janice2007

Send Message

Block

Add Friend

NOTE TO SELf..Remember to ask DR RICHARDS ABOUT THIS.

I just found an interesting post. The woman stated that her son had an anticolic RNY ....WHAT is THAT??? 

There are obviously two surgical techniques for RNY and Im going to find out more!

http://www.obesityhelp.com/forums/teen_wls/a,messageboard/ac tion,replies/board_id,5373/cat_id,4973/topic_id,3680263/


 

WEB INFO

http://www.springerlink.com/content/njv2816p1nx41151/


http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B7MD3-4NWN3HS-8&_user=10&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=7d364b59ef7ace3a45f0c86bb91393ee

I know I saw scotts post on how to create your ticker but I cant find the thread so I found this one to help me remember how to cut and paste my ticker for a signiture.

http://www.obesityhelp.com/forums/ON/a,messageboard/action,replies/board_id,5450/cat_id,5050/topic_id,3623463/

 

I have found Its   always good to be   well rounded in   knowledge about  anything I plan on   making a  decision   about. The areas of   success and   complications  both  need  to  be  looked  at  to  make  an  informed  choice.

What  I  have  found  so  far  is  that  the  general  drs  office  is  not  well  prepared  for  RNY  after  care  and   complication  assessment.
So  this  is  an  area  I  need  to  be  able  to  keep  up  with  and  be  able  to  communicate  to  drs  about.

I  am  so  thankful  for  the  experiences  of  others  on  the  boards.  This  is  the  most  accessible  and  comparable  way  of  keeping  up  with  what  symptoms  come  up  after  surgery.

This  is  my  list  I  am  going  to  start  about  things  to  look  out  fo r after  surgery.

INTESTINAL / metabolic PROBLEMS:
http://www.ajronline.org/cgi/content/full/186/1/104

Low Blood Sugar-- pancreatic problems
http://content.nejm.org/cgi/content/full/353/3/249

Superior Mesenteric Artery Syndrome
http://www.medscape.com/viewarticle/410569
oh: http://www.obesityhelp.com/forums/complications/action,replies/board_id,5368/cat_id,4968/topic_id,3557145/a,messageboard/

 OH  THREAD http://www.obesityhelp.com/forums/amos/board_id,4856/cat_id,4456/topic_id,3673440/a,messageboard/action,replies/#29129922

   obstructions:
  http://www.obesityhelp.com/forums/complications/a,messageboard/action,replies/board_id,5368/cat_id,4968/topic_id,3673094/



NUTRITIONAL PROBLEMS:

TINGLING LOSS OF SENSATIONS IN EXTREMITIES
Its about thiamine deficiency--and what it presents as: in this case Polynureopathy
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1681565


WATER ISSUES
http://www.youtube.com/watch?v=BpiDBKk7uYY


OTHER:
SCAR CREAM RECIPE
http://www.obesityhelp.com/forums/TN/a,messageboard/action,replies/board_id,4844/cat_id,4444/topic_id,3699992/


UNDERSTANDING DIGESTION PROCESS
AFTER BYPASS
http://www.youtube.com/watch?v=f5wEnEMOmqs
http://www.youtube.com/watch?v=Y6SxYvOq6xA&feature=related

AFTER SURGERY COMPLICATIONS RESOURCES 
 http://www.gastricbypassproblems.info/

 

Better news today. When I got back from the NUT this week she said she would approve us to be submitted.

It only took two days for us to get sent out via fax to the insurance company. We got our cards in the mail today saying we were submitted.

ERR kind of getting nervous.   I dont know what to expect from the insurance company. 

I am going to try my best to get the 20lbs off.  I will be following the 200 cal. 6 times a day diet. 

I better vitamins and protien powders looked into.
I want to have vitamins that are liquid.

I have heard latly on the boards how people were having a difficult time getting their fluid in up to two week s after surgery.

I need to get the surgery sippy cup.

 

It is the weekend, Saturday, Its been 1 month from the last time I saw the nut.  This past month has been horrible. I have gained again. I was supposed to get rid of 20 lbs. If I could do that then I would have been ready for the RNY .

I cant do it with out some sort of out side control thing. Why do I feel so weak? I stop eating when I am full. I drink water , I never drink soda. My plate seems normal to me when I do eat. Its not like I am having seconds or thirds. I just dont understand.

The only thing I can tell is that I am not getting enough exercise. That is the only thing I am not doing. I am not walking or anything else.

I started out at 260 on this obesity help site...now I am 280. When I was 260 I was taking phentermine. Obviously, It really did help me.

