James Marusek

Congratulations.

Walking helps reduce gas pains. Things will get better but it will not happen overnight. It took me 6 months to reach a Happy State when all the problems seemed to melt away.

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. Generally one is given detailed guidelines that describe daily requirements, this includes daily protein requirements and meal requirements. 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. So have you assessed your daily protein intake - the sum of the protein you obtain from meals combined with the protein supplements (protein shakes and protein bars)? The reason why I am saying this is because one protein shake may not be enough especially since you are training to run long distances. At 3 months I was consuming 3 protein shakes a day. A good goal for weight loss is to be in the normal category for BMI. That is 18.5 - 24.9. This region has the lowest mortality rate. I choose to set my goal at the high side of BMI because I considered it to be important to have a little excess fat on my body because this fat will sustain me during times of major illness or injury. Generally after surgery your rate of weight loss will slow down the further out from surgery. It will eventually level off and you will slide quite naturally into the Maintenance phase.

I assume that you have recently had surgery because you posted this in a post-op forum. Right after surgery, many people find it difficult to meet their fluid requirements. This is because your body is in a major heal mode. Just keep trying to meet these requirements and in the next few days you should be able to reach 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.

Congratulations.

Intercostal muscle pull is normally caused by excessive twisting of the trunk. So I think you are right when you called it a Non-Surgical Complication! Random Oddity. After surgery my body was very, very tender. I slept on a water bed and getting up out of bed was sheer terror because I experienced shooting pain in the process.

Good luck. I will pray for your success.

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.

Taking a before and after photograph is important because it helps to show your progress. Here is my before photo and my photo at 6 months post-op.

After my RNY gastric bypass surgery, I was on full liquids for the first 4 weeks, pureed foods for the next four weeks and then only after week 9 was I transitioned to solid food. Your stomach needs time to heal. The transition to solids can be rough. There is no need to rush it.

Here is a link to an article that I wrote about my surgery. http://www.breadandbutterscience.com/Surgery.pdf

I was lactose intolerant also. Beware some protein shakes contain lactose. My lactose intolerance lasted for about 2 months after surgery and then went away.

After gastric bypass surgery, it can be difficult. It takes time. It wasn't until around the 6 month that all the problems seemed to melt away and I reached a happy state. 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. So focus on the three main items. Since you said you thought you might be dehydrated. Then focus on solving your problems with 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. Since you indicated you are having a problem with 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. There are many varieties of protein shakes available today. Experiment until you can find one you can tolerate. You don't have to like it, just tolerate it. 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.

Solid foods such as chicken and steak can be difficult to eat. There is no need to rush things. For chicken it must be very soft. For example, take a chicken breast and boil it in water with a couple bouillion cubes on low heat for several hours. When the chicken falls easily apart with a fork then it is done. I have found softer foods such as chili and soups went down much easier and had more flavor so that is what I primarily stayed with. I have attached some recipes at the end of the following article. http://www.breadandbutterscience.com/Surgery.pdf

Congratulations.

Before I had surgery, I would just gobble down my food and I was done and left the table. But after surgery, there was so little food, that I began to realize that dinner had two components: food and conversation. So after surgery, I concentrated on the conversation element. Many people experience hunger after surgery. Many call this head hunger. It should improve once you begin the solid food stage. Chewing is a natural part of digesting food. Chewing releases chemicals in your body to break down foods. Therefore after surgery many people miss the act of chewing.

Just follow the program guidelines and it will happen. It will be wonderful.

The transition to hard foods such as chicken and steak can be difficult. There is no need to rush things, just take your time.

Congratulations.

When I was in the hospital recovering from RNY gastric bypass surgery, I asked the hall nurses, what was the highest weight patient that underwent this operation at their hospital. They said they had one that was 650 pounds.

