Andrew Thompson

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CBC,INRLipid profile, HbAIC Serum Iron, Transferrin, Saturation TIBC Serum \folate, Albumin, Calcium, Magnesium Phosphorus, Vitamin A,Vitamin D -hydroxy Vitamin B12.

Magnesium
Thyrotropin[sensitive tsh]
Ferritin
Sodium
Potassium
Chloride
Total Bilurubin
Alanine Transaminase [ALT]
Alkaline Phosphatase
Gamma-Glutamyltransferase
Calcium
Albumin
Cholesterol
LDL Cholesterol [calculated]
HDL Cholesterol
Cholesterol/HDL Ratio
Triglycerides
Lipid Target Values
Hemoglobin
Hematocrit
White blood cell count
Red blood cell count
MCV
MCH
MCHC
RDW
Platelet count
Absolute:    Neuts
     A       Lymph
     A       Mono
     A       EOS
     A       Baso
Vitamin B12

Glucose-Fasting
Creatinine
eGFR 

1 pound = a Guinea Pig
1.5 pounds = a dozen Krispy Kreme glazed donuts
2 pounds = a rack of baby back ribs
3 pounds = an average human brain
4 pounds = an ostrich egg
5 pounds = a Chihuahua
6 pounds = a human’s skin
7.5 pounds = an average newborn
8 pounds = a human head
10 pounds= chemical additives an American consumes each year
11 pounds = an average housecat
12 pounds = a Bald Eagle
15 pounds = 10 dozen large eggs   
16 pounds = a sperm whale’s brain
20 pounds = an automobile tire 
23 pounds = amount of pizza an average American eats in a year
24 pounds = a 3-gallon tub of super premium ice cream
25 pounds = an average 2 year old
30 pounds = amount of cheese an average American eats in a year
33 pounds = a cinder block 
36 pounds = a mid-size microwave 
40 pounds = a 5-gallon bottle of water or an average human leg 
44 pounds = an elephant’s heart 
50 pounds = a small bale of hay 
55 pounds = a 5000 BTU air conditioner 
60 pounds = an elephant’s penis (yep, weights more than his heart!) 
66 pounds = fats and oils an average American eats in a year
70 pounds = an Irish Setter 
77 pounds = a gold brick
80 pounds = the World’s Largest Ball of Tape 
90 pounds = a newborn calf
100 pounds = a 2 month old horse
111 pounds = red meat an average American eats in a year
117 pounds = an average fashion model (and she’s 5’11”)
118 pounds = the complete Encyclopedia Britannica
120 pounds = amount of trash you throw away in a month
130 pounds = a newborn giraffe
138 pounds = potatoes an average American eats in a year
140 pounds = refined sugar an average American eats in a year
144 pounds = an average adult woman (and she’s 5’4”)
150 pounds = the complete Oxford English Dictionary
187 pounds = an average adult man
200 pounds = 2 Bloodhounds
235 pounds = Arnold Schwarzenegger
300 pounds = an average football lineman
400 pounds = a Welsh pony

 After the operation I was doing fine except that wasn't able to pee. They bladder-scanned me. Bizarre machine sounds exactly like a Taser. 

Discovered I had a 1+ liter of fluids (max out)  in the pig skin so in goes a catheter and out comes 1.8 l of pure release.

The unfortunately side effect of this is that I have to wear the catheter for a couple of days.

I sit at my little chair and have to hang the bad on the chair next to me. Quietly reading and doing I breathing exercise when the other patient has some guests to see her. No worries I thought, mind my own business.

The guest wanted to sit down, sure no worries.

He grabs the spare chair and drags it to the other bed.

.... My pitch sharpens as the hose stretches until glasses vibrates and we realize what was happening.

He pushes the chair back in a fast glide. 

Instant relief until the gentle thought came to mind: "hey isn't a catheter tube like a bungy chord?"


I can confirm that fact.

First and foremost my thanks for my angel Jenny. She asked if she could visit but didn't really answer her. I didn't know if I would feel too shit etc etc etc. But she came none-the-less with a lovely card and Congratulations  balloon. Bet they don't see many of those in a Trauma unit. lol.

Next the people on this board. When Jenny posted two messages regarding my status I was overwhelmed to see the number of people reply. It really helps when you're down in the dumps not certain what way to turn to finally see some smiling faces.

I've never had major surgery. I wished I'd mentioned it. But I had images of a cosy room with gleaming aluminium cabinets and smiling faces, just like on Gray's Anatomy.

OMG!!! It was not like that. The operating table? Looked like a coffee table. And when those two arm rests pop out I shouted inside, "I'm on a f*cking crucifix." 

I looked around and saw a whiteboard with names on it. Dr. Yelle's name was there. Well at least I'm in the right room. Then I read the bottom line: STUDENT. Oh no, I know you have to learn but not on my body. Find someother sap.

I met two of my nurses, can't remember their names, but one had a cougar cap on (knicknamed Cougar) and the other was called "Zebra" because she had a zebra hat on. Oh dear god I'm in a lame Disney musical:  Lion King 3 : The Surgery Room. 

