Total Pageviews

Sunday, June 24, 2012

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.


Wednesday, June 6, 2012

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 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.