James Marusek

After surgery the three most important requirements are Protein, fluids and Vitamins. food is secondary because your body is converting the stored fat into the energy that drives your body. Thus you lose weight. So don't worry about starving. Just make sure you are meeting your protein, Fluid and Vitamin requirements. Your surgeon should have given you guidelines on meal volume and meal content as a function of weeks after surgery. Just follow those guidelines and you should be O.K.

Not sure what this problem is. Why are you taking a laxative if you have regular bowel movements? I had a couple episodes where I had a lack of appetite and repulsion towards food. But this was because I had a stomach flu. And one of the symptoms of the flu was diarrhea. So that doesn't match your symptoms.

Congratulations.

Walking is a good exercise. Walk daily for about 30 minutes. My driveway is steep and I would walk up and down it, it is like hill walking. It uses two different sets of muscles. One on the way up and the other on the way down. I found this to be beneficial. It is like climbing stairs.

When you undergo surgery and recovery in the hospital, they pump your body with fluids. As a result when you leave the hospital, you tend to weigh more than when you went in.

I am 27 months post-op from RNY gastric bypass surgery. There are two stages to RNY. They are the Weight Loss phase and the Maintenance phase. The goals and meal plan in my humble opinion are different between these two stages. At 5 months post-op you are still in the Weight Loss phase and the weight loss will level out soon and you will slide into the Maintenance phase. In the Maintenance phase the goal is to maintain the weight loss that you achieved in the first phase. After surgery, the part of your stomach that processes fats and sugars were cut away. Therefore the meal plan excluded fats and sugars which would lead to rapid dumping syndrome. But somewhere around the 6-12 month post-op mark your body will change. The intestines will develop the ability to absorb fats and sugars in place of the stomach. This change is actually an opportunity. It give you the ability to reintroduce fats back into your diet. I am 27 months post-op and my weight is towards the lower end of the scales. I entered the maintenance phase 20 months ago and have done very well by not adding any pounds back on. (I have actually lost 15 pounds in the Maintenance phase.) For my meals, I concentrate on high Protein meals. I avoid processed sugars. I use only artificial sweeteners (Splenda, sugar alcohol), low calorie natural sweeteners (Stevia) and natural sugars found in milk and fruit. The other types of sweeteners I avoid like the plague. I read nutritional labels. After surgery I completely lost my hunger. Without hunger constantly gnawing at my bones, it was easy to lose weight. So from my opinion the key to succeeding in the Maintenance phase is to control hunger. Fats take away my hunger, so I reintroduced fats back into my diet and at 27 months post op, hunger still does not rule my life. I use whole milk, real butter and normal cuts of meat. When I snack, I snack on fats. I have one or two cups of coffee each day. On the coffee I put a heaping spoon of whip cream. This whip cream is home made and uses Splenda in place of sugar. During the day for Snacks I consume 2 or 3 Adkin's treats. These use sugar alcohol as the sweetener and contain fat that controls hunger. I have a sweet tooth and these satisfy this need. I limit my meals to one meal per day with complex carbs (bread, pasta).

My concern would be that she might be having a pulmonary embolism. Some signs of a pulmonary embolism are shortness of breath and being lightheaded. This condition is life threatening. Pulmonary embolism (blood clot in the lungs) and a gastric leak from the anastomosis are the primary major complications from bariatric surgery. http://www.acphospitalist.org/archives/2013/12/bariatric.htm http://www.nhlbi.nih.gov/health/health-topics/topics/pe/signs

You may want to check with your health insurance and determine if they will cover the surgery. Many insurances require that your BMI exceeds a certain value or that you have co-morbitities. So you might not qualify because your current BMI of 39.5 is not high enough.

In the countryside many dogs run loose and some will try and chase you and bite your feet. So it is always good to have a plan on how to deal with them should the problem arise. Enjoy your bike rides. Good exercise.

Walking 5-6 miles every day seems a little on the high side. Is that really the doctors orders? Like Sajijoma said, with this level of physical activity, 60 grams of Protein a day is on the low side of what your body needs. It is common to hit stalls during the "weight loss" phase. Sometimes medicine can interfere with weight loss. Sometimes stress can also affect weight loss. So relax a little and let the magic happen.

If you are following the plan, then your meal allotment has increased over the past 4 months. This gives you an option. Your total caloric intake is the calories that you get from meals combined with the calories from your Protein supplements (Protein shakes and protein bars). If you are concentrating on eating high protein meals then at 4 months your protein intake from meals can offset some of the protein you obtain from supplements. Therefore you can reduce the total calories you are consuming by reducing some of your protein shakes. That is what I did when I was 4 months post-op RNY and hit a stall. I dropped a Protein shake per day and the weight loss picked up again.

Good luck on your surgery. Shouldn't be long now.

Good luck and let us know if we can be of help.

Good luck on your surgery. I had RNY gastric bypass surgery and I lost hunger. Without hunger constantly gnawing at my bones it wasn't difficult to lose weight. Not everyone experiences this loss of appetite but many do. It is rough in the beginning because of the complexity. But then things improve. I reached my "Happy State" when all the small issues and problems were resolved at the 6 month mark. Just remember after surgery, the most important requirements are daily Protein, fluids and Vitamins. food is secondary because your body is converting stored fat into the energy that drives your body. Thus your fat is burned away and you lose weight. Remember the daily walking. It will make the recovery process slip into high gear.

