James Marusek

If you read the article, it is fairly well balanced.

It is very common. There are many incisions (wounds) on your body and they are healing.

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. I used Muscle Milk Light (Vanilla Creme) powder blended with water and a half a banana. That worked for me. 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. 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. 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.

Nuclear physics and engineering

Generally I would refer to the hospital discharge instructions that you were given when you left the hospital. These instructions generally provide a list of symptoms that should trigger you calling your surgeon's office. The third item on my list reads "uncontrolled or increased abdomen pain." So if your symptoms match that condition, then I would contact the surgeon's office and let them know what is going on.

When my mother was in the nursing home before she passed away. Alzheimer's was beginning to take hold so I tried to treat the condition with essential oils. I requested the nurses administer the oil to her once per day. And then when I visited her, I sometimes asked the nurses if that was being done. Their response was rather surprising. They would say the name of my mom and say "Oh! sure we remember her. She is the one who always smells so nice." Now in a nursing home, the smell can become very bad. Sometimes, it is almost like smelling death. And I can imagine that the nurses and aids that have to work in that environment day in and day out can get overwhelmed by the odors. Now I could not detect that the essential oil blend helped my mother's memory improve. But I decided it was a very good idea to continue treating her with oils because it brought a bit of sunshine into the lives of the nurses and aids that had to care for her. And if it brightened their day, they would go the extra mile to brighten her day.

After my gastric bypass surgery, I became lactose intolerant. Whenever I drank milk, I experienced an upset stomach quickly followed by diarrhea. This condition lasted for around 2 months and then disappeared. Also beware some protein drinks contain lactose.

I am not sure what type of surgery your wife had. That can make a difference on answering your concerns. I had gastric bypass and this the approach. 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. So the first step is to assess these three areas. Your wife should have been given a detailed list of daily requirements. You said that she is 10 months post-op and that "Damn near everything she eats makes her sick." That is a problem that needs to be resolved. Some individuals that undergo weight loss surgery develop strictures. This can cause them to be unable to take in small amounts of food without vomiting it back up. Others develop ulcers which can give the same symptoms. 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 this can be a major problem that will need to be addressed. In a severe form, she might even find it difficult to consume liquids. If that is the case, it must be driven to ground. After my surgery, I found that softer foods (such as chili and soups) went down much easier than harder foods (such as chicken and steaks). Therefore I relied on softer foods for my meals. I have included some recipes at the end of the following article. http://www.breadandbutterscience.com/Surgery.pdf When you say that your wife looks emancipated, "Her legs and arms are twigs with extra skin and some flab." That was the way I looked several months after surgery. I looked like Dopey in Disney's cartoon movie Sleeping Beauty. I would receive comments that I looked like I came from a concentration camp. But it was all in perception. I had to replace my entire wardrobe including all my jackets and coats. It was because when I lost the weight I also lost the fat in my shoulders and as a result all my jackets and coats hung down way lower than the times of my fingers. I looked like Dopey. After I replaced the wardrobe with clothes that actually fit me, all those comments disappear. So make sure you buy her some new clothes. As far as "she has aged about 15-20 years on her face". I experienced that. I had very fine paper thin wrinkles all over my face. I looked like I was 100 years old. My wife suggested that I use a product called Bio-Oil (which can be found in stores like CVS, Krogers, Walmart). I followed her advise and it took all the wrinkles away. I have been using it for 5 years now.

One book that I found very helpful is called "Essential Oils, Pocket Reference". It is a good primer. I have written a short article about the approach that I use and here is a link. http://www.breadandbutterscience.com/Experiments_with_Essential_Oils.pdf

I wish you success on developing your weight loss glossary. I am sure others on this board will find it useful. I have a pet peeve against abbreviations. They can make communications difficult unless you know their meaning. That is why I developed the list in the first place. I felt there was a need for it. Just like you feel there is a need for a glossary. As far as how I have the ability to pin, it seems like I have that ability because I have been on this board for over 5 years. Once you put together your glossary, post it and ask Alex Brecher (the owner of the website) if he could pin the glossary. Or if you stick around long enough, perhaps that ability will magically appear. There are many terms that are specific to weight loss surgery. There are many types of weight loss surgery and the list seems to expand every day. In order for Bariatric Pal to be an effective resource, clarity in communications is extremely important; otherwise many users will be left outside in the dark.

Sorry to hear about your scary episode. It is a little bit common for some individuals to experience a type of hypoglycemia called "reactive hypoglycemia". It seems a little soon because you are less than 5 months post-op. But in your case the alcohol may have played a part. I remember the first time I had a little wine post-op, it almost threw me for a loop. Here is a couple links to the condition. https://www.ridgeviewmedical.org/services/bariatric-weight-loss/enewsletter-articles/reactive-hypoglycemia-postgastric-bypass/ https://www.stjoes.ca/patients-visitors/patient-education/f-j/PD 7972 Reactive Hypoglycemia after Bariatric Surgery.pdf

Good luck on your surgery today and remember afterwards to Walk, Walk, Walk to relieve the gas pains.

