Diet, orange oil, smell
1. it is ok to give my email since PM's are hard for me, so permission to post it:
[email protected]
2. do not be put off by some people's directness. try to picture yourself sliding backward into a hole and the various ppl grabbing your hands and yelling at you, "Hold on! Hold on!" The the perceived scolding becomes a yell of caring and helping.
3. again, get your op report. whatever it takes, have your pcp request it, then you don't pay per page.
4. i can see you having a rather benign rny then having it "fixed" to be more malabsorptive, but if no one explained that to you, you're left feeling stupid and out of control. Not your field of expertise. Don't talk to me about RAM and ROM and stuff, I'm totally last and revert to a kindergartener. So, no, we don't see you as stupid.
5. I am a distal RNY or ERNY, always was, since 1994. I see it as the best of both worlds, but I was armed from day one to handle most of it. Either way, what we mostly need to know is what is your common channel length. Most docs do a standard 100cm.
6. oil slicks, sharts, never trust a fart - all part of our lexicon. we all start out learning this. Process of elimination. As others said, skip red stuff for now. Let's go with meats you've cooked or jerky or cheese or eggs or any combo there of. It'll kick start your wt loss, as well.
7. when your oil is coming out, your fat soluble vites also leave town - which is where the panic in the voices originates.
8. if you email me directly, i can send you a fixit list and the labs or someone can post a link. I am traveling so other than this, am using my phone.
9. have you tried immodium? or rx diarrhea treatments?
10. by the volume of responses, ppl care. don't be put off by tone of voice. I've met so many of these ppl and the tone of voice and face would make you see that even the abbreviated questions are meant in good faith.
sorry I have to be brief. like i said, traveling, but will do the best i CAN BY PHONE emails.
They care, you came to the right place. do not be offended that docs don't know much about vites. it's not their field and if they've had any nutrition, it might be as much as 2 hours! we only rely on them for lab orders and rx.
[email protected]
2. do not be put off by some people's directness. try to picture yourself sliding backward into a hole and the various ppl grabbing your hands and yelling at you, "Hold on! Hold on!" The the perceived scolding becomes a yell of caring and helping.
3. again, get your op report. whatever it takes, have your pcp request it, then you don't pay per page.
4. i can see you having a rather benign rny then having it "fixed" to be more malabsorptive, but if no one explained that to you, you're left feeling stupid and out of control. Not your field of expertise. Don't talk to me about RAM and ROM and stuff, I'm totally last and revert to a kindergartener. So, no, we don't see you as stupid.
5. I am a distal RNY or ERNY, always was, since 1994. I see it as the best of both worlds, but I was armed from day one to handle most of it. Either way, what we mostly need to know is what is your common channel length. Most docs do a standard 100cm.
6. oil slicks, sharts, never trust a fart - all part of our lexicon. we all start out learning this. Process of elimination. As others said, skip red stuff for now. Let's go with meats you've cooked or jerky or cheese or eggs or any combo there of. It'll kick start your wt loss, as well.
7. when your oil is coming out, your fat soluble vites also leave town - which is where the panic in the voices originates.
8. if you email me directly, i can send you a fixit list and the labs or someone can post a link. I am traveling so other than this, am using my phone.
9. have you tried immodium? or rx diarrhea treatments?
10. by the volume of responses, ppl care. don't be put off by tone of voice. I've met so many of these ppl and the tone of voice and face would make you see that even the abbreviated questions are meant in good faith.
sorry I have to be brief. like i said, traveling, but will do the best i CAN BY PHONE emails.
They care, you came to the right place. do not be offended that docs don't know much about vites. it's not their field and if they've had any nutrition, it might be as much as 2 hours! we only rely on them for lab orders and rx.
Michelle
RNY, distal, 10/5/94
P.S. My year + long absence has NOTHING to do with my WLS, or my type of WLS. See my profile.
