Angus Wright

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I went to work yesterday afternoon as I normally would, but had a spell where I felt like my blood sugars were dropping. I stopped to pick up some food, and to try and get back to normal. I ended up being taken to hospital by ambulance. 

After hours of waiting, and tests, I was diagnosed with Postprandial Hypoglycemia. 

I found this information on it, and thought I would highlight some interesting things here: 

Hypoglycemia in People Who Do Not Have Diabetes

Two types of hypoglycemia can occur in people who do not have diabetes:

• Reactive hypoglycemia, also called postprandial hypoglycemia, occurs within 4 hours after meals.
• Fasting hypoglycemia, also called postabsorptive hypoglycemia, is often related to an underlying disease.

Symptoms of both reactive and fasting hypoglycemia are similar to diabetes-related hypoglycemia. Symptoms may include hunger, sweating, shakiness, dizziness, light-headedness, sleepiness, confusion, difficulty speaking, anxiety, and weakness.

To find the cause of a patient’s hypoglycemia, the doctor will use laboratory tests to measure blood glucose, insulin, and other chemicals that play a part in the body’s use of energy.

Reactive Hypoglycemia

Diagnosis
To diagnose reactive hypoglycemia, the doctor may

• ask about signs and symptoms
• test blood glucose while the patient is having symptoms by taking a blood sample from the arm and sending it to a laboratory for analysis^*
• check to see whether the symptoms ease after the patient’s blood glucose returns to 70 mg/dL or above after eating or drinking

A blood glucose level below 70 mg/dL at the time of symptoms and relief after eating will confirm the diagnosis. The oral glucose tolerance test is no longer used to diagnose reactive hypoglycemia because experts now know the test can actually trigger hypoglycemic symptoms.

Causes and Treatment
The causes of most cases of reactive hypoglycemia are still open to debate. Some researchers suggest that certain people may be more sensitive to the body’s normal release of the hormone epinephrine, which causes many of the symptoms of hypoglycemia. Others believe deficiencies in glucagon secretion might lead to reactive hypoglycemia.

A few causes of reactive hypoglycemia are certain, but they are uncommon. Gastric—or stomach—surgery can cause reactive hypoglycemia because of the rapid passage of food into the small intestine. Rare enzyme deficiencies diagnosed early in life, such as hereditary fructose intolerance, also may cause reactive hypoglycemia.

To relieve reactive hypoglycemia, some health professionals recommend

• eating small meals and snacks about every 3 hours
• being physically active
• eating a variety of foods, including meat, poultry, fish, or nonmeat sources of protein; starchy foods such as whole-grain bread, rice, and potatoes; fruits; vegetables; and dairy products
• eating foods high in fiber
• avoiding or limiting foods high in sugar, especially on an empty stomach

The doctor can refer patients to a registered dietitian for personalized meal planning advice. Although some health professionals recommend a diet high in protein and low in carbohydrates, studies have not proven the effectiveness of this kind of diet to treat reactive hypoglycemia.



More info can be found at http://www.reactivehypoglycemia.net/postprandial-hypoglycemia.html

Here are some truths about my Duodenal Switch: 

1. I wake up in the morning, I pee, and I poo. It's not crazy stinky poo that melts the walls (unless I eat bread), it's not a substantial amount of poo. I call it my "bowl of commas" because it looks like a bunch of punctuation when I'm done. TMI, but a fact nonetheless. I may poo 1 or 2 more times that day, but again, it's quick, not everly messy, and I don't even have time to read a magazine like I used to. 

2. I have some breakfast. Sometimes it's cereal, alot of times I have a "Burger First" bun from PC toasted with Peanut Butter. If I have coffee, I'm guaranteed to poo again almost right away... not because it goes right through me, just triggers something I guess, but that counts as one of my poos. 

3. I snack throughout the day, but usually a handful of nuts, some fruit, maybe a cookie or two. That's right, cookies. I pick ones that are low in sugar (arrowroot) and that's good by me. 

4. I eat a light lunch. Everything I eat is light, I don't pack it away. 

5. I have a light dinner. Last night, for example, I had nachos with chicken on it, and a starter size of chicken wings. I ate about 3, and shared the rest with my table. It was delicious. 

