James Marusek

In order to give birth to a healthy child, it is important to have some weight gain. When my wife and I went through Natural Childbirth classes 40 years ago, the nominal number was 35 pounds minimum at full term. My wife is short. She is 4' 11". At the time she became pregnant, she weighted around 95 pounds. At full term she had gained 52.5 pounds. She had no problem losing the weight with the first nor the second child. Both my children were born without any physical defects or mental retardation. The directions for food during pregnancy are very similar to those for weight loss: Protein, and plenty of Vitamin C and stay away from unhealthy foods such as potato chips. And plenty of exercise.

The amount of Protein you consume is the sum of the protein from meals combined with the protein from supplements (Protein shakes and protein bars). At 3 months out, you meal volume has increase. If you are concentrating on consuming high protein meals, this gives you the option of reducing the amount of protein supplements that you need to take to meet your minimum requirements and the extra calories they contain. I hit a plateau around the same timeframe and I dropped a Protein shake (3 per day down to 2) and my stall came to an end.

I am 28 months post-op RNY surgery. So I don't know how well this applies to sleeve patients. Weight loss is achieved during the "Weight Loss" phase through portion control (meal volume). During this phase RNY patients need to restrict their intake of fats and sugars because the portion of their stomach that processes these has been cut away and taking them can result in dumping syndrome. Once you bottom out and enter the "Maintenance" phase, the ground rules change a little. The goal is to control hunger. Generally my nutritionist recommends a balance between Protein, carbs and fats. [At this stage, my intestines have stepped in and have taken over the function of processing fats and sugars replacing what was lost by my stomach.] So for my meals, I shoot for a balance but I always apply the "protein first" rule. I incorporate fats in meals and Snacks to control hunger. Because I once had diabetes, I avoid process sugars like a plague. I limit my complex carbs (Pasta, bread, etc.] to one meal a day.

Life is full of trade-offs. I am 28 months post-op from RNY gastric bypass surgery. I miss the enjoyment of eating a great meal - the taste, the smell, the satisfaction. But before surgery, I had diabetes, high blood pressure, sleep apnea, GERD, problems with profuse sweating and frequent urination. All those problems went into remission within days after the surgery and stayed in remission ever since. I lost 115 pounds and maintained that weight loss. I went from a size 3X in shirts down to a size Small and from a size 46 in pants down to a size 32. Overall it was a good trade-off.

Dr. B. Zanini of the University and Spedali Civili of Brescia, Italy reported the ability of people who said they had non-celiac gluten sensitivity (NCGS) to detect the presence of the gluten Protein in their food. The experiment involved 35 people (31 women) who had been on gluten-free diets for 6 months. None had celiac disease, as determined by blood tests. http://acsh.org/2015/09/gluten-sensitivity-real-thing-or-nocebo/ Dr. Ruth Kava, Senior Nutrition Fellow at the American Council on Science and Health, commented, “This study and others like it support the validity of a NCGS diagnosis in some people. But it is also likely that for many avoidance of gluten is just following the latest fad. The danger here lies in the fact that some foods that tout the freedom from gluten are actually less healthful than the original variety — because they may contain more fat or sugar and thus more calories. The bottom line is that if you don’t really need to go gluten-free, don’t bother. And to determine if you do, consult a gastroenterologist, not a celebrity diet guru.”

Perhaps you are suffering from a stricture. http://www.dartmouth-hitchcock.org/bariatric/risks_of_bariatric_surgery.html and https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=134&ContentID=155 Although I have not seen stomach muscle spasms as one of the symptoms. Most strictures occur suddenly several weeks after gastric bypass surgery.

You may be near your bottom weight. We tend to set a goal, but that is just that - a goal. 119 pounds isn't a bad loss of weight. Your body will determine when you are at your bottom. On the other hand your major spine surgery, may have thrown a right curve to your WLS goal. So you may want to keep trying for a couple more months. Once you have entered the "Maintenance" phase, that doesn't mean that you can't lose more weight. I bottomed out at 6 months. Then my weight was stable for 6 months within a couple pounds. Then I lost a little more weight. I have lost 15 additional pounds in the "Maintenance" phase without really trying. The approach to eating is different between the "Weight Loss" and "Maintenance" phases.

It is important to get a fair amount of physical activity daily. Physical activity is a combination of exercise and physical labor. I am not big on exercise. To me it is more like wasted effort. I drive for a half an hour to go to the YMCA to swim for 30 minutes and then spend another half an hour driving back home. But I am big on manual labor. So I consider work, manual labor, as a good alternative to exercise. Last year I moved by hand over 100,000 pounds of gravel and 50,000 pounds of concrete blocks. This year I did about the same. I am 28 months post-op RNY and am 66 years old. The surgery restored my stamina (ability to perform physical labor) so I can do what I did when I was a 30 year old.

When you undergo a major life change, it has an ability to sharpen your focus. When my wife became pregnant, whenever we went shopping we would see every pregnant woman in the store. When she had our first child, we would notice every newborn. When I had my RNY operation and lost weight, we would notice every overweight person we came across. And there are a vast quantity of overweight people today. This never became obvious until after the surgery.

