James Marusek

Sleepiness after eating is one of the signs of reactive hypoglycemia in bariatric surgery patients. Reactive hypoglycemia (postprandial hypoglycemia) refers to low blood sugar that occurs after a meal — usually within four hours after eating. This is different from low blood sugar (hypoglycemia) that occurs while fasting. Signs and symptoms of reactive hypoglycemia may include hunger, weakness, shakiness, sleepiness, sweating, lightheadedness and anxiety. http://www.mayoclinic.org/diseases-conditions/diabetes/expert-answers/reactive-hypoglycemia/faq-20057778

This site is an exchange of ideas and open communications. This communications is very important to those struggling after surgery. So let us all keep our discussions civil whether we agree or disagree with what someone says. Respect opinions but voice your own. Only do it in a civil manner.

I am fairly open, so I told everyone even strangers on the street. The response from most people was either supportive or curious. The only one I had a negative issue with was my mother. She was relying on me for support and anything that might jeopardize that was a problem to her. I would guess the primary individuals to tell about your surgery is your spouse, children and supervisor.

After my surgery, I was up an walking every 2 hours round the clock while I was in the hospital. This was to prevent blood clots. It also helped to reduce the gas pain after surgery. You will have a weight limitation after surgery but I think moving pots and pans are light enough you should not have difficulty in making dinner for your family. You incisions will still be sore so you may want to avoid some to this work in the beginning. The regiment is fairly complex after surgery when you get home (walking, vitamins throughout the day, meal size, fluids), so I suspect you will be anything but bored after surgery. It will really keep you hopping.

Ultimately it is up to your friend to make the correct food choices that will maintain their health. But since you have been asked to help, then this is my perception. There are two phases to weight loss surgery. These are the weight loss phase and the maintenance phase. These two phases are very different and the strategies that you employ in each phase is different. I have had RNY gastric bypass surgery 4 years ago and this is the approach that I have used. http://www.breadandbutterscience.com/Surgery2.pdf

Frankly I was too busy to feel anxiety. I would recommend three things to begin with. 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.

It can be a little overwhelming at times. I am 4 years post op RNY gastric bypass and the following two articles give you my experiences thus far. http://www.breadandbutterscience.com/Surgery.pdf http://www.breadandbutterscience.com/Surgery2.pdf

Stricture is a complication occurring post RNY gastric bypass, Sleeve Gastrectomy and Duodenal Switch. At least for gastric bypass patients, this can occur at 4 to 8 weeks out from surgery. I do not know if the same timeframe also applies to duodenal switch patients. Since you are 1 month post-op it appears you are probably within this time window. So you may want to discuss this issue with your surgeons office. An endoscopy or an upper gastrointestinal study can help with this diagnosis.

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. One thing to do now at your stage of 3 1/2 months post-op 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. Your lack of bowel movements could be caused by not drinking enough fluids.

Vitaminwater is High in Liquid Sugar, and May Contain Just as Much Fructose as Coca-Cola. One 20 oz (591 ml) bottle of Vitaminwater contains about 120 calories and 32 grams of sugar, just about 50% less than a regular Coke. However, it differs between countries which “type” of sugar is used. After RNY gastric bypass surgery the part of your stomach that processes sugars and fats can be cut away. Therefore consuming sugar can produce dumping. Not all people are affected the same way by the surgery so that may account for your lack of dumping.

It might be a little too soon to transition to protein bars. It wasn't until the 3rd or 4th month that my nutritionist recommended them. Your stomach may still need a little extra time. A protein bar is probably too dense at this point. 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. Some protein bars are almost similar to candy bars, so be careful. So check for protein content, sugar content and fiber content. Protein bars are good when you are on the go and can't drag along a blender in order to mix a protein shake. A Quest protein bar contains 220 calories and provides 21 grams of protein. A Muscle Milk Light protein shake [2 scoops of powder in a 16 ounce glass] contains 210 calories and provides 25 grams of protein. So they are comparable.

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.