6. I don't have to eat thousands of calories to survive. I don't have to eat lots of fatty foods to survive. I eat what normal people eat. I even have dessert if the mood hits me. 

7. I can ride my bicycle, and love to. 

8. I can walk, and love to. 

9. I can dance a jig with my puppy, and it makes my life rich. 

10 I have a big penis. There, I said it. The thing is huge. I didn't know this until I lost 196lbs. It scares my husband. He feels like it's following him around the room. It is. Too much info? Maybe, but damn... I'm impressive. 

11. I can fit in clothes. I went shopping down east at Frenchies, a second hand store. For $100 I bought a dozen or more shirts and sweaters, and my fave, hoodies. For $100 I used to be able to get 2 shirts. 

12. I have an adam's apple. It sticks out and is hard as a rock. It startles me when I feel it. 

13. I have a neck that is smaller than my head. 

14. I have a great set of boobs now thanks to the extra skin from the 196lbs of weight loss. I'm pretty sure if I shaved my chest, I could score with Bruce. 

15. I absolutely love my surgery, my doctor, my surgeon, and all the people who support me, including OHers. I am growing to dislike people who lie about my surgery. It affects me personally. 

16. I have many more truths about my surgery, and am happy to share them with people.  

 2008    It has been quite the year when I sit down and think of it.    For the first 6 months or so of there year, everything was normal, as it had been in the years leading up. I enjoyed life, going to work, coming home, hanging out with friends and neighbours and planning for the wedding to come later in the year.    I struggled though. I was 517lbs, and tired. My body had all but given up. I had a hard time sleeping at night, and had to increase the pressure on my CPAP machine to accomodate. I withdrew a lot from Shawn because I didn't feel sexy, or sexual, and I couldn't fit into most of my clothes. I was reaching a point where I couldn't even buy new ones locally because they just didn't go up to my size anymore.    In June I decided that I had enough of the discomfort, and feeling down about myself, and pursued the idea of having a Duodenal Switch. I had a friend who had a weight loss surgery and who offered me some information on it previously, so I contacted her and started the process.    Cindy (my friend) met me for lunch one day to answer any of my questions. It was nice to see her, and catch up on old times, and I remember feeling a bit jealous of her weight loss, wishing I had done this a lot sooner.    So, I went through the process. I saw my doctor, had the application for out of country surgery filled out, and applied to OHIP for the surgery. About a month later, I was in the surgeons office, and a month later I was in hospital recovering from the surgery.    That was August 14th.    In the meantime, Shawn and I had bought our dream property in a very fast, and by the seat of our pants process. We'd fallen in love with the place, and while we had no plan to move, we had to do it.    So, on September 5th, we were taking posession of our new home, in the country.    October 12th, Thanksgiving Sunday, Shawn and I got married. The day couldn't have been more perfect, and having our friends and family together in one spot was a once in a lifetime experience, that will always be special in my eyes.    Soon after the wedding, we adopted Ana, a rescue puppy. Since then, she's been so wonderful to have as part of the family, and I couldn't be happier.    Luckily, November was quiet, and same with December except for a strike at work.    Our first Christmas in the new home was nice, with a wood burning fireplace, and good food and friends sharing the day. Boxing day came with 3 great friends arriving from Cambridge for a nice getaway, and the new year has come and gone with us surrounded by those we love.    Today is the first day of 2009, and I can only imagine what this new year is going to bring. I look forward to it all. I hope for all the love and hapiness for everyone else, that I have felt in this past year.    Good things are coming.... I can feel it.   

I'm 6 weeks out, and last night I made a Shepherd's Pie. I ate quite a bit of it, and no ill side effects, so I thought I'd post it. 


Aggie's Post DS Shepherd's Pie!

BEEF LAYER

2lbs ground beef (I used organic beef)
1pkg Onion Soup Mix
1 small can of beef broth

Brown beef in a frying pan, no oil. Once browned add onion soup mix and broth. Spread in the bottom of a pan sprayed with Pam

CORN LAYER

1 small bag of corn niblets
1 large can of cream of corn

Mix the two together in a bowl and spread mixture on the top of the beef. 

