Stomach Acid and Absorption

There is a bit of a myth that we don't have any stomach acid to break things down. This is not true. Let me remind you of our surgery.

You have two "stomachs". Your old stomach is called your "remnant stomach". Your remnant stomach is always functioning, creating stomach acids or juices and is spitting them out. Your new pouch produces very minimal stomach acid. That is why you must chew and chew your food, to help break up your food since your food will no longer meet up with the acids in the stomach for a long period of processing. Your food travels down and meets up the stomach acid where the two join up in the intestines.

So yes your food does mix in with stomach acids - but for a far briefer time than before and in a different place than before. So yes, it is possible that you still suffer from any reflux after surgery. For most, RNY helps decrease it and for many it is no longer an issue...but for some, yes reflux can be a problem still.

When it comes to absorption, we don't absorb until later in the intestines. We completely bypass the duodenum which is responsible for absorbing most minerals and vitamins a b d and k, iron and calcium. (Hence the tendency for us to be low in these). The old stomach also produced a substance called "intrinsic factor" that helped us absorbed b-12 and now we no longer have that as well...so hence constant supplementation of b12. Thats' a basic in absorption for you.

Here's a great picture for you!!!

Dawn

Help!! I Hate Eating!

Recently I have seen lots of posts on a board that I read that go along these lines:

I am about 10 weeks out from surgery. Weight loss is good - I hit the 50lb mark today....yay me! But...and it's a big 'but'...I am totally struggling with food. I just do not want to eat; it's almost like I've developed an aversion to food. Nothing tastes right and after a few bites, I just stop eating. I'm getting in 2 protein shakes a day but even those are a challenge because after drinking about 1/2 of it, I feel like I'm done. I'm not in pain, no discomfort; just no desire to eat. I feel full all the time. I don't have any cravings, even for the 'junk' I used to eat. Last night, my husband made steak on the BBQ. It smelled heavenly and looked great. The first 2 bites were wonderful; after that, I wanted to push it away. I forced myself to eat about 1 1/2 oz. of it and I was done. I'm wondering if this is normal? The irony is I used to pray for the day I wouldn't want to eat. Now it's here and I'm worried. Has this happened to anyone?

This was my response:

To me this was the whole BEAUTY of surgery. You are changing your whole relationship with food and are no longer living to eat but rather you are now eating to live.

Food is no longer your enemy. It no longer controls you or defines your life.

I felt this was the most powerful and amazing thing about surgery. Embrace it!!! Relish in it. Eat for nutrition. Say no to cakes and goodies that you are offered. You have the most amazing power right now.

Dawn

Her response was:

OMG...what a lightbulb moment! I had never thought about it in that way. Here I am worried that I don't want to eat, when that was the point of this whole process. I've spent so many years thinking about what I'm going to eat next and I am now - finally - at a point where it doesn't matter to me. I wasn't seeing it as powerful but I'm going to try to now. Thank you.

*****

Gosh, the way surgery initially changes your life is amazing. For three weeks, I had to do full fluids (liquids) and surprisingly for the first time in my life, it didn't kill me to do something as tough as that. It literally was my job to take in nutrition every day and work towards my protein and water goals and it was amazing that I did not get hung up on food.

I was probably different than most - I continued to cook full meals for hubby at the time and it didn't bother me.

I became obsessed with "food porn" as I called it and began to just love watching food on the Food Network and it didn't bother me at all. I convinced myself that I could just enjoy and relish in the look of food. It was such a bizarre experience! I remember watching the sugar sculpture food awards where they created these sculptures out of sugar and it didn't bother me a bit. Watching desserts but not eating them was my new past time! LOL!

I always say when you go through this stage, let your power guide you. Say NO to stuff that you don't need nutritionally. If it is "gee I don't care whether I have that or not" -- damnit, say NO and mean NO and take pride in the fact that food no longer controls your decision making!

Eat for health. Eat for nutrition. Eat what your body needs, not what your head needs.

Think of yourself as being SUPERWOMAN or SUPERMAN and enjoy this new super power of yours :) To be in control over food is a WONDERFUL THING!!!!

Self Sabotage

Dear Self:

Why is it that when you decide to go hardcore on program and adjust your eating and exercise accordingly, and do really well to lose excess weight again, that once you get to a certain number, you decide that self sabotage is needed?

