James Marusek

Congratulations.

It looks like you are a month post-op after RNY gastric bypass surgery. According to my meal plan, I was restricted to full liquids for the first 4 weeks after surgery and then pureed foods for the next four. It wasn't until week 9 that I was allowed to transition into solid foods. So when you said soft foods I am interpreting this as pureed foods, something with the consistency of mashed potatoes. I was given a detailed meal planning book that listed what foods were acceptable at this stage. 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. So make sure you are meeting your protein, fluid and vitamin daily requirements. If all is good at this point, then I would look for possible medical conditions. Generally they fall into 2 major areas: strictures and ulcers. 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 learn by experimenting. At 5 months out, as elcee has said your stomach has healed. If you try something and you have a bad reaction, then avoid that food in the future.

RNY gastric bypass patients tend to lose weight rather quickly. I lost 20 pounds pre-op and 80 pounds in the first 6 months, and then another 20 pounds thereafter. My starting weight was 260 pounds.

It will depend upon the type of surgery that you had. If you had RNY gastric bypass surgery, you will drop weight quickly, like a lead brick, and then the weight loss will slowly taper off. I transitioned into the maintenance phase at around 7 months. Sleeve patients will lose weight at a much slower pace, encounter many many stalls and then transition into maintenance sometimes 2 years out.

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.

OhioSparkle - you indicated that you had RNY gastric bypass but posted this in the sleeve section. The following response is provided assuming you are RNY: 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. So I would recommend you first verify that you are meeting your daily protein, fluid and vitamin requirements. Some members on this board have noted that for RNY gastric bypass surgery, they have entered a stall by eating too little. That may be what is happening in your case. When you eat too little it throws your body into a starvation mode and your body holds onto every calorie as if it is their last - thus no weight loss. So make sure that you are following your daily meal plan volume. You must eat the recommended amount. Also the meal plan is based on volume not calories. If you are looking at calories make sure you are including your protein shakes into the calorie numbers. If eating causes nausea, it may be due to a complication such as a stricture or an ulcer. The transition to solid foods can be difficult on your stomach. I found softer foods such as chili and soups went down much easier than harder foods such as steak and chicken. Therefore I relied on these to a great extend. I provided some recipes at the end of the following article. http://www.breadandbutterscience.com/Surgery.pdf

You minimum daily requirements will depend on they type of surgery that you undergo.

These are my thoughts: 1. Your absorption of prescription drugs may have been altered by the surgery. As a result, you may want to consult with your surgery staff and find out if your current prescription to treat bipolar needs modification. 2. Bipolar is a stress driven condition. Having surgery and then adapting to life after surgery contains a lot of stress. Therefore you might concentrate of ways of reducing your cumulative stress load and bringing your body back to a neutral state. 3. As you lose weight your body will release many of the chemicals stored in your fat cells. These hormones need to be flushed from your system either through you kidneys and urine or through your sweat glands. It takes fluids to make this happen so make sure that you are meeting your daily fluid requirement. At 2 1/2 weeks that sounds a little early for this to be happening. This hormone flush should ease back down to normal levels as you reach the maintenance phase.

I had RNY gastric bypass and these are the directions I received after surgery: 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. 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. As an RNY gastric bypass patient, it is really important for you to take these vitamins for the rest of your life. You body no longer manufactures these, so you must supplement. As a result cost is a major consideration. Generally I buy my vitamins in large quantities to keep the cost down. Also my surgeon's office required I have a full blood workup each year for the first five years. This is to detect any problem in vitamin malabsorption.

When I had my surgery, my mother was the only person who was dead set against the surgery. But when I looked through her eyes - this is what she saw: I was her primary care giver. If something happened to me, then she would lose this support. She would be all alone. She did not want the risk that I might not make it through the surgery. I tried to explain to her that the surgery would let me live a longer life. It was also fairly safe surgery. But she didn't really accept this explanation.

Also try not to cough.