POTATO LAYER

8-10 small potatoes peeled
1/2 - 3/4  tub of sour cream
pepper to taste
plenty of summer savory (I used my mama-in-law's dried savory)
shredded mozzerella
shredded cheddar

Cook potatoes until soft. Mash them down with a masher. 
Add the sour cream, pepper, and savory and beat until smooth with a beater. 
Fold in the cheeses and spread mixture on top of corn  layer. 

Bake in an oven at 350 degrees for about 30-45 minutes. 

This fed 4 chubby adult men, and me, and I had half left to freeze for future meals. 

ENJOY!

  I had a moment tonight. I was sitting on the bed, and going through bags and boxes of clothes to put away. We finally picked up a couple of dressers from Ikea, so it was the first opportunity to put it away. 

Anyway, I'm sitting there folding shirt after shirt and putting them away. I filled two drawers full of shirts, and haven't made a dent. 

Then it dawned on me. This is the first time I've had so much clothing that actually fits. I'm used to buying stuff, and then having it sit there because I gained weight. Trying things on, and having to toss it back into the closet for another day. 

Not anymore. I now have more clothes than I have ever had. 

Alot of it will be going soon because it's too big. Some of it is just way too baggy now. I put on my uniform, one that I could barely get into, and now I swim in it. 

I felt really good about that. 

I wanted to share! 

xoxo Angus 


cross posted for my gays, ontario group, ds, and the men. 

The morning of surgery we had to be up very early. I don't remember a lot about it, other than waking up, and driving to the hospital. On the way there, I took everything in. Made sure to look at all the homes, and roads, and buildings. I wanted to see everything.

Part of me was nervous that I wouldn't make it through. This is normal. You can't have someone tell you the worst possibility and not have it run through your head.

Shawn and I pulled up to the hospital, and walked into the surgery area. Then he left to get breakfast and cash for the day while I sat and watched staff come in. It was 5am.

A nice lady admitted me, and asked my details, and then I was taken in for prep. I stripped down, put all of my belongings into a big old clear plastic bag, and put on the giant gown provided.

I got into bed, and had all my vitals checked out. They had a tv, so I watched Home and Garden shows while going through this. Shawn arrived, and then Dr. L came by too. Then Dr. Wong (I think) who was the guy who'd be knocking me out, and his assistant came in.

The assistant gave me something to take the edge off, and boy did it work like a charm.

I don't remember saying goodbye to Shawn, and I only remember bits of going into the OR, listening to them get everything set up. I was too tall for the table though, I remember that.

Next thing I remember is waking up and being so happy that I was alive. I had tubes, and wires, and drains, and pee tubes all over the place, and seeing Shawn's face was the best thing ever.

The nurses in ICU are amazing! I've never been treated so nice. My cathater stopped working, so when that came out all crystalized, well that tingled, and I managed to pee, which meant it wouldn't have to go back in.

I pushed my pain button on a regular basis, not because I was in pain, but I was nervous I'd feel pain. My blood pressure was high, but they had it under control.

Considering that I was over 510lbs, I was getting around pretty good once out of ICU.

I had my own room, mainly because the hospital bed they gave me blocked access to the rest of the room, so that was cool. I had free tv somehow, so that was on all the time... you guessed it HGTV.

Only negative experience was when Shawn forgot his cell phone in the public washroom, and someone took it. Even though we called it several times, they would send it to ignore. Pretty low down to take someone's phone in a hospital of all places.

Once I was able to be released and go back to the hotel, I was so happy. Shawn picked me up, I wore real clothes, and did the same drive back to the hotel. I looked at everything along the way with a new sense of life.

Back at the hotel, we had new friends we'd made there, Natasha and David. Tash had her surgery the day before. I have to say that I have never been so appreciative of the support and unconditional love as those two. The four of us had a blast, and helped each other out. We miss them horribly now, but we know we've made life long friends.

We met so many new faces at the hotel while there, and I have to say, this board has made that possible. Each person we met was truly amazing, and sweet, and such a value to each other. We are richer having met them, and look forward to sharing their journies as well.


The Drive Home

The long drive back home was good but long. I ended up with some leg pain as a result of sitting in the car, even though I got up and moved around several times.

Home

Our kitties missed us big time, and it's been crazy getting ready for the move, and everything. I'm frustrated most of the time because I can't do anything to help. But it's all going good. We're out of here Thursday, and into the new house next Friday.

