James Marusek

Congratulations.

It is common to experience constipation after surgery. Sometimes it is a sign that you are not meeting your daily fluid requirements. Generally if you are constipated for more than 3 days, it means that you are really bound up and normal stool softness will not work. That happened to me and the only relief was to use a glycerin suppository. You have to insert this into your rear end, but it does unbound you. But you do not want to use this approach forever. You need to find a long term solution. I found that if I eat an apple just before bedtime, this normally meant that I had a good bowel movement when I got up in the morning. But the important thing is you not only need to eat the flesh of the apple but you also must eat the skin. [For those in the pureed stage, an apple can be blended into an apple sauce, but you may have to add a little water to make the blender work properly]. When you get to the stage where you can substitute protein bars for protein shakes, it is important to look for a protein bar with a lot of fiber. Quest protein bars work good. Here is a list of things people use to combat constipation derived from former threads on this site: 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 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

Some individuals find it difficult to meet the daily requirements after surgery. This is because your stomach needs time to heal and this can take a couple weeks or more. But just keep trying and you should be able to get there. 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. Your daily Fluid requirement is more than just the water you drink. It includes the water in Protein shakes, the water component of Soups, milk, the water you use to take your daily Vitamins, the water in tea and decaf coffee.

First off, I do not think this is necessarily related to your weight loss surgery. But 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 the general advice from above avoid NSAIDs (such as Aspirin, Ibuprofen, Diclofenac, Naproxen, Meloxicam, Celecoxib, Indomethacin, Ketorolac, Ketoprofen, Nimesulide, Piroxicam, Etoricoxib, Mefenamic acid, Carprofen, Aspirin/paracetamol/caffeine, Etodolac, Loxoprofen, Nabumetone, Flurbiprofen, Salicylic acid, Aceclofenac, Sulindac, Phenylbutazone, Dexketoprofen, Lornoxicam, Tenoxicam, Diflunisal, Diclofenac/Misoprostol, Flunixin, Benzydamine, Valdecoxib, Oxaprozin, Nepafenac, Etofenamate, Ethenzamide, Naproxen sodium, Dexibuprofen, Diclofenac sodium, Bromfenac, Diclofenac potassium, Fenoprofen, Tolfenamic acid, Tolmetin, Tiaprofenic acid, Lumiracoxib, Phenazone, Salsalate, Felbinac, Hydrocodone/ibuprofen, Fenbufen]. Aspirin can be found in a number of products such as Excedrin. Use proton pump inhibitors [Omeprazole, Pantoprazole, Esomeprazole, Lansoprazole, Rabeprazole, Dexlansoprazole, Rabeprazole sodium, Pantoprazole sodium, Esomeprazole magnesium, Omeprazole magnesium, Naproxen/Esomeprazole, Esomeprazole sodium, Omeprazole/Bicarbonate ion] and/or sucralfate [Carafate] antacid. And make sure you are tested for an H pylori infection.

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. After surgery I was drinking 3 protein shakes a day in order to get the minimum daily requirements of protein. According to my directions from my surgeon, I was told not to transition to solids until week 9. Your stomach needs time to heal. Your weight will vary by time of day and the amount of clothing you are wearing. This can be as much as 5 pounds. Also Water weight can be an issue. So I don't think what you ate yesterday accounted for you 2 pounds weight gain. Just remember, the weight loss phase is short and it is important to maximize your weight loss during this time because sooner than later you will naturally slide into the maintenance phase.

Two of the common problems after gastric bypass surgery are strictures and ulcers. Strictures can occur once you are about 4 to 8 weeks out from surgery. A stricture is a narrowing of the new stomach outlet where it surgically attached to the small bowel. Symptoms include difficulty with eating solid foods, developing increased saliva or mucous, reflux symptoms, and in severe cases, difficulty with liquids. So if you are having a hard time getting liquids down, this may be the cause.

I do not think it was because of the spiciness. I have dumped several times and it generally is due to the fact that I ate too much. Be aware of the pre-triggers. These pre-triggers can be sneezing, hiccups, becoming congested very quickly, or even the taste of food suddenly changing. So the pre-triggers warn me when I am at my limit. So I stop. Another bite I will be in full dumping mode.

What you are probably experiencing is dumping syndrome which can act very similar to severe acid reflux. An episode can last for several hours. You can relieve it a little by vomiting. Try and remain vertical rather than horizontal. You cannot sleep and it is better to just try and stay awake by watching television until the condition eases up. Also never try and eat before bedtime.