There is one other thing that may be going on. Prior to surgery some people have a pre-existing condition, such as a hernia. But their body is so packed tight with fat that the condition is undetectable. But as the fat disappears, the condition becomes obvious. Since you are 8 months post op and lost 62 pounds thus far, this may be what is happening.

I have no idea of the cause of your pain. I did a quick internet search and this is what they came up with for "Pain in the sternum". I do not see any that are related to drinking a glass of water. What causes pain in the sternum?

Let me try and recap. You had Lap Band surgery in 2014. You had a revision to Gastric Bypass Surgery around 8 July 2018. 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. 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. Right after surgery, I was probably consuming around 500 calories per day. But I was drinking 3 protein shakes per day in order to get in the protein I needed. Why is your doctor recommending that you not drink protein shakes? Is there some medical reason for it? If so, you might have to seek an alternative which is drinking a lot of milk. So you have an option of drinking 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. I found it difficult to drink protein shakes because I could not find any that tasted good. But I am not sure you have that problem. In the end I experimented and found one that I could tolerate. As my meal volume increased, and I was able to meet my protein requirement by consuming high protein meals, I was able to offload my shakes. But you are at the beginning of the process. So my words of advice is to MEET YOUR DAILY PROTEIN REQUIREMENTS - PERIOD. Find a way. I totally do not understand the logic of your doctor about not utilizing protein shakes. Is this your surgeon's office making that request or is it your family general practicioner?

It can be quite overwhelming in the first week or two after surgery but then you learn the routine.

It sounds like you are going through the pre-op jitters. Since you are at the beginning of this process, 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. One of the interesting coping mechanisms that I found out about after surgery was shopping. I had to replace my entire wardrobe. That meant shopping and I am very good at bargain shopping. It was fun buying a shirt that was so tight that if I took a deep breath, I would pop a button and within a week it would fit me like a glove.

The main reason why I had gastric bypass surgery was to resolve a number of health issues including diabetes, high blood pressure, sleep apnea, severe acid reflux (GERD) and a few others. In the end all of these issues went into remission within a month after surgery and have not reappeared since. I am 5 years post-op. I was even pleasantly surprised that it also resolved my problem with asthma. So prior to surgery I was taking 5 types of prescription medicine daily and today none.

Some people find it difficult to sleep for the first week after surgery. They find sleeping on a recliner to be beneficial. In my case I am a little unique. I have been sleeping on a waterbed for over 40 years. And right after surgery, the definition of sharp pain is trying to get up out of a water bed and onto your feet. Every incision produces shot of pain when stressed. Now the main problem that I had after surgery with sleeping occurred months after surgery. The fat around my knee joints disappeared and when I slept on my side, I could fell my bones in my knees rubbing together and that was very unnerving. The solution was to stick a pillow between my legs when I slept on my side at night.

I was directed by my surgeon to take 75-90 grams of protein per day. Your taste buds may change after surgery. 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. 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. 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. Several months after surgery, you may be able to transition to protein bars as your protein supplement. I found Quest protein bars to be good. 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. As your meal volume increases over time after surgery, you may be able to eliminate protein shakes from your diet provided you concentrate on consuming high protein meals.

"feel that good" generally equates to "relief" and that generally is in reference with discomfort or pain.

Hi Liz I am 5 years post-op RNY gastric bypass and I rarely become sick anymore. Part of this is due to the strict vitamin regiment that I was directed by my surgeon to follow. Also, I have undergone extensive blood testing once per year to fine tweak any deficiencies in my vitamins. One thing to be aware of is that antibiotics destroy not only bad bacteria but also the good gut bacteria. So it is extremely important to reestablish these colonies of good bacteria after you complete any antibiotic treatment. This is done by taking probiotics. I have also experimented with essential oils and found them to be useful. I have developed a formula that makes me almost bullet proof for the common cold and the flu.

Yes.

Sounds like me. I would drive with the windows down even in winter when it was snowing. The problem disappears after my RNY gastric bypass surgery 5 years ago. So you might experience the same effect with the duodenal switch. Now it is a little in the reverse direction. Fat is a very good insulator. After I lost the weight, I am more sensitive to the cold. I have to bundle up sometimes when I go outside in the cold weather. Thank goodness someone invented hand warmers.

One of the individuals in my bariatric surgery support group went from a band to bypass a few years ago and he was very pleased with the results. His band was wearing through his stomach lining and had to be removed immediately. Because of the scar tissue, his bypass was a little bit smaller than most and as a result, it limited his meal size a little but he was fine with it.