I'm eating bits and pieces. Alot of applesauce, and I found strawberry sauce too (looks like applesauce). I've tried some canned turkey, and tonight I'm going to try tuna.

I'm pretty much off the pain meds at this point, and all of my staples are out as of yesterday.

I went to Montana's last night to celebrate Shawn's birthday, and had the chicken noodle soup. I just ate the broth, chicken, and some carrot from it, and it worked out nice.

That's about it for now. Thanks to Cindyloubear for being my angel during this ride. She's been awesome.

xoxo

Today I woke up at 6am, and decided to do the bowel prep before I woke up too much to realize how evil it is.

I took it all at once and then chugged a huge amount of water. The stuff tasted gross, but my morning breathe was gross to begin with so it took the edge off it.

Thirty minutes later it began. Every 10 minutes, then every 15, then every 20, etc until it seemed to be all out.

Then I met with Dr. L at the hospital, and got the run down of all the risks etc. I was at ease and scared all at the same time but I feel confident about it.

I've been on liquids all day, and it's not as bad as I thought it would be. I'm just low energy.

We went to Target and I bought a Magic Bullet. It should work out nice for protien and stuff.

I bumped into nbonany's hubby Dave at the hospital today. She's doing well. Was really cool to see him there, waiting patiently to see her. I can't wait to meet her!

I wish I have had more of an opportunity to update here. In the past month I have been in a bit of a blur getting ready for surgery, but also preparing for a move. Shawn and I bought our dream home, and move into it about a week after we get home.

TESTS:

I got all the needed bloodwork, EKG, Ultrasound, and bone density test as required, and all of the results got back to my doctor.

At the last minute, I got a call from Julie in Dr. L's office saying she hadn't received the results, so I requested my doctor's office to fax them.  What they sent was garbage, and long story short we ended up having to come a day early to hand deliver the results.

If I had it to do over again, I would suggest requesting a copy from the doctor, and sending them by courier myself.

Crossing the border was a bit of a hassle in the morning traffic with the worry about being late. But I made it on time.

PRE-SURGERY INFO:

Julie, Shawn and I sat down and reviewed all of the information and vitamin info. I'm lost when it comes to vitamins. But we went to this place near the Great Lakes Crossing Outlet Mall, and I got what I'll need for the month.

I also got a pair of walking shoes from the Nike outlet, and a couple of sets of pj shorts to wander around in.

DRURY:

The room is great! It's cozy, and the washroom is well laid out. No complaints there. They have snacks and drinks, a pool, and hot tub. Who could ask for more?

Tomorrow I meet with Dr. L at the hospital. I'm a bit nervous about it because I only lost 7 lbs of the 20 he asked for, but I think I had lost more and then had a bad few days of quick eating and panic last times eatings.

So pooped, but looking forward to doing this.

Tomorrow is bowel prep, seeing the doc, and all liquids, all day. Shoot me now :)

“BPD/DS Basics”

* Consume only the foods allowed on the soft diet (approximately 3 weeks)

until otherwise informed by RD/MD.

* Eat slowly and chew thoroughly!

* Avoid concentrated sugars; they are filled with non-nutrient calories and

will slow down weight loss.

* Avoid high fat foods; they can lead to diarrhea, gas, and malaise.

* Do not drink large amounts of liquids with your meal or just before eating.

If you fill up on liquid, you will not have room for the meal.

* Remember the stomach can only hold 4-6 oz after surgery. You will

probably feel satisfied after 2-3 tablespoons of food. Do Not Overeat! Over

time your stomach will stretch. It takes 6-9 months (possibly longer) for your

new stomach size to stabilize and allow you to determine your normal meal

amount.

* Stop eating when you feel comfortably satisfied- if ignored, vomiting will

follow and you can stretch the size of the stomach. If you are unable to keep

anything down and are having extreme difficulty staying hydrated, sip on

Gatorade which also has electrolytes necessary for normal cell function.

* Drink at least 6 - 8 cups (8oz) of fluid per day to prevent dehydration.

(Monitor for the following signs: headache, dizziness, nausea, lethargy, lower

back pain, a white-ish coating on the tongue and dark urine.)