Simba cut his paw? 
He cut his paw!

Is it deep?
It is deep!
Hakuna Matata!

They start to administer the anae....of whatever...drugs. Didn't do the count backwards from 10...My god why can't I get a professional? Next thing I know he's yelling at me to open my eyes. Oh shut up, you just asked to me close them. Make up your mind.

Apparently I met up with my wife in the trauma room. I told her that I had the RNY and didn't have to have the Sleeve. Apparently I told her I loved her about a million times. I told her that she had to bring my vitamins with her. (Apparently when they say "take all medications" with you to mean your post-op vitamins as well.)

Friday and I was in some pain. About 7-8 on my scale of 10. I'm quite the wimp so that wasn't too bad. All I knew what that I needed to get out of that bed. By Saturday 11:33 and 27 seconds I got out of the bed and sat on the chair. I belched and belched and belched. "Oh, Sorry...oh felt good...oh sorry, oh felt good."

Once you start walking about the pain really does get better. 

My O2 saturation kept dropping and I had to do my deep breathing exercise much more frequently.

Because I wasn't passing water and my diabetes medication needs couldn't be figured out they kept me in an extra night. 

On the Monday morning I of course did the only thing I had yet to do: fall out of the bed. No harm done but a bruised pride.


Spoke with Dr. Yelle and was finally able to say "Thank you." Not just for the visit but for everthing: a new life, a chance to redo it. Everything and nothing. This man has given me this. And all I could say was Thank you.



Finally get checked out and at home. Got settled in my bed and sweated for 4 hours. Cold shakes and everything. Was able to take morphine last night so slept quite well.

This morning and I'm already getting cabin fever. I want to get up and do things. Like walk a dog, paint the house. Me? expend extra energy? They didn't cut away a bit of stomach they did a full body transplant, well not quite full I do have my ugly feet.




I'm still in pain (2/3 out of 10) aching and feeling over the moon happy. My new life begins. No matter what happens I've given myself a new chance and for that reason alone I would never regret this surgery. If I have bucket loads of complications it doesn't change the fact that I have been given a second chance and for that I an grateful.

Thank you Dr. Yelle. I wish I could say something more profound, but I can't. Thank you.
 

Most Gastric Bypass patients recover from surgery without complications; this applies to patients who choose other weight loss surgery procedures as well. Although you will have some discomfort from the surgery, you will need to get out of bed and start walking the next day. This activity is crucial in preventing surgical complications, such as blood clots.

If you have been diagnosed with sleep apnea through a sleep study, you will remain on breathing monitors in a monitored bed overnight or until you are breathing well on your own.

The hospital stay for patients who undergo the Roux-en-Y Gastric Bypass procedure is usually two to four days. Before you are discharged, make sure to receive full instructions for your care at home and schedule to see your bariatric surgeon about one week after the surgery.

At Home After Surgery
If you have any questions or concerns once you are home, you should call the nurse who works with your surgeon. Specifically call your doctor if you experience any of the following:

• Persistent nausea or vomiting
• Vomiting a bright red or dark brown liquid (go to the emergency room)
• Increased redness, swelling or foul-smelling discharge at incision site
• Increased soreness or pain in your incision(s)
• Any new or unusual pain in your abdomen, chest or legs
• Temperature higher than 101°F
• Passage of very dark stool
• Acute depression or negative emotions

Eating
At home after surgery, you will need to follow specific eating guidelines that your dietitian will have explained to you. For the first six weeks after your weight-loss surgery, your diet will consist of liquid/pureed food. This includes foods that are liquid to soft in consistency. Examples of soft consistency foods are scrambled eggs, cottage cheese, sugar-free yogurt, hot cereal and mashed potatoes. You also can drink non-carbonated fluids that are sugar-free and caffeine-free. Good choices are water, milk, sugar-free flavored drinks and high-protein liquid supplements. Your dietitian should recommend liquid supplements to meet your nutritional needs during this time. As your tolerance builds, you will progress to a soft diet and then to regular foods.

Your “new” stomach is roughly the size of an egg. It will stretch to the size of a cup in about a year. You can avoid discomfort and complications if you do the following:

• Eat small, frequent meals (five or six) throughout the day. (Your stomach will be too small to hold large meals.)
• Chew all foods slowly and thoroughly. (It may take you up to an hour to complete your meals and snacks.)
• Drink fluids 30 minutes after your meal. Be sure to drink in sips.
• Do not drink fluids with your meals. Your smaller stomach may not be large enough to hold fluids and food at the same time.
• Do not eat sweets.

Avoid foods that cause any discomfort. You might consider keeping a diary of the foods you eat, as well as any foods that are difficult to tolerate. Your diary will help you identify which foods cause discomfort. During follow-up visits with your dietician, you can use your diary to report any foods you cannot tolerate.

Your dietitian will help you plan healthful, appropriate meals. You also will be guided in selecting a variety of foods that are rich in vitamins, minerals and protein so you will stay well nourished. Your dietitian will also recommend a multivitamin/mineral supplement.

