James Marusek

According to a major new study published in The Lancet Diabetes & Endocrinology, researchers have linked public transport usage with key health outcomes. Specifically, investigators examined the relationship between body fat percentage and BMI values as they relate to individuals who: (1) Just use public transportation; (2) Actively commute by walking or cycling; (3) Use a mixed-approach, combining public transport and an active mode; (4). Commute exclusively by car. The trend was assessed in over 150,000 British residents between the ages of 40 and 69 years old, making it the largest study to date on this topic. Researchers discovered that those who used public transport, actively commuted or relied on a mixed approach for their daily commutes boasted significantly lower BMI values and body fat percentages compared to those resigned to driving alone. The strongest association, as you might expect, was seen among cyclists. On average, men were 11 pounds lighter and women were 10 pounds lighter compared to those who drove. Researchers also saw significant trends among those who walked and the mixed transport category. Both showed comparatively lower BMI and body fat percentages than drivers, but the reduction was less than in the cycling group. The article can be found here. http://acsh.org/news/2016/03/18/losing-weight-comes-with-any-commute-not-done-by-car/ I guess I have a slanted perception about drawing conclusions here. 1. I live in the country and we do not have public transportation. You have to go to the city to receive that benefit. 2. Cycling is good but in the country, stray dogs and potholes will eat you alive. Years ago, when I resided in a city, I use to cycle to work. But cars would pass me going 60 miles per hour. They would purposely get as close to the bike as possible and then at the right moment honk their horn. Its a good way to die. One of the individuals from work was riding his bicycle for exercise during lunch each day. But a truck ran into him. He lay in the hospital in a coma. He was the perfect picture of health. But his brain swelled and he died. Decades before his time. So whatever you do stay healthy and alive.

In general, some of your skin will contract during the first year after surgery. Exercising can help. So you might incorporate exercise the use the muscles in your arms into you daily exercise routine.

Many patients find it difficult to meet their daily Fluid and Protein requirements right after surgery. That is because their body is in a major heal mode. So just keep trying and you should get there within the next few weeks. Many individuals experience changes in the way things taste and smell after surgery. This can make it difficult for some to drink their Protein shakes. It is important that you be able to tolerate protein shakes. You do not have to like it, only tolerate it. I hate the taste of protein shakes. But I did some experimentation until I found something I could tolerate. In the end, I found that I could drink Muscle Milk Light (vanilla Creme) Protein shake powder blended with Water with a half a banana. That was what I could tolerate. But there are many choices out there, many different compositions. If you try them all and still cannot find one you can tolerate then another option is to drink fortified milk. 32 ounces of 1% milk fortified with 1 cup of powdered milk will give you 56 grams of protein. You can mix up a pitcher and drink a little at a time throughout the entire day.

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. In general the requirement for liquid intake is 64-80 ounces per day. But many things count towards this total. It is Water and milk. It is the liquid in the Protein shakes. It is the water you drink when you take the various Vitamins and meds throughout the day. It is the water content of Soups. It is tea, decaf coffee, Crystal Light flavored drinks, etc. So it is generally not hard to reach this goal. The protein requirement is generally 75-90 grams of protein per day. 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. Later after a month or two you can add Protein Bars as an option in meeting your protein goals.

@@silvermoon BMI is normally computed by height, weight, age and your sex. If you are 5 foot 1 inch tall and 130 pounds, even when you factor in age, I do not see how you can have a BMI of 44. If these are really your numbers I tend to agree with @@KristenLe, that this surgery may be unsafe for you.

Congratulations.

After RNY gastric bypass surgery, I completely lost my hunger. I found it was not too difficult to lose weight when hunger was not constantly, continuously gnawing at my bones. Before surgery, whenever I was eating, I was already thinking about what my next meal would be. This condition of no hunger will last for about a year and then hunger will return, but it will not be as strong as pre-surgery.

I am 3 years post-op RNY gastric bypass surgery. I do not daily vomit nor get food stuck. Sometimes I may overeat and this can lead to vomiting but that is rare and generally I have pre-triggers that warn me when I am close. Like sneezing, or hiccups, or the taste of food changes in an instant, or I begin to feel excess mucous. So I stop eating and all is well in the world. This is my experience with gastric bypass. There are recipes at the end of the article. http://www.breadandbutterscience.com/Surgery.pdf

I will pray that you have a successful surgery.

It does get better with time. I have eggs for Breakfast almost every morning and don't even think about it. I am 3 years post-op.

Congratulations.

I suspect that you are not the only one that gets negative criticism when you talk to your co-workers about the surgery. Many women report the same problem. I had RNY gastric bypass surgery 3 years ago and it was one of the best decisions that I ever made. Almost all my health conditions (high blood pressure, diabetes, sleep apnea, GERD) went into remission very quickly after surgery and remained there. That was the main reason why I had the surgery and I consider it a success.

Welcome Nancy. I had RNY gastric bypass surgery 3 years ago. I wrote a short article that describes my experience with the process. I wrote a second article that describes my experience with the second phase, the "Maintenance" phase. Here are the links. http://www.breadandbutterscience.com/Surgery.pdf http://www.breadandbutterscience.com/Surgery2.pdf

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. During the first few weeks after surgery, your body is in a major heal mode. Many patients find it difficult to meet their protein and fluid requirements during this time. So if you have a problem with these, just keep trying and you should be able to get there.