"My thought has been and is....if I had this kind of will power to give up certain foods etc I would never have needed surgery."
Again, I EXHORT you to get some mental health services in addition to medical.
You have a malabsorptive surgery - and that is what it is, pretty much just as much as if you now had ulcerative colitis or Crohn's or celiac disease. The good thing is that it allows you to eat MORE calories than you could before your WLS, albeit with a restriction on SOME kinds of foods - and yet you are complaining that you would not have had surgery if you could give up those foods?? Um, which part of the malabsorptive effects of your surgery do you not understand, and did you not understand when you agreed to have bariatric surgery in the first place? And since you could not have substituted the delicious and satisfying protein and fat-rich foods you can now eat with impunity (well, you WILL be able to eat more fat once you get your diarrhea under control), JUST EXACTLY HOW WOULD YOU NOT HAVE NEEDED SURGERY IF YOU HAD BEEN ABLE TO EXERT WILLPOWER TO NOT EAT BREAD AND PASTA WITHOUT MALABSORPTION??
I realize you are just whining now. I realize this is hard for you. But honestly, you have some underlying issues of immaturity and lack of self-discipline (perhaps related to depression) that you NEED to get help with as you get your life back under control. If you can't envision having the ability or desire to give up bread and pasta in order to stop ****ting yourself, having to wear diapers and living a lonely life, you have WAAAY more issues than just a lack of knowledge about the dietary requirements of your ERNY.
Again, when you get an appointment with your PCP, I urge you to print out and bring this thread in to show what is going on in your head, and what the experienced bariatric patients are telling you. You need help on multiple levels, and you should be getting that help immediately and simultaneously. Perhaps if you weren't so depressed, you might find it a lot easier to take care of yourself, and not find the concept of low-carb eating so daunting and unattainable. That might make the entire process of getting yourself back to a normal condition a LOT faster and easier.
Again, I EXHORT you to get some mental health services in addition to medical.
You have a malabsorptive surgery - and that is what it is, pretty much just as much as if you now had ulcerative colitis or Crohn's or celiac disease. The good thing is that it allows you to eat MORE calories than you could before your WLS, albeit with a restriction on SOME kinds of foods - and yet you are complaining that you would not have had surgery if you could give up those foods?? Um, which part of the malabsorptive effects of your surgery do you not understand, and did you not understand when you agreed to have bariatric surgery in the first place? And since you could not have substituted the delicious and satisfying protein and fat-rich foods you can now eat with impunity (well, you WILL be able to eat more fat once you get your diarrhea under control), JUST EXACTLY HOW WOULD YOU NOT HAVE NEEDED SURGERY IF YOU HAD BEEN ABLE TO EXERT WILLPOWER TO NOT EAT BREAD AND PASTA WITHOUT MALABSORPTION??
I realize you are just whining now. I realize this is hard for you. But honestly, you have some underlying issues of immaturity and lack of self-discipline (perhaps related to depression) that you NEED to get help with as you get your life back under control. If you can't envision having the ability or desire to give up bread and pasta in order to stop ****ting yourself, having to wear diapers and living a lonely life, you have WAAAY more issues than just a lack of knowledge about the dietary requirements of your ERNY.
Again, when you get an appointment with your PCP, I urge you to print out and bring this thread in to show what is going on in your head, and what the experienced bariatric patients are telling you. You need help on multiple levels, and you should be getting that help immediately and simultaneously. Perhaps if you weren't so depressed, you might find it a lot easier to take care of yourself, and not find the concept of low-carb eating so daunting and unattainable. That might make the entire process of getting yourself back to a normal condition a LOT faster and easier.
I brought your thread to Michelle's attention, and she has already responded, so I will (after this post) leave you in her capable hands. HOWEVER ...
