6 Years Post Op: The Good, The Bad and The Ugly

Well it's time for that post – six years since I've had surgery and time to be grateful for my journey, the friends I've made and the things I've learned about me. This is going to be a long post. I'm wordy – I admit it. I thought I'd give you an overview of my victories and my challenges along my journey. I imagine that some people will not take the time to read such a long post, but I put it out there for those that want an idea of what one person's struggles are post op after six years in the journey. I have to say that this journey does not stop when one gets to goal. It truly is a life long journey. Don't rush it. It's going to be there for the rest of your life.

I'm hoping this post won't come across as too negative and whiney...but it just might. I want people to know that there are not always rainbows and unicorns in our journey. There are issues of all kinds after surgery and after you've been out a while.

I had surgery on July 5^th, 2006. Back then many of us went to Michigan My care there was great, after care really sucked. But my surgeon was wonderful and I had very few problems with my surgery itself. The only complication was a nicked artery. I lost a bit more blood than most patients but recovery was fairly easy. I was at the mall my second day home. It truly was easy breezy!

My first year out was GLORIOUS. I have no other word to describe it. It was so wonderful. Although I was a slow loser (my surgical centre gave us no guidelines on carbs and I do think that slowed me down compared to others) I did fairly well. I started at 290 lbs before surgery and ended up being less than half that by goal. My first year I followed the rules very well and made exercise a huge part of my life. I made a point of walking to and home from work every day 3 miles and then would jump on my treadmill at home for another 4 miles. I was pretty motivated, highly focused and felt so strong and powerful. I remember feeling so strong and powerful – I was now eating to live and not living to eat. I loved feeling that power over food! The first year is a CONSTANT high. We long timers wish we could bottle it and have it back. LOL It's purely magical!

Early deficiency of iron and osteopenia developed by the year mark. Started supplementing.

The second year was pretty good too. I still had that high...but the binges started to creep in now and again. Those of us who are binge eaters do tend to struggle post op. I'd binge and then cry about the binge. I hated myself for doing it. I was even planning binges in advance...and then feeling like a failure a half hour later when I felt like crap. I started to gain. It started to freak me out to be honest. Five pounds up. Feeling a bit daunted. People actually commented that I was too gaunt earlier and that I was looking better...but I did not feel that at all. The mental struggle was beginning and the feelings of being out of control and feelings of failure were terribly powerful. I was starting to feel powerless to food, no longer so powerful.

When I got to goal, no one really taught me what it meant to eat in moderation. I'd always been overweight. I always had a problem with food. I was never that person that could eat a small bag of chips and put half of it away for later. Not even as a teenager. It was a foreign concept. Portion sizes were starting to get larger. It started to get scary. I could eat more and binges were bigger. It was getting downright scary. Feeling out of control, feeling worthless.....up 10 lbs...

I ended up as a size 10. I was devastated. People I worked with were size 0 and 2 after having children. I started to obsess and do the 5 day pouch test....then cut carbs completely, then bingeing. I'd repeat the cycle again and again only to have the same results. I'd work hard for a week and lose only 1 lb but then binge on a bad weekend and gain double that. The weight was no longer falling off like it once did. I felt like 10 lbs could have been 100. I know it sounds strange but that 10 lbs was totally overwhelming to me.

I started feeling like a failure because I didn't get to size 4 or 6. I was still “big”. I felt like a failure. I know that it seems so foreign that you'd consider yourself a failure being a size 10 or size 12 after being size 26/28 at your heaviest...but the mind is a strange thing. I became too obsessed with comparing myself to others. Not realizing how far I'd come. The reality is that some of us have bigger frames, some of us will be a size 2, some will be a size 10 or a size 18 or any size really. We are all so different. Again, the worst thing you can do is to compare yourself to others.

I decided I had better get into therapy. I went to our local eating disorder place for 6 months of therapy. They cater to binge eaters, over eaters, bullemics and anorexics. I learned a lot about Cognitive Behavioural Therapy which many of us benefit from post op to deal with the head issues. I learned to try not to base my happiness on a size or number on a scale. I'm still not ready to throw out my scale like they suggest. A funny thing happened at therapy though – I also became obsessed with how skinny the anorexics look so while I made some progress, I think head issues were still skewed. Again head issues are a strange thing post op. More issues with anemia.

Year 2 was also when I discovered that I had Reactive Hypoglycemia. I never had diabetes or had issues with blood sugar so that required a lot of reading and learning on something new. I diagnosed myself, took the information to my doctor and yes, it was confirmed. I managed it fairly well. Sugar is the enemy. I wish I didn't have an issue with sugar – that I could keep it out of my life completely but sugar is my struggle always. Managed the RH fairly well this year. No problems with it other than a few lows.

