COMMON QUESTIONS, CONCERNS & INFO FOR WLS 
 

I would also say for those researching WLS, to examine all the surgeries and surgery types available. CHOOSE the surgery type for you and you’re "after" surgery life. 

Decide which surgery fits your life style and the way you want to live. (Look at the requirements after surgery and stick to them.) Surgeons will NOT do this research for you! SOME of them will not present a balanced picture of all the surgeries. Decide what is best for you and your lifestyle, ask questions but do your own investigation.  try not to stress too much! (added with permission from Dianne from FL) 
 

(really good info from OH home site) 
Making the Weight Loss Surgery Choice: http://www.obesityhelp.com/content/choice.html  

Life after Bariatric Surgery: The Weight Loss Surgery Lifestyle: http://www.obesityhelp.com/content/lifeafter.html   

Surgery Risks: http://www.obesityhelp.com/content/risks.html  

Nutritional Guidelines Following Weight Loss Surgery: http://www.obesityhelp.com/forums/nutrition/cmsID,9212/mode,content/  
Roux-en-Y Bypass Diet and Nutrition Guidelines: http://www.obesityhelp.com/forums/nutrition/cmsID,10282/mode,content/a,cms/
TO-DO LIST BEFORE SURGERY SUGGESTIONS 

Here are some things you might want to do before surgery:
get a comprehensive list from surgeon on the do and don't meds
get a list from nut/surgeon on what you diet is at the different stages
check with hospital to see what they provide you during you in hospital stay
shop for staples for the family and yourself after surgery 
(you might want to make sure you have at least a few weeks worth so you don't have to shop real soon after surgery) 
record your measurments so you have a good starting point to go by on your progress

SUGGESTED THINGS TO BRING TO THE HOSPITAL:
loose clothing to go home in
pillow for the car ride (makes it more comfy)
slippers
toiletries  
Lip balm
flushable wet wipes
long handled tongs (to use with wipes to keep you clean after the bathroom)
through away camera for before and after pics  
 
SOME SUGGESTIONS FOR DIFFERENT EATING STAGES: ALWAYS CHECK WITH YOUR NUT/DR FOR  YOUR LIST OF DOES AND DON'TS ON FOOD    

When you first start eating solids you might get in a few bites to 1oz at a time, by around 6 months out you should be able to eat around 4 oz (depends upon how dense and for some it might be sooner or latter on). By around a year 1 to 1½ cup (about the size of a small lean cosine) this information was given to me by my nut.  

clear liquid stage: clear broth, clear juice, clear soup, sf Jell-O, sf popsicles 
full liquid stage: cream soups (strained), sf yogurt (strained), milk, soy milk, sf pudding, protein drinks 
purer: anything that can be blended to baby food consistency 
soft foods: things easy to chew like soft cheeses and ground meats
full foods: foods cut up to about the size of a pencil eraser  and chewed up finely

Myth Muscle weighs more than fat.   
Truth:  Muscle is more dense than fat, therefore taking up LESS room.  One pound of muscle weighs the same as one pound of fat.  Just as one pound of feathers weighs the same as one pound of bricks.  The difference is in the VOLUME.  Fat will take up A LOT more space than muscle.   

FACTS ABOUT FATS: 
http://www.healthcastle.com/goodfats-badfats.shtml http://www.americanheart.org/presenter.jhtml?identifier=532 
http://www.webmd.com/content/article/49/40075.htm  

HOW TO ADD HEALTHY FAT TO YOUR DIET: 
http://www.ehow.com/how_2151746_add-healthy-fat-diet.html?ref=fuel 
http://www.extension.umn.edu/extensionnews/2005/Healthyfats07.html

KETOSIS:

http://lowcarbdiets.about.com/od/faq/f/whatisketosis.htm

http://www.ilpi.com/msds/ref/ketosis.html
 

Plateaus/Stalls: Here is some good information I found on plateaus/stalls, everyone goes though periods of stalls which are not plateaus. The body going through an adjustment period and is loosing inches. MEASURE MEASURE! We have stalls throughout our weight loss journey; first one usually is about 3 weeks out. Here is a great detailed article on the subject:
www.weightwatchers.com/util/art/index_art.aspx?abnum=1&art_id=23561 

HAIR LOSS: Hair loss may be a temporary problem for some patients within the first three to twelve months after the operation, usually starts around the 3rd month. This is largely due to vitamin deficiency (and surgery). There is no specific remedy other than proper nutrition and multivitamin supplements. Good news is that the new hair growing in is pushing out the old hair, hence the hair loss. Upping protein and taking biotin will not keep your hair from falling out but will help the new hair grow in faster and healthier. Take this time to maybe get a new short sassy hair cut, used cute hats and scarves or maybe a pretty wig. Try not to stress out too much, it will end.  

