James Marusek

During the first couple weeks right after surgery, some people can find it difficult to meet their daily fluid requirement. That is because their body is in a major heal mode. I think that is where "sipping an ounce every 10 minutes" thing came from. It is important to drink enough fluids after surgery so that you do not become dehydrated otherwise a slew of problems can develop. 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. My other question is, when I'm in the gym working out now, if I'm hot or need a drink, I can easily chug some Water. Post-surgery, how will I do that? It is not a good idea to chug water after surgery. After surgery your stomach will be significantly smaller. Chugging water or any drink will trap air in your smaller stomach and can cause you discomfort (gas pain). Just take a few extra minutes and drink slowly. 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.

Congratulations.

Congratulations.

Good luck on your surgery and check back with us when you are on the other side.

It is normal to hit stalls along the way. If I wear my clothes, it can easily add 5 pounds to my scale weight. Some have noted a couple pounds difference between the weight before they entered a shower and the weight after. One thing to do now at your stage is to 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. This is important because protein shakes contain calories. If you can reduce your caloric intake, then you can end a stall. At least that was the approach that I used and it worked for me.

Congratulations.

After surgery, remember to Walk, Walk, Walk. It helps to relieve the gas pain.

Congratulations.

Prior to my RNY gastric bypass surgery 5 years ago I had sleep apnea but I also had severe asthma. The sleep apnea problem went into remission within a couple months. The asthma disappeared after around 3-4 years. There was recent research performed in South Korea that showed a direct correlation between weight loss in men and improved lung function. A group of researchers led by Dr. Eun Kyung Choe from Seoul National University Hospital Healthcare System Gangnam Center, Seoul, South Korea, studied the association between abdominal obesity and lung function — their study published in PLOS One. These investigators used clinical records from about 1100 adult Korean people — 428 men — assessing them at baseline and following them for about 3 years. All were healthy at the beginning of the study, and all were non-smokers who had never smoked. As the amount of VAT (visceral adipose tissue - fat tissue located deep in the abdomen and around internal organs.) decreased in men so did both FVC (forced vital capacity) and FEV1 (1 second forced expiratory volume). These measures are used, as well as their ratio (FEV1: FVC) to help diagnose lung diseases like emphysema and chronic bronchitis. The authors suggested that the changes in lung function associated with decreases in VAT might be due to mechanical differences, e.g. less pressure on the diaphragm, and/or due to the greater propensity of the VAT to release inflammatory cytokines which could trigger systemic inflammation. https://www.acsh.org/news/2018/02/28/losing-fat-might-mean-better-breathing-12629

According to my surgeons directions for sleeve patients, they were required to take: 500 to 1000 micrograms sublingual B12 weekly or 1000 mcg IM injection once monthly. So if you are getting monthly injections, you are fine. For me I found that the sublingual tablets were much easier and less painful to take. It is also less of a hassle to take the tablets instead of the shots because as I recall the shots required a prescription.

Congratulations

Congratulations.

After surgery I decided to not take any pain medicine. Most of the pain is gas pain and walking after surgery relieves that fairly well. So that is what I did. I also told the anesthesiologist to go easy on the anesthesia and she said she would. So for the most part the surgery had very little pain. I was up and walking almost immediately (once every 2 hours around the clock). They had a white board to record the lapse. After the first few lapse, a nurse came in and told me to ease off the walking because when the anesthesia wears off, I would experience great pain. Never happened. I think the anesthesia wore off around 2 am but not sure. Anyways I followed the nurse's directions and tried not to set any records. I remember the pain nurse coming in and she tried to give me pain medicine. She asked me to rate my level of pain level on a scale of 1 to 10. I said honestly 1. (I have a good pain tolerance anyways). I told her "no pain medicine for me". She gave me a scowl look and left. Do not expect to meet your fluid and protein daily goals right out of the gate. That is because your body is in a major heal mode. Just keep working towards those daily goals and you should be able to get there in around 2 weeks. Some patients have ports put in to drain fluids. I did not. I think they have a rougher time. Some patients stayed in bed and didn't walk. I did not. Focus on Walking, Walking, Walking if you are worried about reducing your pain levels. I wrote about my experience with the surgery in this article. http://www.breadandbutterscience.com/Surgery.pdf Also it is quite common to get the jitters right before surgery.

Several individuals develop a condition called reactive hypoglycemia after gastric bypass surgery. Here are some links: https://www.stjoes.ca/patients-visitors/patient-education/f-j/PD 7972 Reactive Hypoglycemia after Bariatric Surgery.pdf https://www.ridgeviewmedical.org/services/bariatric-weight-loss/enewsletter-articles/reactive-hypoglycemia-postgastric-bypass http://www.todaysdietitian.com/newarchives/060415p48tip.shtml https://www.bariatricpal.com/topic/194130-reactive-hypoglycemia/

For me it was the opposite. After my RNY gastric bypass surgery, I was required to take so many vitamins, that I rarely experience any problems in this area. I avoid the flu shots because many times they are unreliable and rather stick to my own blend of essential oils. If I feel any of the symptoms of a cold or the flu coming on, I rub a couple drops on my wrist and its gone 2 hours later.

