James Marusek

I had RNY gastric bypass surgery over 4 years ago. I was not told to delay beginning my multivitamin/calcium regiment after post-op. So I began taking them almost immediately. So I suspect that you should probably begin taking these now. But you might call your surgeons office and verify this approach. After RNY surgery, you are required to take many vitamins for the rest of your life. This is because you body no longer synthesizes vitamins from food. That part of your stomach has been cut away, so this daily requirement is extremely important. Vitamin chemistry is important for absorption. Calcium supplements should be calcium citrate. There are also different chemistries of B12. I use the sublingual B12 and was told to use methylcobalamin. You cannot use a time-release version of B12. If you are taking iron supplements, it must be ferrous sulfate for the best absorption. Gummy vitamins are not absorbed properly and should be avoided. 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. The directions I received after surgery was: Three Flintstone complete chewable multivitamins daily. Additional 65 milligrams elemental iron daily for menstruating women. 1500 to 1800 milligrams calcium citrate daily [this can be tricky because the dosage rate is per 2 capsules - therefore this can mean around 5-8 capsules per day depending on the size (petite or regular)]. 500 to 1000 micrograms sublingual B12 daily or 1000 microgram injection once monthly. 100 milligrams Thiamine (vitamin B1) daily for the first year and then weekly thereafter. Your daily requirement might be different. Your surgeon's office should have given you guidelines. In the morning I put my Citricals in a small finger bowl. Then I take a couple every couple hours. When I am up and about I put them in a zip lock bag and take them with me. For me this is not difficult. Sometimes I take two at once. But right after surgery, I lost my ability to swallow large pills and I had to crush them. It was like eating chalk. The only way I could down these was by mixing them with crystal light and drinking them down. Because they formed a paste at the bottom of the glass. I had to remix these and chug them down several times. Luckily my inability to swallow lasted only a couple months and then I was back to normal.

There are two phases to weight loss surgery, the weight loss phase and the maintenance phase. For RNY gastric bypass patients, the strategy for these two phases is different. You may be nearing the maintenance phase. I transitioned to maintenance at around 7 months. The following article provides my perception of the maintenance phase. http://www.breadandbutterscience.com/Surgery2.pdf

Congratulations on your surgery and let us know if we can be of any help.

I will pray for you.

I had RNY gastric bypass surgery over 4 years ago. I did experience dumping syndrome. It was terrible. But it is also a valuable tool. Generally you will experience pre-triggers before you reach full stage dumping syndrome. Just recognize your pre-triggers and don't take another bite. The pre-triggers can be hiccups, sneezing, excessive mucous, an instantaneous change in the way food taste, and others. Individuals are different and their pre-triggers vary. Dumping experience can last for several hours. In general maintain a vertical position instead of a horizontal. If you lay down on a bed or couch, it will only aggravate the experience. As a result it is important not to eat a meal close to bedtime. Generally when I experience dumping, I go to the toilet and force myself to vomit up some of the food I ate. That helps to relieve the condition. I eat all types of meat. But after a couple months when I passed out of the pureed food stage and into the solid stage, meat was difficult to consume. I found that consuming meats in chili and soups went down much easier than eating steak and chicken. You tolerance will grow the further you are out from surgery.

Good luck on your 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.

Yes it is very common. If you haven't already done this make sure you have a good photograph of yourself taken. 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.

I had RNY gastric bypass surgery over 4 years ago. My medical conditions drove me to seek this surgery. I had high blood pressure and diabetes and was on 4 types of prescription medicine for those conditions prior to surgery. My surgery corrected these conditions and I have been off my meds for 4 years now. But I had several other conditions that were also affected. The surgery corrected my sleep apnea, severe acid reflux (Gerd), my asthma and my severe sweating. So it is interesting that there is a technical name for this condition - hyperhidrosis. Sweat from my underarms often soaks through my clothes, causing obvious sweat marks, and drew rude comments at work. I could sweat even at room temperature. As a result, I normally drove with the windows down in my car, even when there was snow on the ground. When I worked outside on a hot day, after 30 minutes my shirt was so wet that I could wring out a cup of water from it. I had the condition for at least 10 years prior to surgery. This condition went into remission within a few months after surgery.

After surgery, water tasted like swimming pool water, a lot of chlorine. Everything was tasteless. I remember the first time I used ketchup a few months after surgery. It tasted like hot sauce. I loved eating crab legs prior to surgery. But butter was tasteless and therefore crab legs totally lost its flavor. Your taste will change the further you are out from surgery. So it is important to keep experimenting. I did find that spices did add flavor to my foods post-op and it helped to make meal palatable.

After my gastric bypass surgery, I became lactose intolerant. This condition lasted for a couple months and then disappeared. Some protein shakes contain lactose. According to the internet Premier "Contains Milk" in the form of Milk Protein Concentrate. This may be what is causing your stomach to become upset.

Congratulations.

