James Marusek

Although I have seen a lot of post on this board from RNY gastric bypass patients and patients that have revisions from one surgery (such as lap band) to RNY, I haven't seen many from RNY to RNY revisions. There may be others in the same boat as you but they don't seem to gravetate to this board. On the other hand, if we can be of any help, please ask specific questions and we might be able to help. There are two phases to the process. The "Weight-Loss" phase and the "Maintenance" phase. It looks like you did well in the "Weight-Loss" phase but not so well in the "Maintenance" phase. It seems like the guidance given by the surgeons work very well in the "Weight Loss" phase but it seems to come to an end as you transition into the "Maintenance" phase.

I had a RNY gastric bypass 31 months ago. I found it a little difficult to consume foods and when I talked with his nurse several months ago, she said that my surgeon was known to make the pouches a little bit smaller. It wasn't so bad that it brought on malnutrition so I am content. The suggestion from my dietician was to eat more meals a day than 3. I relied on softer foods, primarily chili and Soups. These went down easier. So here is a link that contains some recipes at the end. http://www.breadandbutterscience.com/Surgery.pdf Also your daily Protein requirement is met by a combination of the protein from supplements (protein shakes, protein bars) and the protein you obtain from meals. So if you concentrate on high protein meals, it means that you do not need to consume as much protein from supplements.

Congratulations.

The main objective is to find a Protein powder that you can tolerate after surgery and one that is low in sugar. You may become lactose intolerant after surgery, if so, having a protein powder that is lactose free may come into play.

I use Citrical primarily because it is inexpensive. This is hard in the beginning because it is horse pill size and one is unable to swallow it for the first few months after surgery. That means in the beginning it must be crushed and it taste like chalk.

Why did the doctor prescribe stool softener? It is a little hard to understand what is going wrong and give advice without more info. Have you had surgery yet? One of the things that happens for some individuals that have RNY gastric bypass surgery is that they become lactose intolerant for a few months after the operation. If you drink milk or a product that contains lactose, it can quickly lead to diarrhea. Some Protein shakes contain lactose. In my case I had to eliminate milk from my diet for a couple months.

In the beginning stages after surgery it is very important to follow the rules if you want to maximize the weight loss. One of the restrictions is NO CAFFEINE. Cocoa powder contains caffeine. Depending on the degree of fermentation and the type of cocoa Beans, the caffeine content will vary from 0.1-0.5%. In cocoa powders made from well fermented African cocoa beans the caffeine proportion is in general very low: 0.1% or less. This is a temporary restriction. After you leave the "weight loss" phase and transition into the "maintenance" phase, things ease up a lot. I regularly drink a hot cup of cocoa in the morning during the cold winter. I use the "no sugar added" variety. I am 31 months post-op RNY.

Before I underwent the surgery, I was given a class that explained all the requirements and provided a thick binder with all the instructions.

After surgery, I could not swallow anything medium or large size. The calcium pills were large and had to be crushed. They also tasted like chalk. The only way I found to take these was mix them with a glass of Crystal Light and drink them down. Since the crushed calcium tended to form a paste at the bottom of the glass, this generally meant that I had to refill the glass with some more Crystal Light and try again. At least I was meeting my Fluid quota. The good thing to know is that this condition does not last forever. In about 2 months, I was able to swallow and taking the calciums no longer presented a problem. One of the problems I encountered after surgery was that I became lactose intolerant. Anytime I drank milk or anything that contained lactose, it lead to pain and a quick trip to the bathroom with diarrhea. Some Protein shakes contain lactose. I took myself off all milk products and eventually after a few months this condition also went away. It took me about 6 months to reach my "happy state", when all these type of conditions were resolved and I could get back to living my life. So be patient.

Welcome and let us know if we can be of any help.

Welcome. As far as advice, I will recommend two things pre-op. 1. Walk around 30 minutes each day. This will make your recovery go much, much easier. 2. If you haven't eliminated caffeine and carbonated beverages from your diet, do so now. I had a 6 diet coke a day habit for many decades. I went cold turkey at the beginning of my pre-op diet and lost 20 pounds on that change alone. Also when I give up caffeine in the diet cokes, I suffered from severe withdrawal syndrome - severe headaches and body aches. So if you wait until just before surgery to give up these, the withdrawal effects may compound with the effects of surgery and add to your suffering. It is better to take these on individually. Some literature recommends that you make the reduction gradually, about 25% per week in order to minimize the effects of the withdrawal syndrome.

In the longer scheme of things, as time goes on you will become more capable of dealing with the holidays. Your food volume will go up and you will feel less like it is a burden and appreciate the marvelous changes that are taking place due to the lost weight.

