James Marusek

Congratulations on your surgery. I wrote a short article about my experience. I had RNY gastric bypass whereas you had the sleeve. But many of my experiences and observations apply. http://www.breadandbutterscience.com/Surgery.pdf

Weight loss is achieved during the short weight loss phase through meal volume control. The two operative words here are short and volume. So if you want to maximize your weight loss during this phase, you need to adhere to the program guidelines. I slid into the maintenance phase at 7 months. I had RNY gastric bypass. Sleeve patients lose weight at a much slower pace but often can achieve nearly the same weight loss as gastric bypass patients. Many sleeve patients are still in the weight loss phase 2 years post-op.

Good luck on your surgery, I will pray for its success.

Two points. 1. Your taste buds may change after surgery. Therefore anything that you select at this stage may become intolerable to drink after surgery. So be prepared to experiment after surgery until you find a protein shake that will work for you. 2. The Body Fortress protein powder on the label reads 60 grams of protein. Your body will absorb only about 30 grams of protein at one time. So if you drink this protein shake during a short time, half of it will be wasted.

Some people develop problems with severe acid reflux (GERD) after surgery. This occurs even if they did not have problems with severe acid reflux prior to surgery. There were several people on this site that had revisions from sleeve to RNY gastric bypass because of this issue. One thing to rule out is a helicobacter pylori infection. This is a common infection which for the most part is hidden. About 2/3s of the world population have it and if you have it, it can give you the symptoms of severe acid reflux.

One of the prime ingredients in chili is ground beef. According to my plan, this was acceptable at Week 9 post-op. Some of the soup recipes use shrimp which met my plan at 4 months post-op. I had RNY gastric bypass but I think the requirements for sleeve are similar. So if you are early, by all means strain the solids out, but if you are further along, there is no need.

I found the transition to solid foods such as steak and chicken was difficult. I relied on softer foods such as chili and soups. There is no need to rush into solid foods. I have included a few recipes at the end of the following article. http://www.breadandbutterscience.com/Surgery.pdf

I didn't change my drivers license photograph for several years after I had surgery and lost 120 pounds. Whenever I wrote a check and they asked to see my driver's license, I would give it to them and watch to see if they ever noticed the difference. They never did.

Perhaps you might try natural low calorie sugar, such as stevia or products that use them.

After surgery your body is in a major heal mode. Many people find it difficult to reach there daily protein and fluid goals within the first month. Generally they will be able to meet these goals within the first month. If the nausea that you experience should continue and get worse to the point that you cannot even drink water, then perhaps an underlying condition such as an ulcer might need to be looked at.

I am sorry to hear about your difficulties. Generally sleeve surgery is not recommended for GERD patients because the sleeve will only make that condition worse. RNY gastric bypass is the recommended procedure. I had RNY surgery about 5 years ago and one of the reasons why I went that route was because I had severe acid reflux (GERD). There are several past and present members on this board who had revisions from sleeve to RNY gastric bypass because of GERD. And they seemed to report that the revision worked for them. Perhaps some of them will speak up. But before you go forward, you might want to consider the following: 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. You would want to rule out the possibility of a Helicobacter pylori infection. This is common bacterial infection but generally it is a hidden infection. About 2/3 of the people in the world have it. And this condition if you have it needs to be treated, so make sure you were tested for it, because it might be the root cause of your problems.

I am sorry to hear about your problems. The three most important elements after weight loss 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. According to the internet for RNY gastric bypass patients: 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 gastric sleeve is different but these observations above may also apply. So the points made above are: * Avoid NSAIDs such as aspirin, excedrin. * Use a proton-pump inhibitor, such as Prilosec (omeprazole). [In your case Prevacid Solutab (Lansoprazole) is a proton pump inhibitor]. * Make sure you do not have a H pylori infection and if you do have it treated. (Helicobacter pylori (H. pylori) is a type of bacteria that causes infection in the stomach. It is found in about two-thirds of the world's population.) As far as the kidney stones are concerned, it may be a sign that you are not getting in the required amount of fluids. https://www.health.harvard.edu/blog/5-steps-for-preventing-kidney-stones-201310046721 So make sure that you drink more water.

Good luck on your surgery.

