James Marusek

I had RNY gastric bypass surgery 5 years ago. This article describes my approach in the Maintenance phase. http://www.breadandbutterscience.com/Surgery2.pdf

During the first few weeks after surgery, many patients find it difficult to meet their protein and fluid daily requirements. That is because the body is in a major heal mode. Just keep working towards you daily fluid goals and you should be able to get there soon.

I read a news article this morning that really set me off. So into the Rants & Raves bit bucket this goes. The three most important elements after 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. Weight loss is achieved after surgery through meal volume control. You begin at 2 ounces (1/4 cup) per meal and gradually over the next year and a half increase the volume to 1 cup per meal. With this minuscule amount of food, it is next to impossible to meet your protein daily requirements by food alone, so therefore you need to rely on supplements such as protein shakes. Without sufficient protein, your body will scavenge protein from other areas of your body, such as your muscles. Protein is extremely important after surgery as its job in the body is to build and maintain tissues including your body's major organs and skeletal muscles. Protein deficiency, when continued over a long period of time can cause a disease known as protein caloric malnutrition. Common symptoms are poor healing, fatigue, hair loss and muscle wasting. Immediate post op, protein promotes healing of the staple line and incisions. The article that I read was titled "Protein powders may be damaging your health" at http://www.foxnews.com/food-drink/2018/03/01/protein-powders-may-be-damaging-your-health.html Sometimes you come across an article that was intended to unjustly scare you and this one fits the bill. Right below the Title was a picture of a young healthy man mixing up a protein shake. The captions below read "A new study showed 70 percent of protein powders tested had detectable levels of lead, 74 percent had cadmium and 55 percent had BPA, the chemical formula found in many plastics." The operative word here is detectable. Just because something is detectable doesn't mean it is harmful. Every year we make improvements to our instruments and their ability to measure substances. So today we can detect elements down to one-part-per-million or one-part-per-billion or one-part-per-trillions. And just because an element or substance can be detectable doesn't mean it is harmful, it is the amount of that element that is important. The poison is in the dose. So as far as I am concerned this article was nothing more than a hatchet job. Consider for a moment water. Is water harmful? No, not really. It is very beneficial. But if you drink too much of it all at once you may likely die. Water intoxication, also known as water poisoning, hyperhydration, or water toxemia is a potentially fatal disturbance in brain functions that results when the normal balance of electrolytes in the body is pushed outside safe limits by overhydration (excessive water intake). The Poison is in the dose.

I am 69 years old and had the surgery 5 years ago. No complications but rather just that opposite. I am now off all (5) of my prescription medicines. I also have dramatically improved stamina (the ability to perform physical labor).

After surgery, I developed a new passion. As I lost weight, I had to replace my clothes. This began small, by finding one outfit that looked good on me. But when I got closer to goal weight, I found that I could shop in traditional stores rather than specialty stores for big and tall. I bargain shop and many times buy clothes at 70 percent off. It is a lot of fun to bargain shop, I consider it an art form. Now imagine being put in the position that I could buy the latest designs, the clothes would look good on me and also that I had to replace my entire wardrobe. A perfect storm. Here is another thing that I found. Many times they say don't buy clothes on the way towards you goal weight. Others shop at Goodwill or second hand stores. On the way down, I would buy an item of clothes that I could barely fit in. The kind that if you took a deep breath, you would pop a button. I took it home and a week later it would fit me like a glove. What a motivator.

After my surgery and weight loss, I developed very fine paper thin wrinkles on my face. It made me look like I was 100 years old. I may be old but not that old. Anyways my wife suggested I use BioOil. I put it on once per day in the morning and no more wrinkles. It is available at CVS and Walmart and other stores. I have been using it for almost 5 years now.

It gets better each day but it will still take time. It took me 6 months before I reached my happy state when all the problems seemed to melt away.

It is common for individuals to be unable to meet their daily protein and fluid goals during the first couple weeks after surgery. This is because your body is in a major heal mode. Just keep working towards those daily goals and you should soon be able to get there.

Good luck on your upcoming surgery. At your stage, 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.

There are many different types of formulations on protein shakes. I would recommend that you keep experimenting until you find one that you can tolerate. You don't have to like it, just tolerate it. I used Muscle Milk Light (Vanilla Creme) protein shake 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.

