James Marusek

I will pray for your surgery to be successful and your recovery smooth.

Welcome and good luck on your surgery. Since you are at the beginning of this process, 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.

Since you are at the beginning of this process, 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 had RNY gastric bypass because I had severe acid reflux (GERD) prior to surgery and the sleeve will only make this condition worse. RNY has been around for several decades and is almost the gold standard in weight loss surgery. They have most of the bugs worked out. Also I did not want to undergo surgery a second time. Once is enough for me. The rate of revision surgery is extremely low for this type of operation.

I had Type II diabetes prior to surgery and I was taking to prescription medicines to control my blood sugar levels. Two days after surgery when I left the hospital, I was off all my diabetes meds and haven't taken any since. I had my surgery 4 years ago and periodically once per month check my blood sugar levels to verify it is still being controlled. For me the most astonishing thing was how quickly that disease was sent into remission - only 2 days.

Your rate of weight loss will depend on the type of surgery you had. I had RNY gastric bypass surgery and the weight dropped off quickly but I leveled off and slid into maintenance phase at 7 months. Sleeve patients lose weight at a much slower pace, encounter many stalls along the way. They can achieve almost the same amount of weight loss as RNY patients but it may take them a couple years to reach that weight loss.

I had Type II diabetes and was taking 2 prescription medicines prior to RNY gastric bypass surgery. When I left the hospital 2 days after surgery, I was off all my blood sugar medicines and haven't taken any since. I am 4 years post-op and once per month check my blood sugar levels to verify they are still normal. It was that quick. Some diabetes patients do not experience this effect, but many do. Some see a reduction in the amount of medicine they are taking for the condition. From what I can see, it somewhat depends on how long you have been suffering with this condition and if you progressed to insulin to treat the condition. Generally right after surgery, the volume of food is so minimal that you will not experience constipation at the beginning. At least that is my experience. You may not have a bowel movement in the first week but that is due to a lack of solid food. As time goes on and you transition to solids, constipation can appear. Sometimes I became so compacted that I had to use a glycerin suppository and place it up my rear end for relief. This worked effectively but I did not want to do this for ever. For me, I found a simple solution. I ate an apple a day just before bedtime and the next morning would generally result in a bowel movement. But there is a trick to this. I had to eat the skin in addition to the pulp. So apple sauce would not work. These are the recommendations from several individuals on this site for dealing with constipation after surgery. 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 cause the runs) 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) Low Fat Bran Muffin (recipe). 80 calories each 1 cup flour 2 teaspoons baking powder ½ teaspoon baking soda ½ teaspoon cinnamon 2 cups bran cereal 1 ¼ cups milk 1 egg ½ tablespoon applesauce optional: banana, berries, mini chocolate chips Bake 400° F for 22 minute

I am sorry that you have encountered many problems post-op and I wish you well. In general, the three most important elements after RNY gastric bypass surgery are to meet your daily protein, fluid and vitamin requirements. How are you doing in these areas. A few years after my RNY gastric bypass surgery, I was told that my surgeon tends to make the stomach pouch a little smaller than some. This meant that I had to really adhere to the meal volume requirement. If I exceed this volume, it generally lead to dumping syndrome. My nutricianist recommended that to counteract this, I should eat more small meals per day, perhaps 5. So I was wondering if this might help in your case.

There were only a few prescription drugs after surgery. The key one is Lovenox [Enoxaparin], which is to help prevent blood clots. This I self injected. Generally I pinched the flesh near my stomach and put the needle into it. This medicine period was rather short, about a week and a half. Another prescription was for Carafate. This medication is used to treat and prevent ulcers in the intestines. it is a chalky liquid that comes in large bottles that you swallow twice a day It may be beneficial to obtain a script for the above 2 medicines prior to surgery, because some local pharmacies do not keep one of these in their normal stock. The other prescription medicine that I was given was a proton-pump inhibitor called Omeprazole (or over the counter Prilosec). This I took the first year after surgery to let my stomach heal. There are also a variety of vitamins that you will need to take. Most of these are over the counter. But after surgery, I took an injectable form of B12 vitamin. The injectable form required a prescription. But injecting myself with this was more pain than it was worth. I had my wife inject this into my arm daily. But I noticed she turned her head just before she poked in the needle. So after the first month I transitioned to sublingual B12 which I found much easier to use and it was over the counter. Then there is prescription pain medicine. I took no pain medicine after I left the operating room. I didn't need to because the pain levels were very low.

Prior to my RNY gastric bypass surgery, I was taking 2 prescription medicines to control my blood sugar level (Type II diabetes) and the medicine was not completely controlling my blood sugar levels so my PCP wanted me to advance to insulin shots but I refused. I was also on 2 prescription medicines to control my high blood pressure. I had my surgery 4 years ago. Two days after the operation, I was off all my blood sugar medicine and haven't taken any since. I periodically check my blood sugar levels once per month and they are fine. Two weeks after surgery I took myself off all my blood pressure medicine and haven't taken any since. After surgery, you may have to monitor your blood pressure and blood sugar levels so that you can adjust your prescription levels. In general, they should be significantly reduced levels. From my perspective, it may not make a lot of sense to try and adjust your levels now if you are seriously contemplating surgery. I cannot speak to thyroid issues. Perhaps someone on this board can speak about their experience.