You should be aware that the post I'm replying to crosses a bit of a line with respect to the ethos of this board. You came here, complaining that your life is a living hell - that you've had to stop working and live in adult diapers, **** yourself constantly and are living alone and are miserable. A number of people take the time and effort to post to you with encouragement, information, offering an hand and a hug, and tell you that you can be OK, that this can be fixed, as well as the TRUE and DIRE warnings that you HAVE to fix it, because you are not just ****ting yourself into a lonely life, you are DYING of malnutrition.
And your response is another complaint, that they haven't told you ENOUGH information - that we've told you what to stay away from, but not what to eat. Uh, OK ... seems to me that telling you to stick to lean proteins was the critical information you needed, but you get MORE responses, making specific suggestions.
And then your response is a petulant little foot stomp, saying you don't want to force yourself to eat foods you don't care for??? Are you ******g kidding me?? You're dying, but don't want to change your diet, even temporarily while you get your diarrhea under control, to save your life?
I'm thinking this is more than lack of education. This sounds like you need some intensive therapy, RIGHT NOW. I'm not trying to be mean, I am utterly and deadly serious, and I want to get through to you that this is a HIGHLY abnormal response to this situation. When you meet with your PCP, get a referral (if you need one) to a therapist as well. And truly, I would suggest you print out and bring this thread to your doctor so s/he can see what you are being told, and your response to it.
Good luck - you have come to the right place for help, but you have to take responsibility for the actions being taken. At the rate you are going, you are going to be dead soon, but we can't help you if you don't actually want to be helped. "You can lead a horse to water, but you can't make him think."
You should be aware that the post I'm replying to crosses a bit of a line with respect to the ethos of this board. You came here, complaining that your life is a living hell - that you've had to stop working and live in adult diapers, **** yourself constantly and are living alone and are miserable. A number of people take the time and effort to post to you with encouragement, information, offering an hand and a hug, and tell you that you can be OK, that this can be fixed, as well as the TRUE and DIRE warnings that you HAVE to fix it, because you are not just ****ting yourself into a lonely life, you are DYING of malnutrition.
And your response is another complaint, that they haven't told you ENOUGH information - that we've told you what to stay away from, but not what to eat. Uh, OK ... seems to me that telling you to stick to lean proteins was the critical information you needed, but you get MORE responses, making specific suggestions.
And then your response is a petulant little foot stomp, saying you don't want to force yourself to eat foods you don't care for??? Are you ******g kidding me?? You're dying, but don't want to change your diet, even temporarily while you get your diarrhea under control, to save your life?
I'm thinking this is more than lack of education. This sounds like you need some intensive therapy, RIGHT NOW. I'm not trying to be mean, I am utterly and deadly serious, and I want to get through to you that this is a HIGHLY abnormal response to this situation. When you meet with your PCP, get a referral (if you need one) to a therapist as well. And truly, I would suggest you print out and bring this thread to your doctor so s/he can see what you are being told, and your response to it.
Good luck - you have come to the right place for help, but you have to take responsibility for the actions being taken. At the rate you are going, you are going to be dead soon, but we can't help you if you don't actually want to be helped. "You can lead a horse to water, but you can't make him think."
Well, I don't think I questioned your honesty - and since you don't know the history of this website and the trolls (trouble-making liars who have an antipathy towards a particular surgery or WLS in general) who come and post from time to time almost EXACTLY like your initial post, you can't understand why some people questioned your honesty.
This post from you was apparently being typed as I was responding to a previous post of yours, just to be clear.