Digestive distress, such as gas and constipation, is common in the first few weeks following bariatric surgery. Unless your physician instructs you otherwise, you can use over-the-counter gas relief medications and stool softeners. If you are constipated, you can add extra fiber to your diet by eating applesauce, oatmeal and pureed prunes.

Dumping Syndrome
Dumping syndrome is fairly common following bariatric surgery, particularly if you don’t follow all of the special dietary instructions given to you. The signs of dumping syndrome are:

• Nausea
• Vomiting
• Bloated stomach
• Diarrhea
• Excessive sweating
• Increased bowel sounds
• Dizziness
• Emotional reactions

These symptoms need to be addressed during the initial follow-up with your doctor.

To prevent dumping syndrome, DO NOT eat or drink the following:

• Beverages containing caffeine such as coffee, tea or chocolate
• Citrus food or juices such as orange, grapefruit, lemon or lime
• Carbonated beverages
• Sugar and sweeteners such as dextrose, fructose, mannitol, sorbitol, white sugar, brown sugar, syrup, molasses, candy, jelly, desserts, jams or preserves
• Alcohol
• Sweetened beverages including regular soda, coolers, drink mixes, Kool-Aid, fruit punch or undiluted fruit juice

In addition:

• Eat only canned or very tender, well-cooked fruits and vegetables.
• Do not eat any raw fruits or vegetables, except bananas.
• Do not eat the skins of any cooked vegetables or fruit.

Bariatric surgery will change your eating habits quite a bit. Rely on close family members and friends for support and encouragement, as this may be an emotional time in your life. It is important that you keep a healthy mind and body. Keep your follow-up appointments, exercise and learn to cope with emotional difficulties. Your healthcare team will also be there to guide you after your weight-loss surgery.

Activity Restrictions
Avoid any strenuous activity until you are healed, but do not avoid walking! Walking is a required activity at this stage of your recovery. Don’t drive if you are taking pain medication other than Tylenol. At your first follow-up visit, your doctor will determine when you can return to work.

Incision Care
Even though you may have staples or steri-strips on your incision when you are discharged, you may wash your abdomen with mild soap and water in the shower. Do not take a tub bath or use a Jacuzzi, pool or hot tub until your incision is fully healed.

Call your doctor if you experience any of the following:

• Increased redness, swelling or foul-smelling discharge at incision site
• Increased soreness or pain in your incision
• Temperature higher than 101°F
• Any new or unusual pain in your abdomen, chest or legs

Exercise
After you have healed, you are encouraged to embark on a physical fitness program. Exercise will keep you feeling well and energized. Always discuss exercise options with your doctor so you know what type of exercise is most appropriate for you. Choose an exercise that you will enjoy and look forward to doing. In fact, for many people, returning to physical exercise is an important step toward feeling better.

Avoid Pregnancy
If you are a woman of childbearing age, you must not get pregnant within the first 18 months to two years following bariatric surgery. The rapid weight loss and nutritional deficiencies associated with weight-loss surgery make pregnancy very dangerous for you and for a developing fetus. Take special precautions to prevent an unsafe pregnancy, particularly because weight loss after bariatric surgery tends to increase fertility.

Follow-up Visits
Regular follow-up visits are scheduled during the first year after weight-loss surgery to check your overall physical and mental health, metabolism and nutritional status. It is crucial to your health that you keep these follow-up appointments.

Your first follow-up visit with your bariatric surgeon will be seven to 10 days after discharge. Subsequent visits are scheduled for one month, three months and every three months thereafter for the first year. After the first year, follow-up visits are required on a yearly basis. You also will likely be scheduled to see your dietitian and psychologist about one month following discharge and for regular follow-up visits to help you adjust to life after bariatric surgery.

Many patients may need plastic surgery one to two years after weight loss to remove skin folds around the abdomen.

Body Contouring
Major weight loss in the wake of bariatric surgery or a steady diet-and-exercise program is a significant personal accomplishment and often a life-changing event. But the experience often leaves conspicuous — and permanent — signs of the former physical self: excess skin that has lost its elasticity and that drapes the body in heavy folds.

This weight-loss legacy can make getting dressed a chore and clothing choices problematic, interfere with mobility — particularly with exercise — and even precipitate the development of troublesome dermatologic conditions. Aside from medical issues, after losing so much weight, patients want their bodies to more closely match the new image they have of themselves.

Several criteria must be met before contouring surgery begins: weight trend (i.e., weight has been stable for at least one year and no further weight loss is expected), physical status (e.g., whether abdominal hernia is present), overall health (i.e., what the body can tolerate surgically and whether a patient has a chronic medical condition, such as diabetes, hypertension or heart disease), nutrition (e.g., patients must be screened for protein deficiencies that can impede proper healing), psychological status (i.e., patients must be psychologically “fit”) and patient expectations (i.e., what the patient expects to look like after surgery). Patients who have undergone bariatric surgery shouldn’t go forward with contouring surgery until at least one year has passed.