Years 3 and 4, I continued the same skewed thinking while creeping up and up on the scale. I had a lot of issues going on in my personal life that lead to a lot of emotional eating. At one point, I ended up 27 lbs above my goal. I kid you not. SOOOO easy to do when your mind is skewed. I struggled. I had a few comments said to me that made me feel like giving up and running away. I would battle dark days of hating me, hating the scale and feeling like a total failure. It's very hard to run a support group for weight loss when you are going through the issues but I continued to do it. It was embarrassing to be up at the front when you were feeling like a failure. I lurked more on OH, poking my head in now and again, but feeling like a lost puppy. Didn't really fit in with the “rah rah” of the newbies and feeling like I couldn't offer any thing to anyone when I was struggling with myself. Up to size 12 and then closer to a 14.

Year 5 was better. Feeling like I started to make peace with my bounceback. Do I like it? No. But I managed to get off around 15 lbs of it and felt more in control. Still working on the self image and positive talk but feeling more like I'm a survivor in this thing called WLS rather than a failure. Realizing that I'm not the only person that struggles. I'm not alone in this journey. Back to size 12 but still working towards 10.

So here I stand at year 6, feeling more at peace. Again still a work in progress but trying to like myself more. In my head, I am still big and still relate to the large people in the room than the “skinny minnies”. Constantly have the feeling that I'm still a size 26. Regain is all in my stomach and butt and makes me feel constantly bloated and feeling like I look pregnant. I never feel like clothes fit like they did when I got to goal. I can tell that my body composition has changed with regain. Lost a lot of muscle mass. More wobbly bits than before.

This year again, anemia is still kicking its ugly head. Some low vitamin d for the first time. RH is kicking my butt more this year than ever before. I've had two issues in the past 6 months of passing out from it. (One time I put off symptoms when I shouldn't have – the second one, I attributed the symptoms to being sick from the heat versus RH). That's been scary but both times I really should have known better.

Food issues are still there. I call it my FAT HEAD. I am constantly struggling with my fat head – emotional eating, boredom eating, stress eating and bingeing. It's a constant struggle not to give in and sometimes I do. I am one of the few that can honestly eat anything. There is nothing that disagrees with my pouch – nothing. And I can eat large amounts. It would scare most people how much I can eat. To this day, I've still never vomited once, had things stuck or had the foamies.

I've learned that I have to just keep picking myself up and dusting myself off and set new goals. I'm a work in progress – for the rest of my life. Surgery did not fix my head in any respect.

I still have around 10-12 of regain to get back off. I'm starting to make peace with that though. It's not the end of the world if I stay where I am at. I'm starting to strongly believe the issue of set point. My body is pretty resistant. So I'm trying to make peace with the fact that I may still carry some extra weight with me and that it's not the worst thing in the world if I do. It could be far worse. It could have easily slipped to 40, 50 pounds had I not caught it earlier when it started to spiral. Some days I feel in control of my eating and other days I still feel overwhelmed. For me, it's day to day...one day at a time.

I'm grateful for many things:

Other than the RH issues, I'm healthy. Anemic still but no other problems. Healthy is a good thing. I'm strong. I'm mobile. I'm active. Life doesn't pass me by unless I want it to. I've coached swimming, baseball, basketball. I've done walked three half marathons in Detroit. I've met many nice people in the WLS community. Running a support group has helped me be accountable to myself and others. I cannot put my head in the sand and ignore the creeping weight. I need the support group as much as others.

I see my parents struggling with their obesity and I'm so glad that I made the choice that I did to have surgery. Both of my parents can barely walk a block without being terribly winded, my Mom is at the point that soon she'll need a cane or a scooter. I'm not there. I'm not going to have a heart attack at a young age like my mother did. I still have my life and quality of life. It's really a wonderful thing.

My goal is to keep working on the head issues. I highly encourage newbies to examine these issues before surgery. The head stuff can be brutal for many of us. You will see me on this board talking about regain/bounceback quite frankly. I think we need to start taking the shame out of it. It happens and most surgeons do expect it. I think by beating ourselves up we are not doing ourselves any favours. I wish people had given me more of a heads up on it to be honest. Then maybe it wouldn't have been so devastating to me.

Anyway, there's the good, bad and ugly of my surgery and my life post op. I know that my experiences are not the same as everyone else's but I'm sure I'm also not the only one to go through such a range of emotional issues and head issues after surgery. So I thought I'd put this out there for anyone who may relate to my story or anyone that wants to chat about any of these issues. Sometimes feeling like we are not alone in this journey is a very powerful thing.

Newbies: WLS is an absolutely amazing gift. It's a wonderful gift but also a big responsibility to use it wisely and there may be many times that you struggle along this journey. Please don't waste the wonderful gift you've been given. Get to goal your first year, keep your triggers at bay and work towards getting off the most weight you can while you can. Despite the head struggles, I would still do surgery all over again. It's truly a wonderful gift!