* Eat 3 high protein nutrient dense meals +1 high protein snack a day. Avoid

frequent snacking which can eventually lead to weight gain.

* Meals and snacks should include foods high in protein. Protein is required

to preserve muscle mass and promote wound healing. Aim for 50-70gms per

day for the first few weeks after surgery.

*Introduce new foods one at a time in order to rule out an intolerance. If a

food is not tolerated, reintroduce it in 1 week.

*If you cannot tolerate dairy, substitute Lactaid for milk. You may need to

take Lactase pills with dairy to help digest the lactose.

*Exercise! This is the key to long term weight loss and maintenance. Walking

should be the main exercise for the first 6 weeks. Between 6-8 weeks, more

strenuous exercises can be added.

3

Biliopancreatic Diversion / Duodenal Switch

Your diet progression during and after your hospital stay:

 Bariatric Surgery Clear Liquids – First 2-4 meals. You are on this diet immediately

after surgery. It is composed of clear, sugar free fluids.

• You will be drinking water, tea, broth, and Gatorade (has . the sugar of

juice).

• Try to sip fluids at the rate of . to 1 oz per 20 minutes (=1 . to 3 oz per

hour).

• You will also receive sugar free jello.

• Sipping fluids out of bottles or straws may cause gas. Gas is already a

problem after surgery so you will not want to make it worse.

*Gatorade is offered in the hospital and should be discontinued when you return home. If you experience

diarrhea or vomiting, Gatorade can be used during that time to help re-hydrate.

 Bariatric Surgery Pureed – After you tolerate clear liquids you will progress to a diet

composed of pureed foods low in fat and with no sugar. You will remain on this diet

until you get discharged.

• You will be given foods like cottage cheese and unsweetened applesauce.

• You will only be able to eat a few tablespoons of food, but the hospital will

give normal sized portions.

• It is up to you to control how much you eat.

 Home diet part 1 - You will be discharged on this diet and follow it until your RD or

MD says otherwise. Approximately 3-4 weeks.

• Unsweetened applesauce, ripe bananas

• Meatloaf, moist fish, eggs

• Low fat cottage cheese, sugar free puddings

• Oatmeal, crackers

• Soft cooked vegetables (no corn)

 Home diet part 2– If all foods above are tolerated, you will gradually advance to this

stage. This is a modified diet which emphasizes lean protein, fruits/vegetables, and

whole grains and de-emphasizes fat and sugar.

• This stage is very individualized. It is normal to experience an intolerance to

food. Try to reintroduce that food a week later while focusing on eating

slowly, chewing thoroughly, and not overeating.

• You will eventually be able to tolerate a variety of foods from each of the

food groups.

4

Food Suggestions for Soft Diet

(Home diet part 1/first 3-4 weeks)

Food Group Acceptable Food Choices

Bread, Cereal,

Pasta, and Rice

1-2 serving/d 1= .- . cup

Hot cereal (make with milk)– unsweetened oatmeal,

cream of wheat, and grits. Crackers.

Fruit

1-2 serving/d 1 = .- . cup

Unsweetened applesauce, canned / jarred peaches and

pears in their own juice (not syrup), any fruit pureed with

out the skin, mashed ripe banana.

Vegetable

1-2 serving/d 1 = .- . cup

Any vegetable (except corn) cooked soft. Canned

vegetables. Make sure broccoli and cauliflower are

cooked very well. Baked and mashed potatoes are well

tolerated with out skin.

Meat, Poultry, Fish,

Nuts, Beans and Eggs

2-3 serving/d 1 = .- . cup

Chopped up soft poached eggs, scrambled eggs. Egg

salad with low fat mayo, boiled eggs. Moist fish or

seafood and tuna salad with low fat mayo. Well cooked

non fat beans (beware of gas). Very soft/moist reduced

fat meatloaf, gefilte fish, and tofu.

Milk, Cheese, and

Yogurt

3-4 serving/d 1 = .- . cup

Low fat or non fat cottage cheese or ricotta cheese, sugar

free custards and puddings, non-fat unsweetened / sugar

free yogurt (Dannon Light and Fit , Colombo Light ,

non-fat Total ), sugar free frozen yogurt, and sugar free

fat free ice cream.