Some of the most common post-weight loss procedures are:

• Barchnoplasty: removal of excess skin of the upper arm
• Breast Lift and Augmentation
• Panniculetomy: removal only of the overhanging lower abdominal skin for medical purposes
• Abdominoplasty: removes excessive abdominal skin
• Lower Body Lift
• Face and Neck Lift

The purpose of your diet after gastric bypass surgery is designed to restrict caloric intake to produce desired weight loss, to help develop appropriate eating habits and to prevent disruption or obstruction of your pouch.

In addition, it is strongly recommended to pursue weight loss in preparation for surgery. Even a small amount of weight loss may contribute to a decreased surgical risk during bariatric treatment.

Main Focus:
 1. Drink enough fluids to keep your body hydrated
 2. Eat adequate protein
 3. Take required vitamin and mineral supplements to meet Recommended Daily Allowances.

Diet Principles: 
1. Drink 6-8 cups of fluid each day

•  Sip one cup of liquid over an hour
•  Stop drinking within 30-60 minutes of a meal
•  Sip allowed beverages slowly
•  Do not use a straw

2. All foods, beverages and snacks that are high in calories are omitted.

3. When your doctor gives you permission, vitamin/mineral and calcium supplements are required daily. Additionally, vitamin B12, iron and zinc also may be recommended.

4. Eat very slowly. Foods need to be thoroughly chewed to prevent blockage.

5. Stop eating as soon as you are full. Indications of fullness are: a) a feeling of pressure in the center just below your rib cage, b) a feeling of nausea, c) a pain in your shoulder area or upper chest. Contact your doctor if the above symptoms persist or worsen.

6. Include protein first at each meal to help maximize protein intake. As your pouch expands, you may only need to eat 3 meals and 1-2 high-protein snacks each day.

7. The diet will be advanced gradually, depending on tolerance:

 Phase I: Clear liquid diet (in hospital only)
 Phase II: Full liquid diet (1-2 weeks)
 Phase III: Puree diet (2 weeks)
 Phase IV: Soft diet (2 weeks)
 Phase V: Regular diet (after 1-2 months)

Foods That May be Difficult to Tolerate After Surgery

Meats and Meat Substitutes	Steak Hamburger Pork Chops Fried or fatty meat, poultry or fish
Starches	Bran, bran cereals Granola Popcorn Whole-grain or white bread (non-toasted) Whole-grain cereals Soups with vegetable or noodles
Vegetables	Fibrous vegetables (dried beans, peas, celery, corn, cabbage) Raw vegetables Mushrooms
Fruits	Dried fruits Coconut Orange and grapefruit membranes Skins (peel all fruit)
Miscellaneous	Carbonated beverages Highly seasoned and spiced food Nuts Pickles Seeds
*Sweets	Candy Desserts Jam/jelly Sweetened fruit juice Sweetened beverages Other sweets

 * Sweets should NOT be part of your diet if you want to reach your weight-loss goal followed by weight maintenance.

Phase I: Clear Liquid Diet
1. After surgery, you will not eat any food or drink any liquids until approval by the surgeon.

2. Once approved, you will receive water, clear broth, unsweetened apple juice or decaffeinated* tea (no red fluids)**. You will only be able to drink 30mL (1 oz) every hour. If you tolerate 1 oz of liquid each hour, on day 2 you may advance to 60mL (2 oz) of liquid every hour.

3. Remember to drink liquids SLOWLY. Do not use a straw***.

4. There may be large quantities of liquids brought to you on your tray. You do not have to finish everything. When you feel full, stop!

5. It is not unusual to experience nausea and/or vomiting during the first few days following surgery. Make sure that you drink slowly. If nausea or vomiting persists, contact your nurse.

*Caffeine should be avoided after surgery because it is a diuretic. This will cause you to lose fluids and make it more difficult for you to keep yourself hydrated.

**If “red foods” are consumed after surgery and you vomit, it may be mistaken for blood. “Red foods” include foods on the clear liquid diet such as sugar-free gelatin, sugar-free popsicles or any “red” sugar-free beverages.

***If you drink from a straw after surgery you will cause air to enter into your new pouch. This will create a full feeling and you will have less room for liquids needed to keep hydrated as well as nutritious foods when you advance to those stages.

Phase II: Full Liquid Diet
1. On discharge from the hospital you will start the full liquid diet.

2. You will stay on the full liquid diet for 1-2 weeks unless directed otherwise by your surgeon and dietitian.

3. To prevent nausea and vomiting, drink liquids slowly. Sip ¼ cup (2 oz) of liquid over 30 minutes. You do not have to finish everything. When you feel full, stop!

4. Drink at least 6-8 cups of water or low-calorie drinks between high-protein beverages. Remember to avoid carbonation, caffeine and citrus.

5. Take your prescribed multi-vitamin/mineral supplements and calcium as instructed.

6. Make sure you keep track of the kind and amount of high-protein beverages you drink. Remember, you need a minimum of 60 grams of protein each day.

