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The "Hair loss" is called Telogen Effluvium https://www.webmd.com/skin-problems-and-treatments/hair-loss/effluviums#1 It's not really "Hair loss" it's just a larger % of your hair follicles going into rest at once, so when they reactivate they shed the hair they were holding and that gives the appearance of "hair loss". Fear is normal, NSAIDs are not the only pain relief out there, there are options. Pretty much everything you've listed is normal fears, and pretty much, all of those fears, you'll laugh at down the road. I was 370 at my largest. I'm 210 now, I have some extra saggy skin, but it's really not THAT bad and it's totally hidden under even decently tight clothing. Just remember, staying overweight *WILL* kill you. If something was to happen during your surgery, the best place for that to happen, is in a hospital. No one but you can tell you if what you are going to do is right for you. You have to make that call. Weigh out all the pros and cons, and make your decision based on that, no one is going to look down on you for making the best decision for your life that you can.

RNY-to-sleeve revisions happen, but it's apparently mostly because of severe reactive hypoglycemia and other really weirdly specific complications. Sleeve-to-RNY is more common in part because the sleeve was eventually conceived as a safer surgery to give people with much higher BMIs, with the intention of converting them to RNY once they lost enough weight that that was a safe option for them. They started doing it as a standalone procedure when many of those patients opted not to come in for the second surgery, being successful with just the sleeve. But sleeve-to-RNY absolutely does happen, still, especially for people who have uncontrolled GERD or who can't lose enough weight with the sleeve alone. In my pre-op testing they found some small lesions in my esophagus, which might have been esophagitis or might have been a small amount of GERD. I went with the sleeve despite that, because I also have arthritis and might need to take ibuprofen and other NSAIDs again, ever, in my life. (Also, I had been taking large amounts of NSAIDs over a long period of time, and they may have been responsible for some of the damage they found.) I can't tell you how that turned out for me, since I'm only a week post-op, but I will say my doctor didn't try to sway me toward RNY at all, and given that I also had a hernia repaired, I'm pretty hopeful that it'll all turn out OK.

If it truly is reactive hypoglycemia, eating small meals and snacks more frequently will help. Eat a little something every three hours you're awake. Fasting would be contraindicated. A gall bladder issue would be an extremely common reason for the symptoms you are describing. Reactive hypoglycemia is possible, but is very rare and would surprise me. 25-30% of weight loss surgery patients who have their gallbladders develop issues requiring treatment. Gallbladder attacks are often set off by high fat, high protein foods. Sensitivity to eggs is often reported. Nuts, too. Spicy foods and fatty processed carbs can set off attacks as well. Talk to your doc. If it's gallbladder....it's a horse in a field of horses. If it's reactive hypoglycemia it's a unicorn.

Well I'm up late for a terrible reason. But I thought I should leave record of this because you don't see it on the boards often. I had VSG but I have the unfortunate side effects of dumping and late dumping possibly even reactive hypoglycemia. I need to confirm the later with my doctor the next episode. The very first time it happened or that I can remember, I was 4 months post of in Naples. I was taking a coffee and felt a wave of flush wash over me but it disappeared immediately. Thought nothing of it. The next time I was in Paris, Nothing out of the ordinary lol. I had a pettit croissant and then a spoonful of panna cotta and I thought I was dying. Not exaggerating. Room spinning, heart racing, sight failing all in french subtitles. Took an hour to pass in a highly ornate turn of the (17th) century bathroom. The next few times I was on home soil eating (safely/properly cooked) homemade curried chicken breast. Then roasted lamb, next a tossed salad , then means and even once Greek yogurt! But not dessert/pastries again? Whatever...I'm sure it will happen again Absolutely no rhyme or reason. Every time it happens now I can't predict why, when or what foods will cause it. Just tonight peanuts and salmon pate. My usual suspects. I nearly went to The ER, it was that bad but I passed out in bed. Well now I'm awake to tell the tale. So I maybe a unicorn, who knows, but if you are banking on VSG not causing dumping syndrome, you may be surprised...

