***Appetite Suppressants???***

Ok, so this is a serious question regarding appetite suppressants.  I never considered them before, but my hunger is driving me nuts.  Most of you know that I had the band before my bypass.  It was the best thing for my hunger.  There were days I'd forget to eat because I had zero hunger at "my sweet spot" fill level.  But, band complications, it had to go, and I revised to RNY.  They warned me my hunger might not be as controlled with RNY and alas, it isn't.  It drives me nuts.  I eat what I should, portion wise, and I am still ravenous.  I have been working with my therapist about accepting all the medical problems from my RNY.  She really thinks that if my hunger is under control, I'd be doing better coping with this surgery (maybe not pining for the band, even though I know it had to go).  It's like my band was removed and the hunger switch was turned back on and amplified.  It hasn't shut off since my revision.

So... we're talking about investigating appetite suppressants.  Does anyone have experience with them?  I think the most common medication is phenteramine.  I'm seriously looking into this.  I shouldn't feel this hungry after a solid, balanced meal.  I'll eat 5 ounces of steak, a few pieces of asparagus and force myself to stop eating even though I'm still hungry (not just a little hunger... I mean like I haven't had any food all day hunger).  My doctor calls me "the hungriest person alive".  The only reason I didn't get to 500 pounds is because I tried to stay as active as possible and have been trying to diet and control my hunger since I was 5 years old... so my highest weight was 356 pounds.  I refuse to get back there because I can't control this hunger.  I lost a lot of weight after the surgery and I'm out of the honeymoon phase and am scared the hunger will lead me down a path I don't want.  The hunger even makes me sick.  Pre-RNY, I'd wake up nauseated every day... and since my revision, the nausea is worse.  I've been struggling with this my whole life.  I had a brief break with the lap-band and now that the hunger is back, I can't cope with it anymore... 

Anyways... if you have had any experience with appetite suppressants, please, share it with me?  You can PM me if you'd like (you might have to add me as a friend as my profile is for friends only). 

I'd appreciate any help.  I know 2 friends that are taking Phenteramine and are very happy with the reduced hunger (they had WLS and this was the "final piece of the puzzle" for them).  Please, any thoughts, advice, experience, anything.  I just need help with this. 

Before I had WLS, I tried the Phetermine twice and it didn't really work for me.   Well it did work for about two weeks and really shut off my hunger.   But then after those two weeks, it's like I wasn't taking it anymore because my hunger came back-and then I went off it.   My sister took Phentermine and it worked for her, but she only needed to lose like 20 pounds.   My hubby tried it too and it worked for him like it did me.   With Phentermine though, my doctor told me you can only take it for 3 months at a time and then you have to take a break from it.   Your body will get accustomed to it and then it won't work if you take it for long periods of time.   That might be a problem for you, since you have an ongoing hunger problem.  The cheapest we found it was at Costco, it's like $14 (w/o insurance) for a whole month's worth of pills.  

I would talk to your doctor more about this whole hunger thing, could it be more emotional issues for the eating or what?   The surgery we have takes the part of our stomach out that makes the hunger hormone "ghrelin" out, so we shouldn't have hunger like before surgery.   I get hungry here and there, but it's NOTHING like pre op.   I get normal hungry, but it's not like ravenous and I have to stuff my face like before surgery.  

I hope you find the answers you need, how frustrating for you to have this hunger problem even after surgery!!

Thanks for your feedback on Phentermine.  My doctor suggested I try it a couple of years ago.  He said he puts people on it for 3 weeks, off for 2 weeks, on 3, off 2, etc.  He said you can maintain that for months-years.  I'm thinking about trying it.  Just thinking about it at this point...

The hunger thing.. yeah, we've pretty much attacked the whole emotional eathing thing and really can't blame it on that.  My hunger trouble goes back to infancy.  I ate twice as much as the typical infant.  I would cry for food every 1-2 hours.  The pediatrician said I "would grow out of it".  They new there was a "serious problem" when I was 5.  I was at a Christmas party and ate more than the normal adult.  I ate so much that I had to vomit.  My mom came into the bathroom to see if I was ok and saw that it was just that I overate.  She said, "I told you to stop eating when you felt full".  I looked up and said, "I'm still hungry".  I will never forget the "oh ****" look on her face.  They had me see doctors my whole life about the hunger and they truly think I have a satiety disorder.  They tried cognitive behavioral therapy, placebo appetite suppressants (I was too young to know I was being "tricked"), fat camp, and other things.  Years and years of trying to control my hunger and the only thing that helped was the band. 