Hi RuthD. The vitamin daily requirement for sleeve surgery is very different than for RNY gastric bypass. So from the context of the post, it seems like you had sleeve surgery. Is that true? So according to my surgeon, the following vitamins are required for Sleeve patients: Three Flintstone complete chewable multivitamins daily. Additional 65 milligrams elemental iron daily for menstruating women. [ferrous sulfate] 1200 to 1500 milligrams calcium citrate daily [I use Citrical - this can be tricky because the dosage rate is per 2 capsules.] 500 to 1000 micrograms sublingual B12 once per week. [methylcobalamin] 100 milligrams Thiamine (vitamin B1) once per week. 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. My surgeon also told me to avoid "time release" vitamins and "gummy vitamins". After around a few years, I transitioned off from Flintstone vitamins and started to use normal multivitamins. Flintstone chewable vitamins were fairly easy to use and were easy on my stomach. I use to buy them by the large bottles a few years ago, but they have changed primarily to gummy vitamins today. As a result the large economical bottles disappeared from the store shelves. Now if you had RNY gastric bypass, then the requirements are different. It might also be desirable to take a probiotic to reestablish the colonies of good gut bacteria after surgery.

Wishing you well. I will pray for your recovery.

When we are in the hospital for surgery, generally we can be administered antibiotics to prevent wound infection. This is not a bad thing. There are a lot of bad bacterial germs floating around in a hospital setting. Most surgical procedures do not require prophylactic or postoperative antibiotics. However, certain patient-related and procedure-related factors alter the risk/benefit ratio in favor of prophylactic use. Patient-related risk factors suggesting need for antibiotics include Certain valvular heart disorders Immunosuppression Procedures with higher risk involve areas where bacterial seeding is likely: Mouth GI tract Respiratory tract GU tract In so-called clean (likely to be sterile) procedures, prophylaxis generally is beneficial only when prosthetic material or devices are being inserted or when the consequence of infection is known to be serious (eg, mediastinitis after coronary artery bypass grafting). Choice of antibiotics is based on the Surgical Care Improvement Project (SCIP) guidelines (see Perioperative Management). There is strong evidence that standardizing antibiotic choices and adhering to SCIP protocols or another standardized and validated protocol reduce the risk of surgical infection. Some regions of the US that followed SCIP guidelines were able to decrease surgical site infections by 25% from 2006 to 2010. Drug choice is based on the drug's activity against the bacteria most likely to contaminate the wound during the specific procedure (see Table: Antibiotic Regimens for Certain Surgical Procedures). The antibiotic is given within 1 h before the surgical incision (2 h for vancomycin and fluoroquinolones). Antibiotics may be given orally or IV, depending on the procedure. For most cephalosporins, another dose is given if the procedure lasts > 4 h. For clean procedures, no additional doses are needed, but, for other cases, it is unclear whether additional doses are beneficial. Antibiotics are continued > 24 h postoperatively only when an active infection is detected during surgery; antibiotics are then considered treatment, not prophylaxis. The Center for Disease Control has published guidelines for prevention of surgical site infections that address topical and nondrug antiseptic measures (eg, bathing, sealants, irrigation, prophylaxis for prosthetic devices). Source: Prevention of Surgical Infections The antibiotics destroy not only the bad bacteria in the gut but also the good bacteria. Therefore I feel it is important to reestablish the good gut bacteria after surgery by using probiotics. I ran across an article this morning that discusses the relationship of gut bacteria and weight gain. While it has long been known that low dose antibiotics cause weight gain in animals, the mechanism by which they do this has been a mystery. Researchers are now beginning to zero in on the effect and their work may even shed light on the human obesity epidemic. Animals, like humans, have numerous bacterial species living in their gut. Believe it or not, there are more bacterial cells in our body than human cells. Of course, bacterial cells are much smaller than human cells. But their effect on our health may not be small. Some varieties of bacteria are more likely to cause the body’s immune system to swing into action, but usually different bacteria keep each other’s multiplication rate in check by competing for the same food supply. But if the bacterial balance is upset because an antibiotic reduces the numbers of one species more than others, an inflammatory response can occur. Such a response is linked with making our cells less sensitive to insulin. “Insulin resistance” means that glucose is less likely to be taken up by cells, and since it is the cell’s main source of energy, they crave an increased intake. This translates to a boost in appetite as the body strives to meet cellular needs. What all of this suggests is that some species of bugs in our intestine may contribute to weight gain more than others, and that these may become more prevalent when competitors are reduced by antibiotics. Of course, other factors may also play a role in altering the bacterial flora. The chlorination of drinking water as well as improved sanitation may influence both the type and the number of microbes that reside in our gut. Who knows, perhaps all that emphasis on getting rid of germs may be affecting our waistline. Is there any actual evidence for this postulated link between changes in gut bacteria and obesity? In one word, yes. When Martin Blaser, a microbiologist at New York university, fed infant mice doses of penicillin comparable to those given farm animals, he found that after 30 weeks these mice had put on 10-15% more weight than those not treated with the antibiotic. Furthermore, the mice that had been treated had a different microbial flora in their gut, with Lactobacillus, one of the “good” bacteria, having significantly decreased. When gut bacteria from these mice were introduced into mice had been bred in a totally sterile environment, and were therefore germ-free, they put on more weight than mice with the regular complement of microbes in their gut. While overconsumption of food is the crux of the obesity problem, one of the reasons why we eat too much, as we have now seen, may be due to the changes that have occurred in the microbial population of our gut. A study of ancient feces from caves, as well as from the intestinal tract of mummies, has revealed a microbial makeup that is quite different from that found in our guts today. Those ancient microbial populations are more similar to the ones found in chimps, gorillas and children in rural Africa than in the intestines of North Americans who are more likely to have been exposed to chlorinated water, antimicrobial cleaning agents and antibiotics. Maybe a partial answer to obesity is to repopulate our intestines with the bacteria found in ancient poop. Source: Bugs In Our Guts