After surgery, I found that I could no longer swallow large or medium size pill and Vitamins. I used a pill splitter or a pill crusher. The worse was the large Calcium horsepills. After around 2 months I was able to again swallow these. After my RNY gastric bypass surgery, I had to take a variety of vitamins. This is because my body no longer has the ability to make vitamins from the food that I eat. Thus this is a requirement for the rest of my life. These Vitamin requirements are specific and your surgeon's office will provide you with a list. This is definitely more than your Multivitamin will give you. Your body may not be able to absorb some chemistries or delivery methods. For example any gummy vitamin will not work properly. Around once a year, you will undergo blood work which will focus on your vitamin levels. Therefore any deficiencies will be noted and your vitamin regiment may be changed to match your current needs. Medicine is designed with various layers so that as they react with the acid in your stomach, they will dissolve and be absorbed into your body properly. Therefore crushing and splitting medicine may have a downside. Since your stomach will be a lot smaller after surgery, this process may pose a problem. You may need to work this problem out with your surgeon's office.

According to the internet: Adipose tissue, or fat, is an anatomical term for loose connective tissue composed of adipocytes. Its main role is to store energy in the form of fat, although it also cushions and insulates the body. Excess adipose tissue (fat cells) can lead to problematic changes in metabolism, blood sugar control and blood pressure. Recently scientist have been exploring the role of fat cells acts on the brain to signal satiety (hunger control). More recently, researchers have been delving into the mechanisms that adipose tissue uses to affect other parts of the body. A recent report in the journal Nature investigates one possible source of such control. To describe the study we have to define a couple of terms: microRNA (miRNA): small (19-22 nucleotides long) segments of RNA that do not code for Proteins. There are many different types of miRNAs in the circulation and in different tissues, and they have various functions in the body. In general, they act to prevent translation of mRNAs and thus decrease the production of the corresponding proteins. Dicer: an enzyme found in adipose as well as other tissues that processes miRNAs — without it miRNAs aren't produced. Led by Dr. C. Ronald Kahn of the Joslin Diabetes Center of Harvard University, researchers bred so-called 'knockout' mice that lacked the Dicer enzyme in adipose tissue specifically. These adipose-tissue-specific Dicer knockout (ADicerKO) mice did not produce the usual complement of miRNAs found in normal mice, showing that adipose tissue is responsible for making a large number of the circulating miRNAs. And this is important, because the presence of such miRNAs is associated with improvements in glucose tolerance and other beneficial metabolic changes. Indeed, the ADicerKO mice exhibited a decrease in brown adipose tissue (the most metabolically active type), as well as an increase in insulin resistance. However, when both brown and white adipose tissue from normal mice was transplanted into the knockout mice, they began to produce the miRNAs, demonstrating the importance of the adipose tissue in circulating miRNA production. In addition to their work with the mice, the investigators also compared miRNAs from patients with lipodystrophy [1] with those from control people. They found that the patients with lipodystrophy had lower levels of over 200 different miRNAs compared to the controls. Thus, both the animal and human data suggest an important role for adipose tissue in the regulation of metabolism, and may indicate an important avenue for future research into the roles of Dicer and miRNAs in the obesity-linked derangement of blood pressure, blood glucose regulation and insulin resistance. http://acsh.org/news/2017/03/02/when-fat-speaks-body-listens-10911

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

My surgery was over 3 1/2 years ago and that is a long time to remember but I think I experienced gas pains for the first few days and it was primarily over with after about a week. Walking, walking, walking helps dramatically with this problem. But be forewarned, after surgery, I found that I would fart more frequently. And there was a short period of time when the saying "Never trust a fart" applies. Fortunately this period of time is very short. So exercise caution. There is nothing worse than soiling yourself when you are out and about in public. Congratulations on your surgery.

According to the internet Malabsorption syndrome occurs when something prevents the bowel from absorbing important nutrients and fluids, including Proteins, fats, and Vitamins. Malabsorption can be caused by conditions such as celiac disease, Crohn's disease, lactose intolerance, and intestinal damage. So I don't think sleeve, RNY or duodenal surgery impacts Protein absorption. (I am 3 1/2 years post-op RNY gastric bypass surgery and I currently obtain all my protein from food alone. I no longer take protein supplements and my blood work shows my protein levels are fine.) It sounds like another underlying condition (My last biopsy showed the small intestine villi were enlarged.) is at the root of the problem. I am not a doctor and I suspect most individuals on this site cannot offer you the medical advice that you are seeking. So I would recommend that you work this very specific problem with your surgeons office.

After surgery, my bloodwork showed that I was deficient in Iron. There are different types of iron supplements. The chemistry my surgeon's office recommended was Ferrous Sulfate for best absorption. I take a 65 mg dose daily. So I do not see any harm in taking these short term until you can see your doctor, have blood drawn and analyzed and find a long term solution.