"Kidneys filter 200 liters of blood a day, help regulate blood pressure and direct red blood cell production," states the National Kidney Foundation. "But they are also prone to disease; 1 in 3 Americans is at risk for kidney disease due to diabetes, high blood pressure or a family history of kidney failure. There are more than 26 million Americans who already have kidney disease, and most don’t know it because there are often no symptoms until the disease has progressed." Prior to my RNY gastric bypass surgery around 4 years ago, I had high blood pressure and diabetes. After surgery these diseases quickly went into remission. Which will positively affect the condition of my kidneys. I came across an article today that describes the do's and don't to inhibit the development of kidney disease. Many of these fell into line with the directions I was given after my surgery. They included: Drink plenty of Water daily Avoid drinking tea or coffee to excess Limit one's intake of sugar-sweetened drinks and alcohol Exercise regularly More than 661,000 Americans have kidney failure. Of these, 468,000 individuals are on dialysis, and roughly 193,000 live with a functioning kidney transplant. Each year, kidney disease kills more people than breast or prostate cancer. In 2013, more than 47,000 Americans died from kidney disease. http://acsh.org/news/2017/03/23/caring-your-kidneys-essential-often-forgotten-11042

I had RNY gastric bypass surgery. I lost weight quickly. Those who have sleeve surgery generally lose weight at a slower pace and encounter many stalls along the way. [Someone on the board even created a slogan for it called "Embrace the Stall"]. My weight loss came to an end around 7 months and I transitioned into a maintenance phase. Sleeve patients can achieve the same degree of weight loss but it is over a longer time period. Many are still losing weight after 2 years. It took me around 6 months before all the problems that I encountered after surgery seemed to melt away and I entered a Happy State. So do not expect the problems to disappear overnight. It will take time.

Hi Simon What type of surgery did you have? From you IP address it looks like you are from Western Australia around Perth. There are several different types of surgery for weight loss and the reactions may vary by type. Generally, I would say that memory being hazy is not due to anesthetics at 3 1/2 weeks post-op. If you have been taking prescription pain medicine, that might be the cause. Also if you were diabetic prior to surgery and are still taking your meds, the meds may need to be adjusted. Some of the conditions of low blood sugar are unexplained fatigue and trouble thinking clearly or concentrating. http://www.healthline.com/health/hypoglycemia?m=0#overview1 It took many months before the surgery wounds healed up. For me it was about 6 months.

In general, the fact that you are experiencing constant nausea indicates that there is a condition that should be looked at. 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.

As I was losing weight, some people commented that they were concerned that I was losing too much weight. That wasn't really the problem. It was that since I lost my weight, my clothes no longer fit properly and I looked like I had lost too much weight. The sleeves of my shirts and jackets fell well below my fingertips. I replaced my clothes with some that fit properly, and the comments went away.

Immediately after my RNY gastric bypass I became lactose intolerant. So anytime I drank milk or dairy or anything that contained lactose it resulted in an immediate trip to the restroom with diarrhea. This condition disappeared after a couple months. Be forewarned some protein shakes contain lactose.

I am sorry that you went through these difficulties. But I am a little confused. Are you saying that you are following the daily requirements for vitamins, protein and fluids and ran into these problems? 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.

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. 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.

After weight loss surgery as you lose weight, the chemicals and hormones that are stored in the fat cells are released into the body. This causes a hormone rush in some individuals. Once they transition from the weight loss phase to the maintenance phase, this dump of hormones should return back to normal levels.

I am almost 4 years post-op RNY gastric bypass surgery. The main reason why I went with RNY was because I had severe acid reflux (Gerd) and the sleeve will only make that condition worse. Prior to surgery I had high blood pressure and was taking 2 prescription medicines for that. I had diabetes and was taking 2 medicines for that. I had sleep apnea. When I left the hospital 2 days after surgery, my diabetes went into remission and has stayed in remission ever since. In about 2 weeks I was off all my high blood pressure medicines and haven't taken any since. My sleep apnea went into remission within a few weeks after surgery. I am pleased with the results from this surgery.

One of the great things about loosing so much weight is the experience of entirely buying a new wardrobe. It definitely gives you a new image and look. So by all means consider this option.

One thing to do now at this 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.

I will pray for you and your recovery. I did a quick search on the internet [nausea abdominal pain constipation "elevated red blood cell count"] and it pointed to polycythemia vera as the cause. Then towards the end of the article it read "If polycythemia is related to kidney cancer, liver cancer, or other erythropoietin secreting tumors, the symptoms of these conditions, such as, weight loss, abdominal pain or fullness, or jaundice may be predominant." But again I am not in the medical profession and cannot adequately assess this because this condition covers so many symptoms. Another article read "Polycythemia (elevated red blood cell count) causes are either primary (aquired or genetic mutations) or secondary (diseases, conditions, high altitude). Treatment of polycythemia depends on the cause."