Just to clarify one thing... with RNY, they do not take out the part of our stomachs that make ghrelin.  Only DS and VSG do.  I was going to get VSG originally for this reason, but my severe GERD could have gotten worse with VSG so I chose RNY instead.  With VSG, the stomach will compensate and make more ghrelin in time, but not as much as pre-op.  RNY, our ghrelin is still being made.  Our remnant stomachs are still in our bodies, hooked up to our small intestine, lymphatic system, and circulatory system.  I don't know of a way to turn off ghrelin production.  Naturally, when the gut gets food, chemically, the body will turn off ghrelin production.  When the remnant stomach (and now our pouches) stretch, the body will turn off ghrelin production.  Ghrelin is not the only hormone responsible for hunger though.  There are a couple other hormones in the gut that contribute to hunger-satiety cycle.  The body is a complex and amazing thing (and sometimes a pain in the ass). 

Thanks again for your input!  I am going to do anything to get to the bottom of this.  My therapist is working with me on coping with all the health problems, my depression that resulted (not just from RNY but also my IC), and we did talk about the hunger trouble.  She is an eating disorder specialist and truly believes it is physiological hunger and wants to talk with my doctor about an appetite suppressant.

Well, enough rambling.  Thanks again!  If I find something that helps, I'll let you guys know!

Hi Alyssa...I haven't had any antisupp.meds but some days I do have big hunger. If I give in..the only good thing is it's not nearly as much as before...ie..I don't need to eat all the food in the cabinet.  I will say...I find this relates hormonally...the week prior to my period.  Also, and I haven't used it for this..or if this will upset your tummy....but cough drops ( I use sugar free) seem to knock off the appetite.   
One other trick I try ...and it helps for a while...or to get me over the hurdle....I have a hot drink.  I try not to have coffee even decaf coffee after 12 noon.   So...I will have the sugarfree swiss miss or I will heat up a carnation and milk. I know some of these foods don't agree with you..but maybee a hot tea, hot specialized tea type of drink.  I do this at night as well if I have the hungry horrors at say 8 pm ..a hot drink typically will knock off the hunger.
I hope these suggestions can help....and I also think it is interesting that we are both band to bypass and have hunger!!

Joanie

The good thing about WLS is that when I do eat a lot, the "a lot" is less than pre-op.   I just don't want to gain weight because I can't cope with this hunger.  My surgeon, his nurses, and his psychiatrist said that most people get help with their hunger with WLS, but sadly some have the same hunger trouble post-op.  Naturally, they were all saddened to hear that my hunger isn't better with RNY.  I really makes me miss my band.  I try not to live with regret and I am looking at the future with a better outlook, but there are days where I truly regret this surgery (regret not removing the band and getting a new one, regret not trying to repair it again with a different surgeon, regret getting WLS again, etc).  I do know that my hunger is worse when my hormones are haywire, and unfortunately, my hormones are really screwy right now.  Since surgery, I have not had my period.  I have "hypogonadism".  My body quit making enough sex hormones... so call it perimenopause... at 25 years old.  They think it will reverse, but 8 months and no period makes me worse.  I also have adrenal problems (so cortisol problems and aldosterone problems).  I am on hormone replacement therapy and cortisol is known to screw with your hunger and energy levels.  So... maybe things are bad post-op due to hormone problems?  Maybe when things balance out, I will have less hunger post-op like most people?  Maybe I'll be stuck with this hunger that I had pre-op, even if my hormone problems even out?

Thanks for the tips!  I do have cough drops.  I'll give that a try.  I try to avoid SF things as much as I can... but I have to use some (like with protein shakes).  I can't have tea at all (I'd have to be admitted to the ER before I attempt tea).  Some people with IC can have herbal tea and I've thought about trying dilute herbal tea like chammomile (sp) or blueberry or ginger or something.  I LOVE tea.  I can have certain brands of coffee.  For some reason, I can have a shot of Starbucks espresso (such as a latte or cappuccino which has mostly milk).  I have to us SF flavoring though.  I have been drinking a warm cup of milk when I am hungry and want to make my meal wait another 1-2 hours.  It doesn't always delay eating though.  It sucks.

I'm sorry you deal with some big hunger post-op.  Sounds like you found some ways to cope with it.  I'll give the cough drops a shot.  I get sick from sugar alcohols... so we'll see how that goes.  Maybe 1-2 I could tolerate. 

If I find anything that helps, I'll let you know.

First, I am sorry you are having to deal with this.  It is not something that I can offer assistance with....
I see by your signature line and one of your post that you have IC.  I was just recently diagnosed with it.  I am thankful to finally know what a lot of my issues have been.  Can I ask if you take Elmiron?  I had a cysto/bladder disertion (think that is what it was called) back in October and have been taking Elmiron shortly after the procedure.  I do see some relief however, I am having some severe abdominal cramping and gastro issues.  I didn't really put two and two together until a couple of weeks ago.  I called my urologist and they suggested I stop the Elmiron for a week and see if it clears up.  It did, I just started back on it this past Monday and by Wednesday I started with the cramping, each day it is a little worse.  Not to the point that is was two weeks ago.  If you are taking Elmiron have you had any issues? 
I also watch the clip that was in your signature line.  That was good.