Have a good day,

Dawn

Medic Alert Bracelets

After surgery, it is quite common for the WLS community members to rush out and get a medic alert bracelet.  I was told that this was a must for any RNYer shortly after surgery. Even surgeons still recommend them. Many facilities are now staying NO to medic alerts - at least to putting a lot of information on them and rightly so.  Many facilities are finding that the messages written on them are now causing more problems with hospital treatment rather then helping.

I encourage you to really give the purchase of a medic alert bracelet some good thought.  Think about each thing you choose to put on it and what the benefits (and risks) could be.  Rather than go blindly by common statements that people will tell you to put on them, please consider all the aspects of what you put on the bracelet.  Today's post is going to take some of the common statements put on bracelets and explain why they can be a good and bad thing.  I've read this on various boards, talk to some medical personnel and heard some of the following information.  I admit I blindly went out and bought mine just based on what others told me to do.   Ultimately the decision is up to you, but I thought I would at least share what I've learned over the years that has changed my mind on the whole medic alert issue..  

Remember that medic alert bracelets are for times of unconciousness - when you cannot speak for yourself.  They are designed for FIRST RESPONDERS - paramedics.  Realistically, most of the time when we do go to the hospital - even those of us who had RNY and have complications come up, we are totally capable of speaking when we go in.  Those of us who do go in to the hospital often have caregivers that do the speaking for us.   A well educated colleague, spouse or family member will go much further than having a bracelet speak for us.

So here's the top message that typically RNYers put on their bracelets:

No blind NG tube
RNY Gastric bypass
my surgeons name
ICE phone #
no NSAIDS and no sugar

So let me take the time to explain WHY these messages can cause more harm than good.

First of all, if you are going to get a bracelet be sure to put your surgery type and date on them.  Not simply "gastric bypass". It is called a Roux En Y.  (Not RYN as I see so often!).  Putting your surgeon and your surgery date might help although chances are he's not going to remember you much unless you are fresh out of surgery.  But it is never a bad thing if your surgeon talks to anyone and explains the surgery to them.  That's always a bonus.   

As for NG tubes:  They are inserted in patients immediately after major surgery to help keep the stomach empty and prevent postop vomiting and used to feed and administer meds in critically ill patients. In addition, nasogastric tubes are routinely used to collect gastric contents for lab analysis and to aspirate the gut in case of a GI bleed or a drug overdose. The chances of you needing a NG tube are pretty slim but it may be necessary. There's a myth that when put into you, the medical personnel will push and push the tube through and burst your pouch.  That is untrue.  Medical personnel are trained that when they feel resistance of any kind, they stop. 

The ICE information is always good - in case of emergency call.....

But here's the other thing I see put so many times on RNYer's bracelets that scares me - no aspirin or no NSAIDS. While it is true indeed that we should not be on them long term, there may come a time when I will gladly open my arms to aspirin!  If I were to have a heart attack, PLEASE PLEASE give me aspirin!!

Most heart attacks develop when a cholesterol-laden plaque in a coronary artery ruptures. Relatively small plaques, which produce only partial blockages, are the ones most likely to rupture. When they do, they attract platelets to their surface. Platelets are the tiny blood cells that trigger blood clotting. A clot, or thrombus, builds up on the ruptured plaque. As the clot grows, it blocks the artery. If the blockage is complete, it deprives a portion of the heart muscle of oxygen. As a result, muscle cells die — and it’s a heart attack. Aspirin helps by inhibiting platelets. Only a tiny amount is needed to inhibit all the platelets in the bloodstream; in fact, small amounts are better than high doses. But since the clot grows minute by minute, time is of the essence.

Since my own mother had a massive heart attack at age 59, I definitely will risk an ulcer in order to treat a heart attack!!  Remember, it's generally a long term use (2 weeks or more) that NSAIDS cause ulcers.

Here's another BIG issue that I want to bring up.  The no sugars statement really seems pretty harmless doesn't it? Not so. It could be dangerous.  It is a common side effect for many of us after our first or second year post op, to develop reactive hypoglycemia .  It's been quoted from 1/4 of us to 3/4 of us will get RH.  When you have RH, you bottom out in your sugars and get extremely low. Dangerously low. Guess what you need? Yep, sugars.   You need to raise your sugar up back to a healthy level.  It is much like people with diabetes having a low.  We can appear drunk, wobbly when moving around and having a low.  Like diabetics we can become unconsciousness.  If I were at the mall and someone noticed this and I started to pass out and they perhaps recognized the signs as being low sugar and were going to treat me, I'd hate for them to look at that bracelet and see "no sugars" and not treat me.   Is sugar going to kill me? No.  Could not getting sugar kill me? It potentially could.