I'm a Type2 and had a lapband back in 2009, starting at 153.5 kilos. I lost 20 kgs. However I had a lot of problems (sprung a leak in the tubing in the beginning and it never really worked for me) so I'm having a revision to mini gastric bypass. The thing with my diabetes is I get hypos if I eat high carbs (sugar) and then nothing else for ages. So eg. a croissant for breakfast and then by 1pm I'm having a hypo. My theory is that the body overshoots the insulin for the croissant so I have too much floating around that has nothing to do but send my blood sugar crashing. When I go keto, eg keep carbs to between 20 and 50 grams a day, I simply don't get hypos. So you may find the problem for you is too many high sugary carbs and surgery and limiting your carbs will really help re: hypos. My doc says they perform this surgery specifically to send diabetes into to remission, so it's definitely something to consider. Many blessings Sent from my SM-G930F using BariatricPal mobile app

CHART 1 Correlation of nutrient deficiency and its cutaneous repercussions NUTRIENT Biotin Alopecia, glossitis, keratosis pilaris, periorificial dermatitis, seborrheic dermatitis and erythroderma Copper Depigmented and thinning hair, alopecia, delayed wound healing Iron Pallor, koilonychia, glossitis, alopecia Selenium Delayed wound healing, psoriasis, skin cancer Vitamin A or Retinol Xeroderma, acne, brittle hair, and keratotic follicular papules most commonly in the anterolateral surface of thighs and arms, which may spread to the extensor areas of the upper and lower limbs, shoulders, abdomen, dorsal region, buttocks and neck; phrynoderma Vitamin B2 or Riboflavin Mucositis, lip and angular cheilitis, glossitis, xerosis, seborrheic dermatitis, scrotal and vulvar eczema, erythroderma and toxic epidermal necrolysis. Vitamin B3 or Niacin Pellagra, photosensitive dermatitis in symmetric areas, cheilitis, glossitis. Vitamin B5 or Pantothenic acid Purpura, leukotrichia, seborrheic dermatitis, angular stomatitis and glossitis. Burning feet syndrome. Vitamin B6 or Pyridoxine Seborrheic dermatitis, glossitis, oral mucosa ulceration, lip and angular cheilitis, photosensitive pellagra-like lesions Vitamin B9 or Folic acid and B12 or Cobalamin Lip or angular cheilitis, Hunter's glossitis; diffuse, symmetric hair and mucocutaneous hypo-and hyperpigmentation Vitamin C or Ascorbic acid Poor wound healing, keratosis pilaris, perifollicular petechiae, ecchymosis, purpura, brittle hair, scurvy (gingivitis, bleeding gums, keratosis pilaris), Sjogren-like syndrome Vitamin D Atopic dermatitis, psoriasis, skin infections, acne, autoimmune cutaneous diseases and skin cancer. Vitamin E Atopic dermatitis, acne. Vitamin K Purpura, petechiae, ecchymosis, hematoma Zinc Acrodermatitis enteropathica (alopecia, acral and periorificial symmetric, erosive and eczematous rash), dry, brittle and thinning hair, delayed wound healing, paronychia, stomatitis, psoriasiform dermatitis, blepharitis, angular cheilitis, vitiligo-like lesions Protein Aged appearance, erythematous or hypopigmented lesions most evident in flexure areas; hyperchromic lesions with smooth, fissured or erosive surface; brittle, slow growing nails, onychomadesis; follicular hyperkeratosis, pale extremities accompanied by edema; dry, brittle, dull, and thin hair, with brownish-red color before becoming grayish-white, flag signal with alternating dark and light stripes in the hair; angular cheilitis, xerophthalmia, stomatitis, vulvovaginitis

I loved all these different replies and it just goes to show that we are all so different in the way we are made and in the way we react to the surgery. My son, who is 20 years younger than me, has not had any problems from day 1 post-surgery. I think he could eat the kitchen sink and not have a reaction (he has kept his weight off, too). I, however, have had many problems with different foods and medications and other complications (low iron, anemia, reactive hypoglycemia, nausea). I wonder if our age at the time we had the surgery comes into play here.

