James Marusek

After RNY gastric bypass surgery, your meal volume is incredibly small [2 ounces or 1/4 cup] per meal. Over the next year and a half, this volume is increased to 8 ounces or 1 cup per meal. So as your meal volume increases, the amount of weight loss decreases.

It might be the salad dressing. After RNY gastric bypass surgery, the part of your stomach that processes fats and sugars. Consuming these can lead to dumping syndrome.

I will pray for you.

@Lexuskela I noticed that in past post you discussed doing increased running exercises after surgery. I came across this article and thought perhaps you pain may be due to another source. http://acsh.org/news/2016/02/17/sciatica-a-real-pain-in-the-arse/

Good luck and may you always follow your dreams.

@@Lexuskela I had RNY gastric bypass 33 months ago. According to your profile you had gastric sleeve. RNY gastric bypass causes malabsorption. In other words after my operation my body could no longer synthesis the Vitamins my body needed from my food intake. Therefore I have to take vitamins for the remainder of my life. The process you underwent restrictive procedure because reduced stomach size causes early satiety and reduced oral intake. It is not malabsorption. Taking B12 three times per day? That seems odd to me. I am taking one half tablet of B12 daily. The tablets are 2500 mcg so I break it in half. If you are taking 3 of the same type of tablets, then that would be 1,250 times the recommended daily dose. I don't think there is an upper safe limit on this Vitamin. So what is the total daily dosage of the sublingual B12 you are taking? Another vitamin that can cause neuropathy is a lack of B1. Initially my surgeon prescribed one B1 tablet daily, but after about a year or two and reviewing my blood work, he reduced this down to one tablet a week. This is what one website had to say about vitamin deficiencies in VSG patients. Preoperative Nutritional Deficiencies Nutritional deficiencies can occur with VSG even though patients have intact intestinal systems. Obesity itself is considered a form of malnutrition because deficiencies in both water- and fat-soluble vitamins are seen in the obese population. Kaider-Person and colleagues demonstrated that deficiencies in folate and vitamins A, B1, B12, D, and E commonly are seen in patients with obesity. Research also has shown that up to 51% of patients undergoing VSG had below-normal levels of at least one micronutrient, such as iron, potassium, folate, or vitamins B6, B12, and D. The goal is to correct these deficiencies before surgery because they may be exacerbated after surgery as a result of poor oral intake and tolerance, noncompliance to a bariatric nutrition protocol, rigor of the protocol, absence of dietary guidance, inadequacy of food variety, and adherence to proton-pump inhibitors often prescribed for some time after surgery to reduce stomach acid, which can lead to malabsorption of B12 and iron. Postoperative Nutritional Deficiencies While research still is needed to evaluate the long-term effects of VSG on micronutrient status, vitamin and mineral deficiencies after the procedure are reported up to five years post-op. Research has shown that patients who undergo VSG are at risk of microcytic and pernicious anemia as well as metabolic bone disease because of micronutrient deficiencies in iron, folate, and vitamins B12 and D. VSG decreases hydrochloric acid production and creates a significantly reduced intrinsic factor, directly affecting iron and B12 absorption. Thiamin (vitamin B1) deficiency leading to Wernicke-Korsakoff syndrome also has been reported in several cases after VSG. Moizé and colleagues reported that, after five years, vitamin and mineral deficiencies with VSG corresponded with those seen five years after gastric bypass. VSG patients who take metformin also are at risk of vitamin B12 malabsorption. Despite universal supplementation, the prevalence of Vitamin D deficiency was the most commonly observed deficiency five years postoperatively in VSG patients. Research also has shown that while most bariatric programs and hospital protocols agree that vitamins and minerals are important, there’s variability in the prescribed vitamin/mineral protocol, and a single multivitamin containing more than 100% of the Recommended Dietary Intake may be insufficient to provide some of the necessary micronutrients while concomitantly providing excess in others. I didn't know what Wernicke-Korsakoff syndrome was, so I looked it up. Here is a link. https://www.nlm.nih.gov/medlineplus/ency/article/000771.htm Some of these symptom appear to match but you are closer to this than I am. Anyways this is caused by a B1 deficiency. I am not a medical expert and I think you need to rely on your medical staff. Here is a link of what patients report feeling that are vitamin D deficient. http://www.medicinenet.com/vitamin_d_deficiency/patient-comments-2672.htm

I am 33 months post op RNY. I would recommend that you take a good before photographs so that you can compare it to the after photograph. Often times we fail to really see ourselves. And after surgery, we sometimes question our weight loss because we have nothing to compare it to. This is my 6 month before and after photo. I tried to duplicate the same pose. http://www.breadandbutterscience.com/Operation.jpg

I had my surgery done in a Bariatric Surgery Center of Excellence. There are many scattered throughout the country. The advantage was that they specialized in this type of surgery and had a complete complement of staff to support the surgery. My surgeon only performed this type of surgery. The nutricianist were specialized for weight loss surgery. The entire range of pre-op testing was done in that hospital. They provided courses. They had staff to work the insurance problems. They chartered and managed the various Bariatric Surgery Support Group Meeting scattered throughout the state. It was like a full meal deal (pardon the pun).