The thing is that first responders aren't generally going to start giving you food and start feeding you sweet tarts.  They are not going to make a point of feeding you - that's what happens at the hospital and that's not til you are stable and they've figured out the medical problem.  That's when your family member would tell them about your restricted diet -- or quiet honestly, you will because you'll be conscious by the time the ordering menu comes around and you need to place a meal. No one is going to start feeding you sweet tarts, apple pie or hot fudge sundaes in an emergency situation.  

So give these aspects some thought before you decide what you'll put on your bracelet if you even decide to buy one.  Sometimes like they say, less is more.

Oh and do I wear my bracelet? No.  It sits in my jewellery box.

Dawn

June Meeting 2012

Last night, at the support group meeting, Carrie and I shared information about a few interesting things in regards to hunger.  We started off the meeting by talking to a newbie who has no hunger (it's such a wonderful thing when it's turned off for so many of us at the beginning) and then we made a list of all the foods that people crave.

We went through the list and noticed something, by and large, practically all the cravings from nachos to pizza, from chips to cookies (and even vodka and beer) all revolved around carbs.  The only exception I believe was coffee.  By and large, we crave carbs.  There is a reason why.  We knew carbs would be a high part of the cravings.

When we have sugar, our body gets a "high", it's like a high to our brain.  When we are tired or very hungry, our bodies CRAVE sugar.  Sugar is a form of "instant" energy and our bodies know that. When we are physically hungry, it is often because our blood sugar is low.  When we ingest the sugar, the sugars make us spike up in blood sugar and often come crashing down to the point that they go even lower - hence we are hungrier even MORE than before.  So what does our body crave?

Yep you named it - more sugar.

Now sugar can be in it's simplest form - like glucose - the candy, cookies, chips - again, instant energy.  But it can also be carbs.  Carbs that are ingested are either turned into sugar and sent to the body or stored.  The more that we eat, the more carbs the body doesn't need for energy, therefore, it's sent to the cells for storage.  Therefore, our fat stores, get...well...fatter.  The sugar is sent to the cells for storage and the cell gets bigger.

So we went over a few simple things we can do:

1) Make sure that when you get sugar (whatever form but especially simple carbs, simple sugars) that you pair the sugar with a protein.  It will helps slow down the digestive process and will help to stabilize blood sugar.  Protein has very little effect on blood sugar alone. 

2)  Eat protein at EVERY meal and snack as much as you can. Our bariatric centre says this all the time: balance, balance - 3 food groups at meals, and 2 food groups at snacks. Remember the best calculation: a diet consisting of 40% (or more) protein, 30% (or less) carbs, and 30% (or less) fat.  The more protein, the better the loss.

3) Look for whole grain carbs - especially with the kernels intact.  Complex carbohydrates are good.  Look for lots of fibre.  Some products we highlighted were:  La Tortilla Factory tortillas (Schwabs, Remark), Joseph's Flax Pitas (Remark). That have very little carbs especially when you figure out the fibre.  We also showed a product called "Shiritaki Noodles" (Metro) which are a soy alternative to regular pasta (rinse well) and Carbmaster Yogurt from Kroger (very little carbs, lots of protein).

4) Shop from the outside of the supermarket as much as possible.  The stuff on the insides is all highly processed and will spike blood sugars.  Look at the glycemic index of foods.  It gives you an idea of some foods that will spike blood sugar (high glycemic) or lower/regulate blood sugar (low glycemic foods).  The worst offenders are usually: white breads, rice, white pasta...etc.  The body processes starch almost as fast as it processes glucose (sugar from say, candy).  If you cook pasta, cook it "al dente" - the mushier it is, the more it will spike your sugars.  The more ripe the fruit as well.  Fresh fruit is better than juice or dried fruit (which has sugar added to it generally) because it has fibre.  Fibre slows down digestion.

5) Want to lose faster or are you losing slower?  Watch the carbs. (I wish I would have known this during my surgery as I'm sure this is one reason I lost slowly).  The more carbs in your diet, the more your body doesn't need them, therefore they are stored.

6) Watch drinks. Many drinks may have virtually any calories...but may be full of carbs.  Again, carbs are broken down to sugars if not needed by the body. Find a protein shake that is water based and low carb (2 grams of sugar or other) and that's even better.

7)  Add acid foods - lemon, lime, vinegar, pickles, mustard - all slow down the blood sugar response.

8) Say yes to fibre and favour the good fats.

Here's the interesting about WLS and hunger:  Initially when you have your surgery (Think a few weeks out), your ghrelin hormone (hunger) is greatly reduced in your body so most people experience very little physical hunger.   This changes especially at 6 months out or more and here's why:   A study from 2011 discovered that the physical reaction (spike in blood sugars as our body pumps out insulin to deal with the sugar in our body) changes from surgery to the 6th month after WLS.

