James Marusek

One of the individuals in my Bariatric Surgery Support Group went from a band to RNY gastric bypass. He was forced to because the band was wearing into his stomach and it was about to rupture. He was pleased with the results. Because of the scaring from the band, it meant that his stomach after bypass was a little smaller than most individuals that undergo the surgery so he was somewhat limited by meal volume more than most. It meant that he ate smaller meals but more of them.

It sounds like dumping syndrome. But I have a hard time with that because one blackberry should be too small to trigger that. Anyways, here are a few suggestions. Never eat before bedtime. Your body digest foods differently when you are laying down in a horizontal position than when you are standing up in a vertical position. If you get dumping syndrome at bedtime, it is almost impossible to sleep. The only relief is to visit the restroom and force yourself to throw up and then watch some TV until the episode is relieved a few hours after.

I found that softer foods such as chili and soups went down much easier than harder foods such as steak and chicken, so that is what I concentrated on after surgery. I have included some recipes at the end of the following article. http://www.breadandbutterscience.com/Surgery.pdf

I had RNY gastric bypass surgery 4 years ago. If you have severe acid reflux (Gerd), it would be better to have RNY over Sleeve because Sleeve will only make that condition worse. With bypass surgery, you will lose the weight quickly. I bottomed out after around 6 or 7 months, losing close to 120 pounds. With sleeve you will lose weight at a slower pace but can achieve a good weight loss over a couple years. With RNY, you will need to take vitamins for the rest of your life because the portion of your stomach that manufactures vitamins from food will have been cut away. Although on the face of this, it might look fairly negative. In my case this was offset by the fact that the need to take 4 types of prescription medication for high blood pressure and diabetes disappears right after surgery because those conditions went into remission and stayed there.

Congratulations.

As you lose weight, the chemicals and hormones that were stored in your fat cells are being released into your body. These will pass through your kidneys and are expelled in your urine. But they can generate a flush of hormones during the weight loss phase. They should simmer 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.

Two years out makes you a veteran. How are you doing?

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 bowel 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.

It is very common to hit stalls along the way especially after sleeve surgery. It is so common that someone on this site coined the phrase "embrace the stall". The three most important elements after 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.

When you hit the maintenance phase, your meals should consists of equal parts of protein, fat and carbs, but always put the protein first. But you are still in the weight loss phase. One thing to do now at your 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. 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. Generally your daily protein requirement is 75-90 grams per day. If you are overly active and physically work hard or exercise hard, you may need more protein.

Prior to surgery, I had sleep apnea. But that condition was quickly resolved after my RNY gastric bypass surgery 3 years ago and stayed in remission ever since. While sleep apnea accounts for more than three million cases in the U.S., Insufficient sleep, which is now so widespread that the Centers for Disease Control and Prevention (CDC) has recently called it a public health problem, plagues between 50- to 70 million Americans. So it sounds like the CDC coined a new phrase. So what do they recommend for this new condition? The National Sleep Foundation recommends adopting healthy sleep hygiene habits in order to improve overall quality of life. Among those: skipping caffeine later in the day, exercising daily, and practicing a consistent bedtime ritual that does not include your smartphone. Here is a link to the article that discusses insufficient sleep. http://acsh.org/news/2016/11/30/sleep-apnea-or-insufficient-sleep-both-are-costly-dangerous-10506

Dr. Mark Hamer from Loughborough University, Loughborough, England and colleagues combined data on physical activity from iterations of the Heath Survey for England and the Scottish Health Survey which were obtained between 1994 and 2012. The data in the present study came from 63,500 participants who were aged 40 or more, 46 percent of whom were male. The goal of this study was to look at how the level of physical activity compared with mortality rates. Essentially they broke the data into four groups: Inactive at baseline — 63 percent Insufficiently active — 22 percent Weekend warriors — 4 percent (about one-half took part in one, and one-half in two exercise sessions weekly) Regularly active — 11 percent. Then they compared the bottom 3 groups with the inactive at baseline. There conclusions were "The present study suggests that less frequent bouts of activity, which might be more easily fit into a busy lifestyle, offer considerable health benefits, even in the obese and those with major risk factors. A particularly encouraging finding was that a physical activity frequency as low as 1 or 2 sessions per week was associated with lower mortality risks, even in the insufficiently active." So it is extremely important to get some physical exercise even if this is minimal because it can dramatically decrease your risk of dying early. This reduction is in the order of 30% to 35%. [On the upside, this analysis had a large sample size - 63,500 participants. On the downside, this analysis was based on self reporting. Another weakness in the study was that the Individuals in the inactive group tended to be older and were more likely to be smokers, to be in unskilled occupations, and to report long-standing illnesses. But they did adjusted their analyses for factors such as smoking which could also affect the outcomes. So it is a little like a mixed bag.] http://acsh.org/news/2017/03/08/you-dont-have-run-marathons-benefit-physical-activity-10957

Good luck on your surgery today. When you check into the hospital, make sure that you request that they have trapeze bar above the bed. It will help immensely in getting up out of bed after surgery. And remember to walk, walk, walk every 2 hours after surgery. It really helps to minimize the pain.