As for dying, the odds are, your PCP is woefully uneducated about how to test, much less treat a patient with a serious malabsorptive bariatric surgery. The odds are, you did NOT have adequate blood work done. The average yearly blood work for a DS patient (and presumably also for a distal or ERNY) with NO known issues requires about 14 vials of blood to be drawn - did they do that many? Were you tested for PTH - a far more sensitive measure of the status of calcium metabolism in your body? Copper? Zinc? CRP? Vitamins A, D, E and K? Was it the proper vitamin D test? I'll bet your vitamin D is in the tank, your iron is in the tank, (both iron and vitamin D levels thought to be "normal" are too low for us - we need to be higher than that, e.g., vitamin D should be over 50, more preferably over 70 to adequately absorb calcium, and not the 20-32 currently considered "adequate" for normies) and I don't know what a "densa" scan is, but it should have been a DEXA scan measuring your bone density at wrist, hip and a third place I can't remember at this moment (an arm bone, I think). Without adequate testing, after what sounds like years of malnutrition, with a background of not-in-full-remission diabetes, and at your age, it is hard to imagine you don't have some severe deficiencies going on that were not yet measured.
At the moment, you need to be on an elimination diet to get your diarrhea under control, and should not be eating much fat. However, once you get that worked out, you will be free to eat quite a bit of fat, and to never use fat-free ANYTHING ever again. Do not listen to ridiculously uneducated people like an LPN preparing to have a lapband - she knows NOTHING about your medical issues!!!
I am not trying to berate you for fun - I am seriously concerned that you and your PCP do not appreciate the full extent of the trouble you may be in, based on what you have said about how you have been living, eating and not supplementing. I want you to be WORRIED and to be very aggressive in getting your PCP on board in getting you tested, supplemented and your eating habits revised.
While I'm not sure what your surgery is compared to the ones discussed in this recent study, and you should find out EXACTLY what surgery you have, take a look at this - keeping in mind these people were much more likely to have been under CONSISTENT medical care:
Surg Obes Relat Dis. 2011 Mar-Apr;7(2):189-93. Epub 2010 Oct 11.
This post from you was apparently being typed as I was responding to a previous post of yours, just to be clear.
As for dying, the odds are, your PCP is woefully uneducated about how to test, much less treat a patient with a serious malabsorptive bariatric surgery. The odds are, you did NOT have adequate blood work done. The average yearly blood work for a DS patient (and presumably also for a distal or ERNY) with NO known issues requires about 14 vials of blood to be drawn - did they do that many? Were you tested for PTH - a far more sensitive measure of the status of calcium metabolism in your body? Copper? Zinc? CRP? Vitamins A, D, E and K? Was it the proper vitamin D test? I'll bet your vitamin D is in the tank, your iron is in the tank, (both iron and vitamin D levels thought to be "normal" are too low for us - we need to be higher than that, e.g., vitamin D should be over 50, more preferably over 70 to adequately absorb calcium, and not the 20-32 currently considered "adequate" for normies) and I don't know what a "densa" scan is, but it should have been a DEXA scan measuring your bone density at wrist, hip and a third place I can't remember at this moment (an arm bone, I think). Without adequate testing, after what sounds like years of malnutrition, with a background of not-in-full-remission diabetes, and at your age, it is hard to imagine you don't have some severe deficiencies going on that were not yet measured.
At the moment, you need to be on an elimination diet to get your diarrhea under control, and should not be eating much fat. However, once you get that worked out, you will be free to eat quite a bit of fat, and to never use fat-free ANYTHING ever again. Do not listen to ridiculously uneducated people like an LPN preparing to have a lapband - she knows NOTHING about your medical issues!!!
I am not trying to berate you for fun - I am seriously concerned that you and your PCP do not appreciate the full extent of the trouble you may be in, based on what you have said about how you have been living, eating and not supplementing. I want you to be WORRIED and to be very aggressive in getting your PCP on board in getting you tested, supplemented and your eating habits revised.
While I'm not sure what your surgery is compared to the ones discussed in this recent study, and you should find out EXACTLY what surgery you have, take a look at this - keeping in mind these people were much more likely to have been under CONSISTENT medical care:
Surg Obes Relat Dis. 2011 Mar-Apr;7(2):189-93. Epub 2010 Oct 11.
Long-term results of malabsorptive distal Roux-en-Y gastric bypass in superobese patients.
