James Marusek

Congratulations on your 88 pound weight loss so far. I think I am missing something. Was there a before and after photo?

Right after surgery, I lost my ability to swallow large pills such as the large calcium 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.

A duodenoscope is threaded through the patient's mouth and used to visualize the stomach and duodenum (the upper gastrointestinal (GI) tract). It can also be used to drain fluids from pancreatic and biliary ducts that would otherwise require more invasive surgery. The major problem with this equipment is the difficulty in cleaning it to prevent the transmittal of superbugs (bacteria immune to current antibiotics). This week, the U.S. Food and Drug Administration (FDA), took a step in the right direction by approving a new tool to add in the fight against superbugs - the ED34‑i10T Video Duodenoscope made by Pentax Medical. This instrument has a removable end cap that allows the channels (fiberoptic cables) to be cleaned more efficiently. https://www.acsh.org/news/2017/09/25/new-device-stops-superbug-infections-their-tracks-11867

It sounds a little pricey to 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. 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. 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. 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.

Good luck on your surgery. I hope it meets all of your expectations. Let us know if we can be of any help.

Welcome and let us know if we can be of any help.

Good luck on your sleeve surgery tomorrow. I am 69 years old and I had gastric bypass surgery 4 years ago. It was like getting a new lease on life.

In general, I think the answer is yes. It is important to eat some food. I did not experience starvation mode, I just followed the recommended meal size from my surgeon's office. There are different types of gastric bypass surgery. I am in the States and generally the procedure that is done is RNY gastric bypass surgery. Mini gastric bypass surgery tends to be done in Europe, Australia, Mexico. These surgeries are not the same and the guidance on meal volume will vary. Constipation can be a major problem after surgery. Sometimes this is due to a lack of fluids. At around the 3rd month, I became so bound up that the only way I found that worked was inserting a glycerine suppository up my rectum. This worked but it is not something you want to do every 3 days. For me the cure was to eat an apple a day just before bedtime. Then the next morning I would generally have a bowel movement. But it is important to not only eat the pulp of the apple but the skin of the apple. (for example, eating apple sauce will not produce the same effect). Other on this site recommended dealing with constipation by taking: 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 lead to severe 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)

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. After gastric bypass surgery, the weight loss phase is fairly short. I entered the maintenance phase after around 7 months. So it is very important to follow the program guidelines during this phase in order to maximize your weight loss.

That is an excellent reason to have the 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.

I am 69 years old and had RNY gastric bypass surgery 4 years ago. I definitely was not too old for this surgery. I lived around 120 miles from the hospital where the surgery was performed. My wife drove me home form the hospital. The ride was not bad. I had to stop off at the pharmacy to pick up by blood thinner medicine on the way home. This took about an hour. Not all pharmacies have this medicine in stock so it was better to pick it up near the hospital because they normally stock it.

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. The guidance that I received was 64-80 ounces of fluids a day. 48 ounces sounds a little on the low side.

I ran across some interesting research on obesity out of University of North Carolina at Chapel Hill and North Carolina State University. They are experimenting with patches (specifically a degradable micro-needle patch loaded with nano-particles containing the experimental drug that is applied to the skin of mice). The drugs used were rosiglitazone and a beta-adrenergic receptor agonist. The goal of the research was to turn white fat cells into energy burning brown fat cells. The white fat stores energy in the form of triglycerides whereas brown fat actually takes energy and turns it into heat. Researchers observed a 20 percent fat reduction utilizing either of the two drugs and these results were similar in lean versus obese mice, improved fasting blood sugar and a 20 percent increase in energy consumption. Again these experiments were with mice. One should recognize that what is observed in mice does not necessarily translate into humans. https://www.acsh.org/news/2017/09/15/being-tan-makes-you-look-thinner-–-tanning-fat-makes-you-thinner-11836

One of the individuals in my bariatric surgery support group went from a band to bypass. He had the band for several years but it began to wear into his stomach and had to be removed because it was about to result in a rupture, a life threatening condition. When they did the bypass, there was a lot of scar tissue and as a result they made his pouch a little smaller than most. Therefore the volume of food he could consume in one meal was smaller than most bypass patients. But he just switched to more meals per day and was happy with this. He said he would do it over again in a heartbeat.

Congratulations.

Congratulations.

It will depend on your starting weight and the type of surgery you will have. I had RNY gastric bypass and I transitioned to the Maintenance phase at around 7 months. Individuals that have sleeve surgery generally lose at a slower rate and some enter maintenance after 2 years.

Welcome and let us know if we can be of any help. Since the surgery is expensive, normally the time until the surgery is approved is at the discretion of your health insurance policy. For me it took 9 months from first consult until I was approved for bariatric surgery. But you are a revision, so it may be different. So you may want to dig out a copy of your health insurance policy and see what they require.