Why do you let the number on the scale dictate your happinesss and your worth every day and then once the scale gets stuck once yet again, do you feel the need to throw in the towel, do a complete 180 and start going on crazy binges yet again?

Why do you give up when you are so close to a goal that you can taste it and feel the need to eat and eat until you feel sick and the scale goes up, up and up.

Are you scared of seeing a number? Are you afraid that you won't be pretty when you are thin? Are you hiding from someone? Are you hiding from yourself? Do you need fat on your body to feel hidden from the world and to fall into oblivion?

Why do you insist on doing this to yourself, making yourself miserable and digging yourself deeper and deeper into a hole? Into a funk?

Why?

Why do you sabotage your own success? Why do you continue to ruin your chances to feel good about yourself? Why do you punish yourself constantly? What exactly are you afraid of?

UGH.

And every time, I have to pick myself up and dust myself up and pick my self-esteem up from the toilet do you have to whisper "What is one more cookie? One more ice cream?". "Why can't you just eat and eat and eat?".

This ghost of addiction is haunting. It's destructive. It's depleting. It's frustrating.

It takes every ounce of strength I have to pick myself up, dust myself up and begin again.

To not let the scale solely define me.

But every day is a new beginning, isn't it?

Dawn

"Why Are We So Misinformed?".

I read a post on a board this morning and it was entitled "Why Are We So Misinformed?". Here's what the poster said:

The more I read the more I get bothered for us all about how much we dont know before and after surgery.

I, myself, dont even know when my surgery is(I had to put in a date when I listed my surgeon?), I dont even know who to ask since it seems we all meet many different people throughout all this.

It really is getting frustrating. There are so many people on here that dont know what to eat when they get home, what to do, or even before WLS, they have many unanswered questions.

Is anyone else frustrated and bothered by how little we dont know, and how noone even tells us who to ask???

And I'll be honest. The post IRKED me to no end. Basically this person is EXPECTING other people to tell her about surgery. I find this is often the case in my support group too. People come in with no information. They don't want to be advocates for themselves. They go strictly by the information given by the doctors and are like sheep just following the masses, waiting to be told things on a need to know basis.

While I realize that there are some people that perhaps don't have a skill set that may allow them to access information (perhaps not online, illiterate etc) I believe that most people should have the skill set needed to investigate, to ask, to research, or in the very least, to read a couple of books about Weight Loss Surgery. I believe that everyone should at least own a copy of a book or two. I always suggest Weight Loss Surgery for Dummies as a good beginner tool. I know that most people are not going to be as crazy as me and read study after study, but I do think that with a life changing surgery, everyone should be doing some reading to learn and study their surgery.

There should almost be a test on terms, basic ideas of surgery, basic complications. I shudder when I hear people, 3 weeks out say "What's a stricture?". In this day and age there is SO MUCH out there. All one has to do is LOOK FOR IT!! To Google it for goodness sakes.

This topic reminds me of the conversation that I had last night with my friend and walking buddy from my support group. She is a quiet gal, who doesn't always say much at our meetings  but here's the thing, she had surgery 11 flippin years ago.

11 years ago!!!

I can tell you that five years ago, information wasn't as easily available as it is today to come across. Back then, when I had surgery, there were literally a handful of books to buy and some sites - not a ton of personal ones though - about bariatric surgery. Thank goodness for obesityhelp.com because that one at the time was the best (and still is in my opinion!).

Anyway, when my friend had her surgery 11 years ago, she got nothing in the way of information. Basically the information was to stay away from "Sugar, fatty foods and pop". She had no instruction on post op care, no information of complications (she had no idea of strictures until she came to our group many, many years later). They did not tell her to stay away from NSAIDS. They did not tell her to take any vitamins. There was very little information given to her.

And yet, she did amazingly well. 11 years out and she'd like to lose a few more pounds but she is still in a good place with her weight and eating. She was a success DESPITE her program and I'd venture to say that probably a lot of patients back then were not as successful.

She's amazed by how much information newbies get. She wishes she'd had the supportive network that they have. She never had any kind of follow up care. She's envious that there are so many great resources for newbies to have now when she didn't get any. Not even a support group in her area when she was out. She was like an "island" and the only person that she knew after surgery that her surgery was HERSELF!

I'm in awe of the woman for this reason.