There have been a few individuals that post on this website that have done it (band To sleeve to bypass). Normally their motivation to go from sleeve to gastric was because of severe acid reflux (Gerd). The sleeve only makes the condition worse. I haven't heard of anyone doing it to lose more weight. You might want to investigate why sleeve surgery has not worked for you. Whatever prevented you from losing weight after a sleeve may also apply to gastric bypass.

I am over 4 years post-op RNY gastric bypass surgery and I eat one scrambled egg for Breakfast each morning. My surgeon's office did not recommend eggs until week 5 post-op. So after week 5, I tried to eat eggs, but it didn't go so well at first. But a few weeks later, they became good.

You may want to have the problem check out by your general practitioner. You would want to make sure it is not signs of colorectal cancer or some other problem. According to the internet: Common symptoms of colorectal cancer may include: * An ongoing change in bowel habits (diarrhea, constipation, or feeling that the bowel does not empty completely) * Stools that are narrower than usual * Blood (either bright red or very dark) in the stool (poop) * Rectal bleeding * Frequent gas pains, bloating, fullness or abdominal cramps * Weight loss for no known reason * Feeling very tired (weakness and fatigue) Several months after RNY gastric bypass surgery, I experience extreme constipation. I discovered eating an apple before bedtime relieved the condition. But for this to work, I had to eat the skin of the apple as well as the pulp. Constipation can also be caused by not drinking enough fluids.

I had RNY gastric bypass surgery over 4 years ago. Prior to surgery I had high blood pressure and sleep apnea. Those conditions went into remission very quickly after surgery and stayed there.

I found that each day was a little better. But it wasn't until about the sixth month that I reach my happy state when all the problems seemed to melt away. When you were in the hospital they pumped your body full of fluids. As a result when you leave, generally you are several pounds heavier than when you entered the hospital. Generally you will lose this water weight in the first week. After surgery your body is in a major heal mode. Therefore it is common for patients to be unable to meet their protein and fluid daily requirements at the beginning. Just keep trying to reach this goal and you should be able to get there in a week or two. I wrote about my experience in the following article. You might find something helpful there. http://www.breadandbutterscience.com/Surgery.pdf

I think what has happened that cause the loss of many veterans is conflicts on the board. There are many opinionated individuals in this world. Many of them are newbies and many times they offer unsound advice. When a veteran chides in and tries to correct the advise, they are verbally assaulted. So it is a little like a free for all. Just remember as a veteran that one important quality to have is a thick skin.

Congratulations and good luck on your recovery.

I am over 4 years post-op RNY gastric bypass surgery. I was taking 5 prescription medications prior to surgery (2 for diabetes, 2 for high blood pressure, and 1 for asthma). Now I take none. I took some supplements (vitamins, minerals) prior to surgery. Now I take more. But the cost of the added vitamins is less than the cost of the prescription medicines that I use to take. So I am money ahead. I also had severe acid reflux prior to surgery. That is gone now. I had sleep apnea. I would keep my wife awake at night, all night long because she was a light sleeper, prior to surgery. Several months after surgery, I would find her hovering over my bed at night. I would ask her what she was doing and she said, I was sleeping so silently, that she thought I was dead and she was trying to see if I was still breathing. I had several other conditions as well that went into remission after the surgery. Before you make up your mind about which surgery, it might be good to listen to what your surgeon recommends. Also some insurance companies will pay for one type of surgery but not the other. So it is worth investigating this element. As far as your specific questions: ▪️can you stretch your sleeve/bypass easily? Since I have an issue with portion control, this is a major concern for me. I believe the answer is NO, stretching is a myth. ▪️Is dumping syndrome really helpful or is it not worth it? Helpful ▪️Bypass patients: let's say I can control the Vitamin deficiency issue with supplements and the dumping syndrome issue with cutting out sugar and fats as best I can, do you think it was worth the complications (gallstones, stoma obstruction, etc)? I did not experience complications. Also right after surgery, your body may reject fats and sugars because the part of the stomach that normally processes these has been cut away but as time goes on at about a year, your intestines will realize something is wrong and step up to the plate and your body will again be able to absorb these food types without dumping. I had a major sweet tooth prior to surgery and this contributed to my weight and to my diabetes. So I have to avoid sugars like a plague. I rely on natural no calorie sweeteners (such as stevia) and synthetic sweeteners (such as Splenda) to put the sweetness back into my life.

Glad you are better. Sorry for your insurance trouble. If you get backed against wall, sometimes hospitals/doctors will forgive some of the bill if you talk to them.

Congratulations.

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. I am assuming that you are following your surgeons directions on daily protein, fluid and vitamin requirements to a tee. Since you are several months post-op, one thing to do now at this 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. In your case, I would recommend that you do not weigh yourself daily. Limit it to around once per month. Checking your weight daily seems to be causing stress. Stress can cause depression and weight gain. So avoid stress.

