James Marusek

Dealing with the insurance companies is aways the worst part of the process.

When you take your vitamins or meds, you can take them with fluids. I had RNY gastric bypass surgery and as a result I take quite a few vitamins each day. Sleeve patients take much fewer. It is important to put a 2 hour separation between the vitamins that contain iron and those that contain calcium. So in my case I found that what works best for me is to take the iron supplements just before bedtime. I put my vitamins in a weekly pill container. I have one container for the morning and one for the night. And I use a very small glass bowl for my calcium supplements. I put my calciums in the bowl in the morning and take them throughout the day. If I am up and about I put my calciums in a ziplock bag and carry them with me. After surgery I lost my ability to swallow large pills and as a result I had to split them or crush them in order to take them. That condition was temporary and lasted around 2 months and then I was able to swallow them again. The Citricals were the worse.

While in the hospital they pump your body full of fluids. Thus when you leave the hospital you weigh much more than when you arrived. You have to lose this extra water weight first before you see your weight numbers go down. This normally happens in the first week after you return home.

I had several incision points. There was one located on my lower left side that was where the biggest knots appeared. This was tender for a very long time. It took almost a year and a half until the knots disappeared. Some pain is normal and some is not. If it was upper left shoulder pain that could be a problem. Also chest pain with rapid heartbeats and/or dizziness could be a problem. If you are experiencing uncontrolled or increased abdomen pain that could also be a problem. Check your hospital discharge instructions and see if it meets the criteria for when to contact your surgeon's office.

I had RNY gastric bypass whereas you had the sleeve. So I am not the best expert to answer your question. Sleeve patients lose weight at a much slower pace than bypass patients but their weight loss phase can stretch out for a couple years. But if you haven't lost any weight since November, I would say something is definately wrong and you will need to figure out what that is. You mentioned that you play roller derby. That is a strenuous sport. I have seen some comments from sleeve patients that sometimes a stall is created when they uptake too few calories. Those that experience problems tend to be individuals that perform strenuous sports. Their body goes into a starvation mode. Starvation mode will halt weight loss. Therefore phentermine may not be the right approach but a few more calories might be the solution. I do not remember what types of food they recommended but perhaps one of them might speak up.

Congratulations on your progress so far.

Some people experience problems with ulcers after surgery. According tot he 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 surgery. Remember after surgery to Walk, Walk, Walk. It will help to keep the gas pain at bay. Also make sure they install a trapeze bar above your hospital bed. It will help you get up out of bed with less pain.

Stalls are so common with sleeve patients that one of them coined the phrase "Embrace the Stall!" So don't drive yourself crazy at this point. You may be in the weight loss phase for a couple years. It will be a slow journey. As far as the insulin, your question may be answered after you drop another 20 pounds.

As Jenn1 said most patients are given a diet progression that defines what you can eat and how much food you can consume per meal as a function of time post-op. After you reach the solid food stage probably around month 3 or 4 post-op, assess your protein intake. 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. But to do this you must know your daily protein intake. Be aware there is also another option called protein bars. It wasn't until the 3rd or 4th month that my nutritionist recommended them. Your stomach may still need a little extra time. A protein bar can be too dense early on. 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. 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.

Good luck on your surgery. Since you are at the beginning of this process, 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.

It is manageable. You can always duck into a restroom.

Many people experience hair loss. For many people their hair loss stops when they reach the maintenance phase and they experience hair restoration. Some individuals mention that the texture of their hair changes after recovery. I did not experience hair loss. But I use a product called Juvenon, which is available over the internet. It helps to keep my mitochondria healthy.

Generally after surgery, you are placed under a weight restriction. This can prevent some types of workouts at the gym. Walking is generally very important after surgery. This form is acceptable from the get go. So I would suspect treadmills are O.K.

Right after surgery, your body is in a major heal mode. Many patients find it difficult to meet their daily fluid and protein requirement immediately after surgery. So during the first couple weeks don't stress this problem but just keep working towards your daily goal. It is common for your taste buds to change after surgery. Be willing to experiment. After surgery, my taste buds changed dramatically. Even water changed. In the hospital it tasted excessively chlorinated and I could not drink it. So I experimented. Sugar free popsicles became my best friend. Some individuals find hot or cold can help with fluids. For me, I found that I could tolerate flavored water. So I began using Crystal Light. I also found a new drink Bai which I liked cold. In the winter, I found that I tolerate hot drinks such as piping hot cocoa. But you have to use the "No Sugar Added" variety. Also fine English teas were very good. 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.

Welcome. There are primarily a couple of types of surgery that are most common. These are RNY gastric bypass surgery and gastric sleeve surgery. If you have severe acid reflux (GERD) then bypass surgery is the primary choice because the sleeve will only make that condition worse. You might review the requirements of your insurance policy for bariatric surgery in Ireland. Many insurance plans can be accessed on-line. That will give you the requirements to qualify for the surgery.

Congratulation on your surgery and getting home.

It depends on how long it takes you to wean yourself off of the narcotic pain medicines. I choose not to take any pain medication after I left the recovery room so I could drive almost from the time I left the hospital.

For the first couple weeks after surgery, your body is in a major heal mode. Many people find it difficult to meet their daily protein and fluid requirements during this time. Just keep trying and you should be able to get there. My hospital discharge instructions for when to contact the physician read: Persistent nausea or vomiting greater than 6 hours.

Welcome. Since you are at the beginning of this process, 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.

After surgery it is common to experience problems with diarrhea and constipation. Right after my surgery I became lactose intolerant and any time I drank milk or consumed dairy, my stomach would immediately get upset and then there was diarrhea. That condition resolved itself after a couple months. Some protein shakes contain lactose. According to my hospital discharge directions the time to contact the surgeon is when: Persistent diarrhea beyond the first week after discharge or more than 6 diarrhea stools in a day. Diarrhea is normal after surgery.

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. In your case, since you indicated that you were unable to get your meds down, I should add that to the list. So which of these four elements are you unable to meet your daily requirements? "I've been drinking gatorade and flavoured Water but I can't get regular water down." In my case I could not get water down because my taste buds changed after surgery. But I was able to get other fluids down so I met my daily fluid goals. Are you? If you are unable to get any fluids down or any food, then it might be a sign that you have a stricture. But you said there was no blockage, so does that mean that you were checked for a stricture? Since you were unable to get your meds down, does that mean that also equate to you not being able to meet your daily vitamin requirement? What about your protein shakes? Are you getting in your daily protein? Anyways it sounds like you have a serious problem that must be driven to the ground. Since you mentioned both nausea and heartburn 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. The cause of your problem may be an ulcer. If so the advise give here means; 1. Stay off any NSAID, such as aspirin. 2. Take a proton pump inhibitor, such as Pilosec. (work this thru your doctor) 3. Make sure you were tested for Helicobacter pylori infection. This is a common ailment. About 50% of the worlds population have it. It lays dormant in most individuals but after gastric bypass surgery, it can appear and produce an ulcer causing nausea and vomiting. It is a simple test (breath, stool) to find out if you have it. It is a hard bug to kill and you may have to undergo a couple cocktails of antibiotics to effectively treat this condition.

There was a period of 6 months to a year where this really bothered me. I bought a gel cushion for the car seat and that helped.

Technically Tasmania is considered part of the Australian continent. Not much with hair coloring. Tried it once and found it to be unnatural.

This may be a function of the type of surgery. I think those with gastric bypass experience this effect but I am not sure that holds true for sleeve patients. Perhaps some sleeve patients might speak up about this effect. Also generally this effect does not take hold until you reach the solid state.