The following are examples of protein sources that should be included on the Full Liquid Diet:
1 cup Fat free or 1% milk = 8 g protein
1 cup Soy milk or lactose-free milk (Lactaid or Dairy Ease) = 8 g protein
No-sugar-added breakfast drink made with fat-free or 1% milk (Carnation Instant Breakfast) = 12 g protein
Strained cream soup made with milk (no tomato, mushroom or corn pieces) = 8 g protein
Commercial supplements as suggested by your surgeon or dietician

To help boost protein intake, add non-fat powdered milk to the above list of liquids.
(1 Tbsp = 3 grams of protein, 25 calories)

Phase III: Puree Diet
1. After 1-2 weeks on the Full Liquid diet, you will be able to SLOWLY add foods of a thicker consistency. All foods for the next 2 weeks will be blended to a baby-food consistency.

2. You can continue to include foods on the full liquid diet throughout this stage.

3. It is very important to chew foods thoroughly to avoid blockage or nausea. Try 1-2 Tbsp of food at a time to see if tolerated. Each meal should consist of only 2-4 Tbsp (1/8 – ¼ cup of food).

4. Remember to always include protein first at each meal. You need a minimum of 60 grams of protein each day.

5. Keep yourself hydrated! Drink 6-8 cups of water and low-calorie beverages between meals. Fat free or 1% milk can be included as part of your total fluid intake.

6. Continue to keep track of the kind and amount of protein you eat every day. 

The following are examples of foods from each food group that should be included on the Puree (Blended) Diet. The meat and the milk group include food choices that are “complete” proteins. “Complete” proteins contain all the essential amino acids your body needs. Food choices from the starch, fruit, and vegetable groups are not “complete” proteins and should only be used with foods from the milk and meat group.

Meat Group (7 grams protein per serving)
2 Tbsp (1 ounce) cooked pureed lean meats (chicken, fish, turkey are best tolerated)
¼ cup (2 ounce) baby food meats
¼ cup fat free or 1% pureed cottage cheese
¼ cup low-fat pureed ricotta cheese

Milk Group (8 grams protein per serving)
1 cup fat-free or 1% milk
¾ cup no-sugar-added/low-fat “light” yogurt (no fruit pieces)
1 cup sugar free pudding made with fat free or 1% milk
1 packet of no-sugar-added instant breakfast made with fat-free or 1% milk (12 grams of protein)
1 cup strained cream soup made with milk (no tomato, mushroom or corn pieces)

Starch Group (3 grams protein per serving)
½ cup cream of wheat/rice/baby oatmeal
½ cup mashed potatoes, sweet potatoes, winter squash
1 cup broth-based soup

Fruit Group (0 grams protein per serving)
½ cup pureed peaches, apricots, pears, melon, banana (no skins or seeds)
½ cup unsweetened applesauce
½ cup baby food fruits
½ cup diluted unsweetened fruit juice (limit to 1 serving a day)

Vegetable Group (2 grams protein per serving)
½ cup pureed carrots, green beans (no skins or seeds)
½ cup baby food vegetables

Important Tips:
1. You may need to add fat-free milk, clear broths or fat-free gravies to the above foods and use a blender to make the foods a baby-food consistency.

2. Add non-fat powdered milk or acceptable protein powders to your foods to boost protein amount.

3. Try one new food at a time. If you feel nauseated or experience gas or bloating after eating, then you are not ready for this food. Wait a few days before trying this food again.

4. Portions may need to be adjusted depending on your individual tolerance. Listen to your body. Stop when you feel full.

Phase IV: Soft Diet
1. After 2 weeks on the Puree Diet, you will no longer have to blend your foods. You can slowly add foods that are soft in consistency. Soft foods can be cut easily with a fork.

2. You will remain on the Soft Diet for 2 weeks. Remember to try one new food at a time.

3. For better portion control, use smaller plates and baby spoons and forks. Stop eating when you feel full. 

4. Keep yourself hydrated! Drink 6-8 cups of water and low-calorie beverages between your meals. Don’t drink with your meals. Don’t drink 30 minutes before and 30 minutes after meals.

5. Continue to take your supplements as prescribed.

6. Continue to keep track of the kind and amount of protein you eat every day. Remember, your goal is a minimum of 60 grams of protein each day.

The following are examples of foods from each food group that can be included on the Soft Diet.

Meat Group (7 grams protein per serving)
2 Tbsp (1 ounce) cooked lean meats: skinless chicken, fish, turkey, ground beef (moist meats are usually tolerated best, beef is usually least tolerated)
2 Tbsp (1 ounce) water-packed tuna or chicken
¼ cup egg substitute or 1 egg scrambled
¼ cup fat free or 1% cottage cheese
1 oz (1 slice) low-fat mild cheese
1 tbsp CREAMY peanut butter

Milk Group (8 grams protein per serving)
1 cup fat-free or 1% milk
¾ cup no-sugar-added/low-fat “lite” yogurt (no fruit pieces)
1 cup sugar-free pudding made with fat free or 1% milk
1 packet of no-sugar-added instant breakfast made with fat free or 1% milk (12 grams protein)
1 cup cream soup made with milk (no tomato, mushroom or corn pieces)

Starch Group (3 grams protein per serving)
1 slice of bread (toasted)
4-6 crackers
½ cup cooked cream of wheat/rice/oatmeal
½ cup mashed potatoes, sweet potatoes, winter squash
1 cup broth-based soup

Fruit Group (0 grams protein per serving)
½ cup canned peaches or pears (in own juices or water packed)
½ soft banana
½ cup unsweetened, diluted fruit juice (limit to ½ cup a day)

Vegetable Group (2 grams protein per serving)
½ cup soft, cooked carrots or green beans (no skins or seeds)

Important Tips:
1. All foods should be cooked without added fats. Bake, grill, broil or poach meats. You may season meats with herbs and spices instead of fats.