From your other posts it appears that you had gastric bypass surgery around 16 months ago. Your blood needs iron to work efficiently. Otherwise you become anemic. So if you lose blood then you need to replenish the iron. This loss of blood can be caused by many things, such as a severe cut or a bleeding ulcer. Women lose blood during menstruation. Many times, low iron levels can be controlled through iron supplements. Around my 2nd year post-op, my blood work detected my low iron levels. The chemistry of the iron supplement is important. My surgeon directed me to use ferrous sulfate for the best absorption. So I began taking 65mg daily. After a year, my blood work showed I was too high, so they are having me scale back on the iron. 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. Several years ago, blood began to appear in my mom's stool. She became anemic and was rushed to the hospital and received a blood transfusion. In her case, the cause was she was bleeding internally due to the fact that she was taking Excedrine as a pain reliever. An Extra Strength Excedrine contains 250 milligrams of aspirin (a blood thinner). [that is around 3 times the recommended low dose rate of 81 mg.] She was popping 3 or 4 a day for over 3 years. We reasoned this was causing her to bleed internally. We completely took her off Excedrine and any products containing aspirin and she healed up within a few months and the condition was corrected. 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. Aspirin is a NSAID. Other NSAIDs are Ibuprofen, Diclofenac, Naproxen, Meloxicam, Celecoxib, Indomethacin, Ketorolac, Ketoprofen, Nimesulide, Piroxicam, Etoricoxib, Mefenamic acid, Carprofen, Aspirin/paracetamol/caffeine, Etodolac, Loxoprofen, Nabumetone, Flurbiprofen, Salicylic acid, Aceclofenac, Sulindac, Phenylbutazone, Dexketoprofen, Lornoxicam, Tenoxicam, Diflunisal, Diclofenac/Misoprostol, Flunixin, Benzydamine, Valdecoxib, Oxaprozin, Nepafenac, Etofenamate, Ethenzamide, Naproxen sodium, Dexibuprofen, Diclofenac sodium, Bromfenac, Diclofenac potassium, Fenoprofen, Tolfenamic acid, Tolmetin, Tiaprofenic acid, Lumiracoxib, Phenazone, Salsalate, Felbinac, Hydrocodone/ibuprofen, Fenbufen.

After RNY surgery, you are required to take many vitamins for the rest of your life. This is because you body no longer synthesizes vitamins from food. That part of your stomach has been cut away, so this daily requirement is extremely important. Vitamin chemistry is important for absorption. Calcium supplements should be calcium citrate. There are also different chemistries of B12. I use the sublingual B12 and was told to use methylcobalamin. You cannot use a time-release version of B12. If you are taking iron supplements, it must be ferrous sulfate for the best absorption. Gummy vitamins are not absorbed properly and should be avoided. The directions I received after surgery was: Three Flintstone complete chewable multivitamins daily. Additional 65 milligrams elemental iron daily for menstruating women. 1500 to 1800 milligrams calcium citrate daily [this can be tricky because the dosage rate is per 2 capsules - therefore this can mean around 5-8 capsules per day depending on the size (petite or regular)]. 500 to 1000 micrograms sublingual B12 daily or 1000 microgram injection once monthly. 100 milligrams Thiamine (vitamin B1) daily for the first year and then weekly thereafter.

To ascertain the types and prevalence of adverse symptoms after RNY gastric bypass surgery, Dr. Sigrid Bjerge Gribsholt and colleagues from the Aarhus Univesity Hospital in Aarhus, Denmark, conducted a survey among over 2,200 Danish patients who had undergone RNY. These patients were compared to a control group of 90 people, matched with patients with respect to sex and BMI, but who had not received bariatric surgery. The report was published in JAMA Surgery. Of the operated group, about 1,400 patients responded to the survey, of whom 80 percent were women (the average age of all respondents was 47 years). Nearly 89 percent reported having had one or more symptoms in the nearly five years after undergoing RNY. In spite of that, most of them (over 87 percent) reported an improvement in their well-being post-surgery; only 8 percent said their well-being decreased. The symptoms that most commonly had led the subjects to seek medical counsel, and the percent reporting them, were: * abdominal pain — 34 percent * fatigue — 34 percent * anemia — 28 percent Other less common adverse effects included hypoglycemia (low blood sugar), kidney stones, and gallstones. Characteristics that were most commonly associated with having symptoms included: female gender; being younger than 35 years old; being a current smoker; being unemployed; and having other surgical symptoms prior to having RNY surgery. However, the risk of having symptoms from RNY surgery were small, ranging from 11 percent for current smokers to 34 percent for those with prior surgical symptoms, compared to the risk of the symptoms being reported by the non-operated control group. Reported quality of life decreased as the number of reported symptoms increased. The investigators also noted that nearly one third of patients were hospitalized for some reason after RNY, and this rate was 4-to-5 fold greater than the hospitalization rate in the comparison group. http://acsh.org/2016/01/bariatric-surgery-has-its-downsides/ I had RNY surgery 32 months ago. From my perspective, this was one of the best decisions I ever made.