At 6 months out (or so), the physical blood sugar reaction is 3X stronger or more powerful at 6 months out for those who have had the vertical sleeve.  That means that your body pumps out more insulin, and your blood sugar spikes and comes back down.  When it comes down, you may be hungrier than before.  Sugar has a very strong effect.  More sugar = more hunger...so what do you take in? More sugar...and so the ugly, vicious cycle continues.

If you had an RNY, the response in sugar is 20X greater at 6 months out.

Have hunger? Hungry an hour or so after eating?  Find the hunger increasing?  Time to work on stablizing your blood sugar as possible.  Stable blood sugar is the key to getting the hunger monster under control.  

By the way, the Bariatric Centre has seen a lot of people struggling at the 6 month mark with hunger, cravings, emotional eating and the like.  They have moved their 9 month social work group class up to the 6 month mark.  Hunger *is* going to be back.  While you don't have it, use that super power to say NO to the stuff you just don't need.  It's a wonderful time when you don't have the all consuming hunger and although it's hard to eat initially and can be a challenge early out, the new relationship you have with food when you aren't as hungry, is really a wonderful thing.  When hunger comes back, so many of us struggle.  That's when you may need the support group even more.

As well, so many of us have to start watching out for signs of reactive hypoglycemia.  So many of us after RNY get it around the first year mark or so.   Read about Reactive Hypoglycemia here.

Please don't hesitate to email Carrie or I should you need information on products, information or if you have a question.

Dawn

This week I had the good fortune of talking to some people in my group and recommending a program called myfitnesspal.

If you haven't heard of it, it's an online site much like sparkpeople, fitday or dailyplate where you can track your calorie intake and the like to examine what you are eating. When I talk to someone who is stalling or not losing as they'd like, 9 times out of 10 it is the carbs that they've added back into their diets that is slowing down their progress. Numerous times, it's been people that have been doing protein shakes like Body By Vi that are not low carb.

Low carb is a key to weight loss. It doesn't mean going NO CARB.

When you have an eating disorder, the worst thing you can do is to compound the eating disorder by elimating a food group completely. Your body also needs some carbs and there are nutritional values to carbs as well. (Read the China Study about how all plant diets can do wonders for many medical conditions and you'll understand that life with carbs in our body is a good thing in many respects).

Anyway, low carb is important. Most of us did not get fat by eating too much protein. It's usually the processed junk that gets in the way for most of us whether sweets (cakes, cookies, and the like)or crackers, chips, pasta, breads, cereals, popcorn etc. You'll find often that when you stall it's because you've been slowly adding more and more protein to the diet.

The ideal diet for a post RNY/VSG patient is considered to be 40% protein, 30% carbs and 30% fats. Myfitness pal has a WONDERFUL display on their phone app (not on website and not for blackberry users) where you can click a button and see a pie graph that shows you this percentage breakdown. If you go to "home" and click "daily" - there's a little basketball type looking button - that's it.

This is the brillant tool that I've shared with two people this week who both took the time to send me emails/notes and say it totally shows them that they are getting way too many percentages of carbs. One even wrote that she's been following it and already losing weight from it. She's got hope finally as to why she's been gaining, rather than losing.

This is the tool that I'm currently using myself....as my diet can easily go the way of too many carbs. I've even started doing protein shakes - damn the Premier Protein is pretty darn good =) to see if bumping that up helps me out. I'll keep you tuned! Dawn

Spring is on its way!

Here's a dress shot. LOL I'm getting totally in the mood for spring - but that means, getting off the next 12 lbs of regain to get back to goal. Here I am trying on a cute little dress at Marks Work Wearhouse (yes, they have nice clothes and aren't just work overalls and boots). I didn't end up buying the dress...but the dress does symbolize one goal that I am working on.

I am trying to embrace my inner girliness.

It's ironic that when I was 288 lbs I spent a lot of time in dresses. For some reason, when I was larger I felt like dresses were a great thing - they helped hide my rolls and made me feel pretty despite my size. But once I started to lose weight, I didn't buy a single dress. Funny as you'd think it would work in reverse but this goes back to one aspect of my weight loss. The more I lost, the more critical I became of my body. I think that may sound foreign to people as you'd expect that the weight loss would equal more confidence, not less. But that is how it worked for me especially over the long term.

The first year I was on a perpetual high of feeling great. When I started battling my head, fat and weight issues again, that's when the self confidence went down.

So now my plan of attack is to get the 12 more pounds of weight off. I am thinking that spring is a great time as I'll get more active and enjoy the weather. I have all Spring/Summer to s l o w l y make it happen. No fad diets, just slow loss over time is my goal. The other goal of course, is to wear more dresses and skirts and let myself feel girly.