But this day and age, no one has a reason to be uninformed. It is now a choice. This is the INFORMATION AGE. Use it. Study your surgery, know it inside and out. Know every term from strictures to foamies to NSAIDS. Learn about reactive hypoglycemia (so you can catch it if you get it), all complications (especially those that are common), vitamins, exercise, strength training and all things to do with physical fitness (basal metabolism, learn about the different types of surgery and what is covered in your area because some surgeries are better for different people than others. YOU MUST BE AN ADVOCATE FOR YOURSELF.

Don't assume that your doctor is going to remember the "no nsaid" rule everytime s/he gives you an NSAID.

Don't assume that doctors are going to procedures that are in your best interest. (Like the lady who 2 weeks out was going to get a scope had she not stood up to her emergency room doctor and said, "I can't have one this early out!".

LEARN, READ and learn some more ;)

So my only response to the lady who asked the question "Why are we so misinformed?".
is very simple.

It's a choice. I wasn't. Are you?

Dawn

The Myth of the "Call your surgeon!".

When you have surgery and ask questions or have problems afterwards, you will find people saying this simple statement "Call your surgeon!" or "What does your surgeon say?". This is a bit of a confusing response that I feel the need to explain.

When that phrase is used, what most of us really mean is "what does your surgeon's team say about that?". You see there is a bit of a myth that goes along with surgery - that you'll constantly be in contact with or need to see your surgeon every time a problem erupts.

It is true that if you are having major issues like strictures (not keeping things down) or issues with the mechanics of surgery that you will need to actually see your surgeon, but for the most part, you have to realize that your surgeon is an expert in the mechanics of surgery. Your surgery is not necessarily an expert in your aftercare such as diet, nutrition or psychological aspects that go along with surgery. That's why it is of the utmost importance to make sure that your surgeon has an excellent aftercare team comprising of experts like a dietician, social worker or psychologist, and so forth. These are the people that you will need to talk to the most after surgery. If your surgeon is isolated and has no team behind him/her, I would seriously think of a new surgeon. You need after care. After care is critical to being successful with WLS.

Recently, a lady in my support group was upset because she was having pain and the bariatric team told her to go to emergency. Another lady I know was upset when at her 6 month follow up, she did not see the surgeon but rather "just the dietician and social worker".

Any time you have pain, it will not be the surgeon that you will not see. Again, his/her duty is over. You would go to emergency and they would decide by tests whether it would be something like your gallbladder, kidney stones, or appendix. Your surgeon again is the expert at the surgery he performed on you. If you cannot hold things down and have a stricture, s/he would fix that because it is a direct issue with surgery. But otherwise you will see the inside of the emergency department when you have pain, not your surgeon's office.

As well, the surgeon's last job really is to check that your incisions are healed. When that's done, his/her job is pretty much done and that's when you need the other specialists - dieticians etc to help you with your aftercare. The surgeon does not necessarily read the latest studies on how many grams of protein you need or what studies say in terms of the latest vitamin info.

So remember when we say "see your surgeon!" that it means call your surgeon's office and contact that after care team. That's what they are there for and they are worth their weight in gold :)

Dawn

Why I Hate My Scale

One year post op gastric bypass and five years post op are two very different animals. One thing that I LOVED my first year out was my scale. It was my best friend. It gave me validation practically every day as I would get on and the numbers get smaller and smaller. It was a thrill to step on. It was an amazing feeling to know that I was in the next ten pound range. What an amazing feeling. When I got to ONEderland (out of the 200 lb range), I practically wanted to kiss the scale. My goodness how much I anticipated that love affair with the scale! Along with the compliments from friends and family, it made me feel like a million bucks almost every day. And then new clothing sizes! Can you say: HIGH!! Who neededs alcohol or drugs when you have the scale, compliments and a size medium? They are the "crack" of weight loss.

But then after a year or two, the scale stops. No more validations. Compliments eventually stop coming. You stop and you stay the same (called maintenance) and there's no more new sizes, no more new numbers, no more rewards).

Then temptation starts, food calls out to you more and more and ta-da, as quick as an instant, the scale can start to creep up again.

That's the 2-3 years out range that it happened for me. Gosh, that was a hard year!! All of a sudden I didn't like the scale. If it was down one day, I'd be happy, excited and thinking "yay I'm doing great" but then the next day, it could be up two pounds for no particular reason.

I'd want to weep. I'm not kidding. I'd want to cry. What did I do? I didn't eat anything different. I exercised and did everything right. WHY WHY WHY?