I am 33 months post-op RNY. I like to eat home made high Protein chili. I consume about a cup per meal which equates to 23 grams (around 3 ounces). The recipe is here. http://www.breadandbutterscience.com/Surgery.pdf

The following article documents my experience in "Maintenance" mode. I am 33 months post-op RNY surgery. http://www.breadandbutterscience.com/Surgery2.pdf Before surgery, you were told what you daily Protein goal was. This goal is a combination of the protein you obtain from supplements (Protein shakes, protein bars) combined with the amount of protein from you meals. Since you are a 7 year veteran, you need to do some math. Add up all the protein you consume during the normal day. Subtract this from your protein requirement. That should help you figure how much additional protein you should be taking through supplements. I found Quest bars to be a good Protein Bar. As I said in the article, the goal in the Maintenance phase is hunger control. That is the key. "Eating chips or some kind of carb I know that is not good" does not solve hunger control and may be the main reason why you have seen a weight increase.

Wow. It sounds like you were hit with everything including the kitchen sink. I am 33 months post-op RNY gastric bypass surgery. About 6 months ago, I decided what my goal weight should be. I had dropped to around 140 pounds but basically the research that I did told me that it is important to have a little extra fat on my body and I concluded 150 pounds (the high side of normal BMI) was optimal. The logic behind this was that when you get seriously sick or experience a major accident, you tend to lose weight and this can imperil your life and survivability. So I am now at 150 pounds and that is my new normal. After RNY surgery, the part of your stomach that process fats and sugars was cut away and consuming too much of these could quickly lead to dumping syndrome. But after about a year, you intestines realize this deficit and learn to process these food elements. Therefore as you slide into maintenance mode, you can again consume these foods including whole milk, butter, and normal cuts of meat. Anyways at your stage, the low-fat is no longer a requirement. One of the many pleasure that I found is eating a cheese sandwich. I use Velvetta cheese. I use a very dense white bread. I put the cheese between two slices of bread. Take a frying pan, throw in some real butter and let it melt then throw on the sandwich, until it is well toasted and turn it over and add some more butter and toast the other side. If the cheese doesn't completely melt, I throw it into a microwave and cook it for 15 seconds. It is the most wonderful thing in the world. After you drop off the antibiotics it will be important for you to reestablish your colonies of good bacteria in your gut. That is what Probiotics are for. Some of the better brands of probiotics are stored in refrigerated sections.

Good luck on your surgery. I will pray that everything goes well.

I haven't experienced this. But it is common for individuals to develop nerve pain and numbness after surgery because of nerve damage.

When I experience dumping syndrome, there are some tells. I might get hiccups or sneezes. Then mucus begins to plug up my nose. I might spit out some mucus or slime. Then I might vomit for a couple hours and then I feel better and tell myself never to repeat that again. Throwing up for 10-12 hours doesn't sound normal. It is common for individuals to develop strictures after surgery. If your condition begins to repeat itself again and again and your intake volume decreases, you might explore the possibility it might be a stricture. Also avoid eating just prior to bedtime. There is nothing worse than experiencing dumping syndrome as you lay down on a bed or couch and try to sleep.

Sounds like dumping syndrome. It can happen every once and a while. If it happens all the time it might be a strong indicator for a stricture. It is common for people who have strictures to have another stricture develop again.

Congratulations.

After RNY gastric bypass, there are two problems with traditional chocolate candy: sugar and fat. During RNY the part of the stomach that processes fats and sugars has been cut away. If you eat several chocolates, it can lead to dumping syndrome. Eventually your intestines will figure out something is wrong and will step up to the plate and begin to process these foods. This can take about a year. You are within the "weight loss" phase for such a short time, it is important to maximize the weight loss. Once you transition into the "maintenance" phase, the strategy is different. Fats are a useful tool during maintenance because they take away hunger. Maintenance is about hunger control. But I would recommend you avoid sugars during the maintenance phase. Natural sugar (fruits and milk), artificial sugars (such as splenda), and no calorie natural sugars (such as stevia) are fine, as well as sugar alcohols. So if you have a craving in the maintenance phase, it is fine to consume Adkin's treats. Or enjoy a cup of hot cocoa, only make sure it is the "no sugar added" variety.