Fats and Oils Limit all

Soups (no chunks of meat) - limit cream soups – Healthy

choice , Progresso Lite , and Healthy Request , egg

drop soup and miso soup. Sugar free jello, sugar free

popsicles (Dole , Starburst ), Pedialyte  popsicles,

sugar free/fat free ice cream. Artificial sweeteners which

are acceptable: Nutrasweet/Equal , Sweet and Low /

Saccharine, Splenda /Sucralose.

Miscellaneous

2-3 servings/d 1 = . - .

cup

Liquids (sip as much liquid

as you can tolerate. Do not

drink during meals. Try to

drink at least 6 to 8 8oz cups

of fluid per day)

Flat diet soda, Skim milk or Skim Plus , Crystal Light

, Gatorade , decaf coffee and tea, all broths, any

sugar free beverages (sugar free Kool Aid and sugar

free Tang , Glaceau Vitamin Water , and water!)

 Always eat the protein first (milk, cheese, fish, eggs…)

 Avoid drinking fluids . hour before meals and snacks

 The goal is to drink at least 4 ounces (1/2 cup) of acceptable fluids every hour

 Do not overeat… when you are full, stop eating

 Meats and Chicken can be eaten if blended

5

Sample Menus (1)

(first 3-4 weeks)

Breakfast 8 AM Breakfast 8 AM Breakfast 8 AM

. cup of hot cereal with .

cup skim plus milk

. - . banana

1 scrambled eggs with 1

oz of cheese

. cup of oatmeal with .

cup skim plus milk

. - . banana

Supplement 10 AM Supplement 10 AM Supplement 10 AM

1 cup skim plus or skim

Lactaid milk with 2 scoops

of acceptable protein

powder

1 cup skim plus or skim

Lactaid milk with 2 scoops

of acceptable protein

powder

1 cup skim plus or skim

Lactaid milk with 2 scoops

of acceptable protein

powder

Lunch 12 PM Lunch 12 PM Lunch 12 PM

. - . cup of soup

2 oz of tunafish with low

fat mayo

. cup of cottage cheese

. - . cup cut up melon

. cup egg salad with low

fat mayo

. - . cup of low fat yogurt

Snack 2 PM Snack 2 PM Snack 2 PM

. cup of yogurt

sugar free popsicle

. cup of soup

1 oz of low fat cheese

Dinner 6:00 PM Dinner 6:00 PM Dinner 6:00 PM

2 oz of soft white fish

. - . cup Low fat cream

of spinach

2 oz soft meatloaf

. - . cup pureed broccoli

2 oz soft white fish

. - . cup vegetable

soufflé

6

Sample Menus (2)

(first 3-4 weeks)

Breakfast 8 AM Breakfast 8 AM Breakfast 8 AM

. cup low fat yogurt

. - . cup cut melons

1 egg omelet with 1 oz low

fat cheese and . cup well

cooked spinach

. cup cold cereal with .

cup skim plus milk (let it

sit to soften up)

. - . banana

Supplement 10 AM Supplement 10 AM Supplement 10 AM

1 cup skim plus or skim

Lactaid milk with 2 scoops

of acceptable protein

powder

1 cup skim plus or skim

Lactaid milk with 2 scoops

of acceptable protein

powder

1 cup skim plus or skim

Lactaid milk with 2 scoops

of acceptable protein

powder

Lunch 12 PM Lunch 12 PM Lunch 12 PM

. cup well cooked

vegetables

. cup marinated tofu

2 oz canned salmon

. - . cup mashed potato

. cup steamed tofu with

brown sauce on the side

. cup beans

Snack 2 PM Snack 2 PM Snack 2 PM

. cup sugarfree pudding

1 small sweet potato with

out skin

1 small sweet potato with

out skin

Dinner 6:00 PM Dinner 6:00 PM Dinner 6:00 PM

. - 1 tofu/veggie burger

. - . cup low fat creamed

spinach

. cup mixed beans

. - 1 small baked potato

(no skin) with 2

tablespoons low fat sour

cream

2 oz gefilte fish

. - . cup vegetable

soufflé

7

Most of these foods and beverages are filled with “empty” calories in the

form of sugar. These products provide mainly calories with limited

nutritional value (for ex. vitamins, minerals, protein and fiber.) Every bite

counts after surgery. The above nutrients need to be adequately supplied

through the diet in order to replace those lost from malabsorption. Filling up

on these “concentrated sweets” can prevent weight loss and can replace

healthier foods in your diet.