Note: The National Health Service (NHS) is the name of the public health services of England, Scotland and Wales, and is commonly used to refer to those of Northern Ireland. General guidelines for bariatric surgery is to avoid pregnancy until at least 12-18 months post-op because low caloric intake cannot support a pregnancy. In your case, since you are 2 years post-op, you should be O.K. Normally it is important to gain good weight during pregnancy by avoiding junk food and concentrating on meals high in protein. One area of concern is vitamins. I had RNY gastric bypass and my body is no longer able to synthesize the vitamins that I need from food alone. Therefore I need to take vitamins for the remainder of my life. So it would be important to work with your doctors to ensure that you do not become anemic with any of these vitamin requirements. Generally in the States, pregnant women are prescribe pre-natal vitamins to minimize the possibility of becoming anemic. But after gastric bypass surgery, you body may not absorb these properly. So as a layperson, I would think that your public health service should prescribe prenatal vitamins that can be absorbed by pregnant gastric bypass patients and monitor your vitamin levels through blood testing in order to preclude any deficiencies. But I am not a doctor.

When I was young around 40 years ago, I began to jog after work each day to lose weight. After a few weeks I was up to 10 miles a day. Instead of losing weight I actually began to gain weight. What was happening was that I was replacing fat with muscle and muscle weighs more. If you are 10k steps a day, you may be experiencing the same effect. 10K works out to around 5 miles per day. Also this is a lot of exercise and you would want to increase your intake of Protein to compensate.

I had RNY gastric bypass and my weight loss stopped after 7 months and I slid into the maintenance phase. Sleeve patients lose weight at a much slower rate but they can lose weight over a longer period of time, sometimes up to 2 years. Sleeve patients also experience many stalls along the way.

I would recommend that you 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 really 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. For years I was obese but when I looked at myself in the mirror, I didn't see it because I was looking straight on. Also I was the photographer in the family so I never appeared in photographs. I am including my before and after (6 month) photo as an example.

Good luck on your surgery and check back with us when you are on the other side.

After surgery, I became lactose intolerant. Anytime I drank milk or any product containing lactose, my stomach would hurt and it was a quick trip to the restroom with diarrhea. This condition cleared up after a couple months. I used water rather than milk in my protein shakes as a result.

It is common for your taste buds to change after surgery. I remember in the hospital after surgery I could not drink the Water because it tasted very chlorinated. Eventually I found flavored water such as Crystal Light to work O.K. 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. Over time as your meal volume increases, if you concentrate on consuming 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. The protein shakes that worked for me was Muscle Milk Light (vanilla Creme). I blended the powder with water using a Ninja single serve blender and added in a half a banana to add flavor. But really everyone is different. The operative word is experiment. Find something that works for you.

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. 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. Your fluid requirement can also be met by the water component of Soups and by the water/milk use in making your Protein shakes. What concerns me about your thread, is that you indicated that whenever you drink, you experience pain. This is not normal. Pain is normally an indicator that your body feels something is wrong. Therefore this issue should be discussed with your surgeon's office.

It appears that you had a lap band and are currently trying to obtain a revision to RNY gastric bypass. What happens to several individuals with lap band is a serious complication where the band erodes into the stomach. This is a dangerous condition and causes several individuals to transition to gastric bypass to correct the problem. I am over 3 1/2 years post-op RNY gastric bypass. One of the interesting things that happened to me was that after surgery I completely lost my hunger. When hunger is not constantly, continually gnawing at my bones, I found that it was not difficult to drop the weight. The experience after surgery was not akin to dieting. It was a totally different experience. Many people experience this effect (but not all). Generally you will not notice this effect take hold until you transition from the puree to solid stage of the program. Generally pre-op, the insurance requirement is to show that you are trying very hard to lose weight through diet and exercise. So make sure you document your attempts such as giving up soda, walking each day. Document your diet through a journal to track your food intake. Attend bariatric surgery support group meetings. And let nature take its course.

After RNY gastric bypass surgery, the part of your stomach that processes food into essential Vitamins is cut away. As a result you body will no longer be able to manufacture it own vitamins and you must rely on supplements. There are a variety of vitamins that must be taken after surgery. This is more than just a Multivitamin. It includes calcium supplements, B12, B1 and perhaps Iron. As far as the multivitamin, I was directed to consume 3 Flintstone complete chewable Multivitamins daily. Since you are pre-op, you may not need any additional vitamins at this point. After surgery, your caloric intake will be so low that you will not need to worry about the calories in vitamins.

Good luck on your revision surgery.