James Marusek

I had RNY gastric bypass. But I kept the guidance sheet from my surgeons office and it did include requirements for Duodenal Switch patients. It read: Four children's chewable complete Multivitamins daily 1800-2400 mg calcium citrate daily A total of 5000 I.U. Vitamin D3 daily 1000 micrograms sublingual B12 weekly or B12 injection monthly 100 mg thiamin (vitamin B1) weekly

Congratulations on your weight loss. It is important to maximize your weight loss during the weight loss phase by following the program guidelines. Soon you will slide quite naturally into the maintenance phase. One hundred pounds down - you have accomplished a lot and should be proud of yourself.

I had RNY gastric bypass surgery because I had severe acid reflux (Gerd). The sleeve will only make this condition worse. I am 3 1/2 years post op RNY at this point. I am 68 years old. The last couple years I moved 100,000 pounds of gravel by hand along with around 60,000 pounds of concrete blocks each year in one of my building projects around my home. So I do not think lifting heavy loads and walking with heavy loads should be much of an issue after RNY or sleeve surgery. You should be in much better shape after you heal from the surgery than what you are now.

Many insurance companies require a medically supervised weight loss program that includes diet and exercise. The operative words here are medically supervised. I went through the program. I kept a food and exercise journal. I attended bariatric surgery support group meetings. After I completed the program, I took a couple months to get through the rest of the requirements including almost a day of classes, almost a day of pre-op testing, a second round of pre-op testing with specialist in their respective field for problem areas, and also there was the delay waiting for the insurance company to approve me.

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. The transition to hard foods such as steak can be very difficult. So there is no need to rush headlong into it. I relied primarily on softer foods such as chili and soups. I am over 3 1/2 years post-op RNY. I put together a short article that describes my experiences. http://www.breadandbutterscience.com/Surgery.pdf

Congratulations.

Congratulations.

Your taste buds may change after surgery so don't stock up on too much food or Protein shakes. Wait until after surgery. I found that I could not swallow medium to large Vitamins after surgery, so I used a pill crusher and a pill splitter. I put together a short article that describes my experience after RNY gastric bypass surgery. It may be of some help. http://www.breadandbutterscience.com/Surgery.pdf At your stage pre-op I would recommend you do 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.

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.

I experienced very little pain after my RNY gastric bypass surgery. It was so little that I did not even take any pain meds after I left the operating room. Most of the pain was gas pain. Walking really helps to reduce the pain. Here are some suggestions. 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.

After I had RNY gastric bypass surgery, I became lactose intolerant. Anytime I drank milk or something that contained lactose it was immediate upset stomach and a quick trip to the bathroom with diarrhea. Some Protein shakes contain lactose. Anyways I cut out the lactose and I was fine. This condition lasted for around 2 months and then I was back to normal.

Since you were recently on antibiotics, it is important to take Probiotics after you finish the antibiotics. Antibiotics destroy not only the bad bacteria but also the good bacteria in your gut. Probiotics helps you reestablish these colonies of good gut bacteria. Transitioning to solid food such as steaks can be rough. I found it easier to consume softer foods such as chili and Soups. I have put some recipes at the end of the following article. http://www.breadandbutterscience.com/Surgery.pdf

You indicted that you are shaky and weak after consuming food (your Protein shake). After surgery a few individual's experience reactive hypoglycemia. Here is a link. http://www.weightlosssurgery.ca/before-after-surgery/reactive-hypoglycaemia-post-gastric-bypass/ But generally this condition shows up several months after surgery. If you were diabetic prior to surgery and taking prescription medicine for this condition. And you still are taking medicine to reduce your blood sugar, it might be important to reassess your medicine with your doctor and reduce the level.

There are two phases after gastric bypass surgery. These are the Weight Loss phase and the Maintenance phase. The meal strategy is different between the two phases. During the weight loss phase it is best to adhere to the meal guidelines (food types and meal volume transitions during the first 1 1/2 years post-op). For me, I found that when I entered the Maintenance phase the strategy was very different. I included this strategy in the following article. I am over 3 1/2 years post op. http://www.breadandbutterscience.com/Surgery2.pdf

After surgery your body is in a major heal mode. It is common for individual to be unable to meet their Fluid and Protein daily requirements during this time. Just keep trying each day and you should be able to get there soon.

At week 9 post-op RNY gastric bypass surgery, I transitioned to solid foods (such as chicken and steak). But this transition was difficult so I relied primarily on softer foods such as home made high Protein chili and Soups. As my meal volume increased, the protein that I derived from my meals increased and as a result I was able to begin to offload my Protein shakes and the calories these protein shakes contained. I put some of the recipes at the end of a short article about my experience. http://www.breadandbutterscience.com/Surgery.pdf

@@Sadiebug asked "James - did you have surgery at St. V's Carmel? I'm 1 day post op here and I swear I've seen your pics in the hallway I'm waking! You look fantastic!!!" Yes, I had surgery there 3 1/2 years ago.