For some reason people tend to use way too many abbreviations. This causes exclusion and confusion. So here is a list of abbreviations that are commonly used in this forum. Abbreviations ACL = Anterior cruciate ligament AMRAP = As Many Rounds As Possible (crossfit) bc = because BCBS = Blue Cross/Blue Shield BED = Binge Eating Disorder bf = best friend BM = bowel movement BMI = Body Mass Index bp = blood pressure BPD = Borderline Personality Disorder or Biliopancreatic Diversion (Scopinaro procedure) btw = by the way CBT = cognitive-behavioral therapy CC = common channel c diff = clostridium difficile cos or cuz = because CPAP = continuous positive airway pressure CRNP = certified registered nurse practitioners cw = current weight CXR = Chest X-Ray Dr. = doctor DS = Dumping Syndrome or Duodenal Switch EGD = Esophagogastroduodenoscopy EKG = Electrocardiography ff = fat free GERD = gastroesophageal reflux disease GI = gastrointestinal GNC = General Nutrition Corporation store GP = general practitioner or family doctor HBP = high blood pressure hr = heart rate hw = highest weight ICU = Intensive Care Unit Idk = I don’t know IMHO = in my humble (honest) opinion IMO = in my opinion IUI = Intrauterine insemination LAP Band = Laparoscopic Adjustable Gastric Band lol = laughing out loud LSG = Laparoscopic Sleeve Gastrectomy med = medicine msg = message NASH = Nonalcoholic steatohepatitis nf = non fat NG = Nasogastric NP = nurse practitioner NSAIDS = Non-steroidal anti-inflammatory drug NSV = non-scale victory (“scale” means “weight scale”) NUT = nutritionist Onederland = a magical place or destination for those trying to lose weight. It might correspond to attaining a weight in the hundreds or losing a hundred pounds. op = operation OSA = Obstructive sleep Apnea Oz = Australia PCOS = Polycystic Ovary Syndrome PCP = Primary Care Physician PM = private message (email) PMS = premenstrual syndrome postop or post–op = post-operation or post-surgery PPI = Proton Pump Inhibitors ppl = people preop or pre-op = pre-operation or pre-surgery PTSD = Post-Traumatic Stress Disorder PVC = Premature ventricular contractions RA = Rheumatoid arthritis RN = registered nurse RNY = Roux-en-Y s/f or sf = sugar free smh = shaking my head, scratching my head sw = weight at surgery tmi = too much information TPN = total parenteral nutrition u = You VSG = Vertical Sleeve Gastrectomy Vit = Vitamin wks = weeks WLS = Weight Loss Surgery WOD = Workout of the Day w/o = without wt = weight or :-) = ☺ = smiley face or :-( = ☹ = sad face

Congratulations on your weight loss thus far. As far as the Vitamins are concerned, this is the approach that I use. It may be of help. Since I had to separate my calciums from my Iron, I take my Multivitamin (which contain iron) and my iron supplement (because I was iron deficient) at night before bedtime. [i suspect the Calcium in the milk I was drinking brought down my iron numbers.] I put all my calciums (8) tablets in a miniature glass bowl on the countertop when I get up in the morning. These I take throughout the day a couple at a time and try and space them a couple hours apart. Otherwise it would be hard to keep track of these. All the other vitamins I put in a pill container separated by days of the week. I take these first thing in the morning. And when I am up and about, I put the calcium tablets in a plastic zip lock bag and take them with me.

The approach in the "maintenance" phase is different than in the "weight loss" phase. This is my personal experience with the maintenance phase. http://www.breadandbutterscience.com/Surgery2.pdf

The strategy in the "Maintenance" phase is different than in the "Weight Loss" phase. This short article describes my personal experience with this phase. http://www.breadandbutterscience.com/Surgery2.pdf

My vote is for Coconut Cashew.

I found that blending in a half a banana made the protein shakes more tolerable to drink.

I wrote a short article about my experience with RNY surgery. Perhaps it may be of help. http://www.breadandbutterscience.com/Surgery.pdf

Generally, RNY gastric bypass is recommended for individuals with severe acid reflux (GERD). I am 31 months post op from RNY and have not had any severe acid reflux after the surgery. Although I had several episode prior to surgery.

Walking makes the recovery process go smoother. It will help to relieve the gas pain. Hopefully they have a hanging trapeze type bar above your bed. This will help you stand easier. If they don't, request one so that you can get out of bed to walk a little less painfully.

Welcome and let us know if we can be of any help.

My Psych evaluation was not paid for by my insurance. I believe most insurances refuse to pay these costs. But that was noted on the first consultation. The cost at the time was $100. The psychologist operated out of the same office as the surgeon (one of the advantages of going to a Center of Excellence). But the psych evaluation cost is minimal compared to the cost of the hospital, surgeon and pre-op testing. So the bigger question is what portion of these costs will your insurance cover? Are you within network for these costs? Dealing with the insurance companies can turn your hair gray early or make you pull out your hair.

Good luck on your surgery and let us know if we can be of any help.

It is my understanding that sleeve will only make severe acid reflux (GERD) worse. That is the reason why most surgeons perform RNY gastric bypass surgery on individuals with this condition. I had severe acid reflux prior to my RNY surgery 31 months ago. This condition has never been a problem since. Stick to your guns and demand the surgery that you wanted, RNY gastric bypass. It is the best one for you condition.