Realistically, the scale does this especially being out a long time. Take for instance, yesterday when I ate very healthy and exercised. Here's my day in recap:

Breakfast: Veggie Omelette with low fat cheese, 1 piece toast, light becel
Lunch: leftover cabbage casserole (1 cup).
Dinner: Piece of pork chop (deck of cards size, 1 small ear of corn, 1 tbp butter, 1/4 cup of potato salad).
Snack: apples and 22 almonds.
Exercise: Walked 10 miles.

Pretty good day. Eating was fairly good - even the potato salad (made by my mother in law) was "low cal, no salt and "healthfied" as much as possible). And those 10 miles - c'mon on!!

Yet, I'm up a half of a pound today.

What power that little scale has over me. It made me feel totally worthless this morning as I was sure I'd have a loss and I was up. So automatically the thought/mindset does this:

"Those 10 miles weren't worth it".

"Why bother watching what I'm eating if I'm just going to gain anyway. I should have had the chips (or chocolate or whatever I am craving at the time).


The scale is no longer my friend. It beats me up. It validates if I'm doing a good job (even if I just happen lose despite eating poorly) or if kicks me in the rear when I don't see the results I want. It either starts my day feeling like a million bucks (if I'm down) or feeling like a dog's breakfast (if I'm up on the scale).

I hate it. I love it.

Dawn

There are no guarantees with WLS.

I'm a die hard realist and for that reason, I always like to express how there are no guarantees with weight loss surgery. I see and talk to a lot of people being that I run the local support group and I see a variety of attitudes within the group. Most people have very realistic expectations but once in a while, I run into people that make a lot of assumptions about surgery - only to disappoint themselves when they don't get the results that they want. Realistically, we need to go into this surgery with the mindset that we do this for health. Here are the statements that I hear sometimes that worry me:

~ "When I get to a size 2, I will....".
~ "When I'm smaller than my sister, I will....".
~ "When I lose all my weight, I will....".

I worry about these because even though I was positive I had realistic expectations, I know that there was somewhere deep inside of me, where unconsciously I was certain that I'd end up being an 18 year old, blonde bombshell who was too small for a size 2.". LOL!! I think everyone subsciously has this desire to turn into Britney Spears with rock hard abs and a killer body. LOL!

Then we are disappointed to end up as a scraggly, wrinkly 40 year old like myself who looks good when I dress myself appropriately upscale but looks haggard in a pair of shorts and tank top. I'm serious here.

And I barely got to a normal bmi despite the fact that I exercised like a mad fiend my first year (I walked a half hour to work and home and then jumped on my treadmill for four more miles after that!).

I ended up not a size 0, not a size 2, not a size 4...but a size 10. I mean I had coworkers who were size 0 after having three kids!! It was devastating!

Realistically though I know that I'm bigger boned in many respects. I didn't even change a shoe size after WLS whereas many people can change and lose 2 or 3 sizes in their shoes.

The Bariatric Centres of Ontario often quote that a 50-60% loss of excess weight is what they consider a success with WLS. I surpassed that easily my first year. But then hit bounceback and, still went higher than that amount. Even with bounceback I've lost more than 50 - 60%.

So what does that mean? That means that they are being absolutely conservative in their numbers and well, they have to be. Knowing that people's genetics are all different, people's metabolisms vary greatly, mobility varies and definitely the amount of weight to lose. Most people that are 400 lbs will not see a number in the 100s. Some do - but they are few and far between. That means that being 400 lbs, you won't necessarily be guaranteed to be 150 lbs by the time two years are out. Can you be happy with 200?

That's the concept that people need to grasp. There are no guarantees that you will ever be a size 2, that you will lose *all* your excess weight, or that you will ever be smaller than your sister.

Mindset is key here because where you end up will be determined by *YOU*. If you don't reach a certain size or a certain weight (yes you can keep trying!) will you define yourself as a success or a failure? For me, because I was a 10, for a LONG time I defined myself as a failure. Now I'm changing that attitude and seeing that life is SO MUCH MORE than just a dress size or a number on the scale.

So be sure to measure your success by NON SCALE VICTORIES. Make lists of things you can do after surgery that you couldn't before. Keep those biggest pair of pants to remind you were you were and where you are now.

Remember my friends, attitude is EVERYTHING!

Dawn