James Marusek

I am sorry to hear about your daily struggles. It seems like nowadays its the grandparents taking care of the great grandparents. Probably not something one thinks about in early life. I haven't heard of the weight loss drug "qsymia" and don't know anything about it. I am 30 months post-op RNY and have been fairly successful about keeping the weight off. I wrote a short article about the "Maintenance" phase. It is available on-line at http://www.breadandbutterscience.com/Surgery2.pdf

I'm sorry, you lost me. What is Program A and B? Both the bariatric surgeon and nutritionist should be on the same page. What is a bariatric specialist? Here is my experience. Many health insurances require conditions be met before they will approve the surgery. Some of these relate to minimum BMI limits and co-morbidities. Others relate to diet and exercise. In my case, my BMI was above the limit meaning that I was obese, also I had several co-morbities such as High Blood Pressure, sleep Apnea, Diabetes. My insurance company required that I undergo a 6 month diet and exercise program to show that I was trying to lose weight on my own and unable to do so. So in the pre-op stage, my doctor had me keep food journals to track what I ate (this highlighted where I was eating excess calories), prepare healthy meal plans, attend bariatric surgery support group meetings, perform daily exercise. All this information was eventually used in a letter that the doctor sent to my insurance company to support the need for the surgery. At the end of 6 months, I lost 20 pounds and my RNY surgery was approved by my insurance company. Since you are on a 700-800 calorie diet, you will need to take Protein shakes or your body will begin to degrade. For example you may lose hair. It probably also means that because you are consuming less food, you body does not have the material necessary to produce some of your needed Vitamins. Therefore taking a Multivitamin each day is probably an important part. I can't see that your specialist would object to this. I guess the most important part of whatever decision that you make is to keep an eye on your goal. At this point it is to obtain approval for the surgery from your insurance company.

I had severe acid reflux (GERD) for a few years prior to RNY surgery. It went into remission shortly after surgery and has not occurred since then. I am 30 months post-op.

After surgery, your taste buds may change. So if you find a Protein shake that agrees with you prior to surgery, it may taste awful afterwards or the opposite may happen. So experimentation is the best way to go. You are a lot closer to telling what will work and what will not. There is a lot of variation available out there. In my opinion all Protein shakes taste terrible. The goal after surgery for me was to find one that I could tolerate. What worked for me was "Muscle Milk Light" vanilla Creme powder mixed with Water in a Ninja blender (individual serving cup) blended with a half a banana. Since you are in pre-op, you might even try using a few cups of hot cocoa each day. But you must use the "No Sugar Added" type and low fat or no fat milk. The weather is beginning to turn colder and hot cocoa is rather enjoyable.

Congratulations.

After RNY bariatric surgery, the most important requirements are Protein, fluids and Vitamins. food is secondary. This is because you body is converting stored fat into the energy that drives your body. Thus you lose weight. If you had your surgery in October of this year, you are still very early in the program. You are posting a weight loss of 88 pounds, which is very good. Stalls happen and you should not panic. Generally meal volume is measured in terms of volume not calories. If you decide to track calories, are you including the calories in your protein supplements (protein shakes, protein bars)? They can be a major component. Since you already indicated that you are not meeting your daily protein requirement, this is the area I would most be concerned about.

I found that chili and Soups go down a lot easier. You can fortify them to double their Protein content. It is easier to get exact measure volumes when using these, because you are using one measured cup for the total rather than several cups or measuring spoons for meal components.

Sorry for not updating that yet will do it now I am down 76 pounds That sounds a lot better. As far as food volume. It is important to try and stay within the program requirements for meal volume. If you begin to exceed them too soon, you may begin to see your weight loss plateau sooner than what you desire. According to your profile, you still desire to lose another 100 pounds.

I am down 7.0 pounds in 10 days using a blend of essential oils that I named "Anti-Hunger". So far, so good! Able to completely resist the temptation of snacking. Loss of hunger is similar to being in the Honeymoon stage after RNY surgery. I am 29 months post-op RNY surgery and very near my bottom weight when I began this experiment. In a couple weeks if I find this experiment to be successful, I will post the formula on my updated webpage at Protein back into my diet (in the form of one large cup of hot [no sugar added] cocoa). This brought the weight loss to a dead crawl. Anyways this is good information since this experiment is just as much about weight stability as weight loss. I will now drop the hot cocoa and see if weight loss will ramp up again. [October 16] Since I dropped 1.6 pounds from yesterday. The weight loss ramped up surprisingly quick. Now here is the good news! I have now broken through my lowest weight barrier after surgery. It gives hope to those that are trying to meet a weight goal and can’t just quite seem to be able to get there. [October 17] I dropped 0.2 pounds from yesterday. [October 18] I dropped 0.6 pounds from yesterday.

At 3 months post-op from RNY gastric bypass surgery, your meal volume should be limited to 3/8 cup per meal. I use measuring cups to measure my meal volume. 3/8 cup is not typically a normal measuring cup size, but if you look around in the stores, you can find them. The most important elements after surgery are meeting your daily Protein, Vitamin and Fluid requirements. food is secondary because your body is converting stored fats into the energy that drives your body. Thus you lose weight. So if your food volume remains low during the "weight loss" phase don't be too concerned, you will not starve to death. As ritzipa pointed out, you weight loss thus far is abnormally low for this type of surgery. So if this is real and not the produce of not updating your ticker, you might be concerned and see your nutritionist.

