James Marusek

Congratulations on your surgery. Let us know if we can be of help.

One of the conditions that several people encounter is the fact that they had a preexisting Helicobacter pylori infection prior to surgery and didn't know it. After surgery, this condition causes many of the symptoms that you are experiencing and you must kill that infection or you will suffer. Sometimes this condition is not easy to kill. It may take several rounds of antibiotic treatment and different regiments to end it. So stay strong and don't give up the hope, just kill the bug.

After surgery your body can be thrown into ketosis. Ketosis is a normal metabolic process. When the body does not have enough glucose for energy, it burns stored fats instead; this results in a build-up of acids called ketones within the body. According to the internet: The most typical source of energy used by the body is glucose. This is typically derived from carbohydrates, where the digestive system breaks down complex sugars into simple glucose molecules. On very low carb diets, however, the body is unable to utilize such a fuel. Instead, the liver utilizes the fat present in the body as an energy source, producing “ketones” in the process(2). This is known as “ketosis” – and is the process from where keto diets get their unusual name. These ketone bodies come in three common forms; acetoacetate, beta-hydroxybutyrate and acetone(3). In large quantities they are removed from the body in the urine or through exhalation. Ketones can have quite a characteristic smell; they often make the dieter’s breath smell quite sweet and fruity, quite distinct from typical halitosis. Excessive volumes of acetone, however, can smell rather different. Acetone on the breath is most commonly likened to the smell of nail varnish remover(4). Protein Excess A second possible cause of ketosis breath isn’t directly linked to the breakdown of fat as a fuel source. Instead, it is a side issue caused by typical changes to the diet. As those on keto diets try to minimize the consumption of carbohydrates, so the diet is often filled with other constituents; most typically fat and protein. A diet that is high in protein can have two impacts on breath. Firstly, the breakdown of protein in the body produces ammonia; this can lead to urine or breath smelling particularly strongly. If your breath has started to smell like a cat litter tray while on a ketosis diet then this may well be your culprit! Standard bad breath is most commonly caused by bacteria in the mouth. This bacteria breaks down its food, producing volatile sulphur compounds (“VSCs”). It is interesting to note that studies suggest that the most common source of VSC production is the breakdown specifically of protein, as opposed to other food sources. Higher protein diets, especially in the absence of suitable oral hygiene, can also therefore impact one’s breath. Some advise to normalize this condition are: Drink plenty of water. Rinse your mouth with an anti-bacterial oral rinse. Consider the use of calorie-free and carb-free mints or gum, or use a flavoured oral preparation such as a mint-flavoured breath spray or mouthwash. One of the other suggestion it seems you are already doing. Studies suggest that cleaning the tongue is almost twice as effective as brushing alone at removing bad breath. As a result, investing in a tongue scraper can be a worthwhile exercise. Ketosis often causes increased urination. This diuretic effect is due in part to your glycogen stores being emptied. Also known as “water weight,” one gram of glycogen necessitates around 3 to 4 grams of water in storage. This mass exodus of surplus fluids (aka pee) can cause dry mouth, and increased sensations of thirst. One of the other conditions that I encountered after weight loss surgery was dry mouth. I found that Biotène® Dry Mouth Oral Rinse helped with this condition.

Good luck on your surgery. I will pray for you.

After I lost my fat, which is an excellent insulator, I became more sensitive to the snow. I found that hand warmers were really helpful when I went out and shoveled the snow.

Good luck and make sure you check back in with us when you are on the other side and let us know how it went. Tips: ask for a trapeze bar on your hospital bed. It really helps in getting in and out of bed during your hospital stay. Also remember to Walk, Walk, Walk.

I did it on my own. I have been testing my blood pressure daily for years and I knew when I could go off. On my next visit with my PCP, I informed him that I went off the meds and he was O.K. with that.

The definition of Full Liquids in the manual I received prior to surgery indicated these are foods that have a semi-solid or pudding like consistency. That definition includes strained cream soups. So I think lobster bisque (if strained) would qualify as full liquids. The definition given on the internet for a clear liquid diet consists of clear liquids or foods that turn to liquids at room temperature. So based on this, I believe you are fine. Good luck on your surgery and let us know how it went when you are on the other side.

Congratulation.

My blood pressure dropped around a few weeks after surgery and I went off my high blood pressure meds. Your initial weight was significantly greater than mine. So it is a little hard to predict. You are taller than me. For me I cut my meds in half when I lost 20 pounds pre-op, that was when I hit 240 lbs and then completely off the meds around 200 pounds. So even if you do not come completely off the meds, you may find that your body needs a lower dosage. Congratulations on losing 127 pounds thus far 12 weeks after surgery.

Congratulations.

Yes, I still live in the same place. The tornado missed the house but it did take out about 100 of my large trees. I spent the first year of my retirement cutting firewood. I still have around a 5 year supply of firewood left. Luckily I have a wood stove that I use to heat my home.

Congratulations.

It is probably only a decision that you can make. I had RNY gastric bypass surgery around 5 years after I retired. The regiment of vitamins/fluids/protein I found to be rather rigorous and it would have been more difficult to follow, if I was still working. In my case, I was hit with tornadoes a few months after I retired. A couple years later by destructive floods. After these, the surgery was not difficult and being retired allowed me to focus on the process.

Congratulations.