2. Moist meats are tolerated better at this phase. Add chicken or beef broths, fat free gravies and low-fat cream soups to moisten meats. Finely dice meats and chew well.

3. Add 1-2 Tbsp of a new food at a time; if you feel nauseated or bloating after eating then you are not ready for this food. Wait a few days before trying this food again. Everyone progresses differently. Listen to your body.

Phase V: Regular Diet
1. After 2 weeks on the Soft Diet, you may begin the Regular Diet if ready. You may be ready for this phase at 1 month after surgery or possibly not until 2 months after surgery. Everybody progresses differently.

2. This is the last stage of the diet progression. Continue to add new foods in slowly. Raw fruits and vegetables can be added in as tolerated. You may want to avoid the skin and membranes on fruit.

3. Follow a low-fat diet and avoid simple sugars for life. Your protein goal remains at a minimum of 60 grams each day. For successful weight loss, caloric intake may range between 800-1200 calories each day. Ask your registered dietitian how many calories are appropriate for you.

4. Continue to eat 5-6 small meals each day. As your pouch expands, 3 small meals and 1-2 high protein snacks may be more appropriate.

5. Continue to take your prescribed supplements for life.

6. Keep yourself hydrated! Always drink 6-8 cups of water and low-calorie beverages daily.

7. Continue to track your daily intake and activities. Include calories, protein, fluids, supplements and exercise.

The following are examples of foods from each food group that are included on a Regular Diet:

Meat Group (7 grams protein per serving)
¼ cup egg substitute, 2 egg whites or 1 egg
¼ cup fat-free or 1% cottage cheese
1 ounce cooked lean meats (chicken, turkey, pork, fish, beef)
1 Tbsp peanut butter
1 ounce lean luncheon meats
1 ounce low-fat cheese
½ cup cooked beans, peas or lentils

Milk Group (8 grams protein per serving)
1 cup fat-free or 1% milk
¾ cup no-sugar-added/low-fat “lite” yogurt
1 cup sugar-free pudding made with fat free or 1% milk
1 cup cream soup made with milk

Starch Group (3 grams protein per serving)
1 slice of bread (may be tolerated better toasted)
4-6 crackers
½ cup cooked cream of wheat/rice/oatmeal
¾ cup unsweetened dry cereal
½ cup potatoes, winter squash, corn or peas
1/3 cup rice, pasta
1 cup broth-based soup

Fruit Group (0 grams protein per serving)
½ cup canned “lite” fruit 
½ banana or small fresh fruit (avoid skins and membranes)
½ cup unsweetened, diluted fruit juice (limit to ½ cup a day)

Vegetable Group (2 grams protein per serving)
½ cup cooked non-starch vegetables
1 cup raw non-starchy vegetables

Fat Group
1 tsp margarine or oil
2 tsp diet margarine
1 tsp mayonnaise
1 tbsp low-fat mayonnaise or salad dressing

Here I sit, scared shitless,
Waiting for my W.L.S.,
Knowing that I need it
and tired of the optifast diet.


You see I'm a fatso,
Without out any go-go;
All my weight causes strife
And I want a real life.


To run, bike and climb the stair
Without running out of air;
A time with my family that I care
Of joys of a better life to share.


I know that I will lose my hair
But honestly doin't really care
And take my vitamins each day
For that is the RNY way.


Protein first is the cry
And not to question why;
Then water I must drink
Or else I will surely sink.


I must use carefully my tool
And not treat it like a foold
For if I don't, it is very clear
My pouch will spew without fear.


For this cost is as nothing
For my new life of something.
I look to a stunning life
To Share with my daughter and wife.

Some people were able to go back to work after one week. Others took 2 weeks.

http://www.obesityhelp.com/forums/ON/4237016/How-much-time-off-from-work/

www.obesityhelp.com/forums/ON/4002591/We-should-have-a-chili -cook-off/

DUMPING SYNDROME DEFINED, 
EXPLAINED, 
AND AVOIDABLE! 

Ok arkman asked for a description 
Of Dumping and here goes-

It’s a combo of What I’ve been told, 
What I’ve experienced and 
Some of the Med-Speak Crap 
and some from handouts from my Doc. At Support group.

(Remember, If you opt for DS or the Band
No dumping “per sea,” But, often
Some lactose intolerance and minor dumping
Even with the DS.)