In general after surgery you are given antibiotics. The antibiotics destroys not only the bad bacteria that might be lurking in the hospital but also your good gut bacteria. So it is important to reestablish the colonies of gut bacteria afterwards using probiotics after surgery. I read an article this morning that reinforces the reason why this should be done. Clostridium difficile (C. difficile) is a bacterium that causes a life-threatening infection. According to the CDC, it is responsible for about 500,000 infections and 15,000 to 29,000 deaths every year in the United States. Though the bacterium can infect healthy individuals, it is of particular concern to those who are hospitalized or are taking antibiotics. Antibiotics can wipe out the normal flora of the gut, and C. difficile is happy to fill the vacuum. An infection with this pathogen can cause horrible cramping and 10 to 15 episodes of watery diarrhea per day. The epidemic has gotten worse in recent years, and a team of researchers led by James Collins and Robert Britton of the Baylor College of Medicine wanted to figure out why. In the year 2000, the FDA approved the addition of trehalose, a type of sugar, to food. Europe followed suit the next year. Within just a few years, the C. difficile epidemic exploded. Was that merely a coincidence? Dr. Collins and Dr. Britton believe it is not. Their research indicates that trehalose appears to be a good growth media for two particular strains of C. difficile (RT027 and RT078) that are causing epidemics all over the world. https://www.acsh.org/news/2018/01/04/food-additive-may-be-worsening-clostridium-difficile-epidemic-12367 In nature, trehalose can be found in animals, plants, and microorganisms. In animals, trehalose is prevalent in shrimp, and also in insects, including grasshoppers, locusts, butterflies, and bees, in which blood-sugar is trehalose. In plants, the presence of trehalose is seen in sunflower seeds, moonwort, Selaginella plants, and sea algae. Within the fungi, it is prevalent in some mushrooms, such as shiitake (Lentinula edodes), oyster, king oyster, and golden needle. But recently this sugar has been manufacturer into an artificial sweetener. It is found in foods such as nutrition bars and chewing gum. It is not that you need to ban the use of trehalose or foods that contain trehalose from your diet. Rather it is important to restrict this type of food until you reestablish you good gut bacteria after being treated with antibiotics. The findings suggest that when the food industry widely adopted the sugar, called trehalose, into food manufacturing, it played a major role in the emergence of super-strong strains of C. difficile.

It is common to have regrets immediately after surgery. It gets better but not overnight. It took me 6 months to reach my happy state when all the problems seemed to melt away. 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. 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. This article describes my experience after surgery. http://www.breadandbutterscience.com/Surgery.pdf

Right after surgery, your body is in a major heal mode. Many people find it difficult to get in the required protein and fluid at the beginning. Just keep working towards those goals and you should be able to get there. Having said this, you are at week 3 and should have made some progress at this point. Protein 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. If you tried all the various varieties and still are unsuccessfully, then there is the fallback of fortified milk. 32 ounces of 1% milk fortified by adding 1 cup of dried milk provides 56 grams of protein. It also takes a dent out of meeting the fluid requirements. Mix up a pitcher and drink a little throughout the day. 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. Fluids 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.

Good luck on your upcoming surgery. Three things to do at the moment if you haven't already done them is: 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. As far as what to do while in the hospital: 1. Walk, walk, walk. - It helps to reduce the gas pain. 2. Make sure you get a trapeze bar on your hospital bed. It helps you get up out of bed. You will be very sore after the operation and this will help with rule number 1.

Congratulations.

I came across an article this morning that discussed the relationship between obesity and cancer. There are at least 13 different types of cancer that are associated with overweight (BMI = 25-29.9) and obesity (BMI = or > 30), according to Dr. C. Brooke Steele of the CDC, and colleagues. These include: adenocarcinoma of the esophagus; cancers of the breast [in postmenopausal women], colon and rectum, endometrium, gallbladder, gastric cardia, kidney, liver, ovary, pancreas, and thyroid; meningioma; and multiple myeloma. These investigators used data from the US Cancer Statistics database for 2014 to determine new cases of such cancers, as well as assessing trends between 2005 and 2014. They reported that approximately 40 percent of cancers diagnosed in 2014 were among those associated with overweight and obesity and affected about 631,000 persons. Overweight and obesity-related cancer incidences were greater in people over the age of 50, as one would expect, and were also greater in women than men: 218 vs 115 per 100,000 persons, respectively, because about 42 percent of these cancers affected breast, endometrium, or ovaries. However, for most of those cancers that affected both genders, there were higher incidences in men than in women. https://www.acsh.org/news/2017/12/28/obesity-associated-cancers-are-increasing-12330

I had RNY gastric bypass surgery around 5 years ago. I found that after surgery I completely lost my hunger. It wasn't difficult to drop 120 pounds when hunger was not constantly continually gnawing at my bones. About a year after surgery, hunger returned but it was not as strong as pre surgery. If you have GERD, it is probably better to have gastric bypass over sleeve because sleeve surgery will only make this condition worse.

I had a different surgery than yours. I had gastric bypass. I found the transition to solid foods such as steak and chicken to be difficult, so I relied on softer foods such as chili and soups. I have included some recipes at the end of the following article. http://www.breadandbutterscience.com/Surgery.pdf

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. 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. 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. 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 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.

After surgery I discovered that I could no longer swallow medium to large pills. So I used pill splitters and pill crushers. This condition lasted for about 2 months and then things returned back to normal. Calcium pills were the worse because when you crushed them, they tasted like chalk. I found that if I put the powder into a glass of crystal light, I could take it this way. After I drank the glass full, there was a white paste at the bottom (calcium), so I added some more crystal light and stirred it really good and drank it. After 3 or 4 times the paste was gone. This also helped with meeting my daily fluid requirements. I was so glad when I could swallow again normally. Now the calciums are no problem at all.

I tend to buy my vitamins in bulk and keep the cost low. I had several health conditions prior to surgery and all these went away after surgery. As a result the cost of the prescription medicines was several times larger than the cost of the vitamins I am currently taking. So I consider it a plus.

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.