The two most common problems that occur after bariatric surgery are pulmonary embolism and a gastric leak from the anastomosis. It seems like you are showing at least one of the symptoms of a pulmonary embolism. Pulmonary embolism is a life-threatening condition. http://www.mayoclinic.org/diseases-conditions/pulmonary-embolism/basics/symptoms/con-20022849

I am 27 months post-op RNY gastric bypass. I have lost 115 pounds which equated to a weight loss of 44%. I have been in a maintenance phase for 20 months. As far as keeping it off, I don't seem to have a problem. Still practicing portion control. Using fats to control any hunger.

Congratulations. You found one of the joys of weight loss.

After surgery, the most important requirements are Protein, fluids and Vitamins. food is only secondary because your body is converting stored fats into the energy that drives your body. Thus you lose weight. It sounds like you are having problems in at least two of the three required areas. Are you getting in the required protein supplements (protein shakes) each day? How is that going? Your blood work shows low levels, generally this could be caused by Vitamin deficiencies. You indicated you have problems with Fluid intake. I recommend you experiment. For fluid intake try other things until you find something that works for you. My tastes after surgery changed so much that I found it hard to drink even Water. It was a struggle. I used Crystal Light and that worked for me. But later I found fine English teas that also worked. The liquid content of Soups also count towards your fluid requirement. Since you are talking about the fact that you are so nauseous and constantly dry heaving and vomiting up saliva. This combined with the fact that you are unable to eat minimal amounts of food, almost makes me think you may have a stricture (too much scar tissue at the site of the operation seriously restricting food intake). This is fairly easy to correct. http://www.realself.com/question/stricture

From the time I started the process until the surgery almost a year went by. Since this time was spread out over two calendar years, it meant that I had to pay the minimum co-pays before the insurance kicked in. My insurance required a 6 month medically supervised weight loss and exercise program. But even though they required this, the insurance would not pay for the monthly doctor visits. What was even stranger was that they in the end paid for every other visit. I asked them why and they said the payments they made were their mistake but I didn't have to pay them back. Dealing with the insurance can be frustrating. It is almost like they do not want you to have the surgery so they don't have to pay for it. Sometimes you just have to put blinders on and go forward no matter what. Even when you do your homework and find doctors within your preferred network. They sometimes want to charge you the out of network rate. This happened with a pulmonologist. He was within network on their online database of in network providers, but when the bill came in they charge his fees as out of network. I called the insurance company and said he is within network per your online list of in network providers. They said our database must be wrong.

Your pain should ease up in the next day or two. If you are taking a heavy duty narcotic, how stable are you for walking. Do you have someone who can walk with you to prevent falls. I am not sure narcotic pain medicine really relieves the pain. A muscle relaxer would probably work better. The soreness from the surgery generally eases up as your work the muscles through walking.

Take a deep breath and don't panic. Towards the end of the process, you will undergo around 4 hours of pre-op tests. This will tell if you have any preexisting conditions that could interfere with the surgery. After these tests, the medical team will determine if there are any potential problems that need to be looked at in finer detail. Then there is a second round of pre-op tests that are done by specialist in the specific field. For example, I snored, so they set me up with an evaluation by a pulmonologist (sleep study). Because of other medical conditions, I had an hour of ultrasound testing that looked at potential blockages in my blood vessels. I also had an EKG test as part of the second round of testing. The point is that you may go through the first round of testing in flying colors and need no additional follow-on tests.

For me eating sucks. I am a RNY surgery patient. I wonder if this is different for sleeve patients. I have found some things that I like such as chili and can almost spend the rest of my life eating this. Recently I found that a Velvetta cheese sandwich is almost like heaven.

Whenever I go to see the surgeon's office, even though I am 27 months post-op, the word obesity appears on the forms. This threw me for a loop because I am no longer obese. It dawned on me that this is all about insurance. They have to code my visit for insurance billing purposes and since I had WLS, this is the best coding they can use. I was wondering about your hypoglycemia. There is one form that is tied to meals which is called reactive hypoglycemia. Reactive hypoglycemia (postprandial hypoglycemia) is low blood sugar that occurs after a meal — usually within four hours after eating. Low blood sugar (hypoglycemia) usually occurs while fasting. Signs and symptoms of reactive hypoglycemia may include hunger, weakness, shakiness, sleepiness, sweating, lightheadedness, anxiety and confusion. Someone told me that it is like a spike in blood sugar followed by a crash. If this is the type you have then you have a bit of control because you can time your meals.

I threw my last scale away. I was angry and threw it in the trash. Every time I weighed myself (even seconds apart), the scale gave a different reading. It had no accuracy. I found one that was consistent and had an accuracy down to 0.2 pounds. The scale I now use is a Beurer Model BF-66 which I purchased at Bed Bath and Beyond.

I don't know what is going on in your case, but since you asked for ideas, I will throw these out. A few individuals in our bariatric support group meetings complained of back or joint pain after surgery. It is as if the fat provided a cushion and as the fat dissolved away, the damaged joints which existed prior to the surgery became more painful after weight loss. It might be due to a post-operative leak at the site of the surgery. The classic peritoneal signs are not always present post-operatively, and the emergency physician must be aware of subtle signs and symptoms that may point to this diagnosis requiring early surgical consultation. These include fever, increasing abdominal pain, back pain, pelvic pressure, hiccups, unexplained tachycardia, and restlessness. A pulse rate that remains above 120 beats/min has been associated with gastric dilatation and leak with peritonitis. It might be related to a Vitamin deficiency, specifically a B1 deficiency. I am no medical expert so take whatever I say with a grain of salt. Your medical staff is best qualified to determine the cause. But it sounds like you are already consulting with them.