Last week I went to my three year surgery follow up at Kaiser Fremont. It was a group appointment that took a couple of hours and included talks by our Bariatric Medical Doctor, Bariatric Psychologist, Bariatric Nutritionist, and Bariatric Surgeon. If you needed one on one appt, they scheduled those after. Kaiser does a great job with education. There were a lot of good handouts and good information shared.

Some highlights:

From the Surgeon:

• When people get a revision, weight loss is only around 10 lbs., which the surgeon credited to the liquid diet followed before and after surgery. He said they don’t know why there is not substantial weight loss with the revision surgery, but he theorized that whatever was reset during the first operation was a one time thing.
  
• He also showed an image of stomach and how blood flow to the stomach is decreased with each operation. I hadn’t realized how many veins and arteries were connected to the part of our stomach that is removed. A lot!
  
• The stomach can only stretch so much. It does not continue stretching once it gets to maximum capacity. People may think they are eating more at one time because the brain adapts.
  
• Ulcer is leading cause of death in long term complications. Ulcers are caused by too much alcohol, smoking, and some drugs, including SSRIs, immunosuppressors and the usual suspects. Not spicy or acidic foods.

From the medical doctor:

• Kaiser Vitamin recommendations have changed. For the latest, along with the latest Kaiser Bariatric Surgery Guidebook, see:
  Iron in Ferrous Sulfate form can cause stomach upset, that’s why they recommend Ferrous Fulmanate or Ferrous Gluconate. Take with stool softener if needed.
  
• Watch for birth control pill malabsorption.
  
• For those that don’t like pills, she offered the following schedule:
  • Morning: Wellese liquid Calcium or calcium citrate chews, multi with iron
  • Evening: Wellese liquid calcium or calcium citrate chews, multi with iron
  • Weekly: 5000 mg B12, 250 mg B1, Iron with Vitamin C
  • Once per month: 50,000 iuVitamin D

From the Psychologist:

• Tip for eating less: Do not put serving plates on table. People eat more then. Serve from kitchen so people don’t see extra food and have to get up to have a second helping.
  
• Cross addiction is more common in year two than year one post op.
  
• She had a whole list of books for us, but strongly recommended Mindess Eating by Brian Wansin.
  
• She had a handout from AmiHungry.com for Mindful Eating After Bariatric Surgery. Download it here:
  Water, etc.

From the Nutritionist:

• Eat 20-25 grams of Protein per meal (70 grams per day). 3-5 planned meals per day, 1200-1500 calories per day, limit carbs to 30 per meal (15 carbs average in 1 starch, dairy or fruit).
  
• Eat protein first, then up to ½ cup veggies, then carb such as whole grain, fruit or dairy.
  
• Eat protein with any foods with higher sugar content. For example, have some cheese with grapes.

Last week I went to my three year surgery follow up at Kaiser Fremont. It was a group appointment that took a couple of hours and included talks by our Bariatric Medical Doctor, Bariatric Psychologist, Bariatric Nutritionist, and Bariatric Surgeon. If you needed one on one appt, they scheduled those after. Kaiser does a great job with education. There were a lot of good handouts and good information shared.

Some highlights:

From the Surgeon:

• When people get a revision, weight loss is only around 10 lbs., which the surgeon credited to the liquid diet followed before and after surgery. He said they don’t know why there is not substantial weight loss with the revision surgery, but he theorized that whatever was reset during the first operation was a one time thing.
• He also showed an image of stomach and how blood flow to the stomach is decreased with each operation. I hadn’t realized how many veins and arteries were connected to the part of our stomach that is removed. A lot!
• The stomach can only stretch so much. It does not continue stretching once it gets to maximum capacity. People may think they are eating more at one time because the brain adapts.
• Ulcer is leading cause of death in long term complications. Ulcers are caused by too much alcohol, smoking, and some drugs, including SSRIs, immunosuppressors and the usual suspects. Not spicy or acidic foods.

