James Marusek

Weight loss depends on the type of surgery. After my gastric bypass, my weight dropped like a lead brick but I transitioned into maintenance at 7 months. Sleeve patients drop weight at a much slower pace but many do not transition into maintenance until 2 years post-op and they experience many stalls along the way. So be careful when comparing your weight loss with others. At 16 days post-op you are really at the start of your journey.

Congratulations.

Prior to surgery, I suffered severe acid reflux (Gerd). As a result I had gastric bypass because sleeve will only make the condition worse. After my surgery, my surgeon put me on Omeprazole (over the counter Prilosec), which was the same thing that I used for acid reflux. He said the reason why he prescribed this was to allow my stomach to heal properly. I took it daily for a year and then stopped. I am 5 years post-op and haven't taken it past the first year and haven't experience Gerd since. So you might see if your surgeon will prescribe Omeprazole (a proton-pump inhibitor) for you. 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.

Good luck on your upcoming surgery and check back with us when you are on the other side and let us know how it went.

Good luck on your surgery tomorrow. Remember after the surgery to Walk, Walk, Walk, it helps to alleviate the gas pains. Also make sure they install a trapeze bar above your hospital bed to that you can get up with less pain, so that you can Walk, Walk, Walk.

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. 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. Your daily protein requirement is met by a combination of the amount of protein you obtain from food combined with the amount of protein from protein supplements (protein shakes, protein bars). Right after gastric bypass surgery, the volume of food you consume is minuscule (2 ounces) per meal. But as you get further along, the meal volume increases. Therefore you have a very important option available to you. As a result, you can begin to reduce your reliance on protein shakes if you concentrate on consuming high protein meals. I went from 3 protein shakes a day, down to 2, down to 1 and eventually none when I reached 1 cup per meal at a year and a half post-op. Because you meal volume requirements are fairly small, you have the option of cooking up a pot of food for yourself and consuming it over several days. I found that softer foods (such as chili and soups) went down much easier than harder foods (such as steak and chicken). Therefore I relied upon these. So as your food options expand and you reach the solid stage at around 2 months post-op, then you may want to take this approach. I have included a few recipes at the end of the following article. http://www.breadandbutterscience.com/Surgery.pdf

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. Fiber helps with issues of constipation. 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.

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.

I don't mind the attention. Before surgery, society did not see me. I was invisible. After surgery, I became visible. There are many invisible people in this world. I make it a point whenever I go shopping I notice the name of the person on their name tags. And as I am paying I tell them thank you by name. Many of these people are invisible too. Because I look good, normal, this catches many of them by surprise and I think in some small way, makes their day.

I would plan the surgery over the summer just to give you a little more time adjusting to it. I had gastric bypass surgery and one of the interesting points was that after surgery I completely lost my hunger. (It didn't happen immediately but when I reached the solid food stage. And it didn't happen forever but it lasted for about a year post-op.) As a result, it didn't really feel like a diet. I just followed the instructions and the weight dropped off like magic. I do not feel like I changed inside. When you are overweight and obese in todays world, you are somewhat invisible. Many people treat you like you are not even there. Once you lose the weight people notice. So from my perspective, it was not I that changed but how the rest of the world began to treat me. I don't know what you mean by "I am such a thirsty individual." After surgery, you will need to drink a lot of fluids. You may find it difficult at first to meet your daily requirements. But if you mean by thirst the need to consume alcoholic drinks, that might pose a problem. My stomach and insides do not feel weird an I feel like I did internally prior to any surgery. The first year my stomach was sore but then it healed.

Good luck on your surgery and check back with us when you are on the other side and let us know how it went.

Stalls are especially common after weight loss surgery. Someone on this board even coined the phrase "Embrace the Stall".

Consult your hospital discharge instructions. In the ones I received, some of the reasons for contacting your surgeon's office are: * Temperatures greater than 100.5 degrees F. * Uncontrolled or increased abdominal pain. * Chest pain, rapid heartbeat and/or dizziness.