It seemed like a great plan last week when I wore some dresses to school. I think I could have knocked some of my colleagues over with a feather by the way from the looks they gave me seeing me in a dress. LOL But I also got a ton of compliments too. I ended up course wearing the wrong shoes to walk to work and ended up with about 5 blisters and cuts on each foot. So much for my inner girliess! LOL

Dawn

History of My Support Group

I know I mentioned before that I run my local support group. How did I get into this? Quite honestly, I ran it because there wasn't one when I had my surgery. Well, correction - there WAS a group and I did attend...but the group was only for MY SURGICAL centre and at the time people in my community in Ontario typically went across to Michigan for surgery. Hence there was no "local" surgical centre. So all of us went to typically one of five different places. So meeting people, I knew there was a need and started one that was open for all people in our fair city and surrounding communities.

After having surgery, my parents (who were not thrilled that I had it in the first place) became amazing converts about weight loss surgery. They would go to their dentist, and the office manager there would often talk with them about me. Teresa ended up being curious about surgery and so asked me to come over her house and talk with her about it. In the end, she had surgery and became the second person for my "support group".

Next, she met someone having surgery and invited her in. We continued our support groups, and each time added more and more people to our coffee talks at Tim Hortons (a local coffee place). We ended up eventually needing a "place" and moved to Teresa's basement which thankfully was quite large. Imagine having 40 strangers in your basement! LOL Those were the old days.

Eventually we looked high and low for a place and ended up finding an auditorium to host us. Thank goodness!! It took quite some time!

Years later our local bariatric centre opened up in our community. They've helped us a bit, we've actually had to learn their process but we pretty much do what we do on our own. Our own ideas, members requests, our own imagination and arranging guest speakers. Eventually we moved to a 5 person team.

In the last few months, we've had changes. Teresa decided to move on and "retire" from the group and I took on Carrie a wonderful member who has been coming for many years, is devoted to helping others and is a nurse which is a bonus for medical info. We've done two meetings together - trying to "gel" still and figure out how to bounce off one another at the meetings. It's turning out really well. Anyway last night one of the ladies came to our meeting and posted this on Obesityhelp.com:


I just wanted to give a shout out to diminishingdawn for all of her hard work and love that she puts in to the first tuesday of every month for the support groups. As is started out 4 years ago at a coffee shop to now over 50 (Edit: Hubby counted around 110 people last night)50 people every meeting is such a great accomplishment. It is a great place to be if you need someone to talk to or just share your stories with. I know this journey is not an easy one, before or even years out but everyone is welcome every month and it really puts your heart at ease when you leave. It is such a miracle and such an enjoyment to see how everyone is putting themselves first and taking that first step to their new life. Even if they dont proceed with the surgery, they have started their own journey by seaking support from others and reaching out for help. Diminishingdawn is a great speaker and you can tell she really does care. If you have a NSV you can just share your story and everyone can relate to you and it just gives you encouragement and that your not alone. If you are from the windsor area, please go to the support meetings, they are great. I started going 2 years ago with my bf who had currently got it done, not even having the guts to do it. But now, look at me, i go every month practically and having surgery in 2 weeks. Its really got me thinking that i can do it. and i believe everyone can do anything they put their minds to. If your not from windsor, i hope you have a great support group in your area, or make one of your own from pple you meet on here. Everyone deserves a second chance and people around them that beleieve in them.
Just a little shout out and just sharing my experience.
Take care everyone and have a great Wednesday!!!

I have to say that sometimes running a support group, you have some drama and nonsense and complaints from time to time. You come to the underlying conclusion that you do it for people who want your help, who need help and not for them. But I have to say that this just made my day!! :)

Dawn

HELP! I'm failing beause I don't dump....

Going into surgery some people have some very unrealistic expectations. Sometimes I want to just shake my head at the misconceptions people have going into surgery or having had surgery. I don't know if it is because they depended on their surgical centre to tell them everything they needed or because they just didn't take the time to read. It baffles me that people don't go into surgery learning all they can learn about their new life.

To have the expectation that you are going to dump and then expect that to carry you through life post op is very unrealistic. While I *prayed* for dumping, I knew that many people don't dump. I dumped maybe a handful of times, hardly ever.

Here's a post I read in another group:

I have a question. I am out 14 months now since RNY Gastric Bypass Surgery. I am not doing well with weightloss. Since regaining about 41 pounds, I discovered that I do not ever experience "Dumping Syndrome" with any food at all - including SUGAR???? How can this be possible?? That is why I requested RNY with malapsorbtion, so I would not be able to eat surgar and other bad foods. Anyone out there with a logical explanation? I sure would appreciate it.

Let's dispell this myth: Do not count on dumping (getting sick from too much fat or sugar) to "save" you from food. Realistically, the surgery will only do so much for you and it will be the choices that you make that result in success or failure. Many people expect dumping but realistically, only around 60% of people dump. Out of those that do, many only dump early out. Eventually for most, the body adapts well to sugar and reactions diminish over time (unless you beome one of those who develop reactive hypoglycemia like myself).