The science does not support that high of stats on reactive hypoglycaemia in bypass patients. It seems in your case, you did not continue to have it with the sleeve, but now need the rny to combat something causing you daily pain and a definite issue. I would go with fixing the current known issue.

We had one individual in our support group that developed reactive hypoglycemia after gastric bypass surgery. He even fainted. As a result he looked into the condition and found that he could easily control it with his eating habits and by being sensing the pretriggers to the condition. So it did not really bother him except for the first time it happened. The figure you cited "happening to 1/3 of bypass patients" seems overly high. I would not give it much weight. But since you experienced this condition before, it might be more of a concern in your individual case. It is your decision, but if it were me I would eliminate the Gerd by gastric bypass and be hyper-vigilent about monitoring the potential for reactive hypoglycemia and using dietary means to control it should it arise.

Here is where you weigh out the risks. I bet the risk of getting reactive hyperglycemia is a lot lower than the risk of weight related heart issues, diabetes, knee and back issues... etc etc etc. So, weigh out the risks and make the call. Personally, some ultra rare issue that almost no one experiences... isn't enough of a risk to outweigh all the things that WILL happen if one continues to be overweight.

So I was reading an post yesterday and now I am having serious second thoughts. I may not even show up tomorrow to surgery. The post was about Reactive Hypoglycemia, a side effect to bypass that can develop 2 the 10 years post bypass. In the post, the patient had symptoms 1 to 2 times a year at first and now is having them 2 to 5 times a week. Patient occasionally passes out because of it. When I had my sleeve six years ago I had experienced those symptoms and I just thought it was because I forgot to eat. It was a weird feeling of dizziness, confusion, and I was with a client at the time and I nearly passed out. It scared the crap out of me. I started doing research online and discovered an article from 2017 that identified that this is happening to 1/3 of bypass patients and is not something that is discussed typically with there doctor. Reactive hypoglycemia may be related to dumping syndrome but can be far more dangerous. In extreme cases the bypass needs to be reversed to fix the problem which brings me to my fear. In my case they will not be able to reverse my bypass after I have it as they are removing the stomach because the polyps I developed taking PPIs for Gerd. So now my challenges is do I live with Gerd and run the risk of getting Barrett’s syndrome and Possible esophageal cancer or do I have a bypass and run the risk of getting reactive hyperglycemia ? Thoughts anyone?

It's so good to find someone with a similar problem (though I am really sorry you are experiencing this). A friend gave me a glucometer but I drove myself crazy with it and finally gave it back. I can tell by my symptoms that I am about to have an "attack." I have discovered that the correct term is "reactive hypoglycemia" and it first started showing up around 2005. Then it started being reported at scientific conferences and being written up in peer-reviewed scientific journals starting about 2012 (all this discovered from a search on the web under "reactive hypoglycemia post gastric bypass surgery"). It's can also be called "late dumping" although diarrhea and stomach cramps don't seem to be associated with it. It is most prevalent in gastric bypass patients. I think I mentioned earlier in a post that I only had these episodes once or twice a year until this year. Then, after shopping with a girlfriend all day, we stopped at McDonald's and got a large mocha frappucinno. At her house my lips started going numb and then I didn't really know who I was and could not talk straight. Her husband was a diabetic and for some reason she decided to check my blood sugar which came in at a whopping 34. Off to the ER where the physician on call told me it was "fluctuating hypoglycemia." I am searching for an endocrinologist or gastroenterologist now to see if I can get some help for this. In the meantime I am reading everything I can about what foods to eat. "Protein first," all the articles say coupled with a food that has a low glycemic index (I still don't know what that means). Searching for the sweet spot in the management of this condition!! We can journey together. Thanks for sharing.

