James Marusek

From a past post it appeared that you had surgery on September 26, almost a week ago. The three most important elements after RNY gastric bypass surgery are to meet your daily Protein, Fluid and Vitamin requirements. In part not meeting these requirements can cause you to be tired. Tiredness can also be a side effect of some medication. It might also be due to low blood sugar. If you were diabetic prior to surgery and took prescription medicine for the condition, it might be time to reduce your medication. Also some people who had no signs of diabetes prior to surgery also developed reactive hypoglycemia after surgery. But all in all, you are only one week out and your body may need a little extra time to mend.

Generally I recommend three things for those that are preparing for surgery. 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. In my case I was the photographer of the family, so I rarely appeared in photographs. Also the only time I saw myself in the mirror was a straight on shot which doesn't really show the extent of my obesity prior to surgery. So I am attaching my before and [6 month] after photo as an example. I tried to create the same pose, so it was a good one-to-one comparison. 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.

My wife is a seamstress and this is an interesting problem because normally when she alters wedding dresses she has to deal with the opposite effect. Many young brides gain several pounds after they order their wedding dress and so by the time of the wedding, the dresses no longer fit and wedding dresses are very unforgiving. It is very difficult to impossible to make them larger. [My wife says it is probably best to get a corset style dress where it can be pulled in, in the back.] I had RNY gastric bypass surgery 3 years ago. I lost weight very quickly and then it slowed down. I slide into the maintenance phase at 7 months and my weight loss essential stopped at this point. Since you are nearing your 5th month, I suspect that your weight loss will begin to slow down soon. So this may not be a major problem in planning your wedding dress.

I suspect that this is a side effect of ketosis. A high-Protein, low-carb diet can put your body into ketosis -- a state where your body is burning fat instead of glucose for energy. When you limit your carb intake, your body has to use stored fat for energy, which can be a way to lose a pounds. When your body burns fat, by-products called ketones are released. You'll expel most of them in urine and perspiration, but some will be expelled in your breath -- and ketones don't smell good. There are two phases after surgery. These are called the "Weight Loss" phase and the "Maintenance" phase. As your weight loss comes to an end and you slide into the "Maintenance" phase, I suspect that this problem will ease up significantly. I had RNY gastric bypass over 3 years ago. I transitioned into the "Maintenance" phase at around the 7th month. I could never smell my bad breath during this stage, but my wife did. She said I smelled like death itself. So maybe your inability to smell, might actually be a good thing.

Congratulations.

Congratulations and glad to hear all is well.

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. For the first few weeks after surgery, many patients find it difficult to meet their protein and Fluid requirements. Your body is in a major heal mode. So don't be too concerned right at the beginning, just keep trying to meet the goal and within a few weeks you should be able to get there.

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 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. So concentrate on your requirements for protein, fluids and Vitamins. Transitioning to solid foods can be difficult. I relied primarily on softer foods such as chili and Soups rather than harder foods such as steak and chicken. My plan directed me to full liquids for the first 4 weeks, pureed foods for the next four and then finally at 9 weeks I was cleared for solids. So there is nothing that says you cannot take things slow. You do not have to push yourself into the semi-solid phase now, you can transition slowly until when your stomach is comfortable with the transition.

Congratulations.

Good luck on your surgery. The clock is ticking down and soon you will be on the other side.

When I got home after surgery, I slept in my own bed. That was fine. But because I had a Water bed, trying to get up out of bed was a killer.

It is all part of a learning experience. Many times there are pre-triggers before you reach the full dumping stage that clue you to the fact that you are very close. They can be sneezing, hiccups, excess mucous, a change in the way food taste. So clue into your particular pre-triggers to help you avoid dumping in the future.

After my RNY gastric bypass surgery, as I transitioned from Full liquids to pureed Foods and then finally to Solid Foods, I found the softer foods such as chili and Soups went down much easier than solid foods such as steak and chicken. I developed my own recipes for homemade high Protein chili and soups. They are at the end of the following article. http://www.breadandbutterscience.com/Surgery.pdf

Congratulations.

I remember the feeling. I just wanted to sleep in my own bed. Congratulations.

I would recommend that you follow the guidelines that were given to you. I recommend you do three things at this stage. 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. By giving up my diet coke habit, I lost 20 pounds on that change alone.