Congratulations.

I went with the 6 month of medically supervised diet and exercise program that was aligned with of the bariatric surgery program. Many PCPs are either unable to fulfill the requirements in order to generate the required paperwork for approval. Most insurance companies require that you meet with your doctor religiously once every month for 6 months. It seems better to deal with a doctor that specializes in meeting the program requirements rather than a general practitioner. The elements of the program required that I not only exercised and dieted, but that I kept a food journal, that I attended bariatric surgery support group meetings, that I analyzed my caloric intake for each meal and snack. It was more thorough that what a PCP might direct.

Have you looked into the possibility that you might have a stricture? Strictures are a problem unique to the Bypass and Sleeve patients. Basically, it is a narrowing preventing food to pass normally through your digestive system. With the Bypass, strictures occur at the gastro-jejunal anastomosis (the top connection where the small bowel is attached to the gastric pouch). Sleeve patients can have a stricture anywhere along the length of the stapled stomach. A stricture will almost always occur within the first three months after surgery. Generally, a patient will complain of not being able to advance their diet beyond liquids. They may have frequent vomiting episodes, or even night time regurgitation/reflux. A stricture can be identified by an Upper GI Swallow, but the most appropriate test is an EGD (v). An EGD is where the doctor gives you an IV sedation, and they pass a long flexible scope with a camera on the end, down the esophagus to evaluate the narrowing. If there is indeed a stricture, the doctor can usually dilate it with a balloon. Strictures commonly are fixed withEGD dilations, but sometimes a surgery is required for persistent symptoms. One of the new options for treatment include placement of a temporary stent via the endoscope.

There are two stages to bariatric surgery. These are the weight loss phase and the maintenance phase. The strategies to be used in each phase are different. It sounds like you wife is in the maintenance phase. This article describes my approach in the maintenance phase. http://www.breadandbutterscience.com/Surgery2.pdf

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. Some individuals find out they have Helicobacter pylori infection after surgery, so it is a little common. If the first line of treatments are not effective, repeating the treatment with a triple set of antibiotics is recommended. http://gi.org/guideline/treatment-of-helicobacter-pylori-infection/

It is common for individuals who just had weight loss surgery to be unable to meet their fluid and protein goals in the very beginning. Your body is in a major heal mode. Just keep trying and you should be able to get there in the next couple weeks.

It could be due to a number of factors. If your blood sugar gets too low or if your blood pressure gets too low, fainting can result. 1. If you were diabetic prior to surgery and taking medicine for it, the amount that you take for this condition might need to be reduced or eliminated. The same may apply to those taking prescription medicine for high blood pressure. 2. Some individuals (irrespective of whether they had diabetes prior to surgery) get a condition called reactive hypoglycemia. Here is a couple links. https://www.mayoclinic.org/diseases-conditions/diabetes/expert-answers/reactive-hypoglycemia/faq-20057778 https://www.verywell.com/what-to-know-about-reactive-hypoglycemia-1087744 3. It can also be due to dehydration or an electrolyte imbalance. Possible triggers of orthostatic hypotension include: dehydration – if you're dehydrated, the amount of fluid in your blood will be reduced and your blood pressure will decrease; this makes it harder for your nervous system to stabilise your blood pressure and increases your risk of fainting. https://www.medicalnewstoday.com/articles/182524.php Generally, electrolyte disturbance symptoms depend on which electrolytes are affected and the severity of the imbalance. Most electrolyte problems involve abnormal levels of sodium, potassium, or calcium. Typical mild symptoms of an electrolyte disturbance include dizziness and muscles cramps or weakness. https://draxe.com/electrolyte-imbalance/ It is important to drive this one to ground. Consult your surgeon's office. If you have a blood pressure monitor and a blood sugar monitor at home, you might be able to localize the cause immediately after your next episode.

I think what is being referred to here is Crystal Light mixed with unflavored protein powder. Here is a thread. http://www.obesityhelp.com/forums/rny/4254508/Protein-Powder-add-to-Crystal-Light/

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. Thus you lose weight. Several individuals report feeling weak after surgery. But it could be due to a number of issues. One issue is dehydration, but you seem like fluids are not your problem. Other issues might be due to low blood sugar or low blood pressure. Sometimes if one was on medication for high blood pressure or diabetes prior to surgery, the medications might need to be reduced after surgery. Otherwise severe weakness can result. Being tired can also be due to an electrolyte imbalance. Symptoms of an electrolyte imbalance vary greatly depending upon which electrolyte is unbalanced, but may include thirst, weakness, drowsiness, sluggishness, fatigue, confusion, cramps, abnormal heart rhythm, loss of appetite, nausea, vomiting or seizures. https://www.livestrong.com/article/234160-how-to-prevent-a-fluid-electrolyte-imbalance/ That is why taking vitamins and minerals and taking them in the right form for absorption by your new stomach is important.

As you lose weight, the chemicals and hormones that were stored in your fat cells are being released into your body. These will pass through your kidneys and are expelled in your urine. But they can generate a flush of hormones during the weight loss phase. They should simmer down once you transition into maintenance. It is important to meet your daily fluid requirements, because it take fluids to flush these hormones from your system. But since you are still in the pre-op stage, I am not sure this is the exact cause. It may be the stress associated with the fact that you will soon undergo major surgery.