From the medical doctor:

• Kaiser Vitamin recommendations have changed. For the latest, along with the latest Kaiser Bariatric Surgery Guidebook, see:

  http://mydoctor.kaiserpermanente.org/ncal/facilities/region/gsaa/area_master/departments/Bariatrics/binder.jsp

• Iron in Ferrous Sulfate form can cause stomach upset, that’s why they recommend Ferrous Fulmanate or Ferrous Gluconate. Take with stool softener if needed.
• Watch for birth control pill malabsorption.
• For those that don’t like pills, she offered the following schedule:
  • Morning: Wellese liquid calcium or calcium citrate chews, multi with iron
  • Evening: Wellese liquid calcium or calcium citrate chews, multi with iron
  • Weekly: 5000 mg B12, 250 mg B1, Iron with Vitamin C
  • Once per month: 50,000 iuVitamin D

From the Psychologist:

• Tip for eating less: Do not put serving plates on table. People eat more then. Serve from kitchen so people don’t see extra food and have to get up to have a second helping.
• Cross addiction is more common in year two than year one post op.
• She had a whole list of books for us, but strongly recommended Mindess Eating by Brian Wansin.
• She had a handout from AmiHungry.com for Mindful Eating After Bariatric Surgery. Download it here:

  http://amihungry.com/pdf/Bariatric-Surgery-Its-Not-Just-What-You-Eat-But-Why.pdf

• Much of the stuff they covered I already knew from years in Weight Watchers, 3.5 years in the bariatric program, and support groups (including here!). We did a mindful eating exercise with a raisin, talked about cross addictions, healthy eating, avoiding grazing, exercise, Water, etc.

From the Nutritionist:

• Eat 20-25 grams of Protein per meal (70 grams per day). 3-5 planned meals per day, 1200-1500 calories per day, limit carbs to 30 per meal (15 carbs average in 1 starch, dairy or fruit).
• Eat protein first, then up to ½ cup veggies, then carb such as whole grain, fruit or dairy.
• Eat protein with any foods with higher sugar content. For example, have some cheese with grapes.

Thank you and congratulations on your loss and long-term success!

Wonderful post; good information. Thanks for sharing. Sorry to ask such a stupid question. But what do you mean by a revision? Lap band to sleeve?

Thanks for taking the time to share!

Wow! That was better than my 9 months appointment. LOL. That is really great you have a supportive system. Congratulations on what you're doing and hope all goes well.

Thanks for sharing. When you say revision do you mean having the sleeve redone?

you take great notes. i want you in my study group!

Great information! Thanks for sharing this with us.

great info!

Wonderful post; good information. Thanks for sharing. Sorry to ask such a stupid question. But what do you mean by a revision? Lap band to sleeve?

Thanks for taking the time to share!

Revision is any other op on the stomach after WLS. For sleevers, it could be RNY, DS, or a modification of the sleeve due to ulcers.

Lynda

Wow, some really great info here! I'm particularly glad you mentioned the birth control pill malabsorption issue - that one definitely raised an eyebrow. I see a lot of surprise pregnancies on the forums, but had attributed it to various other factors and considered it more of an issue in the first year post op.

The problem is, my docs talk about 2 way contraception. Can you imagine how small the possibility of pregnancy is because of either barrier contraception, abstinence, and/or a shot, in 2 ways? That is why there is suspicion that people just aren't following the directions and are ignoring them, for whatever reason.

Well then I have to disagree with the 10 pound lose for revisions. I started at 308 and am now weighing in the low 140s after revision to sleeve.

Wonderful post; good information. Thanks for sharing. Sorry to ask such a stupid question. But what do you mean by a revision? Lap band to sleeve?

Thanks for taking the time to share!

Revision is any other op on the stomach after WLS. For sleevers, it could be RNY, DS, or a modification of the sleeve due to ulcers.

Lynda

Wow, some really great info here! I'm particularly glad you mentioned the birth control pill malabsorption issue - that one definitely raised an eyebrow. I see a lot of surprise pregnancies on the forums, but had attributed it to various other factors and considered it more of an issue in the first year post op.

yeah, for me it's a non issue, but it's important info for younger sleevers!

Well then I have to disagree with the 10 pound lose for revisions. I started at 308 and am now weighing in the low 140s after revision to sleeve.

Revision is any other op on the stomach after WLS. For sleevers, it could be RNY, DS, or a modification of the sleeve due to ulcers.

Wonderful post; good information. Thanks for sharing. Sorry to ask such a stupid question. But what do you mean by a revision? Lap band to sleeve?

Thanks for taking the time to share!

Lynda

Yes, I think there are others that have good weight loss with revision, but that's what they said. Maybe it's the same as weight loss after the surgery. They say to expect 60% EWL or something like that, but I had 100%+ EWL.

With everyone being different, some more or less, and how far out they are, etc. all makes a difference.

I think people who revise when they are very close to goal weight lose very slowly and are often disappointed. I had 100% EWL too and I know that is not typical for either virgin or revision sleevers who start at a 50+ BMI. However, I also know that revision people typically lose way more than 10# so that seems like a strange statement is all.

Anyway, good info, thanks for sharing!!!