The best advice: eat as though you will dump. Follow those guidelines for sugar/fat limits like they are the be all and end all. Keep triggers out of your life as long as you can. And most of all, do not depend on dumping. It's all about choices still and that's why we say surgery is a tool =)

And if you are having thoughts like the person above, you *need* therapy because obviously the psychological issue is winning and not you. To gain 41 lbs back at 14 months out is pretty scary. Remember folks, surgery only changes your body, not your brain.

I truly hope this lady gets the help she desperately needs.

Dawn

Great Iron Info

This is a great article (published) from my friend Leona who works in an anemia clinic. Lots of interesting information.


Anemia and the Surgical Bariatric Patient
By: Leona A. Dove RN, BScN

Anemia is a prevalent diagnosis among the surgical weight loss community. The primary cause of this anemia is related to the absorption of components necessary to build healthy red blood cells. Anemia is clinically defined as a HGB < 120 g/L in men and non-menstruating women and a HGB < 115 g/L in menstruating women. As a Blood Conservation Specialist, I tend to treat all patients whose HGB is < 120. Making allowances for the fact that women bleed once a month does not necessarily make that person feel any less symptomatic in terms of fatigue etc.

Hemoglobin (HGB) is an iron derived blood protein that carries oxygen and nutrients to the tissue. It is what makes our red blood cells, and thus our blood red. Low hemoglobin means less than optimal oxygen and nutrients are getting to our tissues. Some of the symptoms of this lack of oxygen and nutrients getting to our tissues are directly related to the tissues not getting enough oxygen and nutrients (e.g. slow healing and infection at the site of surgery, moodiness because the brain is not getting enough oxygen etc). Other symptoms are related to our body’s reaction to not having enough oxygen and nutrients (e.g. Our respiratory rate increases to get more oxygen into our lungs, our heart beats faster to get more blood carrying less oxygen to our vital centres, our blood pressure drops to hold what blood we have in our vital core instead of sending it to our extremities etc).

As I mentioned HGB is an iron derived blood protein. There are three components necessary for the body to convert Iron to hemoglobin.

Iron-The building blocks of hemoglobin

Vitamin B12- The brick mason

Erythropoietin-The General Contractor

Anemia is a result of a lack of, or functional failure of, one of these three components. The type of anemia can be determined from a common blood test (a complete blood count) specifically two values of that count. Once the CBC is evaluated additional blood work may need to be ordered.

Iron Deficient Anemia
Anemia related to low iron is the most commonly diagnosed anemia. If your body does not have enough iron to convert to hemoglobin, you will not have an adequate hemoglobin level. In the bariatric patient, the iron deficiency is often related to the decreased iron absorption surface. Eighty percent of the iron from our food is absorbed at the level of our stomach. Weight loss surgery significantly reduces the size of the stomach thus significantly reducing the absorption surface for iron as a result most Surgical Bariatric Patients need to increase the intake of iron rich foods and rely on iron supplements to ensure they have the “building blocks” necessary for HGB production.

Iron Rich Diet
It is nearly impossible to poison yourself eating foods naturally containing iron; as such this strategy is perhaps one of the easiest if not safest ways to increase the body’s iron reserve. There are two types of Iron we can get from our food:

Heme Iron: Found in animal protein sources, red meat, poultry (specifically the dark meat of the legs and thighs vs. the breast) and fish. Heme Iron is readily absorbed and used by the body, is not affected by what you eat and drink in conjunction with them and helps the body to absorb and use non-heme irons.

Non-Heme Iron: Found in plant protein sources, beans, lentils, whole grains, dried fruits, nuts, green leafy vegetables and some fruits. Non-Heme Iron is not as readily absorbed and used by the body and are affected by what you eat and drink with them. Heme Iron containing foods, and foods rich in Vitamin C (bell peppers, broccoli, strawberries, citrus fruit, Cantaloupes) increase the absorption and use of non-heme iron. Foods containing Oxalates (coffee, tea, cola, and chocolate) and foods rich in calcium (milk, cheese etc) block the absorption and use of non-heme irons.

To Maximize The Absorption of Iron From your Food:

ü Remember iron is in colourful foods red meat, green leafy vegetables and the rich golden browns of whole wheat. If your food is grey because of age or over cooking what iron was in it is likely minimized.

ü Maximize the body’s absorption and use of Non-Heme Iron by consuming them withfoods containing Heme Iron and/or foods rich in Vitamin C.

ü Avoid the consumption of oxalate and calcium containing foods for one hour before and after your Iron Rich Meal

Iron Supplements
The arbitrary use of an iron supplement without the recommendation of a health care professional can be dangerous. Iron is a “fat stored” mineral, which can reach toxic levels, resulting in liver damage. If an iron supplement is recommended there is some valuable information you need to have.
There are two generations of iron supplements; the difference is related to where the iron is absorbed.

