RNY Vets--here goes....

So I just looked at a poster saying that "stepping out of her comfort zone, she was posting".... anyway, that remark encouraged me to do the same.

Happy sleever here since 2012 that is now (due to a pancreatic MCN) scheduled soon for a Whipple procedure. This is going to be a dicey one- pun intended, I guess-. As a byproduct of the resection, it looks to me like I will be left with a pouchless RNY (?). The other consequential concern is that I stand to drop 10% of my current body weight (which is now at 134#) putting me too damn close to underweight.

I look to my fellow WLS cousins here for information on the RNY experience - not for medical advise, of course, but rather for your anecdotal contributions. It seems like the RNY (malabsorption, initial food tolerance issues, etc) are going to work against me. Ironically, I will want to be gaining that initial loss (due to the pancreatic surgery) back ASAP, while at the same time loosing more weight, because I will be going through the same initial transition experience many of you worked through in order to kick-start weight loss. Seems like a Catch 22.

My dilemma and my question- How to well take care of a healing bypass while at the same time confounding its natural intention, which is weight loss? Help me through--(I understand this is crazy, but thanks, any way) Bonnie

edited for typo.

Do you know how long your intestinal bypass will be? That will probably impact some of your weight issues. I had a sleeve revision for medical issues. I have a bypass but it is a modified form of the mini gastric more than an RNY, if that makes sense. (My intestinal bypass is much shorter because the goal of my surgery was to restore a route for nutrition and hydration around a narrowing due to scar tissue in my upper sleeve). I have one stoma/an omega loop bypass rather than an RNY and I believe my surgeon said my bypass was roughly 1 meter vs. the typical 3 meter bypass length. I had some blood sugar issues at first but I can eat and tolerate much more at 3 months roughly, (not that I should just because I can). I think some of my blood sugar issues were due to the fact my body had used up so much of its glycogen stores that eating again took a bit of adjusting for my body. I would say write down your concerns and make sure you ask your surgeon or dietician etc. and take it slow to see how your body responds. Everyone is different. I found the most helpful information on total or subtotal gastrectomy support groups on Facebook. There were quite a few bariatric oddities like us there as well as people with other issues impacting GI systems and nutrition. I hope this helps

I agree the surgeons are who you should be consulting... they can give you a good idea of expectations and with your concerns they may be able to modify the amount of intestine they will remove. Some of that may not be evident until they see how much intestine is involved with any irritations..

Diet.. you will not tolerate fats after this procedure. ..and sugars will be the same. Your complex carbs will necessarily need to be curtailed, which you are undoubly already doing with the weight loss you have already had. Hidden fats will be very difficult to avoid unless you practice this now. Generally after initial healing from surgical, a high protein diet. High protein and your tolerance beyond that.

Thank you for your response. I am in very close communication with my surgeon re the procedure/expectations from their perspective, and appreciate your thoughts from a RNY angle. Yah, bummer about the loss of raw veggies, complex carbs- a staple for me. Also the fats element which up to now has been a non issue/concern. I also understand I may have some lactose problems. So, dang, what is there left to eat in the whole wide world? Protein forward has been a mainstay with me for a long while. No doubt a new world awaits--

FWIW, 55% of of my daily intake is fat at 5 years out. I went low fat at first because my dietician recommended it, but I started eating full fat dairy by 2 months out. Sometimes, yes, I can eat too much fat at a meal-it's usually fatty cuts of beef that get me, and I feel queasy for about 15 minutes, but for the most part...I tolerate fats just fine.

I choose chicken thighs over breasts, use 90% lean ground beef, and don't shy away from bacon or pork rinds/cracklings. I use full fat dairy for cooking and I eat full fat cheese and yogurt. I eat A LOT of fat.

Thanks for the FB reference. Good point re length of the intestinal part of the procedure as impacting nutritional capabilities. Hadn't thought of that, and will ask. Best of luck on your recovery, Continue to heal well. bonnie.

Hello Bonnie:

I am sorry that you have to go through such a complicated procedure after you have been so successful with your weight loss and maintenance with VSG.

The best place to get your answers is from your surgeon, either the surgeon doing the Whipple procedure or your bariatric surgeon.

Did your surgeon draw a picture for you so that you understand the changes that will occur in your gastrointestinal tract after the surgery? I always find that a picture helps me understand things better. It helped me understand my RNY better both before and after the surgery.

On a quick review of the literature, there are very few articles on Whipple procedure following bariatric surgery. The only articles I found (only 4!) were following RNY. There were none after VSG.

If you look at the schematic at the bottom of my post, it shows the changes made in a person without previous bariatric surgery. The schematic is from The Mayo Clinic.

I would suspect that after VSG, you will still have your very small stomach that was formed when you had the VSG done. (Please confirm this with your surgeon.) I would think that after the Whipple procedure, you will still have restriction from your small stomach, but you will still have part of a stomach to absorb nutrients.

When I think about regain of weight after bariatric surgery, I think of "grazing." Perhaps, frequent small meals, if tolerated, would help you maintain your weight.

If your surgeon thinks you are going to lose a significant amount of weight from the stress of the surgery, you may want to discuss PPN (peripheral parenteral nutrition) or TPN (total parenteral nutrition) with him/her for the perioperative period. This is a serious undertaking because these require venous access into a major vein and there can be complications like infection. But, done correctly and in the right situation, it can help maintain weight during the time you can't use your own gastrointestinal tract.

These are just some thoughts . . . Once again please bring your concerns about this to your surgeon and/or to the surgeon who did your bariatric surgery.

I wish you well with your upcoming surgery.

Joyce

Appreciate your feedback. Again, I am very well informed of the procedure. I absolutely hope that I can avoid the need for PPN/TPN. You mentioned the restriction I have with the sleeve, and I know what that feels like- what I'll be loosing, that RNY's know about, is my pyloric valve- and wondering how that will impact my eating experience in a practical sort of way.

Good point about having some of my remaining sleeve to absorb some of the nutrients/mostly vitamins and minerals (won't know how much until my last contrast scan)- I am hoping to keep as much of my tummy as possible.

Thank you again for posting. Smiles your way, bonnie.

Good Luck with surgery.

Liquid and soft/slider calories go down the easiest.

obviously also choosing calorie dense foods like peanut butter and avocado.

Thank you for the well wishes. Funny about the peanut butter/avocado suggestion (Yum-yummy stuff, eh?). It reminds me of when I was about 5 years old and had my tonsils taken out. The one time in my life when I was given permission to eat all the ice cream in the world, if I wanted to, and I did not feel much like having even a little bit. Almost 60 years ago and still remember it like it was, well, you know.

I certainly hope to be able to enjoy those things in the same way Popeye likes his spinach!