And remember it is important to meet you daily protein requirement to avoid hair loss.

I suspect it is a stall. Sleeve patients can be in the weight loss phase for up to a couple years and encounter many stalls along the way. That is why someone on this site came up with the slogan "Embrace the Stall". Many find that when they are in a stall, they find other successes, like dropping a size in clothing or other NSVs.

According to the internet, the Premium Protein label says "Contains Milk" in the form of Milk Protein Concentrate, according to the ingredients list. I guess that would qualify it as low-lactose, but not lactose free. 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. Also generally in the hospital you were given antibiotics to kill any bad bacteria and prevent wound infection. Antibiotics not only kill the bad bacteria but also the good bacteria in you gut. So after you go off the antibiotics, it is good to restore the good gut bacteria. This can be done by taking probiotics.

Good luck on your surgery and check back with us when you are on the other side.

Many times people question which type of weight loss surgery should they choose. The following article discusses the results from the latest studies. Bariatric surgery can successfully deal with the excess weight, and both prevent the occurrence of diabetes and, in some cases, cause its remission. However, there are several procedures that can be used: Roux-en-Y gastric bypass; sleeve gastrectomy; adjustable gastric banding. How to choose among them can be gleaned from a group of articles in the Journal of the American Medical Association (JAMA). Two of these involved trials in which participants were randomly assigned to various treatments (e.g., types of surgery), and compared the outcomes with respect to various parameters. In the third, surgery was compared to medical management. Weight Loss Salminen et al. (1) compared the amount of excess weight loss five years post-surgery in 240 severely obese patients (average BMI = 46) who were randomly assigned to receive either Roux-en-Y or sleeve gastrectomy surgery. All surgeries were performed via laparoscopy. Most of the patients had some co-morbidity — diabetes, dyslipidemia, and hypertension. Those who underwent the sleeve gastrectomy had lost 49 percent of their excess weight by five years, while those in the gastric bypass group lost 57 percent. This difference was not statistically significant. The comorbidities were ameliorated in both groups — 37 percent of those in the gastrectomy group had partial or complete remission of their diabetes, compared to 45 percent of those in the bypass group. The dyslipidemia was similarly impacted: medication was discontinued in both groups —for 47 percent of those with gastrectomy and 60 percent of those with gastric bypass. Discontinuation of hypertension medications occurred for 29 and 51 percent of those in the gastrectomy and bypass groups respectively. Similarly, Peterli et al. also compared the 5-year effects of gastric bypass and sleeve gastrectomy on weight loss in severely obese people. In this study, 107 participants underwent sleeve gastrectomy, and 100 had gastric bypass surgery. They were randomly assigned to each treatment. In this study, the average BMI was 44. Five years post-surgery, those undergoing sleeve gastrectomy lost 61 percent of their excess BMI, while the gastric bypass surgery resulted in a 68 percent loss of excess BMI. These differences were not statistically significant. However, 32 percent of patients undergoing sleeve gastrectomy experienced a worsening of gastroesophageal reflux (GERD) symptoms, compared to only 6 percent of the bypass group. By five years post-surgery, 19 percent of the gastrectomy group had had to have re-operations or other interventions, versus 22 percent of those with the gastric bypass surgery. Surgery vs. Medical Management (diet and exercise) In a third random controlled trial, Ikramuddin et al. examined the impact of either Roux-en-Y bypass surgery or medical management on indicators of diabetes control (hemoglobin A1c or HbA1c[4]), heart risk (LDL cholesterol: goal <100 mg/dl), and systolic blood pressure (<130 mm Hg) 5 years post-intervention. The study included 120 individuals whose initial BMI ranged from 30 to 39.9; their HbA1c levels were 9.6 percent. After five years, 23 percent of patients in the surgery group vs. only 4 percent of those in the medical management group had achieved the goal levels for the three indicators, although further observation suggested that the differences between the groups tended to wane over time. Also, 16 of the surgery patients achieved partial or full remission of their diabetes, compared to 5 of those in the non-surgical group. As expected, those in the surgery group lost more weight as a percent of initial body weight — 22 percent vs. 10 percent of those receiving only medical management. Thus the results of these randomized trials support the efficacy of both Roux-en-Y gastric bypass surgery and the gastric sleeve surgery when it comes to weight loss, and gastric bypass was also superior to medical management. However, anyone considering such surgeries must also consider adverse events — for example, the sleeve gastrectomy exacerbates pre-existing GERD, and thus wouldn't be recommended for such patients. Both of the surgeries involve some modification of the GI tract — most extensively with the bypass type. And thus the bypass is more likely to result in nutritional deficiencies than the gastric sleeve operation. A positive aspect of these studies is that the benefits of the surgeries were durable — an important issue for anyone considering undergoing them. https://www.acsh.org/news/2018/01/22/which-bariatric-surgery-procedure-best-it-depends-12442

