James Marusek

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. One thing to do at the stage you are at now 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. That is how I broke my stalls.

Good luck on your surgery. Intractable bile reflux sounds a little like GERD. I am 3 years post-op RNY gastric bypass. One of the reasons why I had RNY was because I had severe acid reflux (GERD). Sleeve will only make this condition worse. I have not been bothered with GERD since my operation. This article explains my experience with RNY. http://www.breadandbutterscience.com/Surgery.pdf

I am 3 years post-op. This is my impression of the "Maintenance" phase. http://www.breadandbutterscience.com/Surgery2.pdf

Many insurance plans are similar, so I looked up what my insurance requirements were. It reads Clinically significant obstructive sleep apnea. So I did an internet search and came up with the following article. http://www.aasmnet.org/Resources/clinicalguidelines/OSA_Adults.pdf This article goes into a lot more detail than I want to digest. But OSA is the abbreviated term for Obstructive Sleep Apnea. Clinically from my perception means that it was diagnosed in a clinic by medical professionals, such as a sleep study. Significant would mean that the results were detectable and serious. So this overview paragraph seems to be a good summary. Obstructive sleep apnea (OSA) is a common disorder affecting at least 2% to 4% of the adult population and is increasingly recognized by the public. The signs, symptoms and consequences of OSA are a direct result of the derangements that occur due to repetitive collapse of the upper airways: sleep fragmentation, hypoxemia, hypercapnia, marked swings in intrathoracic pressure, and increased sympathetic activity. Clinically, OSA is defined by the occurrence of daytime sleepiness, loud snoring, witnessed breathing interruptions, or awakenings due to gasping or choking in the presence of at least 5 obstructive respiratory events (apneas, hypopneas or respiratory effort related arousals) per hour of sleep. The presence of 15 or more obstructive respiratory events per hour of sleep in the absence of sleep related symptoms is also sufficient for the diagnosis of OSA due to the greater association of this severity of obstruction with important consequences such as increased cardiovascular disease risk.

The following Abbreviations are commonly used on this discussion board: ACL = Anterior cruciate ligament AMRAP = As Many Rounds As Possible (crossfit) BB = belly button bc = because BCBS = Blue Cross/Blue Shield BED = Binge Eating Disorder bf = best friend BM = bowel movement BMI = Body Mass Index bp = blood pressure BPD = Borderline Personality Disorder or Biliary Pancreatic Diversion bs = blood sugar btw = by the way CBT = cognitive-behavioral therapy CC = common channel c diff = clostridium difficile cos or cuz = because CPAP = continuous positive airway pressure CRNP = certified registered nurse practitioners cw = current weight CXR = Chest X-Ray Dr. = doctor DS = Dumping Syndrome or Duodenal Switch EGD = Esophagogastroduodenoscopy EKG = Electrocardiography ff = fat free GERD = gastroesophageal reflux disease GI = gastrointestinal GNC = General Nutrition Corporation store GP = general practitioner or family doctor HBP = high blood pressure hr = heart rate hw = highest weight ICU = Intensive Care Unit Idk = I don’t know IMHO = in my humble (honest) opinion IMO = in my opinion IUI = Intrauterine insemination LAP Band = Laparoscopic Adjustable Gastric Band lol = laughing out loud LSG = Laparoscopic Sleeve Gastrectomy med = medicine MFP = my fitness pal msg = message NASH = Nonalcoholic steatohepatitis nf = non fat NG = Nasogastric NP = nurse practitioner NSAIDS = Non-steroidal anti-inflammatory drug NSV = non-scale victory (“scale” means “weight scale”) NUT = nutritionist OA = Overeaters Anonymous Onederland = a magical place or destination for those trying to lose weight. It might correspond to attaining a weight in the hundreds or losing a hundred pounds. op = operation OSA = Obstructive sleep Apnea Oz = Australia PB = Productive Burps PCOS = Polycystic Ovary Syndrome PCP = Primary Care Physician PM = private message (email) PMS = premenstrual syndrome POSE = Primary Obesity Surgery Endolumenal postop or post–op = post-operation or post-surgery PPI = Proton Pump Inhibitors ppl = people preop or pre-op = pre-operation or pre-surgery PTSD = Post-Traumatic Stress Disorder PVC = Premature ventricular contractions RA = Rheumatoid arthritis RH = reactive hypoglycemia RN = registered nurse RNY = Roux-en-Y RTD = ready to drink SADI-S = single anastomosis duodeno–ileal bypass with sleeve gastrectomy s/f or sf = sugar free SIPS = stomach intestinal pylorus-sparing surgery smh = shaking my head, scratching my head SO = significant other SOB = shortness of breath sw = weight at surgery tmi = too much information TPN = total parenteral nutrition TT = tummy tuck TTC = trying to conceive Ty = Thank you. [but according to the urban dictionary “Ty” is also an abbreviation for “a total stud with a massive carrot”.] u = You UGI = Upper Gastrointestinal VSG = Vertical Sleeve Gastrectomy Vit = Vitamin wks = weeks WLS = Weight Loss Surgery WOD = Workout of the Day w/o = without wt = weight or :-) = = smiley face or :-( = = sad face

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.