After surgery some individuals experience low blood sugar (reactive hypoglycemia). This occurs to both individuals with diabetes and those who did not have diabetes prior to surgery. The easiest way to test for this is by measuring your blood sugar levels when you get tired after you eat. http://www.mayoclinic.org/diseases-conditions/diabetes/expert-answers/reactive-hypoglycemia/faq-20057778

Experiment. I found that blending in fruit (a half a banana) made the Protein shakes more tolerable.

Congratulations on your weight loss. Eighty pounds in less than 3 months. At this stage your meal volume should have increased to the point that you can derive much of your Protein requirement from your meals. (That is if you have been concentrating on protein first in your meals.) This should allow you to reduce your reliance on protein supplements (Protein shakes, protein bars) and the extra calories they contain. This should help you continue with your weight loss. After a few more months you will go from a "Weight Loss" phase into a "Maintenance" phase. This requires a different strategy. I am 28 months post-op RNY. I discussed this in a short article titled How I Survived Bariatric Surgery, Part II which is available at http://www.breadandbutterscience.com/Surgery2.pdf

I had RNY surgery 28 months ago. I was on the maximum dosage of Metformin and Glipizide and even at that my diabetes was not under control and my doctor recommended I go to insulin. When I left the hospital 2 days after surgery, I was off all my diabetic medicine and my diabetes has been in remission ever since.

I put my experience in gastric bypass surgery down in a couple articles. The first article called "How
 I 
Survived
 Bariatric
 Surgery
" describes my experience during the "Weight Loss" phase. It is available at http://www.breadandbutterscience.com/Surgery.pdf The second article called "How
 I 
Survived
 Bariatric
 Surgery
, Part 2" describes my experience during the "Maintenance" phase. It is available at http://www.breadandbutterscience.com/Surgery2.pdf

People are different and their caloric window is different. For me, my window is approximately 1,000-1,600 calories per day. This is probably because I am old and less active and also because I am short. If I consume less than 1,000 calories per day, I lose weight. If I consume more than 1,600 calories per day, I gain weight. If I stay within my window, I maintain my weight. Weight loss is accomplished by portion control. As you increase your portion size and concurrently the number of calories per day, your weight loss will gradually come to an end and you will enter the maintenance phase.

I weigh myself each morning when I get out of bed. This is usually my lowest weight for the day. I log the weight. I do not obsess about my weight. I just use it as a tool while I experiment with food and meals. It has taught me a lot.

Everyone has different taste. The important thing is to experiment until you find one that you can tolerate. For me that was "Muscle Milk Light" (vanilla Creme) powder blended with Water using a half a banana. I used a Ninja blender with a single size serving cup. Good luck.

When I took the Citracal's (Calcium Citrate) tablets, I failed to read the label and the dosage was based on consuming 2 tablets. Therefore at my first appointment with the nutritionist, she pointed out the error of my ways. I put the Citracal's in a small bowl and take them throughout the day, spacing them around 2 hours apart. I take two at a time. (Therefore I don't have to remember how many I have taken. I just load up the bowl first thing in the morning.) I found out that a few months after surgery I was again able to swallow the large tablets whole without crushing them. That made life a lot easier. I take my Iron tablets and Flintstone Multivitamins that contain iron at night just before bedtime. That way I don't get them mixed up. Also because I have milk (which contains calcium) during the day, it also doesn't conflict.

Congratulations on being accepted for surgery. I love food, the taste of food, the smell of food. And I believe this love of food eventually caused me to gain too much weight, become obese and develop a slew of bad medical conditions. In life one needs to make trade-off. In my case it was trading my love of food for good health. I am 28 months post-op from RNY surgery and I feel the decision was the right one.

It will take awhile. Cut open and 38 staples removed - this is a lot more surgery than most. It will definitely take you sometime to heal. I reach a happy state when all the problems were resolved at the 6 month mark. But after surgery every day was a little less stressful, a little better.

Glad to hear you are on the mend.

I would recommend that you try and stay with the program and the volume restrictions for meal size even if your stomach is not revolting yet. Your body will handle liquids different than solids. You are currently in the full liquid state. I suspect that once you get to the full solid state, exceeding the volume requirement might produce some pain Back to what is your goal. Isn't it to lose weight. The way this is done is with portion control. So if you want to lose weight, you should be consuming 2 ounces which is 1/4 cup per meal. Your Protein shakes fall under a different set of requirements. Drinking an 11 ounce Protein shake is good. Your body handles liquids different than solids.

A new drug to counter the effects of nausea and vomiting will hit the market soon called Varubi. It received FDA approval and will be sold by Tesaro Inc., a Massachusetts-based oncology specialty biotech. http://acsh.org/2015/09/new-superb-weapon-against-chemos-side-effects/

I am 28 months post-op RNY and I eat popcorn sometimes when I am in the movie theater - the good kind with plenty of butter.

Yes use it. There are a variety of different mixes and if you buy one type and don't like it, try another blend until you find one that you like.