I am 3 1/2 years post-op RNY. My taste buds changed very dramatically after surgery. I couldn't even drink Water because it tasted overly chlorinated. As the years went by my taste buds are slowly returning more to normal. They will never return to the same way as pre surgery but they did improve. I remember the first time I tried ketchup after surgery, it tasted like hot sauce. Ketchup now taste like ketchup. Many foods like butter completely lost their taste post-surgery and became very bland. I use to love crab legs dipped in butter pre-surgery but post surgery they completely lost their flavor. Anyways expect things to improve but not overnight. Your body is probably in a state of ketosis which is affecting the smell of your breath, sweat and poop. This will come to an end when you transition from the weight loss phase to the maintenance phase. One of the things I found difficult to tolerate was my Protein shakes. They tasted terrible. I improved their taste by blending in a half a banana into my Protein Shakes. Also I concentrated on eating high protein meals. As my meal volume increased, I was able to reduce my reliance on protein shakes. So now I no longer drink them because I am getting my protein from my meals.

After my RNY gastric bypass surgery I became lactose intolerant. Anytime I drank milk or anything that contains lactose, I had an upset stomach and an immediate trip to the bathroom with diarrhea. So I complete cut out anything that contained lactose. After about 2 months this condition magically went away and I was back to normal. Be forewarned some Protein shakes contain lactose. 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.

Here is my before and after photo.

Your weight will vary during the day. So generally I weigh myself first thing in the morning butt naked using a very accurate and repeatable scale. When I put my clothes on (shoes, wallet, pants, shirt, coat etc) it can easily add 5 pounds to my weight. Also my weight will vary due to the weight of my meals and drinks. 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 this stage is to assess your protein intake. Your protein requirement is met by a combination of the protein from your meals combined with the protein from your supplements (protein shakes, protein bars). Since your meal volume is beginning to increase, that also means that the amount of protein from meals is increasing, especially if you concentrate on consuming high protein meals. Therefore you could be able to reduce your reliance on supplements and the calories they contain. I went from 3 protein shakes a day, down to 2, then 1 and finally zero when my meal volume increased to 1 cup per meal at a year and a half.

Many times when you are in the hospital they fill your body with fluids through an I.V. so when you leave the hospital you weigh more than when you entered. It can take a week or two after you leave the hospital to lose these fluids.

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. Even the formulations in the vitamins are important. For example gummy vitamins are not readily absorbed and therefore this is not an option. You cannot use a time-release version of B12 and sublingual formulation must be methylcobalamin. If you are taking Iron supplements, it must be ferrous sulfate for the best absorption. The calcium supplements formulation must be calcium citrate for best absorption. Also after surgery I lost my ability to swallow large or even medium size vitamins. I used a pill crusher or pill splitter to break them up to a size that I could consume. This condition lasted for a couple months and then my body returned to normal. As @@Redmaxx said, they generally provide you with a half day class where they give you a book that details the Vitamin requirements in great detail.

If feeling older than you look appeals to you, take a seat while you read this: A recent study found that women who sit longer than 10 hours a day, combined with low physical activity, have cells that are biologically older — eight years older to be exact — than their actual age. The study looked at the lifestyles of 1,500 women, between the ages of 64 and 90, who are part of a Women's Health Inititative (WHI) — a national study on chronic disease and postmenopausal women. Researchers found that women who sat for more than ten hours per day, and exercised less than 40 minutes daily, had shorter telomeres — the caps at the ends of DNA strands which protect chromosomes. Shorter telomeres have been associated with increased risk for disease and poor survival, which is why low activity combined with prolonged sitting can contribute to cell aging. The picture was not as bad for women who incorporated at least 30 minutes of daily moderate to vigorous physical activity, even if they spent most of their day sitting at a desk. http://acsh.org/news/2017/01/20/tips-age-fast-sit-more-exercise-less-10753 Well let me inject a few words about this discussion. DNA (Deoxyribonucleic acid) is a molecule that carries the genetic instructions used in the growth, development, functioning and reproduction of all known living organisms. Essentially they are the blueprints of life. Within the DNA are nucleotide composed of one of four nitrogen-containing nucleobases—either cytosine ©, guanine (G), adenine (A), or thymine (T)—and a sugar called deoxyribose and a phosphate group. The order of building blocks in a strand of DNA makes up a "sequence." We can read a DNA sequence like letters in a book. In fact, we know the sequence of the entire human genome—all 3 billion letters. This DNA structure defines each individual, the color of our hair and eyes and skin etc. Most of the DNA is core and very important. But at the end of the DNA strand is DNA that seems to provide no purpose, it is called Junk DNA. But in reality Junk DNA (telomeres) do serve an important function. The reason is that when the DNA replicates, it loses a little of the strand of junk DNA at its ends. Eventually as we age, this junk DNA gets shorter and shorter and eventually it eats into the core DNA. When it does, it introduces anomalies, age related sicknesses. So this article is saying that exercise can reduce the loss of the junk DNA and we can live long healthier lives as a result.

In a new position statement, the American Association of Clinical Endocrinologists (AACE) and the American College of Endocrinology (ACE) have replaced the word “obesity” with “Adiposity-Based Chronic Disease” (ABCD). While that sounds like a clunky switch, the authors have laid out why a simple notion should be replaced with what they call a "complications-centric" approach to the diagnosis and treatment of excess body fat (adiposity). It's more complex than something like BMI. By making this change they have decided to use a new term that puts more emphasis on the chronic diseases that result from excess body fat. Here is a link to the article that discusses this change. http://acsh.org/news/2017/01/20/abcd-obesity-has-new-name-will-it-stop-epidemic-10751