Vitamin and/or iron deficiency: This may occur in a mild form in as many as 40 percent of patients after gastric bypass. Iron and some vitamins, most notably Vitamin B-12, are primarily absorbed in the stomach and upper part of the small intestine which is bypassed. Both the vitamin and iron deficiencies are easily treated by either oral supplementation or injections. Women who are regularly menstruating will need additional iron supplements. (info taken from OH complications listed on home page)

Vitamin and iron deficiencies are uncommon after stapled gastroplasty because, with this operation, the food passes through the stomach and small intestine in the normal way.

Low calcium and protein levels and deficiencies in fat soluble vitamins (A,D,E) are known to occur after distal gastric bypass. Gas, flatulence and diarrhea may be more prominent after distal gastric bypass.  

LAB TESTS: 
(Not to be construed as medical advice.  This list includes labs suggested regularly for gastric bypass patients)  

Regularly (every 3-6 months depending on your previous results), yearly as the further you are out and not having any problems. Keep track of any levels that are declining from one set of tests to the next, even if not yet in the low range.  Make any corrections necessary in your diet and vitamin regimen before the levels get too low. 

*10231-COMPREHENSIVE METABOLIC PROFILE (sodium, potassium, chloride, glucose, BUN, creatinine, calcium, total protein, albumin, total bilirubin, alkaline phosphates, aspartate aminotransferase)  (Nc,K,C1,CO2,Glu,BUN,Cr,Ca,TP,Alb,Tbili,AP,AST,ALT)*84134 - PRE-ALBUMIN

*7600      - LIPID PROFILE (cholesterol, HDL, LDL, triglycerides, chol/HDL ratio)

((Fasting specimen) , Tchol,Trig,HDL,Calc,LDL)

*10256- Hep panel - ALT (SPGT) & GGT

*593-LDH                                                                     

*718-PHOSPHORUS - INORGANIC

*905-URIC ACID

*1759-CBC HEMOGRAM/PLT/DIFF)
                                            
*7065-B-12 & FOLATE

*7573-IRON, TIBC, % SAT (Transferrin)

*31789-HOMOCYSTEINE, CARDIO               

*457-FERRITIN

*4052-Vitamin B-1 (Thiamin)

*84207-VITAMIN B-6 (Pyradoxine)

*921-VITAMIN A

*680-VITAMIN D (25-hydroxy)

*7444-THYROID PANEL (T3U, T4, FTI, TSH)

*945-ZINC

*83735-MAGNESIUM

*83970-SERUM INTACT PTH                   

*367-CORTISOL

*496-HEMOGLOBIN A1C

SUGGESTED YEARLY -DEXA SCAN for bone density. 

DIAGNOSIS: 
268     vitamin D deficiency 
269.2  hypovitaminosis              
268.2  metabolic bone disease 
244.9  hypothyroidism                  
250.0  diabetes 
579.3  short bowel syndrome     
401.9  hypertension      
276.9  electrolyte and fluid disorders 
579.8   calcium malabsorption 
579.8  intestinal malabsorption

272.0  hypercholesterolemia

275.40 calcium deficiency

266.2  cyanocobalamin deficiency

280.9  iron-deficiency anemia

269.3  zinc deficiency

281.0  pernicious anemia

281.2  folate deficiency

281.1  other B-12 deficiency anemia

285.9  anemia, unspecified

B-12/B-1  INFO FACT SHEET: http://ods.od.nih.gov/factsheets/vitaminb12.asp
http://www.publix.com/wellness/notes/Display.do?id=Supp&childId=Vitamin_B1 

 

B vitamins

From Wikipedia, the free encyclopedia

The B vitamins are eight water-soluble vitamins that play important roles in cell metabolism. Historically, the B vitamins were once thought to be a single vitamin, referred to as vitamin B (much like how people refer to vitamin C or vitamin D). Later research showed that they are chemically distinct vitamins that often coexist in the same foods. Supplements containing all eight are generally referred to as a vitamin B complex. Individual B vitamin supplements are referred to by the specific name of each vitamin (e.g. B₁, B₂, B₃ etc ).

The B vitamins often work together to deliver a number of health benefits to the body. B vitamins have been shown to:

• Support and increase the rate of metabolism
• Maintain healthy skin and muscle tone
• Enhance immune and nervous system function
• Promote cell growth and division — including that of the red blood cells that help prevent anemia.
• Reduce the risk of pancreatic cancer, one of the most lethal forms of cancer^[3], when consumed in food, but not when ingested in vitamin tablet form.^[4][5]

Together, they also help combat the symptoms and causes of stress, depression, and cardiovascular disease.