The weight loss that is achieved through the RNY 
Appears to be greatly dependent 
On the removal of the Pyloric Valve, (the “sphincter” of the stomach)
Leaving the individual with a small stoma 
(see “Foamies” in another thread.) As the only regulator 
Of food movement into the small intestine. 
This results in the phenomena called "Dumping Syndrome."
It can cause an individual to feel sick or even faint. 
And by “sick,” I mean anything from – 
“I feel a little icky…” to “Please God, Let Me Die!!!”
Although many think the name would come from 
“Taking a Dump” just with the Volume turned WAY UP!
The Slang term actually comes from the way food is “dumped” 
Into the duodenum or the jejunum moments after eating,
Rather than being released gradually in small amounts 
By the Pyloric Valve from the stomach into the small bowel.

This Rapid gastric emptying, or dumping syndrome, 
Happens when the lower end of the small intestine (jejunum) 
Fills too quickly with undigested food from the stomach. 
Now this is the part 
That leads to so much confusion-
There is –
“Early Dumping”
And “Late Stage Dumping”
They are rather different.
And caused by different things.

"Early" dumping begins during 
Or right after a meal. 
Symptoms of early dumping may include –
Nausea, Vomiting, (resulting from that nausea)
Bloating, (Fast Gas Production)
And Diarrhea, (ranging from mild to Frightening)
And shortness of breath. 

It is caused by –
“the high osmolarity of simple carbohydrates in the bowel.”
*Brain running in back room to look for Biology Text Book*
Remember “Osmosis”?
That Permeable Membrane stuff?
Osmolarity is the “Come Hither” quality of osmosis. 
Things with High Osmolarity have a lot of molecules and
“Suck” water To themselves.
The various types of sugar all have small molecules, 
So that a gram of (for example) sucrose has MANY 
More molecules than a gram of protein, 
Creating a higher concentration 
From simple sugars than from other foods. 
They “Suck” More Water.
Still follow?
This matters because, inside the body, 
Fluid shifts will generally go Toward 
The higher concentration of molecules.

So, a bite of milk chocolate (lots of sugar), 
When it gets to the Roux limb it will quickly "suck" 
A lot of fluid into the bowel. 
This rapid filling of the small bowel causes it to be stretched 
(Which causes cramping pain). 
With fluid from all throughout your body,
Rushing to “The Party in your intestines,”
Blood pressure can drop, you can feel suddenly
In the full blown effects of dehydration, etc… 
I feel warm all over very quickly
Like I’ve had a Big Double shot of Brandy.
Flush face and cheeks and hot inside.
This also “Can Cause” 
The activation of hormonal (depending on the person)
And nerve responses 
That cause the heart to race (palpitations) 
And “Can Cause” 
The individual to become clammy and sweaty. 
Vomiting or diarrhea may follow 
(Diarrhea is most common)
As the intestine tries to 
Quickly rid itself of this "irritant. "
The same sort of reaction 
That you would have to Food Poisoning!
“Everybody OUT!!”
You typically have between 5 and 15 
Minutes before It hits. 
Later than that, could just be plain Ole Runs.

This Diarrhea “Can” Range from-
“Wow, I’ve really got to Go!”
To-
Rip the porcelain off the Bowl,
Explosive, “This is like ‘From the Exorcist’ Crapping!!!”

That best describes Mine. 
Well, actually coupled with Late as well.
Some people have both types to a degree.
I’m lucky that way….

"Late Stage Dumping” 
Happens 1 to 3 hours After eating. 
Symptoms of late dumping include weakness, 
Sweating, and dizziness. 
Late dumping has to do with the blood sugar level. 
The small bowel is very effective in absorbing sugar, 
So that the rapid absorption of a relatively small 
Amount of sugar can cause the glucose level in the blood 
To "spike" upward. 
The pancreas responds to this glucose challenge 
By "cranking up" its output of insulin. 
Unfortunately, the sugar that started the whole cycle 
Was such a small amount that it does not sustain 
The increase in blood glucose, 
Which tends to fall back down at about the time 
The insulin surge really gets going. 
Yes? 
So you feel like 
Someone has given you an unnecessary
Shot of insulin.

It’s basically a bout of hypoglycemia (low blood sugar), 
Which causes you to feel weak, 
Super Sleepy, and completely fatigued. 
Late Dumping has another Evil in its arsenal.
It is a way for gastric bypass patients 
To Fall into a vicious cycle of eating. 

If the patient takes in sugar 
Or a food that is closely related to sugar 
(simple carbohydrates like rice, pasta, potatoes) 
They will experience a small degree of Hypoglycemia 
In the hour or two after eating. 
The hypoglycemia stimulates appetite, 
You eat more, cycle repeats,…..
And it's easy to see where that is going....
Yes?
Some, who claim “bingeing” with Carbs
Have actually been riding like a surfer
On a wave of hypoglycemia.
That requires some bravery and stupidity 
In just the right balance, but does happen.
That “Emotional Eating,” Thing is a doozey!

The reason that sugar does not cause dumping 
In non-operated people is that the stomach, 
Pancreas, and liver work together to prepare nutrients 
(Or sugar) before they reach the small intestine for absorption. 
The stomach serves as a reservoir that releases food 
Downstream only at a controlled rate, through the Pyloric Valve.
This avoids the sudden large influxes of sugar
That can occur after a Roux En Y. 
The released food is also mixed with stomach acid, 
Bile, and pancreatic juice to control the chemical makeup 
Of the stuff that goes downstream 
And avoid all of these effects above. 