My initial weight was similar to yours. I had RNY gastric bypass surgery. I transitioned quite naturally from the "weight loss" phase to the "maintenance" phase at around 6 or 7 months post-op. The strategy in the 'maintenance" phase is different than the "weight loss" phase. I am 33 months post-op at this point. And even in the "maintenance" phase it is possible to lose additional weight. I lost around 20 additional pounds in the "maintenance" phase. I wrote a short article about the "maintenance" phase. Here is a link. http://www.breadandbutterscience.com/Surgery2.pdf

I had been using the large Citrical's of 5 per day. Then I switched to the smaller (petite) ones of 8 per day. After about a year and a half post-op, I tried to reduce the large ones down to 4 per day but my blood work showed that I wasn't getting enough calcium, so I had to go back up. One of the things that might be confusing with the Citrical's is that the dosage rate is based on 2 tablets (not one). So until my first post-op visit with the nutritionist, I was incorrectly taking the calcium dosage. Anyways, there are a lot of calcium's to take daily.

For me the major problem is keeping track so that I don't miss any. It is important to separate Iron from calcium. I found out that taking iron is best to take just before bedtime. When I get up I take half my Vitamins. Then I take my calciums throughout the day spaced about 2 hours apart. And just before bed I take all the rest. Since my blood work showed I was deficient on iron, I take a separate iron pill in addition to the iron in the Flintstone chewable vitamins that contain iron. I use two pill organizers. One for the morning and one for the evenings. I fill these once every 2 weeks *with all the vitamins except the calciums). I place the calciums in a very small bowl when I get up. That way I don't lose track of the number of calciums. I just reach in every 2 hours and take some of them. If I am up and about, I put my calciums in a zip lock bag and take it wherever I go. Right after surgery, I found that I could not swallow medium to large pills. I used pill splitters and pill crushers during this time. The calciums were terrible because crushed calciums taste like eating chalk. I found the only way to take these when crushed is to mix them with Crystal light. I would have to fill the glass several times and stir it in order to consume all the powder. Fortunately, this limitation only lasted a couple months and I got back my ability to swallow again.

Generally the guidance is to restrict the volume of your meals as a function of time after surgery. At 4.5 months, that should equate to 4 ounces per meal (1/2) cup per meal at 3 meals per day. [but this guidance may vary by surgeon]. So if you are controlling the volume of your meals, counting calories isn't as important. The surgeon identified a minimum requirement for Protein. This requirement is met by the protein from supplements (Protein shakes, protein bars) combined with the protein from meals. In the beginning with such restrictive volume control, it is impossible to meet the protein requirement unless you consume protein shakes. But as time goes on, if you concentrate on consuming high protein meals, you will be able to drop off some of the protein shakes and the calories they contain. I am 33 months post-op RNY gastric bypass surgery. I consume an equal mix of protein, carbs and fats, with the emphasis on protein first. I avoid all sugars except natural sugars (found in fruits and milk), artificial sweeteners and low calorie natural sweeteners (such as stevia). But again I am in maintenance mode. After surgery, the part of the stomach that process fats and sugars was cut away and most people who consume excessive fats or sugars encounter dumping syndrome. After about a year, your intestines learn to process fats and sugars and the dumping goes away. So it might be a little early to consume fats at 4.5 months. When I was in the weight loss phase, I restricted myself to very lean meats and low fat milk. But now I consume butter, whole milk and other fats.

On a side issue. I went into Krogers recently after they remodeled and I kept getting blocked in the aisle ways or bumping into people. In order to add more food and goods to the store, they shrunk the aisle ways, so they are not as wide as they were before. I guess if I was still obese, I would probably become claustrophobic and wonder if there was a conspiracy afoot. Your outsides may change but inside is the real you.

33 months post-op and sleep is fine. Probably better than fine since the sleep is a better sleep, a deeper sleep. I no longer have sleep apnea. And my frequent urination problem that woke me up every hour or two during the night is gone. So I sleep almost the entire night long now.

My wife was organizing the photograph albums the other day. She came across a photo of me from several years ago. She rushed over and said "you have to see this - I hardly even recognized you". Give it a little more time. You have lost 125 pounds. Congratualtions.

Just stay with the basics. Meet your daily Protein, Fluid and Vitamin requirements and walk about 30 minutes each day and let the magic happen. Your body is still in a major heal mode.