James Marusek

I am 34 months RNY gastric bypass. I chose this type of surgery because I have severe acid reflux (GERD) prior to surgery and this is the recommended approach for that condition. I was in the weight loss phase for 6 or 7 months and then transitioned into the maintenance phase. What you are requesting, I believe is how to minimize your weight gain prior to surgery. This is somewhat similar to the maintenance approach, perhaps the following article might provide you some clues. http://www.breadandbutterscience.com/Surgery2.pdf

I am sorry for the loss of your cat and the sickness within your dog. Over the years, I have witnessed the death of many of my pets. When they pass, I find the best thing to do is to find another. You may not ever be able to replace them, but you can find another furry friend who can become enduring to you over time.

Not sure. I suspect that as you lose weight, the hormones that were stored inert in your fat cells are being dumped into your system. As you flush out your system with Water, your kidneys are expelling them from your body. Eventually when you level off in weight loss and enter maintenance phase, these extra hormones will no longer be dumped from your fat cells and your system should level out. Exercise might help. Also I would make sure that you are drinking filter water not tap water in order to minimize any additional load on your kidneys.

It is a function of age and activity level. Your surgeon should provide you with a recommended daily minimum.

After RNY surgery, my taste buds changed very dramatically. Many foods became very bland. For example I love shrimp dipped in garlic butter. But after surgery, it was tasteless. [i am 34 months post op, so the time will come when you can also try this.] A couple months after surgery, I tried ketchup. It burned my mouth like hot sauce. [but that was the very first time I tried it and now its O.K.] Because the diet was very bland after surgery because basically everything was mono-food (one food type at a time), I understand your desire to find taste again. I discovered taste by mixing food groups together. I made my own high Protein chili and this restored taste. It seems like you might be a newbie, so you may have to wait awhile before you try the recipes at the end of the following article. But they should provide you with tasty food again when you reach that point. http://www.breadandbutterscience.com/Surgery.pdf

Most people report the opposite effect. Many report surviving colds and flu much better after surgery. This is probably due to the added Vitamins after surgery. In my own case, I survived cold and flu season much better after surgery. I did get a stomach flu that was going around. But in a way that was a bit of a good thing because I lost 5 pounds from this and was able to keep that weight off.

Congratulations and good luck on your upcoming surgery.

Whatever you select it is recommended that they provide at least 20 grams of Protein and less than 5 grams of sugar per serving. Some examples of premixed Protein drinks that are recommended are: Ensure High Protein EAS Advantage Carb Control EAS Myoplex Muscle Milk Light Isopure Atkins Advantage CytoSport Monster Milk Pure Protein Met-Rx Protein Plus Oh Yeah and Premier Nutrition and then there is a longer list of protein powders used in making Protein shakes. Also your taste buds may change after surgery, which means that you may want to wait a little bit until after surgery to stock up. It also means that you may need to experiment with the various options available to find something that you can tolerate after surgery.

I am 34 months post op RNY and after surgery my taste buds definitely changed but I noticed no difference in my sense of smell. In time this goes away. On the other hand, many people report that after surgery, the smell of your breath changes toward the bad side. This is generally due to the fact that your body is undergoing ketosis. Experiment with various Protein shakes until you can find one that you can tolerate. Don't be afraid to experiment with various foods. After surgery, you will undergo a variety of changes including the volume of your meals, the types of foods you are allowed to eat, changes to clothing, chemicals and hormones released into your body as your fat cells dissolve, sensitivity to various foods (for the first 2 months post op I was lactose intolerant), changes to how much you can swallow. Everything is somewhat Fluid so go with the flow. And many of these changes you will find are in the right direction, making the whole process worthwhile. It was 6 months until I reached the "happy state" when almost all the problems seemed to melt away.

Congratulations on your weight loss of 114 pounds. I am 34 months post-op RNY gastric bypass surgery. This is my perception of the "Maintenance" phase. http://www.breadandbutterscience.com/Surgery2.pdf

Stalls are common. Your Protein requirement is a combination of the protein that you consume from supplements (Protein shakes, protein bars) and the protein that you obtain from meals. In the beginning because you meal volume is restricted to a minuscule amount, you are force to rely on protein shakes. But as time goes on you meal volume increases. This give you the option of reducing the amount of protein supplement and the calories those supplements contain. But that is only if you concentrate on high protein meals. I am 34 months RNY. I went from 3 shakes a day, down to 2, then down to 1 and finally 0. When I hit my first stall around the 3 month mark, I cut off one shake and my stall disappeared. The weight loss phase for RNY patients is very short and you want to maximize the weight loss during this period. So make sure you meet the daily requirements for protein, fluids and Vitamins. Limit yourself to the required volume size. Get around 30 minutes of walking each day and then let the magic happen.

Congratulations. Here is my perception of the "Maintenance" phase. http://www.breadandbutterscience.com/Surgery2.pdf

It is typical to run into problems during the process. All I can say is keep focused on the goal. It seems that is what you are doing. Also it might be worse. We had one individual in our Bariatric Surgery support group who had everything set. Surgery was in a couple weeks. He got a call to check into the hospital immediately. It turns out he was about to die of a heart attack. He had a quadruple bypass the next day. He lost a little weight from that operation, but he hung in there and a few months later after his body recovered, he went and underwent gastric bypass. So anyways if you are meeting with a cardiologist and he is recommending a stress test and an Echo test, then there must be something either in your family history or your medical history, that might interfere with the success of the operation.

Good luck and let us know how it went when you get on the other side.