After surgery, I walked for 30 minutes each day. I would describe this walking as hill climbing. My driveway is a step hill and all I have to do is step outside and walk up and down my driveway. It uses two different muscle types. One for going uphill and one for going down. I would recommend walking. The primary reason is that running puts shock pressure on the joints. And as we get older (I am 70), I see many people my age undergoing knee replacements.

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

That is because I am an out of box thinker. It is one of my skills. So I consider how many websites have been hacked and personal data stolen by other entities in the past few years. Personal information on hundreds of millions of people and that is the ones we hear about. Many times these hackers are sponsored by foreign countries or criminal elements. And the data is then suddenly used for criminal activities. [These are systems that the IT scientist have come up with counter measures for such a scenario and failed.] Next consider that the organizations storing this information probably do not even consider the DNA information to be extremely high on the privacy act material. So in general, this material is very vulnerable to attack and exploitation. Remember this business [Ancestry DNA] is a money making business. In a way it is like a hobby business dedicated to matching ancestry information. So protecting privacy is not their highest priority. And it appears that they are also in the business of selling this information. Next consider how quickly the ability of man to replicate or modify genes has grown in the past few years. DNA analysis has been used for several years in identifying criminals and putting them behind bars. It is almost like a gold standard. So I see this as a vulnerability. And I like this gold standard and prefer not to see it tarnished by becoming vulnerable to abuse.

Congratulations on your success.

In the hospital, they pump your body with fluids. It is common to weight 10 pounds more when you leave than when you entered. You have to lose this water weight first before you see results.

Good luck on your surgery.

Right after surgery I found that I could no longer swallow large and medium size pills. But after approximately 2 months that changed and I was able to swallow even the large horse pills easily.

I had gastric bypass whereas you had the sleeve. I dropped weight so quickly that it was like jumping off a cliff. But then at around 7 months, my weight loss stopped and I went into the maintenance phase. Sleeve patients lose weight at a much slower pace. They encounter many stalls along the way. But their journey is much longer. And they can achieve almost the same weight loss as gastric bypass patients. Many do not transition into the maintenance phase until 2 years.

I think you are overthinking it. You are already showing a 55 pound weight loss in the pre-op stage, although this may be spread out over a couple years. You seem to know how your body works. I only lost 20 pounds pre-op, so you are far ahead of me at that stage. So in the pre-op stage, what works for you WORKS. But post-op, this is where you will need to follow their directions to a tee if you want to see the dramatic results. I lost 80 pounds in 6 months without much effort on my part. For me it was easy because I lost my hunger.

Congratulations.😀😎😊