Artificial sweeteners such as nutrasweet/Equal ®, saccharine/Sweet & Low

®, or sucralose/Splenda ® are OK to use.

Foods to avoid

Ice cream Regular soft drinks

Chocolate milk Lemonade

Pudding Kool aid

Sweetened, fruited or frozen yogurt Sugared ice tea

Dried fruits Snapple or fruit drinks

Canned or frozen fruits in syrup Table sugar

Fruit juice Honey

Sugar coated cereal Candy

Doughnut Regular Jell-O

Popsicles Sugar gum

Cakes Molasses

Pies Syrups

Cookies Sherbet / Sorbet

Jellies Jams

Concentrated Sweets

8

Diet Progression for Duodenal Switch

*This is a general guideline of when to introduce various foods. Everyone is

different and may not progress at the same rate.

• Day 1 Post-op: Nothing by Mouth.

• 2-3 Days Post-op: Progress from Clears to No Concentrated

Sweets, Low Fat Puree Diet. Try to consume 4oz of fluid every

hour you are awake.

• 4 Days to 4 Weeks Post-op: Modified Soft Diet (no beef or

poultry unless ground, avoid raw fruits and vegetables except

mashed banana, blended fruit, or canned fruit). Try to consume

4-6 oz of fluids every hour. You should be able to eat 4-6 oz of

food per meal (size of baby food jar).

• 4-6 Weeks Post-op: Poultry (no skin), soft fruits and

vegetables, thinly sliced deli turkey or ham, boiled chicken in

broth, crisp toast, soft pasta, tempeh, veggie burgers, imitation

crab, shrimp, fish filet such as sole, flounder, and red snapper.

• 8 Weeks Post-op: Crunchy fruits and vegetables. Bread.

• 3-4 Months Post-op: Lean and moist veal, beef, turkey,

chicken, and duck. Choose poultry and fish more often- red

meat is higher in fat and more difficult to digest).

• 1 Year Post-op: You should be able to consume foods from all

6 food groups. Your stomach capacity should be about the size

of an entrée per meal.

The diet should always be high in protein and low in fat and

refined carbohydrates. Protein first, then fruits and

vegetables, and then whole grains.

9

Biliopancreatic Diversion / Duodenal Switch Surgery

You will require vitamin and mineral supplements for the rest of your life in order to prevent

deficiencies. You will not be absorbing all the nutrients you ingest from food, therefore extra

vitamins, minerals and protein are required.

First 3 weeks after surgery:

• Chewable Multi-Vitamin: Flintstones Complete or Centrum Jr. with Iron

(Chew 1 in the AM and 1 in the PM- best if taken with food)

• Chewable Calcium: Tums, Viactiv, Bariatric Advantage

(Chew 1 with each meal = 3 per day)

• ADEK’s: ( By AxcanPharma) To order call 1-800-472-2634 Ext: 3 or

online: www.axcan.com

(Chew 1 tablet 3 times/ day with food or take 1ml of the liquid 3 times/day with food)

• Protein shakes: These must be high protein (at least 15 grams/serving) AND low

sugar (less than 6 grams/serving). You must read product labels to determine

the nutritional value. There are 2 types of protein shakes 1) pre-mixed-

Some brands are: Atkins, Myoplex Low Carb, Perfect Zero Carb Isopure and

2) powders that need to be mixed with milk- Some brands are: Designer Protein,

GNC Challenge 95, Whey Supreme, Revival Soy, Lindora. Directions for

powders: Add protein powder by the scoop/tablespoon to 8 oz Skim Plus Milk,

Skim Milk, or Fat Free Lactaid daily.