I'm 14 years out from gastric bypass surgery (RNY) and still get nauseated when I eat meat and many other things that I won't bore you with. I still have a protein drink every single day to compensate for the loss of protein from meat products. A young woman stopped by my house the other day asking for advice. She was six months out from surgery and still experiencing nausea with most foods, especially meat. Why would your doctor think your throat had suddenly gotten too small when you have been eating all your life prior to surgery without this issue? I don't think so. My son had this surgery and he doesn't have any problems at all. Yet I have a lot of nausea, reactive hypoglycemia, trouble with low iron and a couple of other things. Each of us is different. Most doctors don't seem to know that!! Give it time. Take it slow. Very slow.

Matt, thank you so much for taking the time to reply. My doctor told me about dumping syndrome before he did the surgery, but he emphasized that it would be caused if I ate sugary products (which I don't). I did a search of this site AFTER I wrote the hypoglycemia post (duh, I'm a new person here and didn't know I could search this site) and found almost 700 issues of people talking about "reactive" hypoglycemia (not fluctuating - which is what the doctor in the ER called it). With that new terminology I searched the web and found many scientific articles written since 2014 about this "new phenomena in gastric bypass patients." I'm really scared at this point, but I now see that I have got to find a gastroenterologist or endocrinologist to get some serious advice. I can't manage this on my own. I moved to a small town about three years after surgery and at that point was no longer followed by the physician who did my surgery. So, do you really think reactive hypoglycemia and dumping syndrome are the same thing?

You have forgotten to relax and trust your team! Don't pack a ton of stuff. In between walks, try to sleep. You're going to be loopy as all get-out anyway. Don't buy anything new like a phone charger for one night. You're overthinking - big time. Buying more stuff might make you feel like you're getting prepared, but it's not necessary. No regular socks, they won't let you wear them. Bring a hairbrush, toothbrush. Don't bother with makeup. I wore the hospital gown for my entire stay. I didn't want to bleed all over my clothing. You might bring a shawl for your shoulders. Any type of garment with sleeves is a pain because you'll have an IV. If you use hypo-allergenic wipes, I'd bring those. Just take a deep breath, you're going to be fine. We're all in your corner!

As Fluffy said, differences for different programs - and also for different individual needs. I never worried about carb or fat counts as those don't bother me, just calorie count as that is what ultimately drives the weight loss. There is too much good nutrition associated with foods that are nominally carbohydrates for it to make sense to place arbitrary limits on them; on junk food (high calorie/low nutrition stuff) yes, but not solely on the basis of something being high carb or fat - the calories are an adequate limitation. With your bypass, however, and the prospect of dumping or reactive hypoglycemia, a reasonable carb restriction can be in order, particularly for simple carbs and/or sugars, at least until one figures out ones' individual tolerances.

Disagreements on opinion are allowed, personal bashing and bullying of individuals is not. Everyone here is entitled to share their opinion, but if the opinion differs from your own it is no reason to become so reactive. Good day.

My mother, grandmother, and great-grandmother had Hashimoto's. I have it. Surprisingly, it skipped my daughter. You might have Hashimoto's thyroiditis. It tends to pass to females. You need a simple antibody test to confirm the diagnosis. Depending on your age, you might still be flip-flopping from hyper to hypo. You're probably in a hypo state now.