For the first year after surgery, I walked 30 minutes each and every day. I was cleared for lifting after my first follow up appointment with my surgeon. I am not so much lifting weights because it seems like wasted effort to me but rather into manual labor. So during each of the second and third years after surgery, I moved 100,000 pounds of gravel by hand along with around 60,000 pounds of concrete blocks for one of my building projects around the house.

Right after surgery, you body is in a major heal mode and it is common for patients to not be able to meet their Protein and Fluid goals during the first few weeks. But keep trying and you should be able to get there. And since you are 2 weeks post-op you should almost be able to meet these requirements. 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 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 my RNY surgery, life improved almost every day but it still took time. I think I reached my happy state at around 6 months. That was when almost all the problems seemed to melt away.

Good luck on your recovery.

When you are in the hospital recovering after surgery, remember to walk around every two hours. It will significantly help the gas pains to go away and speed your recovery. Also ask for a trapeze bar to be installed above your hospital bed. Many hospitals will do this routinely. The trapeze bar will help you get up on your feet. It can be very painful to get up out of bed after surgery. If you find that you cannot tolerate the Water after surgery, try the crushed ice or better yet the no-sugar popsicles. Good luck on your surgery and check back with us when you are on the other side and let us know how it went.

Over the past decade I have had episodes of dry mouth. I used a product called Biotin Dry Mouth Oral Rinse and it seemed to help the condition. It can be found on shelves of most drug stores. Also I read that sucking on crushed ice helps to relieve the discomfort.

It seems like you are saying that you had gastric bypass surgery 8 years ago and gained some of the lost weight 52 pounds back. I am only 3 years post-op, so you are much further along than I. I looked at the question "Does birth control cause weight gain?" This is a link to an article on the subject. https://bedsider.org/features/328-gaining-weight-is-it-the-birth-control

I haven't heard of nissen fundoplication operations before so I looked it up. Laparoscopic Nissen fundoplication is now considered the standard surgical approach for treatment of severe gastroesophageal reflux disease (GERD). GERD is increasingly prevalent and costly, and it may affect as much as 20% of the US population. The pathophysiology of GERD is not due to acid overproduction but rather mechanical dysfunction centered around the lower esophageal sphincter (LES). Furthermore, the mainstay of GERD treatment, proton pump inhibitors (PPIs), have come under scrutiny because of worrisome side effects. Laparoscopic magnetic sphincter augmentation of the LES has been proposed as an additional surgical option. Like Nissen fundoplication, it relies on 360° buttressing of the LES, but it may cause fewer long-term adverse effects. http://emedicine.medscape.com/article/1892517-overview Prior to my RNY gastric bypass surgery 3 years ago I had severe acid reflux (GERD). But after surgery this condition went into remission. Sometimes dumping syndrome feels a little like GERD. My severe acid reflux was caused by the fact that I was obese. That doesn't seem to be the cause of your problem. I am not a medical professional, so take whatever I say with a grain of salt. 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 basically there are 3 recommendations here. Strictly avoid NSAIDs such as aspirin. Use proton-pump inhibitors such as Prilosec (omeprazole). Make sure you are medically tested for Helicobacter pylori infection. My surgeon put me on omeprazole for the first year after surgery, not for GERD but to allow my stomach to heal properly. So you asked for ideas from non-medical professionals, so this is all I can offer.

After graduating from college, I looked for a job but it was in the middle of an "engineering depression". Over 6 months I sent out 500 resumes and I visited around 300 companies in person. Nothing, NADA. Then by chance my future brother-in-law obtained a job and recommended me also. I received an interview and a job offer and worked for four decades before I retired. Lessons learned: * It is probably not you but a sign of the times. We are still in a recession, so keep trying. * Expand your horizons. I focussed solely for work in California at the time. But the recession was localized to mainly California. If I had included other states, I might have been more successful. Perhaps there might even be a position overseas for you. * When you go to an interview, be professional. Dress for the occasion. Do advanced research of the company prior to the interview. Know more about them than the interviewer. Be able to explain how you could fit in and your fine attributes. * Obtaining your first job in a profession is extremely important. Because it is a transition from academia to the real world. All subsequent employment depends on it because many companies require experienced employees. So keep trying. * In some positions, large companies have internship programs such as summer aids. This is a way to get your foot in the door and gain experience. Over my career, I went from one who was applying for a job to one who hires. I hired around 30-40 engineers, scientist and technicians over my career as one of my supplemental duties.

Good luck on your surgery. I am 3 years post-op RNY gastric bypass. I have been off my diabetic meds the day I left the hospital 2 days after surgery and haven't taken any since.