After surgery your body is in a major heal mode. This takes a few weeks. Some people find it difficult to meet they daily Fluid and Protein requirements at the beginning. But keep trying and eventually you should be able to reach these goals. You fluid requirements is met by the amount of fluids you uptake daily. This includes Water, the water you take when you take your Vitamins, flavored drinks such as Crystal Light, the water in Soups, milk, the fluids in protein shakes, decaf coffee or tea, even hot cocoa (provided you use the "no-sugar added" variety). So it is generally not difficult to meet this daily requirements.

Probably best to describe what is meant by honeymoon period. For me the honeymoon period after RNY gastric bypass surgery was the fact that after surgery, I completely lost my hunger. It was not difficult to lose weight when hunger was not constantly continually gnawing at my bones. But hunger did eventually return about a year later but it just was not as strong as before surgery. My question is "Is the honeymoon phase truly something to be concerned with if you're following the plan and losing weight like you're supposed to?" Yes. The approach in the "Maintenance" phase is different than in the "Weight Loss" phase. http://www.breadandbutterscience.com/Surgery2.pdf

Good luck on you surgery.

Congratulations and let us know if we can be of any help.

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 essentially, the approach is not counting calories, carbs and fats during the "Weight Loss" phase. Eventually after several months you will slide into the "Maintenance" phase, and the approach in that phase is different and you can go back to counting calories, carbs and fats.

Good luck on your upcoming surgery and check back with us when you are on the other side and let us know how things are going.

Congratulations.

After RNY gastric bypass surgery, the part of your stomach that normally process fats and sugars is cut away. If you consume too much fat or sugar, it will most likely lead to dumping. And that is something you will learn from experience to avoid. About a year after surgery, you intestines will realize something is wrong and will step up to the plate and start to process fats and sugars. So after that time you can return to eating these. But I strongly advise you to not eat sugars because the lost weight might pile back on. My nutritionist said after you reach the maintenance phase, one should eat around a equal portion of Protein, carbohydrates and fats, but always put protein first. After RNY surgery, I completely lost my hunger. It was not difficult to lose weight when hunger was not constantly continually gnawing at my bones. But hunger returned around 1 year post-op, only not as strong as before. I am over 3 years post-op and I consume fats. I drink whole milk, eat good cuts of steak and I love butter. Fats can keep the hunger at bay. So after surgery, give up fats. But realize this is temporary for about a year.

Good luck on your upcoming surgery. My mother was the only one that expressed negative opinions about my surgery. She didn't want me to do this. She is elderly and was somewhat dependent on the care I provided her and she wanted nothing to happen that could interfere with this care. So I could understand her reluctance to the surgery. It is natural to fear the unknown. But sometimes this fear of the unknown is manifested in others about you, like your parents, spouse, children. Some of it is a true concern for your health. Some of it may be an aversion to change.

Congratulations.

Congratulations on your weight loss. After my blood work they found I was deficient in Iron. So they told me to add an iron supplement, 65 mg of iron. It had to be "ferrous sulfate" chemistry or it would not be absorbed properly. So that is what I have been taking once per day for a couple years now and it seems to work. All iron supplements must be spaced 2 hours from all Calcium supplements otherwise they interfere chemically with absorption. I take calcium either in the form or calcium supplements or in dairy products such as milk that contain calcium throughout the day. In the end, the only way I could achieve the time spacing was to take my iron supplements at the end of the day, just before bedtime. From my perspective an iron transfusion seems a little drastic. Especially since you had a severe reaction to this process. Have you tried the normal iron supplement approach?

You will need someone to bring you home from the hospital after the surgery and also accompany you the the drug store to pick up the prescription meds. You can stock up on a week or two of Vitamins and Protein shakes prior to surgery. I did not find it any more difficult to manage than after other surgeries. I did not take any pain medicine after I left the operating room because I didn't have much pain and because I also wanted to drive as soon after surgery as I was able. If you are on pain medicines, it will prevent you from driving safely.

Good luck on getting approved by your insurance and good luck with your surgery.

Congratulations.

This is my approach during the maintenance phase. http://www.breadandbutterscience.com/Surgery2.pdf I do not have a problem with spicy foods but normally I do not eat too much spicy.

Congratulations and good luck on your surgery.

Many insurance plans are similar. This is the language in my plan. •Surgical treatment of obesity (bariatric surgery) is covered only if: - eligible enrollee is 18 of age or over - clinical records support a body mass index of 40 or greater (or 35-40 when there is at least one co-morbidity related to obesity). Applicable co-morbid conditions include the following: •Type II diabetes mellitus (by American Diabetes Association diagnostic criteria). •Refractory hypertension (defined as blood pressure of 140 mmHg systolic and or 90 mmHg diastolic) despite medical treatment with maximal dose of three antihypertensive medications. •Refractory hyperlipidemia (acceptable levels of lipids unachievable with diet and maximum doses of lipid lowering medications). •Obesity–induced cardiomyopathy. •Clinically significant obstructive sleep apnea. •Severe arthopathy of the spine and or weight bearing joints (when obesity prohibits appropriate surgical management of joint dysfunction treatable but for obesity. - Documentation of failure to lower the body mass index within the last 12 months through a medically supervised program of diet and exercise of at least 6 months duration.

I think after surgery they put me on a weight lifting restriction of 10 or 15 pounds. I think this was in effect until my doctor's appointment when they removed the stitches. But that was around 3 years ago so I do not totally recall. Perhaps someone more recent can chime in.

Congratulations.