For Late Dumping –
Lying down immediately after eating reduces the symptoms
Because gravity isn’t draining the stuff straight into
Your intestines. Yes?
It may give you just a serious nap.

Now,
One more Intricacy that makes it so
Difficult to pin down –
“Dumping Syndrome-Do I have it or Not?”
Is-
Lactose Intolerance.
The symptoms of this are typically
Gas, medium to extreme,
Diarrhea, medium to extreme,
And most all of the symptoms of dumping syndrome 
Except the Blood Sugar drop 
Seen in Late Dumping.
Since Bypassing some of the small intestine,
(That portion where typically the milk sugar Lactose
Would be processed,)
The milk sugars may also create small 
Amounts of Dumping syndrome on their own.
Many Bypass patients who do not have the big reaction to 
Sugar in the form of Dumping Syndrome will
Experience the typical Lactose intolerance symptoms
That some Non- Bypass people have.
The Lactose in milk, has been eaten or processed
By bacteria mostly in Yogurts, and Cheeses 
Which is why those don’t cause problems.

Some will also have Dumping-Like Symptoms resulting from
Foods with high fat content. 
More like severe indigestion with diarrhea rather
Than full out Dumping.
This is due to not mixing with bile
Soon enough in the system. 
This is one of the reasons
For the 38% mal-absorption of Fats in RNY people
And the 81% mal-absorption of Fats in DS people.
In Both, the extra unabsorbed fats tend to cause them to 
Poop like a goose! 
So for both, particularly
The RNY folks who still get calories from a lot of that fat,
Best To keep those fat percentages down to keep 
The Poo Normal. Yes?

Sugar Alcohol is another confusion in the mix…
Sugar Alcohols have a Laxative effect and can cause cramping
and bloating for anyone, WlS post-o*****n-Op,
even when eaten in moderate doses.
This cramping / diarrhea effect of one bite too much of
a Sugar Alcohol would happen even without the surgery,
But since many Post-Ops are seeking out more SF alternatives,
They end up being the folks who “test out” more Sugar-Alcohols.
(so not Dumping, just the Laxative property of Sugar Alcohol…)
 
Many, (me included)
Consider dumping syndrome 
To be a beneficial effect of gastric bypass.
It provides quick and reliable negative feedback 
For intake of the "wrong" foods. 
In practice, most patients DO NOT 
Experience full-blown dumping 
More than once or twice. 
Most simply say that they have 
"Lost their Taste" for sweets. 

Some, have Dumping Syndrome early on, 
But as their system adapts to the new
“Goings On,” they lose it, 
And their Digestive system compensates.
Others, like me, have it for life.

There are some people who have had no reaction
To sugars and then One Day- POW!
Full Blown Dump!
Something about the food they ate, 
And the speed that in went into
The intestines, set them off. 
This happens sometimes 
Due to drinking with a high osmolarity food.

Speed into the Intestine 
Plus
Molecular Density Of the thing entering, 
Equals “Degree of Dumping Syndrome Effect.”

Now,
All that sounds bad.
But, It can all be avoided-
JUST DON’T EAT SWEETS! 
AND HIGH CARB/SWEET MIX FOODS!
Or-
The General Guidelines 
For avoiding/reducing Dumping Syndrome
(From a handout at my support group 
From a Nutritionist who works with Bypass folk.)

1.) Avoid taking liquids with meals. 
Liquids should be taken 30 minutes before or after meals 
And limited to ½ to 1 cup servings. 
Carbonated beverages are not recommended 
In the initial stages of the diet to prevent excess gas formation.

2.) Small, frequent feeding should be provided. 
The number of feedings depends on the patient’s tolerance 
To specific portions of food. 
Foods should be eaten slowly and chewed well. 
Avoid those known to cause individual problems. 

3.) The diet should be low in simple carbohydrates, 
High in complex carbohydrates and protein, 
And moderate in fat 
With the purpose of achieving and maintaining 
The optimal weight and nutritional status of the patient.

4.) All food and drink should be moderate in temperature. 
Some patients tolerate warm water 
Better than iced or cold water.

5.) Avoid foods that are natural laxatives, 
Such as figs, prunes, and licorice.

6.) If “dumping” is a problem, 
It may be helpful to lie down 
20 to 30 minutes after meals and even up to an hour 
To retard transit to the small bowel.

7.) Slowly introduce small amounts of milk into the diet
To determine tolerance. 
If milk products are tolerated, 
They can play a key role 
In providing an easily tolerated protein 
And other nutrients such as calcium and vitamin D.

Trick/Tip from my Doc- (useful for Diabetics as well)
Pectin, 
A dietary fiber found in fruits and vegetables, 
May be helpful for treating dumping syndrome 
And even simple diarrhea. 
Pectin delays gastric emptying, 
Slows carbohydrate absorption, 
And reduces the glycemic response.
1 tsp pectin powder 3 times daily may be effective.
(It’s that “Sure-Jell” stuff for making 
Home-made Jelly. Great food additive)

So,
That’s the –
“Everything and then some I know about Dumping.”