Good luck on your surgery and remember after surgery to Walk, Walk, Walk, it really helps to reduce the gas pain.

There is no need to rush into solids. Just take your time. I found that softer foods such as chili and soups went down much smoother than solids such as steak and chicken. I have put a few recipes at the end of the attached link. http://www.breadandbutterscience.com/Surgery.pdf

Prior to surgery I had Idiopathic hyperhidrosis, or excessive sweating for several years. Shortly after surgery this condition went away. I am now 5 years post-op and that condition is no longer a problem. This weblink list 10 causes of night sweats. http://www.activebeat.co/your-health/10-common-medical-causes-of-night-sweats/ #4 and #10 look interesting. Do you have other symptoms that pair with these conditions. Many people develop a condition called reactive hypoglycemia after bariatric surgery.

The three most important elements after 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. Weight loss is achieved after surgery through meal volume control. You begin at 2 ounces (1/4 cup) per meal and gradually over the next year and a half increase the volume to 1 cup per meal. With this minuscule amount of food, it is next to impossible to meet your protein daily requirements by food alone, so therefore you need to rely on supplements such as protein shakes. Without sufficient protein, your body will scavenge protein from other areas of your body, such as your muscles. Protein is extremely important after surgery as its job in the body is to build and maintain tissues including your body's major organs and skeletal muscles. Protein deficiency, when continued over a long period of time can cause a disease known as protein caloric malnutrition. Common symptoms are poor healing, fatigue, hair loss and muscle wasting. Immediate post op, protein promotes healing of the staple line and incisions. 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)

Congratulations. 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.

The main reason why I had gastric bypass surgery was because of my health conditions. My body was going downhill fast. I had high blood pressure, diabetes, severe acid reflux (GERD), sleep apnea, and many other conditions. I was taking 4 kinds of prescription medicine. Within a month after surgery I was off all of these. I am now 5 years post-op and these conditions have not returned. Also something that I though was unrelated, asthma, went dormant at around the 3rd year post-op.

I have tried many of the artificial sweeteners and had no problem. But stay away from Haribo sugar free gummy bears. Eating too many of these can cause instant diarrhea. They contain lycasin. [Lycasin is a maltitol syrup with properties of taste and sweetness ideal for the preparation of sugar-free syrups, lozenges or jellies, according to manufacturer Roquette.com. Little known to most gummy bear connoisseurs, however, the side effects of Lycasin are gas, bloating and diarrhea.] http://universe.byu.edu/2013/09/24/sugar-free-haribo-gummy-bears-have-a-gas-tly-effect1/

Good luck on you upcoming surgery. And remember after the operation to walk, walk, walk.

Congratulations.

When you underwent surgery, you were probably given antibiotics during your hospital stay. This was to prevent the possibility of an bacterial infection. The problem is that antibiotics kill not only the bad bacteria but also the good bacteria in your gut. Therefore it is necessary to take probiotics after you finish the antibiotics to restore the colonies of good gut bacteria that can fight off recurring episodes of UTI. According to the internet: One promising alternative is the use of live microorganisms (probiotics) to prevent and treat recurrent complicated and uncomplicated urinary tract infection (UTI). The human normal bacterial flora is increasingly recognised as an important defence to infection. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2684288/

Generally when you are released from the hospital after surgery, you are given a Bariatric Discharge Instructions. One of the sheet that I received was titled When to call your physician. One of the potential hazards after surgery is the possibility of blood clots. They can form in the veins of your legs and then move up into your lungs. Therefore one of the times to call you physician is Shortness of breath or calf pain. Your description of your symptoms soreness and pressure around my lung area. So review your discharge instructions and see if any of the listed symptoms match your symptoms and if so contact your surgeon's office. It is better to err on the side of caution.

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.

I suspect the answer is Yes, but check with your surgeon's office just to make sure.

I use Traditional Medicinals brands called "Breathe Easy" and "Throat Coat". I generally buy them at Krogers, but many health food stores will carry them or similar brands. Since you mentioned having problems with immune functions, you might try "Echinacea Plus".

I am a big fan of herbal teas such as Breathe Easy. They seems to help me in the pasts when I had the flu.