Kellum JM, Chikunguwo SM, Maher JW, Wolfe LG, Sugerman HJ.Source
Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA. [email protected]
Abstract
BACKGROUND:
The purpose of the present study was to evaluate the safety, efficacy, and nutritional outcomes of malabsorptive distal Roux-en-Y gastric bypass (D-RYGB) 20-25 years later at a university hospital.
METHODS:
From 1985 to 1989, 49 mostly superobese (body mass index >50 kg/m(2)) patients had undergone D-RYGB. D-RYGB consisted of open laparotomy with a 50-mL proximal gastric pouch and gastroenterostomy performed 250 cm proximal to the ileocecal junction, with common channels of 50-150 cm. These 49 patients were compared with a similar group of 92 consecutive patients who had undergone long-limb RYGB, with a 75-cm biliopancreatic limb and 150-cm alimentary limb.
RESULTS:
The mean ± SD preoperative body mass index was 58.9 ± 9.3 kg/m(2). After 1 perioperative death secondary to pulmonary embolism, limb-lengthening revisions were required in 21 (43.7%) of the 48 remaining patients for protein-calorie malnutrition. Of the 23 with a 50-cm common channel, 13 required revision compared with 8 of 25 with ≥100-cm common channel (P 5 years of follow-up. Of the 48 patients who had undergone D-RYGB, 8 had died 6-19 years after D-RYGB. Of the nonrevised patients, 19 (70.4%) of 27 had >5 years of follow-up. In these, the latest body mass index was 34.2 kg/m(2) at 10 ± 6.1 years. The percentage of excess weight loss was 66.8% ± 14%. The lowest late serum albumin level was 3.4 ± .5 g/dL (range 2.3-4.4). The mean 25-hydroxy vitamin D level was 14.6 ± 11.3 ng/mL. Compared with patients who had undergone long-limb RYGB, the D-RYGB patients had a significantly greater percentage of excess weight loss after 5 years but significantly lower albumin, hemoglobin, iron, and calcium levels.
CONCLUSION:
Although D-RYGB afforded superior long-term weight loss, it caused protein-calorie malnutrition requiring frequent revision. The nonrevised patients had frequent severe metabolic derangements. Thus, D-RYGB should not be the primary operation for morbid or superobese patients.
EDITED BECAUSE THE MOST IMPORTANT LANGUAGE IN THE RESULTS SECTION MYSTERIOUSLY DISAPPEARED WHEN I POSTED - THE PART ABOUT DYING!!
On July 18, 2011 at 1:35 AM Pacific Time, WinkNAsmile wrote:
Hmmm if you are telling the truth you are something of a professional student.I don't see anything in your credentials that really qualifies you to give the advice that you do.
Get a clue. People seeking multiple, advanced degrees, like law or medical degrees, are not "professional students." What are YOUR credentials, sweet pea? "Queen of the Morons" is NOT a legitimate degree even at the best of the online universities, just so you know.
You say you have a problem and I see lots of people jumping in to help you. Apparently they are wasting their time. You do NOT want to be helped. You want to whine and complain. Fine. Slip into dehydration, malnutrition and death. Be my guest. Just do it quietly, without dragging others into it.
You are too old to be this uneducated. How on Earth did you pass even the most rudimentary psych evaluation? Shame on you, Dr. Sudan, for letting this nutter through the gates!
Nicolle
I had the kick-butt duodenal switch (DS)!
HW: 344 lbs CW: 150 lbs
Type 2 diabetes and sleep apnea GONE!
Hah - in addition to deleting her whining posts that disclose that she spends all day alone, unemployed, sitting in an adult diaper, in a pool of stinky orange oil **** she's blocked me for being too MEEEAAANNN to her - i.e., telling her the truth, bluntly, that she needs therapy in addition to medical help.
Uh, let's see: "You might need therapy if ...."