I am very open about my IC diagnosis.  I'm glad you like the video.  I just found it (and the creator recently).  She's a college student whose IC was so bad that she had to stop attending school and attend online.  She runs support groups now.  If you are on Facebook, I can point you toward some support groups. 

My IC... I started getting symptoms in November 2006.  I only had symptoms when running, so I stopped training for my half-marathon.  Then I got symptoms when I walked and lifted weights... so I only swam... then I had symptoms when I was active... so I became sedentary... then I got symptoms when I would sit and sleep.  The disease is progressive unfortunately.  Earlier you catch it the better.  I got a horrific bladder infection from the foley during my RNY and since then, I've been really struggling with it.  But early on...

I got my diagnosis after 6 months (April 2007).  They started me on Elmiron in April and after 9 months and no improvement, they stopped the drug.  It can take a year or so for it to help.  I know plenty of people that it has helped, so I would give it time.  They also did bladder instillations with Elmiron, heparin, bicarb, lidociane/marcaine, and saline.  3 months of those weekly instillations and no help.  Elmiron only helps about 40% of patients.  My liver enzymes also went up.  Hair loss then developed... so we stopped the Elmiron.  I never had GI trouble with it though. 

Elmiron comes in a capsule.  Do you take it whole or do you open it?  A lot of people say that the capsule (the coating not the contents) causes GI trouble.  Most people that I know on Elmiron, empty the capsule into a cup of water and drink it that way.  Make sure you drink a whole up of water with Elmiron.  Also, take it on an empty stomach (they say it leads to better absorption... but I hear that some people take it with a couple of crackers and still get the benefits of the drug). 

When I took it, I would open the capsule on my tongue and drink a glass of water after it.  It tastes a little like sodium bicarbonate.  Very mild taste... and I usually have a gag reflex to medication taste.  Give it a try.  Open the capsule and either put it in water or dump it on your tongue and see if that helps your GI symptoms. 

There is also a good support group called The Interstitial Cystitis Network (ICN) http://www.ic-network.com/forum/ .  When I tried Elmiron, I had the band and couldn't take my meds whole, so I never even tried Elmiron whole.  I just read that a lot of people found emptying the capsule helpful with GI trouble.  It seems pretty common actually...

I know I rambled... but I hope this helped!

Thank you so much for the information....I have had bladder problems since I was a small child.  I always had chronic bladder infections and did have a bladder suspension 10 years ago.  It seems since I had my WLS the problems intensified.  I thought I was having bladder infections and since I had a history of them would be put on antibiotics.  Well, it got so bad that my PCP had me start coming in for urinalysis before given me the antibiotics.  Well, they would come back negative so he sent me to a urologist.  When I had my first cysto he was certain I had IC, that is when he did the other procedure and a biopsy on my bladder.  He gave me a bunch of literature on IC and I discovered so many other issues I had that I just thought had to do with me aging.  Even though I don't like that I have it I am grateful to know it was not in my head and now we can deal with it. 
I am going to try taking the Elmiron like you said and see if I do better...it had really gotten bad (diarrhea and cramping) all day..I was afraid I would end up dehydrated.  Right now I am just having the cramps in the morning but that is how it started out when I first started taking it. 
Thanks for the above website and for your help....good luck with the appetite issues you are having.  I wish you the very best.

I'm sorry to hear about all your bladder troubles.  I never had a problem before my first symptom... which is not the norm.  Most people tend to have stories like yours.  Give the Elmiron a few days opened and see if it helps.  If not... then I have no other tips regarding it :(  When Elmiron helps people, it really does wonders.  It just doesn't help enough people unfortunately!

Thanks for the well wishes!  I'll try to get this hunger under control.... somehow...

I've actually been wondering about phentermine as well but for a different reason.  I took it several years back and lost quite a bit of weight, it truly did suppress my appetite but I did not like the way it made me feel.  I would get shakey, agitated and sometimes felt like my heart was racing.

Then a year or so ago I was diagnosed with Chronic Fatigue and the doctor prescribed some for me to take only on days when I couldn't stay awake enough to even drive (I actually had a couple episodes of falling asleep at the wheel).  Those days were few and I found the Phentermine helped quite a bit.

I haven't needed it since surgery and am scared a little bit to ever take it again.  I will have to talk to my surgeon and primary doc about it first.  I'm also hoping that with getting rid of some of the extra weight maybe I won't have to deal with the CFS like I did before.

Lynne