Immediately after surgery your body is in a major heal mode. So don't be too concerned if you cannot meet the daily fluid and protein goals. Just keep trying each day and your volume should increase each day. 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.

Good luck on your surgery.

According to my hospital discharge directions. One of the conditions that patients should contact their physician after surgery is #6. Chest pain, rapid heartbeat and/or dizziness. Since you are still in the hospital, it is probably a good place to be until they figure out the cause. According to the internet: Any sustained heart rate reaching 120 beats per minute should be a red flag to check for a potential leak, Dr. Madura said. Christopher Still, DO, FACP, director of Geisinger's Obesity Institute in Danville, Pa., strongly agreed. “Tachycardia greater than 120 with or without left-side shoulder pain should be a leak until proven otherwise,” he said. https://acphospitalist.org/archives/2013/12/bariatric.htm

I had severe acid reflux before my RNY gastric bypass surgery. That was one of the reasons why I chose RNY over sleeve. Sleeve will only make the condition worse. I had my surgery 4 years ago and have not been bothered by severe acid reflux since. Sometimes dumping syndrome will mimic this condition. This generally happens when I exceed my food limit. I can detect the pre-triggers to dumping syndrome, and generally I just stop eating at that point. After surgery, my surgeon put me on Omeprazole [Prilosec OTC] for the first year after surgery in order to allow my stomach to heal properly. This is what I used to treat the condition prior to surgery. So I couldn't tell during the first year that it was really in remission. But now 4 years out from surgery, I have not been bothered by severe acid reflux (GERD) and have not taken any Omeprazole since the first year.

Just be forewarned that your taste buds may change after surgery and that you may have to experiment to find something that works for you.

I will pray that you recover and get well again.

Just keep trying and a door or window will open up. I remember after I graduated, it was in the middle of a recession. I sent out 500 resumes and visited over 200 companies in person. Sometimes it is just being in the right place at the right time.

Many activities that revolve around dating revolve around eating food or drinking alcohol. Even a trip to watch a movie can incorporate popcorn and a large coke. I suspect with a fair degree of planning, some of the pitfalls between dating and gastric bypass surgery can be avoided. But that will take some planning on your part. The Weight Loss phase is fairly short. So if you want to maximize your weight loss during this Weight Loss phase, you need to adhere to the program guidelines. I slid into the Maintenance phase at 7 months.

Individuals who have RNY gastric bypass loose weight at a quicker pace than sleeve patients. I had RNY. I transitioned to the Maintenance phase at 7 months. My daily weight loss gradually reduced and my weight loss leveled off. 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. One thing to do now at your 3 month 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. If you concentrate on high protein meals,, you can begin to reduce your reliance on protein shakes. I went from 3 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.

It is common for your taste buds to change after surgery. Be willing to experiment. After my RNY gastric bypass 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. 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. You do not have to like protein shakes only tolerate them. There are many varieties of protein shakes available today. Experiment until you can find one you can tolerate. 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.

It is common to do a little experimentation after surgery. That is how we learn. Some people can tolerate anything after surgery while others have problems and can tolerate very little. Weight loss is achieved during the short weight loss phase through meal volume control. The two operative words here are short and volume. So if you want to maximize your weight loss during this phase, you need to adhere to the program guidelines. I slid into the maintenance phase at 7 months.

According to the instructions that I was given: Months 4-6 each meal should be 4 ounces. Months 7-9 each meal should be 5 ounces. Also you may have fresh fruit or vegetables as a daily snack.

I did not transition to solids foods such as steak and chicken until week 9. It is a difficult transition. No need to rush it. I found that softer foods such as chili and soups went down much easier so that is what I primarily stayed with. I put some recipes at the end of the following article. http://www.breadandbutterscience.com/Surgery.pdf

The amount of sugar will probably vary by patient. I strictly avoid processed sugars. I have a sweet tooth and that is one of the major causes that contributed to my weight gain over my lifetime. I limit myself to artificial sweeteners (such as Splenda and sugar alcohols), to natural low calorie sweeteners (such as Stevia) and to the natural sugars found in fruits and milk. I had diabetes. That went into remission when I left the hospital two days after surgery and I have not taken any diabetic medicine ever since and my blood sugar levels are good. I test my blood sugar levels periodically. I read the labels of all food that I consume. I look at the grams of sugar per serving. If it is above 5 grams, I look at the ingredients. The ingredients are listed in order by highest percentage, and if the first 5 ingredients contain processed sugar (in any of its many forms), then I avoid this food, like a plague.

On choosing the type of bariatric surgery, it is important to discuss this with a bariatric surgeon. Some conditions such as GERD can limit your choices. Severe acid reflux (Gerd) will only become worse with sleeve surgery.