I. Iron Salts (ferrous sulfate, ferrous Gluconate, ferrous Fumarate) are absorbed in the stomach. They must be taken on an empty stomach (1 hour before a meal or 2 hours after a meal) to maximize its absorption. They cannot be taken with calcium containing medications or foods, aluminum salts based antacids (Maalox, gaviscon, Tums) or oxalate containing foods as these things block the absorption of the iron salt. The use of Vitamin C in conjunction with the Iron Salt will increase the absorption of the iron salt. Recent studies have also proven that the use of Proton Pump Inhibitors and H2 inhibitors (medications that reduce the acidity of the stomach “juices”) inhibit the digestion and absorption of iron salts.

Things to know about Iron Salts

ü Can cause black “tarry” or “sticky” constipated stools. Fastidious skin care is necessary after bowel movements to avoid painful skin irritation in this area.

ü Should not be taken with coffee, tea, milk, cola, or chocolate as these will block its absorption

ü Consider taking your iron salt supplement with a juice rich in Vitamin C to maximize its absorption. My personal favorite is a swallow of prune juice for two reasons:

i. Prune juice is a natural laxative ii. Prune juice is rich in iron

ü Can cause gastric irritation and GERD like symptoms, this can be minimized by remaining in an upright position for 30 minutes after taking the iron salt

ü Antacids (Maalox, Gaviscon), or calcium supplements should not be taken within 30-60 minutes of the iron salt because its absorption will be blocked.

ü Absorption of Iron Salts is most effective when taken on an empty stomach (one hour before you eat or two hours after you eat). Personally and professionally I recommend two hours after you eat to decrease the gastric irritation and GERD like symptoms common to iron salts

II. Non-Salt Iron Supplements

A. Proferrin is a bovine sourced HEME iron. It is absorbed in the small intestine

B. Polysaccharide Irons (FeraMAX, Triferritin) are manufactured irons also absorbed lower in the digestive tract. Severely Iron Deficient patients may be prescribed an intravenous form of polysaccharide iron, while beneficial in some cases this alternative will not be discussed today. Things to know about Heme and Polysaccharide Irons ü DO NOT need to be taken on an empty stomach

ü Are Not effected by the use of antacids, calcium supplements Proton Pump Inhibitors, or H2 Inhibitors

ü Are Not effected by Vitamin C consumption

ü DO NOT cause Gastric Irritation or GERD like symptoms

ü DO NOT usually cause black tarry, sticky or constipated stools.

The Great Supplemental Iron Debate

ü ODB most supplemental health plan will cover prescribed Iron Salts.

Some supplemental health plans will cover Proferrin if bought with a prescription.

Polysaccharide Iron Supplements are considered a dietary supplement (they have no DIN) and are not covered by either ODB or Supplemental health plan

ü Decreased absorption surfaces resultant from surgically decreasing the stomach size directly results in the decreased absorption of iron salts

ü Use of Proton Pump Inhibitors, and H2 inhibitors decrease the digestion and absorption of iron salts

ü Although exact location in the intestine where polysaccharide and heme irons are absorbed has not been mapped, it is believed that polysaccharide irons are absorbed still lower than Heme irons and as such are the supplement of choice for Duodenal Switch patients

ü Heme irons are derived from animal sources vegetarians, and certain religious groups may object to using such derivatives

ü Physicians and dieticians are more familiar, and thus more comfortable with the use of Iron Salts as opposed to Heme and Polysaccharide Irons

B12 Deficient Anemias

As mentioned earlier B12 is the brick mason of HGB production. B12 stimulates the conversion of Iron into Hemoglobin. Without sufficient B12 adequate Iron reserves cannot be converted into oxygen and nutrients carrying Hemoglobin. The absorption of B12 requires Intrinsic Factor which is secreted by the stomach. The area where Intrinsic Factor is excreted is severely reduced and/or completely lost during the surgical reduction of the stomach. Without sufficient Intrinsic Factor, B12 from food or oral supplements cannot be absorbed. It is recommended that Surgical Bariatric Patients take a sublingual (under the tongue) B12 supplement or regular B12 injections.

Erythropoietin and Anemias

Erythropoietin is a hormone manufactured and excreted by the kidneys; it is the substance that triggers the bone marrow to use hemoglobin to produce Red Blood Cells. It is very possible to have adequate stores of Iron and B12 and still be anemic related to an insufficiency of erythropoietin. This malady is common in patients with impaired kidney function. The reason why I mention it however is that it is possible to use synthetic erythropoietin (Eprex) in conjunction with oral and sometimes intravenous iron supplements to rapidly boost the hemoglobin of patients with severe iron deficient anemias.

Conclusion

Anemia is a broad spectrum diagnosis, individually honed through the assessment of the patient and their lab work. Just as every patient is unique so is the treatment of their anemia. I urge you all to advocate for yourself, be health care consumers, educate yourselves and in turn educate the health care professional that is caring for you