I am 4 years post-op RNY. As far as the inner me, I did not detect any change. But some individuals do. I think perhaps it might be expectations. They might believe that if they lost the weight, everything in their lives would change for the better - that overweight was the root cause of all their personal problems. It doesn't. In my case I had the surgery because my obesity was causing me to slide down the slippery slope of bad health conditions (high blood pressure, diabetes, sleep apnea, severe acid reflux [Gerd]). The surgery corrected those conditions and I am very please to be healthy again. I also was pleasantly surprised on how easy it was to drop the weight because after the operation I lost my hunger. And I was also surprised by the fact that I went from a size 3X in shirts down to a size Small and from a size 46 in pants down to a size 33. It meant that I could shop in department stores again and replace my wardrobe with the latest fashionable styles. Perhaps another component is hormones. As you lose weight, the chemicals and hormones that were stored in your fat cells are released into your body. These will pass through your kidneys and be expelled in your urine. But they can generate a flush of hormones during the weight loss phase and in some people dramatically affect their mood. This hormone rush generally simmers 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. Another component to your question is how the outside world treats the obese you from the slim, fit you. People treat fat people differently. Some comments may rub you wrong. Sometimes this is out of jealousy. Some people perhaps may even wish you to fail because they are obese and do not want to follow your path.

Most insurance companies use the initial weight at time of first consult to determine qualification for bariatric surgery. Many insurance plans require a 6 month doctor monitored weight loss and exercise program in order to qualify. Since you wife recently went through this process, she will have many of the answers. My insurance plan reads: Surgical treatment of obesity (bariatric surgery) is covered only if: - eligible enrollee is 18 of age or over - clinical records support a body mass index of 40 or greater (or 35-40 when there is at least one co-morbidity related to obesity). Applicable co-morbid conditions include the following: • T ype II diabetes mellitus (by American Diabetes Association diagnostic criteria). • Refractory hypertension (defined as blood pressure of 140 mmHg systolic and or 90 mmHg diastolic) despite medical treatment with maximal dose of three antihypertensive medications. • Refractory hyperlipidemia (acceptable levels of lipids unachievable with diet and maximum doses of lipid lowering medications). • Obesity–induced cardiomyopathy. • Clinically significant obstructive sleep apnea. • Severe arthropathy of the spine and or weight bearing joints (when obesity prohibits appropriate surgical management of joint dysfunction treatable but for obesity). - Documentation of failure to lower the body mass index within the last 12 months through a medically supervised program of diet and exercise of at least 6 months duration So if your plan is written in a similar manner than since you have at least one comorbidity it would mean that you could qualify for surgery if your BMI is 35 or greater. As far as extreme exercise, I think you will still be able to do these, but not at the beginning and you will need to work over many months towards that goal. There was a Chef Woody in Indiana who cycled. He was a restaurant chef in real life and after surgery specialized in developing dishes fit for bariatric patients. Anyways cycling was his passion. He regularly competed. In one race he rode from one side of Indiana to the other. After he passed the finish line, he fainted. He needed a little more food intake along the way. Unfortunately, he moved to Florida a few months after I had my surgery. But I did meet him once at a Bariatric Surgery Support Group meeting.

heycrystal2052 wrote "I also consume 2 or 3 Adkin’s treats each day for their fat content and to satisfy my sweet tooth." How much fat should be be getting daily? I will admit, this is something I never pay attention to. Are fats like carbs, "good ones vs. the bad"? Great idea, I too feel one egg isn't enough, but I hate to waste food so I've learned to deal with it or I'll add more veggies to fill me up. I never thought about getting bigger eggs, I sure will do that now. After around the first year and a half post op, my nutritionist said each meal should consist of equal amounts of protein, fats and carbs. But always put protein first. Generally I consume fat in natural forms such as butter, whole milk, eggs, heavy whipping cream, and meat. I do not distinguish between the types of fat. Much of the concern on saturated/unsaturated fats is based more on hype than real science.

I am 4 years post-op RNY gastric bypass surgery and I eat one egg each morning. At my stage size is important, the egg must be Jumbo. Large eggs are too small and two eggs are too many. Personally I would stay away from oatmeal due to the carbs. This article describes the approach that I use. http://www.breadandbutterscience.com/Surgery2.pdf

If you have the surgery done in the U.S., I would recommend going to a Center of Excellence in bariatric surgery. There are many components to the surgery (initial consultation, surgeon, nutritionist, pre-op testing, training, support groups, five years of post-op follow-ups, etc.) A center of excellence will have all the bases covered. A quick internet search shows that UPMC in Pennsylvania is a center of excellence. It may not be the only one. http://www.upmc.com/Services/bariatrics/Pages/default.aspx I do not know what the acronym UPMC stands for but here is their contact info. UPMC 200 Lothrop St. Pittsburgh, PA 15213-2582 412-647-UPMC (8762) 1-800-533-UPMC (8762)