Generally most artificial sweeteners are O.K. unless you have an allergic reaction to them. So if you can tolerate sweet-n-low before surgery, you should be able to do so afterwards. Generally, I use Splenda and Stevia. I also use sugar alcohols, such as those found in Adkin's treats. But I am a 30 months post-op. I have diabetes type 2 that went into remission the day I left the hospital. And it has remained in remission the entire time. I periodically check my blood sugar levels to validate. This link may be of help. http://acsh.org/wp-content/uploads/2015/07/Sugar-Substitutes-and-Your-Health.pdf

After surgery meat is hard on your stomach and has lost its taste. It gets better with time. For poultry, it needs to be made very tender. For example put a chicken breast in a covered pot, add Water and a bouillon cube. Put the pot on low heat for a couple hours until the meat is so tender that it comes apart easily with a fork. Spices will add a lot of flavoring to meats. Generally I found meats go down much easier when they are in the form of chili or Soups.

In RNY that part of your stomach that processes fats and sugars is cut away. Therefore fats and sugars pass into your intestines. This leads to dumping syndrome. So no, you can't have fats and sugars for about a year after the operation. Then your intestines change and they evolve to absorb fats and sugars. At this point you will be able to eat fats and sugars. My recovery was quick. In the 2 days I was in the hospital, I walked 100 laps around the corridor, the normal walking track.

Congratulations.

Generally if you have severe acid reflux (GERD), RNY is the recommended surgery. With RNY, weight loss is generally very quick and short. With sleeve weight loss is slower but the weight loss phase lasts longer. I believe, RNY has been around longer so it has a more defined track record. Sleeve is a newer procedure. With RNY, your body no longer manufactures many Vitamins from food, thus one needs to take a regiment of vitamins for the remainder of one's life. With sleeve this is not the case. I had RNY and I am more familiar with that procedure than the sleeve. So take my comments about the sleeve with a grain of salt.

Congratulations and good luck on your surgery. Check back with us when you are on the other side.

I think the answer to the second question is that they want you to become self conscious of your caloric intake for each meal and as a result start to limit them. I found it to be a useful tool especially when I ate out. I began choosing meals that were less calories and higher Protein. I found out that chili at Wendy's was good and crunchy tacos at Taco Bell were good. But milk shakes at Steak and shake had too many calories and so did pizza. When I gave the nutritionist my meal journal, often times she did not even glance at it. That is when I discovered she was more interested in using this as a tool for self regulation.

My support group was led by a nurse who had undergone bariatric surgery around 7 years earlier. I attended support group meetings just to give back a little bit to the community. When I first started to attend support group meetings, they were very negative. I thought maybe I should even rethink the upcoming surgery. Then I realized that many of the people who were attending the meetings had problems and needed help, but those that were managing successfully were skipping the meetings. So I made sure I attended the support groups meetings after surgery just to give a positive spin to the meetings. Anyways, I enjoyed bringing in things for a show and tell flavor about solving many of the minor problems and celebrating many of the successes after surgery.

This is a list of some of the Abbreviations used on the Bariatric Pal website: ACL = Anterior cruciate ligament AMRAP = As Many Rounds As Possible (crossfit) BB = belly button 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) bs = blood sugar 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 OA = Overeaters Anonymous 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 PB = Productive Burps PCOS = Polycystic Ovary Syndrome PCP = Primary Care Physician PM = private message (email) PMS = premenstrual syndrome POSE = Primary Obesity Surgery Endolumenal 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 RTD = ready to drink RN = registered nurse RNY = Roux-en-Y s/f or sf = sugar free smh = shaking my head, scratching my head SOB = shortness of breath sw = weight at surgery tmi = too much information TPN = total parenteral nutrition TT = tummy tuck u = You UGI = Upper Gastrointestinal 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

At 6 years post-op, you are definitely in the "Maintenance" stage. The approach during this stage is different than the approach used in the"Weight Loss" stage. I wrote a short article that describes the approach that I followed. It is available in the following link: http://www.breadandbutterscience.com/Surgery2.pdf

I don't know how to pin an item so ask Alex.

I did not seek mental health services (even though they were available) because I didn't feel the need for any. I did attend support group meeting for the first year and a half after surgery. I found it beneficial.

I have been sleeping on a waterbed for over 40 years. They are warm and comfortable. But I would not recommend this for at least a couple years after surgery. It was extremely painful to get out of bed in the morning after I had the surgery. Anyways waterbeds may have gone the way of hippies. They are hard to find nowadays.

Hi. I am not sure what type of surgery you had. But if you had RNY gastric bypass, you may find eating meat/fish to be difficult in the beginning. I could tolerate tuna fish early. Poultry was very difficult unless you boiled it in slow heat for several hours until the meat is so tender that if falls apart with a fork. Congratulations on your weight loss thus far.

Welcome. You might also find a Bariatric Surgery Support Group Meeting in your area. Generally they happen monthly and are free. It seems like you are in the middle of the process. You will undergo a series of pre-op testing which takes almost a day. If they find anything of concern, they will schedule you for follow-on specialized tests with a specialist in the field of expertise. They are just trying to be extra careful to avoid problems during surgery. They will set a surgery date. Towards the end, there is a half day class that provides great detail about the surgery and post-op requirements. A lot of information is provided during this class.