I had RNY surgery whereas your daughter had duodenal switch. I suspect the meal plans are different between the two types of surgery. I found softer foods went down easier, such as chili and soups. I made my own, high Protein versions. The recipes are contained at the end of the following article when she is advanced enough to eat them. http://www.breadandbutterscience.com/Surgery.pdf

Almost 50 years ago when computers were young I worked on integrating computer systems together. It was stressful, because I worked far away from home, and I put in long hours, typically double shifts (swing and graveyard) 17 hour days, 6 days a week. I worked with a couple sets of contractors, one from Raytheon and one from Univac. I remember a young man from Raytheon had so much stress that computer handshaking logic became part of his dreams. He was from Boston but was detailed to California for over a year. He had a girlfriend on the other coast. In his nightmares, he dreamed that he was sending out RT's (Ready to Transmit signals) but his girlfriend was not responding with RRD's (Ready to Receive Data). [After 50 years, acronyms change and my memory grows a little fuzzy.] So make sure you get plenty of rest and try not to have nightmares about your future weight loss surgery. Learn to manage and minimize stress - such as yoga classes, or drain it out of you through exercise. Listen to music. Weight Loss Surgery is a good thing. It can open doors that you never knew existed. Life is an adventure.

A recent study was conducted by Dr. Jos Runhaar of the Erasmus MC, Department of General Practice, Rotterdam, the Netherlands, and colleagues. These researchers examined the records of 353 overweight or obese women (BMI ≥ 27 m/kg2), a subset of participants in the PROOF study (Prevention of Knee Osteoarthritis in Overweight Females), which was designed to examine the preventive efficacy of diet and exercise and glucosamine sulphate supplementation on the incidence of knee osteoarthritis. On average, the participants in this subgoup were 56 years old, and had BMIs of 33 kgm/m2. They compared the arthritis incidence in women who met a goal of losing either 5 kgm (about 11 pounds) or 5 percent of their body weight within 30 months of beginning the study, to the incidence in women who did not meet that goal. Initially, the women did not suffer from osteoarthritis, as determined by X-ray evidence of joint space narrowing. The incidence of knee osteoarthritis was 15 percent for women who met that weight loss goal, compared to 20 percent in the women who did not; a numerically small but statistically significant difference. In addition, more of the women who didn’t meet the goal had osteophytes (bone spurs along the edges of the joint) than did those who did lose the weight — again a statistically significant difference. I wonder what effect might be observable on the many weight loss patients who have reduced their weight by as much as 50% of their body weight instead of the 5% within this study. Here is a link. http://acsh.org/news/2016/02/18/weight-loss-helps-prevent-knee-arthritis-who-knew/

My blood work showed I was low on Iron. After surgery, the doctor tries to fine tweak the Vitamin levels. So it is common to make adjustments to the daily vitamin requirements after surgery. As you lose weight, your body is consuming many fat cells. These cells contain many chemicals and hormones which are dumped into your blood supply. The liver filters and processes blood as it circulates through the body. It metabolizes nutrients, detoxifies harmful substances, makes blood clotting Proteins, and performs many other vital functions. Therefore during the weight loss phase you are putting an additional strain on your liver. Fluids especially Water is used by your body to flush these substances out of your system. If you have liver concerns I would probably recommend that you use filtered water instead of tap water and also drink the minimum daily requirements (but it looks like if you are drinking a gallon a day, you are on target).

If the surgery approval requirements for Tricare are the same as for Kaiser, then it shouldn't be too much of a problem. But I think surgery in 2 weeks is a bit optimistic especially when you are deal with insurance companies.

I ate a lot of ice during my stay in the hospital. My taste buds changed and Water tasted terrible so I avoided it. They started to bring me sugar free popsicles and that was good. I did a lot of walking in the hospital and that definitely reduced the bloating, the pain and made the recovery process go much smoother and quicker.

Two thoughts cross my mind. First - there seems to be very little guidance once an RNY patient reaches the "Maintenance" phase, other than avoid grazing. (Whereas, the direction during the "Weight Loss" phase is very, very detailed - almost a book.) Second - The approach in the "Maintenance" phase is very different than during the "Weight Loss" phase for RNY gastric bypass patients. After surgery, the part of the stomach that process fats and sugars is cut away and consuming these items in quantity can lead to dumping. But after about a year, the intestines learn to process these elements to take up the function that was once performed in the stomach. Therefore patients can once again consume these types of food. The key to the "Maintenance" phase is hunger control. Fats can play a vital role in this area. Anyways more here. http://www.breadandbutterscience.com/Surgery2.pdf

You might be right. All of the experimental patients in this study did not suffer from osteoarthritis, as determined by X-ray evidence of joint space narrowing prior to the commencement of the study, they were just overweight. So maybe if you catch it early (and lose the weight), it may never progress to the point where it becomes a major problem.

Rice is probably too hard on the stomach in the beginning. According to my guidelines Brown Rice was acceptable at month 7 post-op. But some rice products were acceptable right at the beginning such as Cream of Rice. Dumping is generally not the villain it is made out to be. Sure it is an uncomfortable painful experience. But more important, it is a learning tool. Once you dump you quickly decide that you do not want to do that again, so you avoid the problem. You become very attuned to what the pre-signs are, such as hiccups or stuffy nose, and then you just don't go there.

They are looking at a variety of Vitamin levels, your Protein, your Calcium. It seems like they take 10 small bottles of blood. I should have been a blood donor.

Congratulations on your 80 pound weight loss prior to surgery. It will add to your total weight loss. Don't be too concerned about your Protein shake at this point. Your taste buds may dramatically change after surgery and what you find acceptable now may be terrible after surgery. So be open to experimentation. The goal is to find a Protein Shake that you can tolerate. The constipation may be due in part to the substantial weight loss you have experienced at this point. Many people use powder Protein shakes and blend them using a Ninja blender or equivalent with Water or milk. Blending shakes is appropriate and I would not be too concerned about the air caused by blending.