/jamafacialplasticsurgery/article-abstract/2688763 ) warning of Snapchat dysmorphia. The pervasiveness of filtered images of unattainably perfect pictures on apps like Snapchat can take a toll on one’s self-esteem, make one feel inadequate for not looking a certain way in the real world, and may even act as a trigger and lead to body dysmorphic disorder (BDD). Classified in 1987, BDD is an obsessive-compulsive preoccupation with perceived flaws in one’s appearance, impairing one’s functioning and often leading to repeated plastic surgery. Dysmorphia literally means ‘bad form’ in Greek. https://www.independent.co.uk/life-style/cosmetic-surgery-snapchat-instagram-filters-demand-celebrities-doctor-dr-esho-london-a8197001.html