After RNY gastric bypass 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 bowel 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.

According to my discharge instructions, one of the times to call your surgeon's office after surgery is when you have chest pains. So I recommend that you consult with them.

I had RNY gastric bypass surgery 4 years ago. The three most important elements after 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. In the beginning, you are eating such an incredibly small amount of food that you will not be able to consume enough protein from your meals, thus you will need to supplement your protein intake. Generally this is done by using protein shakes. If you do not get in your protein bad things happen. Your body will scavenge protein from your muscles (such as your heart muscle), your hair, etc. Protein is extremely important after surgery as its job in the body is to build, repair 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 know as protein calorie malnutrition (PCM). Common symptoms are poor healing, fatigue, hair loss and muscle wasting. Immediately post-op, protein promotes healing of the staple line and incisions. Right after surgery, this protein supplement will be in liquid form (protein shakes). This is because your stomach is in a heal mode. A protein bar is probably too dense at this point. But after a few months, you will be able to transition to protein bars for your protein supplement. Eventually as your meal volume increases, if you concentrate on consuming high protein meals, you can reduce your reliance on supplements. Protein bars are good when you are on the go and can't drag along a blender in order to mix a protein shake. But be careful, some protein bars are not much different than candy bars. They contain too much sugar and very little protein. I used Quest protein bars. These bars were good in that they had high protein, minimal sugar and also contained fiber. They also came in a lot of different flavors. If you compare a protein bar with a protein shake, they are comparable. A Quest protein bar contains 220 calories and provides 21 grams of protein. A Muscle Milk Light protein [2 scoops of powder in a 16 ounce glass] contains 210 calories and provides 25 grams of protein. You asked if a protein bar is a meal replacement or a snack. The answer is neither. Your protein requirement is separate requirement from your food volume allotment. But again don't go overboard with the calories.

I had RNY gastric bypass surgery 4 years ago. Eating lettuce became acceptable after week 9 according to my surgeons directions. But go easy on the salad dressing - go with dressings that have minimal fat and sugar. Chewing is a natural craving and your desire for salad may be related to that craving. Some people experience problems in meeting their daily protein, vitamin and fluid requirements. But it sounds like in your case these problems are extreme and there may be an underlying medical condition that needs to be treated as well. 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. So condensing this down general advice (coordinating with your surgical staff) might be to avoid NSAIDs (such as aspirin), use proton pump inhibitors (such as Prilosec) and have yourself tested for Helicobacter pylori infection.

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. In your case since you had broke your knee and fractured your spine (two knee surgeries, have disc bulging, arthritis and joint dysfunction on your spine) this could be difficult to say the least. So you might see if there is an alternate form of routine exercise that you could do as a replacement, such as swimming. 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.

gpmed wrote This is interesting. I'm not currently having any trouble, but this sparked a question. I'm 19 months out from RNY and I've had to deal with reactive hypoglycemia. I find it helps me to eat smaller amounts throughout the day instead of three meals and no Snacks. So what's the difference between this and grazing? Or how does one do this without falling into the pitfalls grazing presents? Grazing is more akin to snacking. Consuming 5 smaller meals a day is not grazing.

This is common after RNY gastric bypass surgery. It is not difficult to drop the weight when hunger is not constantly continually gnawing at your bones. The feeling of hunger will return at around 1 or 2 years post-op. But it will not be as strong as pre-surgery. So enjoy this loss while you can.

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 included some at the end of the following article. http://www.breadandbutterscience.com/Surgery.pdf

After my RNY gastric bypass surgery, I found that softer foods such as chili and soups went down much easier than harder foods such as steaks. So this is what I relied upon. I made my own high protein chili and soups. I have included recipes at the end of the following article. http://www.breadandbutterscience.com/Surgery.pdf

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 diabetes for around 10 years before RNY gastric bypass surgery and was on two types of prescription medicine to control it. But it was still out of control and my doctor recommended I transition to insulin shots. But I ignored his recommendation. Two days after surgery when I left the hospital I was off all my blood sugar medicine and I haven't taken any since. I periodically once per month check my blood sugar levels and they are fine. I am 4 years post-op. I do put a greater focus on reducing processed sugar (in all of its many forms) after surgery. I use natural no-calorie sweeteners such as stevia and synthetic sweeteners such as splenda and sugar alcohols instead. Some individuals do not experience this benefit. Some only see a reduction in the amount of meds they take. From what I can gather it depends on the depth of Type 2 diabetes (how long you have had the disease and whether you transitioned to insulin.) I do not believe this surgery affects those with Type 1 diabetes.