* You are a supposedly educated person, a professional with a (former) career in IT, who doesn't know what surgery you had
* You are a supposedly educated person, a professional with a (former) career in IT, who doesn't know what the rules and requirements were for how to eat and supplement with your surgery
* You are a supposedly educated person, a professional with a (former) career in IT, who doesn't know how to use the internet to search for help
* You are a supposedly educated person, a professional with a (former) career in IT, who doesn't know that you should probably get medical help if you are ****ting orange oil and need a diaper, for years
* You are a supposedly educated person, a professional with a (former) career in IT, who decided that quitting your job rather than seeking medical help was the answer to the problem of ****ting orange oil and spending your life alone and sitting in an adult diaper in a pool of stinky orange oil
* You are a supposedly educated person, a professional with a (former) career in IT, who doesn't know that when you come begging for help on an internet forum, and you get that help - even if you don't like the information and/or the tone of voice - you say "thank you" not "fuck you"
* You are a supposedly educated person, a professional with a (former) career in IT, who doesn't know that you don't get to be a forum nanny when you first join a forum - or, for that matter, EVER
* You are a supposedly educated person, a professional with a (former) career in IT, who doesn't know the difference between suggesting that you seek therapy, and diagnosis - especially when more than one person says the same thing
Anyway, you should read the indignant "fuck you" PM she sent me, and then immediately blocked me so I couldn't respond. Oh wait - I just did.
The 5 stages of grief (at having the wrong surgery, at what she has allowed her life to come to, at having to face the facts and either take charge of her life or die):
Denial - it's not just a river in Egypt - she's fully there - doesn't think it's all that serious
Anger - she's mad at ME for telling her the truth
Bargaining - she wants to be told she can still eat what she wants to eat
Depression - uh, yeah, that's my "diagnosis" of her inability to deal with ANY of what's wrong with her, and her inappropriate responses to the help she has received
Acceptance - she ain't there yet
Oh well - can't save them all. On to the next one.
Uh, let's see: "You might need therapy if ...."
* You are a supposedly educated person, a professional with a (former) career in IT, who doesn't know what surgery you had
* You are a supposedly educated person, a professional with a (former) career in IT, who doesn't know what the rules and requirements were for how to eat and supplement with your surgery
* You are a supposedly educated person, a professional with a (former) career in IT, who doesn't know how to use the internet to search for help
* You are a supposedly educated person, a professional with a (former) career in IT, who doesn't know that you should probably get medical help if you are ****ting orange oil and need a diaper, for years
* You are a supposedly educated person, a professional with a (former) career in IT, who decided that quitting your job rather than seeking medical help was the answer to the problem of ****ting orange oil and spending your life alone and sitting in an adult diaper in a pool of stinky orange oil
* You are a supposedly educated person, a professional with a (former) career in IT, who doesn't know that when you come begging for help on an internet forum, and you get that help - even if you don't like the information and/or the tone of voice - you say "thank you" not "fuck you"
* You are a supposedly educated person, a professional with a (former) career in IT, who doesn't know that you don't get to be a forum nanny when you first join a forum - or, for that matter, EVER
* You are a supposedly educated person, a professional with a (former) career in IT, who doesn't know the difference between suggesting that you seek therapy, and diagnosis - especially when more than one person says the same thing
Anyway, you should read the indignant "fuck you" PM she sent me, and then immediately blocked me so I couldn't respond. Oh wait - I just did.
The 5 stages of grief (at having the wrong surgery, at what she has allowed her life to come to, at having to face the facts and either take charge of her life or die):
Denial - it's not just a river in Egypt - she's fully there - doesn't think it's all that serious
Anger - she's mad at ME for telling her the truth
Bargaining - she wants to be told she can still eat what she wants to eat
Depression - uh, yeah, that's my "diagnosis" of her inability to deal with ANY of what's wrong with her, and her inappropriate responses to the help she has received
Acceptance - she ain't there yet
Oh well - can't save them all. On to the next one.
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