Sorry to hear about your scary episode. It is a little bit common for some individuals to experience a type of hypoglycemia called "reactive hypoglycemia". It seems a little soon because you are less than 5 months post-op. But in your case the alcohol may have played a part. I remember the first time I had a little wine post-op, it almost threw me for a loop. Here is a couple links to the condition. https://www.ridgeviewmedical.org/services/bariatric-weight-loss/enewsletter-articles/reactive-hypoglycemia-postgastric-bypass/ https://www.stjoes.ca/patients-visitors/patient-education/f-j/PD 7972 Reactive Hypoglycemia after Bariatric Surgery.pdf

The following is a list of abbreviations commonly used on this board. ACL = Anterior cruciate ligament AGB = Adjustable gastric banding AMRAP = As Many Rounds As Possible (crossfit) AT = Aspiration Therapy BB = belly button bc = because BCBS = Blue Cross/Blue Shield BDD = Body Dysmorphic Disorder 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 C25K = Couch Potato to Running 5K 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 CT = Computed Tomography (commonly called CAT Scan) cw = current weight CXR = Chest X-Ray DDD = degenerative disc disease Dr. = doctor DS = Dumping Syndrome or Duodenal Switch EBT = Endoscopic Bariatric Therapies EGD = Esophagogastroduodenoscopy EKG = Electrocardiography ER = emergency room ESG = Endoscopic Sleeve Gastroplasty ff = fat free f/u = follow up GB = gastric bypass GERD = gastroesophageal reflux disease GI = gastrointestinal GIF = Gastric Intrinsic Factor 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 IGB = intragastric balloons IF = Intrinsic Factor IMHO = in my humble (honest) opinion IMO = in my opinion IUI = Intrauterine insemination LAP Band = Laparoscopic Adjustable Gastric Band LES = lower esophageal sphincter lol = laughing out loud LSG = Laparoscopic Sleeve Gastrectomy med = medicine MFP = my fitness pal MGB = Mini Gastric Bypass msg = message NAFLD = nonalcoholic fatty liver disease 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 omw = on my way 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 OTC = Over the counter Oz = Australia PB = Productive Burps PCOS = Polycystic Ovary Syndrome PCP = Primary Care Physician PICC= Peripherally Inserted Central Catheter 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 Rx = Prescription medicine RYGB = Roux-en-Y gastric bypass SADI-S = single anastomosis duodeno–ileal bypass with sleeve gastrectomy s/f or sf = sugar free SG = Sleeve gastrectomy SIPS = stomach intestinal pylorus-sparing surgery smh = shaking my head, scratching my head SO = significant other SOB = shortness of breath st = stones (a unit of weight measurement) 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

I originally wanted a sleeve; however, the surgeon strongly recommended a mini gastric bypass owing to my history of insulin resistance (PCOS, gestational and prediabetes). I heeded his advice; however, am now dealing with significant reactive hypoglycemia. This results from carbohydrates being rapidly absorbed causing immediate high blood sugars and then rapid reactive lows. These lows can be unpleasant and sometimes scary. I'm now on a drug that slows the absorption of carbs, but I have to take it every time I eat and there are some unpleasant side effects. So while I'm generally happy with the results of my surgery (I'm within 5 pounds of my goal), in my situation I do wish I'd gone with the sleeve.