I feel horrible now. My feet and legs hurt anytime I walk, so It detours me from walking or even moving around. My hips hurt when I am doing any chores and moving like sweeping the floor or bending for laundry or scrubbing the bathrooms. I have to rely on my kids for help.  This is not how I want to be.

My next Nut appt is Monday. I know she is going to be vicious to me. I am just going to have to tell her It doesnt work for me unless I have something like phentermine.  I just cant do it by myself.

She probably wont approve me to get my insurance sent off. Thats fine.

I want to lose the 20 before I go through with the RNY anyway. I would not  even be able to meet my goal weight if I DONT LOSE IT Before.

I a m getting discouraged easily about having this done to myself. ... But I am still going to stick through things...because I found I cant rely on my emotions of discouragement to accomplish anything.

I just wish I could get excited and have the energy to move around.  Thats what phentermine did for me.  It sounds horrible to rely on something outside of myself to give that to me. But its true. And hopefully when I do meet my goal weight the crutch wont be needed anymore. Hopefully at that time my body will be healed and It can give me the energy and the ability to move around on my own.

 

Ok from what I learned at the NUT office the meals and vitamins and water are a juggling act.

I am going to post the guidelines they gave me so I can try and create a good schedule. This is a place to keep them so I dont lose them! :)

NOTES TO KNOW:
* VERY important to understand and look at what ,when and how much you are putting into your pouch because you could burst it  !!!!!
 
* It takes the stomach and the brain 20 minutes to communicate
* So you may start eating and may be full way before your brain signals you.]


---- Do Not Drink ---

 --  30 min Before Meal
 --- During your meal (30 - 40 min)
--- 45 min after your meal

(total time of not drinking liquids for meal times: 2 hours)    

-- 2 hours not drinking --- 3 times a day
----------------------------------------------------------------------------------------------
 #1            Full Liquid Stage (NO MEALS)

Begins when you leave the hospital.
7-10 days duration
  up to first follow up visit
* Note - must use liquid vitamins and protien
* Liquids are tomatoe juice thickness or thinner

--Goal is 8 cups (64 oz) of liquid per day--
-- 70 grams of protein liquid form
    
       ---- 32 oz are clear liquids
       ----- 24 - 32 oz are protien liquids
                must get 70 grams of protien in

-------------------------------------------------------------------------------

#2                  Pureed Diet (Meals Start)

Only with Dr. Approval.
Pureed lasts for 3 weeks.

---  Pureed to texture of baby food-- moist no chunks
----  Three meals per day
----   No drinking rules start
---    Bites must be size of a dime..eat slowly
          wait 1 MINUTE between bites (use a timer)

-----------------Phase one----------
-- TWO tablespoons equal 1oz
 --- first meals should only be 2-3 tablespoons
          STOP IF YOU FILL FULL
    STOMACH IS SIZE of a Medicine Cup

--------------Phase two-----------------------------
--- Each meal is no larger than 1/2 cup equal to 4 oz or 8 tablespoons


** Note some of the protein will still need to come from liquids at this stage...between meals.


-- HELPFUL MEASURES--
  -- Icecube trays --- puree food and freeze in trays
---- each ice cube is 1oz
----  you will need up to max 4 cubes per meal (4oz=1/2cup)

--------------------------------------------------------------------------------------

#3             Solid Meal Stage
                  Last Stage

---- When eating use dime size to Pea sized bites
----- Chew 30 times then swallow
----- only  4 tbl spoons of veggys
----- only card deck sized piece of meat 

THESE ARE THE NUTRITIONAL RULES AND POINTS I WANT TO REMEMBER FROM MY FIRST MEETING:

ANY time the Nut says "AT A TIME"  they mean within TWO HOURS

Normaly Physicians do not draw for a BMP or CMP 
  You will need to ask for a Bariatric Nutritional blood draw.
    (ask the bariatric department or surgeon what test needs are for nutritional lab draws so you dr can order the correct labs)

For the rest of your life you will need to get nutritional labs drawn every year  best to draw twice a year though.

In the First year Nutritional labs are drawn:
3 months--- 6 months-- 12 months


PROTIEN:
--- 1oz of meat = to 8 grams protien
-- the most lean and best ground meat is ground sirloin
--- second best is the 97/3  ground round
---Your body cannot absorb more than 30 grams of protien within two hours
-- Your Minimum/ MAX protien in take for the day should be 70 grams
         * untill your first nut blood tests after surgery

-- Too much protien intake extracts calcium
--- Extra protien shows up in blood test at the pre-albuim result levels


VITAMINS:

Multivitamins:
--Multivitamins and Iron can be taken together
 --- WARNING-- Do not take Iron, or Multi together with YOUR Calcium supplement
      YOU MUST WAIT FOR TWO HOURS BETWEEN THEM

--- you must choose one that has ZINC and IRON 
--- Iron must be > 15mg
   *  Senior, mature, silver and Viactive vitamins Do Not Contain IRON 
         or Calcium Citrate  (they contain CA carbonate)
--- Use super complete vitamins or prenatal 
      *make sure they have iron, B12, Folic acid

CALCIUM CITRATE-- and VITAMIN D
--YOU MUST TAKE CALCIUM CITRATE---
     DO NOT TAKE CARBONATE---IT WILL NOT ABSORB

*NOTE: Your body can only absorb Ca 500-600 mg per 2hours.