3 Weeks after surgery:

• Multi-Vitamin: Centrum Silver (tablets/chewables), Geritol Complete

(1-2 daily with food, chewables are best absorbed. Avoid time-released Multivitamins)

• Calcium: Citracal, Posture D, Cal Apatite, Chewable Calcium Citrates: Twinlabs /

Bariatric Advantage / NSI. Calcium should be in the Citrate form, Carbonate is not

absorbed as well. (Aim for at least 1200 mgs of calcium daily in 2 doses, best absorbed with food)

• ADEK’s : see above

(continue same regimen)

• Iron: Repliva 21/7, Niferex Gold (iron will be prescribed by your surgeon)

(1 per day on an empty stomach. Do not take with milk, calcium, coffee, tea, or antacids! )

• Protein: supplements as above

(If unable to consume 80-120 gms of protein / day from diet, then protein supplement may be

indicated. The amount needed depends on size and gender. Check with MD or RD)

*Labs will be followed and other supplements may be prescribed as needed.

10

PROTEIN POWER

Food Name Portion Cals Pro gm

Beans, Cnd, Baked 1/2 cup 123 7

Beans, Kidney, Cnd 1/2 cup 112 8

Beef Eye of Round 3oz. 143 21

Beef Top Loin 3oz. 176 21

Cheese, American Fat Free 1 oz. 40 6

Cheese, Cottage, 1% Fat 1/2 cup 82 14

Cheese, Cottage Creamed 1/2 cup 109 13

Cheese, Parmesan, Grated 1/4 cup 128 12

Cheese, Mozzarella, Part-skim 1 oz. 78 8

Cheese, Ricotta, Part skim 1/2 cup 170 14

Cheese, Part Skim Ricotta 1/4 cup 90 8

Chicken, White Breast Meat w/o

skin

3 oz. 138 26

Chicken, Leg w/o skin 3 oz. 162 21

Cod, White, Baked 3 oz. 89 21

Crab, steamed 3 oz. 82 17

Egg, Hard Cooked 1 78 6

Flounder 3 oz. 62 21

Halibut 3 oz. 119 21

Ham, Lean, 5% Fat 3 oz. 133 21

Hamburger (90% lean ground beef) 3 oz. 169 21

Lobster, Steamed 3 oz. 77 16

Milk, Skim 1 cup 86 8

Milk, Skim Plus 1 cup 120 11

11

Food Name Portion Cals Pro gm

Peas, Chick, Cnd 1/2 cup 134 7

Pork Tenderloin 3oz. 139 21

Pork Loin Chop 3oz. 172 21

Protein Powder (There are many different

brands which vary in amount of protein. Read

labels.)

1 scoop 110 16

Salmon, Baked 3 oz. 155 21

Shrimp, Steamed 3 oz. (15 large) 84 18

Soybeans (edemami) 1/2 cup 149 14.3

Soy Flour, defatted 1/4 cup 81.7 12.8

Soymilk, plain 1 cup 79 6.6

Soynuts 1/4 cup 202 15

Steak, Sirloin, trimmed 3 oz. 166 26

Swordfish, Baked 3 oz. 132 21

Tempeh 1/2 cup 165 15.7

Texturized Soy Protein 1/2cup 59 11

Tofu 1/2 cup 94 10

Tuna, Cnd, Water Packed 3 oz. 111 25

Turkey, White Meat 3 oz. 105 21

Veal Loin 3 oz. 149 21

Veal Leg (top round) 3 oz. 128 21

Yogurt (sugar free), Frozen, Vanilla 1/2 cup 80 5

Yogurt, Fruit, Fat Free, low sugar 1 cup 120 8

Yogurt, plain, w/o Fruit, Lowfat 1 cup 194

In preparation for my surgery there are a few tests I have to get done.


I've managed to get an appointment for a Bone Density Test at Merivale Imaging. My appointment is for 10:20am on Wednesday, June 25, 2008. They can be reached at 613-727-1072 and located at 1370 Clyde Avenue in Ottawa's end. Most other places were booking well into late July early August. 

I was quite bothered by something when I called though. Because of my size, I had to specify that I'd need accomodation. When asked what I weigh, I told her 517lbs. Her reaction was to repeat it, and to make no effort to hide her absolute astonishment. If it wasn't that I needed the appointment, I would have said something right then. Because I need this for surgery, I'll provide my feedback after the results are in. 

Booking an ultrasound has been a challenge as well. Mostly time constraints so I'm booked in at the Carleton Place Hospital for July 24th at 1pm. 

I can get a chest xray and blood work done at any time, so will do those soon. 

I want to get a will into place, and my passport so that I have it just in case the US changes their requirements for entering the US.