I don't know how many are "many" (there is something called "adverse selection" that is common in online forums, where negatives outnumber positives because everyone with a complaint will post about it, but those with nothing to complain about are largely silent, so things tend to seem worse than they are,) but it does happen for a few reasons. The sleeve is predisposed do reflux problems due to its geometry and physiology. The volume of the stomach is reduced much more than the acid producing potential, so it takes a while for the body to adapt, and sometimes it doesn't. Also, the sleeve is considered to be a "high pressure" system in that the stomach is often closed off by the pyloric valve at the bottom, so excess gas, fluids or solids have no place to go other than back up; the bypass is a "low pressure" system as there is no pyloric valve in the system, so excess gas can vent down into the intestines. In contrast, the RNY due to its geometry and physiology is predisposed to dumping, marginal ulcers, reactive hypoglycemia and bile reflux. With either procedure, this does not mean that everyone will experience these problems, just that this is the natural result of the anatomical changes that have been made. Another compounding factor with the sleeve is the relative experience level of the profession - in the US, the sleeve has been routinely approved by insurance for about the past 6-8 years, while the bypass has been routine for around 40 years. This means that there has been some revisions needed due to inexperience in some of those early sleeves - the surgeons may have been well experienced doing bypasses and bands, but a new procedure, even a straightforward one such as the sleeve, brings along its own subtleties and nuances that take practice to master. Resultant shaping issues can promote or exacerbate the reflux problem. In the US, most bariatric surgeons are now far enough up the learning curve that most are now making routinely making functionally competent sleeves (one should always seek out a surgeon who has several hundred of whatever procedure one is interested in under his belt.) However, now the problem is, as it has been since early on, is that many are not very experienced in correcting any problems that may crop up with a sleeve, so the natural inclination is to stick within their comfort zone and revise to a bypass when a problem occurs, rather than correct the sleeve. So yes, the OP is correct in some respects that there are some unnecessary revisions being done, though not necessarily just for the sake of charging for two procedures. As time marches on and the industry gets more experience with sleeves, I would expect that the revision rate will decline as both the sleeves will be made better overall, and the surgeons learn how to repair them when necessary rather than revise them, much as the bypass has matured over time and some of its predisposed problems are less common as they have learned how to mitigate them to the extent they can (bile reflux isn't too common anymore as they have worked out techniques to minimize its occurrence, for instance.) Another factor that may skew the impressions some is that the bypass is a difficult procedure to revise - it is something of a dead end surgically speaking. If poor weight loss performance or regain is experienced, there is little point in reversing it and revising it to a sleeve as they are both so similar in performance that there isn't much to be gained. There are minor tweaks that are offered - tightening of the stoma or intalling a band over the bypass - but overall results are generally pretty poor. Revising it to a DS, which can offer improved weight loss and regain resistance, as well as diabetes remission, is a very complex procedure that only a handful of surgeons are capable of performing. So, we don't see a lot of bypasses revised for that reason, though sometimes they are reversed if there are significant complications that can't otherwise be resolved, though that isn't a trivial option, either.

Several individuals that undergo bariatric surgery experience a type of low blood sugar after the surgery. It is known as reactive hypoglycemia. This is independent of whether you were diabetic prior to surgery. Here are a couple links to the condition: https://www.ridgeviewmedical.org/services/bariatric-weight-loss/enewsletter-articles/reactive-hypoglycemia-postgastric-bypass https://www.mayoclinic.org/diseases-conditions/diabetes/expert-answers/reactive-hypoglycemia/faq-20057778

The regulation of type I and type 2 will differ as yours is autoimmune and mine is metabolic. You do not have any information on your profile so not seeing how much you currently weigh. I am still very large at 265 lbs. As my weight comes down my BG will also change as it has already changed due to weight loss. I am taking a lot less insulin now than 5 weeks ago. The ultimate goal is NO insulin resulting from a large weight loss. I know its possible. When my BG gets to 5 I start to feel hypo. Everyone is different I really wish that I could just 'go back' to protein shakes. Very early post op i could not eat or drink much. But the hunger I am experiencing NOW is what is throwing me off and I am trying to satiate myself. I did not get to almost 300 lbs because I decided I could just not eat. Said no morbidly obese person. LOL that is funny. I am going to check with my doctor in Mexico if they will allow me to take an appetite suppressant since my blood pressure is now very good

I would test before Breakfast and 1 hour after dinner. You want to take advantage of what little info you are able to gain. What is your typical fasting blood glucose level? Those are exactly the times that I test. Post surgery my BS is about 12 for fasting. I purposely do not take a lot of insulin at night because I live alone and if I go hypo there is no one here to help me get glucose or shake out of it if I am sleeping. I am happy with 8-10 for fasting levels right now I was a completely out of control diabetic. I only started to reign it in about 4 months ago when I had my ah ha moment. In my out of control days I was regularly at 26-31 at night and fasting levels of 18-23. Crazy numbers