---You must take Ca supplement with D vitiamin supplement

-- 1200 mg males and pre menopausl females
--1500 mg-- post menapausal females


LIQUIDS:

--MAIN LIQUID IS WATER FOR HYDRATION

-- 8 CUPS PER DAY 
     -- 64 OZ per day
       ---  1/2 to  1 cup per hour

* Caffine pulls h2o from the body-- it dehydrates
     for every 2 cups of caffination drink 8 cups of water
 BASICAlly DO NOT DRINK CAFFINE!!



OTHER NUTRIENTS:

Vitamin B12---
   Check levels with Primary care doctor every 6months
    to see if one is needed.

Biotin--
   Use this vitamin to minimze hair loss.
      2-5 mg daily

Fats:
If using fat free items and drinking mostly water (liquid phase)   all day  add 1 teaspoon of oil  to your food or drink three times a day.


          

OK,
Vandy Requires 6 nutritional appointments.They say its a discounted rate since insurance wont pay for it.
They charge $250 for 6 appointments.

So here are the Nut appointment requirements For VANDY Program:

--- NOTE: The office will not allow you to schedule any NUT appointment untill your FIRST DR visit is over with. Then the girls upfront schedule it for you.

-- total of 6 visits
      - 3 before surgery
     -  3 after surgery

-- all 6 visits ($250) must be paid for upfront
        -- this payment is required to be met on your first scheduled appt.
        --  there are no refunds

--- 1st visit is a conference with a group
       -- you get a packet that shows nut. requirements
            -how to eat
               -what measuring tools and utensils
            - what vitamins to take
                  and how many
              -- what stores and brands to buy
                   food and vitamins
               -- Sample menus
              --  Sample meal logs
     ---  You also get actual vitamin and protien shake samples to take home

--- 2nd visit
      -- is an actual personal one on one visit with the NUT
       -- must be scheduled for two weeks after the first visit
      --  you are expected to have started at least the multi vitamin
        --and also  vitamins Ca, D according to the blood results of  your
             first Dr visit

-- 3rd Visit
    * NOT SURE YET when this is suppose to be will ask at the 2nd visit 
     

May eighth finally came and went.
We had our consultation with Dr.Richards.
I really enjoyed meeting him especially when he spoke about the actuall surgery he was going to be preforming. 

The office staff mixed up the insurance info. Easy to do because we have BlueCross Blueshield. Ours is in MA and they put it down for TN.

MA doesnt have as many requirements for approval.
We just have to show a bmi over 35 and morbidities or bmi 40 or greater with unsucessful weightloss.

Thats it....no psy exams or nothing.

Now we just have to follow the Vanderbilt program and then submit the paperwork to the insurance and we should be done.

We will be able to see if they approve us or not.

Hope we dont run into any snags. Everything seems to be going so easy , so far.

I have to be coordinated with the office people though, and making double sure they have all the info they need and its correct. 
So this is my list:

Insurance lady needs:
Letter of recomendation from primary dr
medical weightloss records from primary dr
medical records of comorbidities
------
to show her for the Vandy program:
psych nurse consultation and exam---short question and answer session
three nutritional appointment attendences
transcript showing participation in an RNY support group


Office Staff Needs:
Medical records
Blood Test results
Sleep Apnea Test results
Second Consultation with Nurse Practioner at one month from Initial consultation

Videos: 
FOOD REVIEWS::
Protein --
http://www.youtube.com/watch?v=sJivydMedhI&feature=related


Powdered foods:
Peanut butter-
http://www.bellplantation.com/index.php?option=com_content&task=view&id=15&Itemid=35

ACESSories:
http://www.bariatricdiet.com/lil_sip_mug.htm



ViDEO:
UNDERSTANDING DIGESTION PROCESS
AFTER BYPASS
http://www.youtube.com/watch?v=f5wEnEMOmqs
http://www.youtube.com/watch?v=Y6SxYvOq6xA&feature=related


AFTER BYPASS WATER ISSUES
http://www.youtube.com/watch?v=BpiDBKk7uYY