Many experience problems drinking protein shakes. I hated them. But in the beginning I drank them, three 16-ounce protein shakes a day, in order to meet my protein requirements. You do not have to like protein shakes only tolerate them. There are many varieties of protein shakes available today. Experiment until you can find one you can tolerate. I used Muscle Milk Light (Vanilla Creme) powder blended with water and a half a banana. That worked for me. But on the opposite end of the spectrum, you might try premixed Isopure.

Congratulations.

Protein shakes do not count as a meal, so you can drink other fluids without the time restriction.

As we age, our bodies degrade. Some of the latest research shows that exercise can minimize this process. The study, published today in the journal Aging Cell, involved 125 healthy cyclists of both genders, between the ages of 55 and 79. They underwent physical testing to obtain a range of health data, whose results were then compared to those from two other healthy groups – aged 20 to 36, and 57 to 80, totaling 130 people in all – who were not physically active. Those in poor health, or adults who drank heavily, smoked or had high blood pressure, were kept from participating. Specifically, the scientists focused on the cyclists' thigh muscle, or VL for vastus lateralis, since it figures most prominently in this physical activity. "Fibre type composition, fibre sizes, capillary density and mitochondrial protein characteristics were examined in relation to age. Our hypothesis was that in these individuals who showed similar high levels of physical activity," they wrote in their paper (using British spelling), and any age-related factors "could be ascribed to an inherent aging process not confounded by inactivity." What they found was that bodily processes were positively affected by remaining active. "With the exception of capillary density in males, no association between age and any other property of the VL was observed in either males or females," the paper's conclusion stated. "Overall, these data show no age-related deterioration in selected properties of the VL muscle which are relevant to aerobic function or explosive muscle power, but are more closely related to an individual's level of function irrespective of their age. The data support the view that high levels of exercise training are able to maintain many of the properties of muscle which are negatively affected by aging when it is accompanied by sedentary behaviour." Routine exercise can help prevent deterioration of the body and the onset of life ending diseases and conditions. So what is important is not that you live to be a 100 but rather that you are up-and-about at a 100 living your life; rather that restricted to sitting in a wheel chair in a nursing home with someone feeding you each meal. https://www.acsh.org/news/2018/03/08/your-bodys-breakdown-not-inevitable-study-indicates-12678

Congratulations.

Prior to surgery, generally everyone goes through almost a day of pre-op testing. This testing is to determine if there are any pre-existing conditions that might prevent the surgery from being successful. If any are uncovered, these conditions are treated prior to surgery. There was one person in our bariatric support group meeting who was scheduled for surgery. He had gone through his pre-op testing. He received a call from his surgeon to report to the hospital immediately. The testing uncovered that his heart was almost completely plugged and he was about to have a heart attack. So instead of the bariatric surgery, he had open heart surgery.

Right after surgery, I became lactose intolerant. That meant anytime I tried to drink milk or other products that contain lactose, there was an instant upset stomach and a quick trip to the bathroom with diarrhea. Therefore I immediately cut out all lactose from my diet and the diarrhea problem was resolved. [Warning some protein shakes contain lactose]. Long story short after about 2 months this lactose intolerant condition went away. If you haven't already, I suggest that you take a probiotic. Generally when you were in the hospital you were given antibiotics to fend off any bacterial infection. The antibiotics not only kill off the bad bacteria but also the good gut bacteria and you need to reestablish colonies of this beneficial bacteria. This is done by taking probiotics. Fluids are very important. So maybe you might try something warm to drink such as tea. Maybe a fine herbal tea such as chamomile, or blackberry leaf or raspberry leaf tea. When you get out of the liquid stage, you might try bananas. They always seemed to help me.

Good luck on your upcoming surgery.

We have an ingrained need to chew. The process of chewing release enzymes that help to break down food. The last time you had something to eat, did you give any thought to how long you chewed? Most likely not, as chewing is done, for most people, almost as a habit or unconscious reflex. As soon as a piece of food enters your mouth, you chew and swallow, probably far too quickly. The chewing process, also known as mastication, is actually extremely important, however, and serves as the first step in your digestive process. Saliva contains digestive enzymes, so the longer you chew, the more time these enzymes have to start breaking down your food, making digestion easier on your stomach and small intestine. One of these enzymes is lingual lipase, an enzyme that helps break down fats, for example. Saliva also helps to lubricate your food so it’s easier on your esophagus. Long story short - You have a subconscious need to chew. It may not be the food that you really miss but the act of chewing that is driving you crazy.

Constipation became an issue for me towards the end of the weight loss phase. I would be bound up for a week or more. The only way I found to unbind myself after that long is to use a glycerin suppository that you have to shove up your rear. It works but you don't want to repeat that process again and again. For me the final solution was to eat an apple each night before bedtime. But you have to eat the skin of the apple also, not just the pulp. [applesause will not work]. Other suggestions from past posts are: Smooth Move Herbal Tea Prune Juice (warmed) Prunes (4 in the morning and 4 at night) Magnesium citrate Insoluble fibers (Garden of Life Raw Fiber or Renew Life Triple Fiber). Haribo Sugar Free Gummy Bears [Be careful with this one because it can cause major diarrhea.] Aerobic Magnesium 07 Ground Flax Seeds (but don’t try to grind it yourself). Use 2 tablespoons per glass of water every night before going to bed. Bowel Clear (herbal blend)