As you lose weight, the chemicals and hormones that were stored in your fat cells are being released into your body. These will pass through your kidneys and are expelled in your urine or through your sweat. But they can generate a flush of hormones during the weight loss phase. They should simmer down once you transition into maintenance. It is important to meet your daily fluid requirements, because it take fluids to flush these hormones from your system.

Congratulations.

After surgery I began using protein shake. I hated them. There is no comparison to milk shakes, so I even hate the phrase. After a few months post op, I began blending in a half a banana into my protein shakes to make them more palatable. According to my instructions, bananas became an acceptable food group to consume at week 5.

Welcome In general, I told everyone, even strangers on the street. Generally the reaction that I received was either supportive or curious about the surgery. But I can understand that after the operation and the pounds begin to drop off, some people might wish you not to succeed because it might put them on the spot. Your success might put pressure on them to lose weight themselves.

Congratulations.

I had Type II diabetes prior to surgery 5 years ago. I was on two types of prescription medicine to control my blood sugar and they were not doing the job and my GP recommended I transition to insulin injections. I refused. Two days after surgery when I left the hospital, I was off all my diabetes medicine and I haven't taken any since. I periodically once per month check my blood sugar levels and they are fine. Some people are able to get off all their meds after surgery and some are not. From what I can gather it somewhat depends on how long they lived with the diabetes. If they were on their meds for just a few years, many times the condition goes into remission. But if they were on meds for decades, many only see a reduction of the meds they take. It is very important after surgery to control you sugar intake for the rest of your life in order to control this condition. In my case I had a major sweet tooth which is probably one of the root causes of my being overweight. The following is the approach that I try to follow: I limit myself to artificial sweeteners (such as Splenda and sugar alcohols), to natural low calorie sweeteners (such as Stevia) and to the natural sugars found in fruits and milk. I look at the grams of sugar per serving. If it is above 5 grams, I look at the ingredients. The ingredients are listed in order by highest percentage, and if the first 5 ingredients contain processed sugar (in any of its many forms), then I avoid this food, like a plague. I also restrict myself to about one meal per day containing complex carbohydrates (such as pasta and bread). I also avoid all carbonated beverages. I lost 20 pounds pre-op solely on eliminating carbonated beverages from my diet and I will not go back. Another approach that I recently began is to limit grazing. Grazing is eating snacks throughout the day in place of full meals. A recent study showed that the majority of people eat over a 15-hour period each day. When people restricted their eating to 10 hours per day they achieved a 3.5% weight reduction. I am a late riser and sleep until around 7 or 8 a.m. I decided to restrict my “eating window” to a 12-hour window and not consume any meals or snacks after 7:30 p.m.

The fluid requirement is met by a combination. It is not only the water that you drink each day. But also the water you drink when you take your vitamins and medicine. It is the milk you drink. It is the fluids content of the protein shakes. It is the water component of the soups you take. It is met by flavored water such as Crystal Light. It is met by sugar free popsicles. It is met by tea and decaf coffee. It is a combination of all the fluids that you consume during the day.