All B vitamins are water soluble, and are dispersed throughout the body. Most of the B vitamins must be replenished daily, since any excess is excreted in the urine.^[6] A six year cobalamin store can be found in the liver, despite its water soluble nature.^{[citation needed]}

SUGGESTED VITAMIN SUPPLEMENTS AFTER WLS: (used with permission from Melting Mama) http://meltingmama.typepad.com/wls/files/vitamins-mineral-recommendations.pdf 

Signs and symptoms Dehydration: 
Mild to moderate dehydration is likely to cause:   
Dry, sticky mouth 
Sleepiness or tiredness — children are likely to be less active than usual
Thirst 
Decreased urine output — fewer than six wet diapers a day for infants and eight hours or more without urination for older children and teens 
Few or no tears when crying 
Muscle weakness
Headache 
Dizziness or lightheadedness 

Severe dehydration, a medical emergency, can cause: 
Extreme thirst
Extreme fussiness or sleepiness in infants and children; irritability and confusion in adults 
Very dry mouth, skin and mucous membranes 
Lack of sweating 
Little or no urination — any urine that is produced will be dark yellow or amber 
Sunken eyes 
Shriveled and dry skin that lacks elasticity and doesn't "bounce back" when pinched into a fold 
Low blood pressure 
Rapid heartbeat 
Fever 

In the most serious cases, delirium or unconsciousness      

Unfortunately, thirst isn't always a reliable gauge of the body's need for water, especially in children and older adults. A better barometer is the color of your urine: clear or light-colored urine means you're well hydrated, whereas a dark yellow or amber color usually signals dehydration.

When to seek medical advice:
If you're an adult, call your doctor if:     

You're not able to keep liquids down for 24 hours. 
You've been vomiting for more than two days. 
You're vomiting blood. 
You're dehydrated. Signs of dehydration include excessive thirst, dry mouth, deep yellow urine or little or no urine, and severe weakness, dizziness or lightheadedness. 
You notice blood in your bowel movements. 
You have a fever above 101 F.   

FULL VS. HUNGER
During surgery they cut the nerves that help tell us when we are full and hungry, it takes a while for those feelings to come back. It is very important when you are a new pos-op to measure you food so you don't over eat and hurt your new tummy. Most people get the sensation of fullness back or indicators that you are full like burping, hiccups and such. When you are first out what you think is hunger is not true hunger, its head hunger. Most people get that hunger feeling back (I think people get this at different times). Some people don't get it back (I haven't) I eat by the clock. When you are first out you can eat a few bites to a few ounces, by around 6 weeks or so (estimate) you can eat 2-4 ounce, around 6 months around 4-6 ounces. At about a years time you can eat 1 up to 11/2 cups (about a small size lean cuzine) (stick to your plan that was given to you by your dr/nut)

HOW TO FIGURE OUT YOUR PERCENTAGE OF WEIGHT LOST:  
092108
blood lab test posted by Andrea

Lipid panel
CBC
CMP
serum thiamin (b1)
PLP (b6)
serum b-12
MMA (b-12 secondary test)
RBC folate (folate, b9)
Ferritin (iron)
TIBC (iron)
plasma retinol (vite A)
25(OH)D (vite D)
serum PTH (parathyroid hormone)
plasma alpha tocopherol (vite E)
PT/PTT (vite K, clotting factors)
plasma zinc
serum albumin (protein)
serum total protein

Okay, first you subtract your goal weight from your start weight.  This determines that you had 170 pounds to lose.  Then, you figure out how many pounds you've lost by subtracting your current weight from your start weight and find that you have lost 146 pounds (awesome!).  Next you do the following:
weight lost divided by weight needed to lose equals percentage of excess weight lost
IN YOUR CASE
EXAMPLE: 146 divided by 170 equals 86% of excess weight lost 

SUGAR ALCOHOL: http://en.wikipedia.org/wiki/Sugar_alcohol

RESIZING AN AVATAR:  
http://www.shrinkpictures.com/create-avatar/resize.phpHernia: http://www.medicinenet.com/hernia/article.htm

Dry skin: http://www.aocd.org/skin/dermatologic_diseases/dry_skin.html

Gallbladder: 
http://www.sensiblehealth.com/gallbladder.html  http://www.mamashealth.com/organs/gallbladder.asp  
http://health.ivillage.com/digestion/digallblad/topics/0,,4v25,00.html 
ULCER INFO:  

 

http://familydoctor.org/online/famdocen/home/common/digestive/disorders/186.html 

http://www.mamashealth.com/Stomach.asp   

http://www.ahealthyme.com/topic/topic114222

DUMPING SYNDROME: http://www.cnn.com/HEALTH/library/DS/00715.html    

Muscle pain and working out:
http://www.liveleantoday.com/article.cfm?id=387
http://www.drmirkin.com/fitness/lact...intervals.html 

Obstruction of the opening of the stoma: This rare complication occurs in less than 1 out of 100 gastric bypass patients and can occur when a piece of food becomes lodged in the stoma. When this happens, the piece of food is removed through a tube (endoscope) passed from the mouth into the stomach.   (No medical advice is intended, info is from oh)   

http://som.umdnj.edu/departments/clinical/bariatric_surgery/specificrisks.html