I had a different surgery - RNY. Which is different but there are similarities. For DS's the Vitamin regime is more intensive. So this article gives my experience from RNY. It may be of some help. http://www.breadandbutterscience.com/Surgery.pdf

The same thought cross my mind but it didn't happen but if you ever get seriously bound up, then you need to deal with it.

Congratulations.

After surgery, I found that softer foods such as chili and Soups went down much easier than harder foods such as steak and chicken. So I primarily relied on these. I made my own chili and soups and fortified them with extra Protein. I have included some of the recipes at the end of the following article. http://www.breadandbutterscience.com/Surgery.pdf

Good luck on your surgery and let us know if we can be of any help.

That is a lot of questions! 1. What do I expect? This will vary by surgeon and insurance requirements. After my initial consultation, I underwent psychological testing. I had to undergo a 6 month medically supervised weight loss and exercise program. I attended Bariatric Surgery Support Group meetings during that time. I then went through almost a day of pre-op testing. Because several problem areas were identified, I then went through a second round of pre-op testing with specialist in their respective fields (such as sleep apnea). Then I went through a half day of classes. Then when my insurance was finally approved a date of surgery was set. 2. Insurance. For me battling with he insurance companies was the biggest hustle. Even though the insurance company mandated that I undergo medically supervised weight loss program, they refused to pay for the doctor to conduct them. Actually that is not true. They paid for every other one. They said it was a clerical error that they made those payments. But like clockwork, the first was paid, the second was not, the third was paid, the fourth was not, the fifth was paid and the sixth was not. Made no sense to me. Also they tried to pay at the out of network rate when it clearly was in-network for some charges. Even though insurance policies will vary somewhat, many are similar. These were the requirements from my health insurance company: 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. So since it appears that you do not have any co-morbidities, then the decision is based on your BMI. If it is over 40 BMI, you will probably be approved. Some insurances will cover some forms of bariatric surgery and not others. 3. liquid diet. I did not undergo a liquid diet. This is sometimes called a liver shrink diet. But I had RNY surgery and also because I was in a mandatory weight loss program I lost 20 pounds already through the program. 4. hair Loss and Lose Skin. I didn't lose any hair after surgery. It is important to meet your daily Protein requirement otherwise you might. Most of my loose skin was below my belt line, so it was unimportant to me. After surgery I did develop very fine paper thin wrinkles on my face. I looked like I was 100 years old. My wife recommended I use a product called Bio Oil available at Walmart, CVS and other stores. I put it on once per morning when I got up and the wrinkles disappeared. Also, it is important to meet your daily Fluid requirements because this can lead to dehydration and wrinkles. 5. Advice. I will give you three bits of advice. First, take a good before photograph of yourself. I would take a total body side view. Later after surgery, you can then take a good after photo. Many people do not really look at themselves and do not know how obese they really are. When the pounds drop off after surgery, they cannot see, the weight that they actually have lost. That is where the photograph comes in. Many carry the photos around with them or on their smart phones to show what they actually accomplished. Second, walk 30 minutes each and every day. It will help with the recovery process after surgery. It will also help with minimizing pain after surgery. I had no pain medicine after I left the operating room. I didn't need any. Third, if you haven't already, go cold turkey on any caffeine and carbonated beverages that you normally drink. It is a requirement of the program. I went cold turkey on my 6 diet coke a day habit at the start and I was extremely miserable for about a week. It was due to caffeine withdrawal. I suffered a week of severe headaches and body aches. You do not want to combine this withdrawal syndrome with the effects of surgery. So it is good to get this one out of the way now. Well that is all for now. I have to go.

Many individuals after surgery suffer from severe constipation. It is important to make sure you meet your daily fluid requirements because dehydration can lead to constipation. Sometimes you can get so bound up that stool softeners just will not work. In that case, I used a glycerin suppository that I inserted up my rear end. This will generally unbind you and then you can try and seek some relief using stool softeners. The following are some past recommendations posted on this website for constipation: Apples with the skin 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 (but beware - too many will give you the runs) 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. 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 minutes

So far they have been covering the cost of my blood work. I am 3 years post-op RNY. But the scripts for this blood work come from my surgeon's office, not my PCP. My surgeon's office did state that when I get to my 5th year post-op, they would change the responsibility for generating the script for the blood work to my PCP.

Passing a kidney stone can be very, very painful.

My mother suffered from Urinary Tract Infections all the time. You could always tell when she had this infections because she became weak on her feet which could lead to a fall. She was also confused and incoherent. Generally she had to take antibiotics for a week or two to get rid of it. She developed a strain that was antibiotic resistant and had to take a cocktail of several antibiotics at once. This link describes the symptoms of UTI. http://www.webmd.com/women/guide/your-guide-urinary-tract-infections

My taste buds changed dramatically after RNY gastric bypass surgery. I remember the first time I had Ketchup after surgery. It burned my mouth like hot sauce.