After gastric bypass surgery, your body will no longer be able to synthesize some vitamins from the food you eat. Therefore you will need to take supplements for the rest of your life. B12 is an important vitamin. It is important in helping form red blood cells and for maintenance of the central nervous system. B12 is also required for the synthesis of DNA in the body. A deficiency could cause pernicious anemia, causing mood swings, paranoia, irritability, confusion, dementia, hallucinations, or mania, eventually appetite loss, dizziness, weakness, shortness of breath, heart palpitations, diarrhea and tingling sensations in the extremities. B12 deficiency has also contributed to anxiety, stress and depression. After my surgery I was directed to take 500 to 1000 micrograms sublingual B12 daily or 1000 microgram injection once monthly. So I began with the shots. I thought once per month would be easier than taking something daily. There were a couple problems with this approach. First, shots are prescription medicine whereas the sublingual vitamin are not. Now the second problem was the clincher. I had my wife administer the shots to me in the arm. I noticed that just before she put the needle in my arm, she would close her eyes. She hates blood. So I decided to forego the shots in favor of the sublingual vitamins. After I started taking them in this form, I liked them. They tasted good. Also they are not swallowed like other vitamins but rather just placed under your tongue to dissolve. I was also told that there are also different chemistries of B12. I used the sublingual B12 and was told to use methylcobalamin. You cannot use a time-release version of B12. I never used Eligen B12. It is not sublingual. I would leave the decision to your bariatric surgeon. It may not be absorbed properly and it is his/her job to know if this would be an approved application. Eligen website identifies some limitations with this vitamin. You should not take Eligen B12™ if you are allergic to vitamin B12, cobalt, or any ingredient of Eligen B12™. You should not take Eligen B12™ if you have Leber’s disease, which your doctor may refer to as hereditary optic nerve atrophy. Cyanocobalamin can lead to optic nerve damage (and possibly blindness) in people with Leber’s disease.

Pain can be a sign something is wrong. I hope you find out what the problem is in your follow-up meeting (or sooner). You might refer to your hospital discharge directions. Mine indicated the time to contact your physician for pain was as follow: Uncontrolled or increased abdomen pain. Shortness of breath or calf pain (possible signs of blood clot). New onset of upper back or left shoulder pain. Chest pain, rapid heartbeat and or dizziness. Changes in your incision - new pain, swelling, redness, cloudy drainage.

Congratulations.

Research looked at the long term effects of RNY gastric bypass surgery at 12 years post-op. They concluded surgery appears to be successful for at least 12 years in terms of diabetes prevention or remission, as well as for improvement of lipid profiles and weight loss. But they noted an increase in suicide risk among patients. The investigators, led by Dr. Ted D. Adams from Intermountain Healthcare in Salt Lake City, Utah, followed 418 patients who had RYGB gastric bypass surgery, and compared them to 417 patients who didn't have surgery (although they wanted to) because their insurance didn't cover it (non-surgery group 1 (NS1) and to a group of 321 equally obese people who didn't have surgery and hadn't tried to obtain it (NS2). As expected, the surgery group lost more weight than either non-surgery group by 12 years post-procedure — - 35, three and zero percent respectively. In addition, the surgery group maintained an improved metabolic profile compared to either their baseline status or to the other groups. For example, their blood glucose levels dropped post-surgery, while those of NS1 and NS2 increased. Similarly, the level of LDL cholesterol decreased post-surgery while that of the NS groups had increased, and the opposite was true for HDL (good) cholesterol. Furthermore, the level of glycated hemoglobin (a measurement of glucose levels over time) didn't change in the surgical group, while it increased in both non-surgery groups. Also, of the 88 patients in the surgery group who had type 2 diabetes initially, 43 of those were no longer diabetic 12 years post surgery. By contrast, the risk of developing diabetes was less than one percent of that for either non-surgery group — a highly significant difference. However, there was an association between bariatric surgery and death by suicide, an association that has been described in the past. The authors noted that it's unclear whether the increased suicide rate is related to the surgery itself, or might follow any large and sustained weight loss. https://www.acsh.org/news/2017/09/21/bariatric-surgery-effects-are-good-long-term-11856

Good luck on your surgery. Check back with us when you are on the other side to let us know how it went.

Over the years long prior to my gastric bypass surgery, I had 2 hernia operations. I found them to be much more painful than my gastric bypass surgery. So I sympathize with you. After surgery many people report problems with sleeping, primarily because they cannot find a comfortable position. Some resort to sleeping on a recliner during the first few weeks. I found slipping a pillow between my legs helped me. Life right after surgery can be rough. It does get better each day but it does not happen overnight. It took me 6 months until I reached my happy state when all the problems seemed to melt away.

I found the Beurer Model BF66 to be a good scale. I bought it at Bed Bath and Beyond. It was a few years back but I think I spent less than $50 on it. I like it for the following reasons. It is accurate to 0.2 pound increments. It is repeatable. Using my old scale, I would step on it and get a reading. And then a few seconds later I would step on it again and get an entirely different reading. Sometimes this was as much as 5 pounds different. So repeatability is a must. It has a lit LED reading that has large numbers. This was important because I generally remove my glasses before I weigh myself. I am almost blind without them. So I want to see the reading without them. On my old scale, there was a small reading. I would step down and bend over to read the weight, just when the scale cycled off.