QUESTION/ANSWERS AFTER RNY GASTRIC BYPASS SURGERY

These are Hi jacked from salley perez it' long but I made a copy and will take it with me to the hosopital.. Good luck all. Some common Questions/fears after RNY Gastric Bypass & Answers (pasted from my GastricBypass-PostOp Group): Q: I haven't lost anything for a week (or 2 or 3) and I am only (fill in the blank) month(s)/week(s) post-op - is this where my weight loss will stop? Will I fail at this too? A: The weight does not just drop off most of us. We do not wake up out of our surgeries thin. LOL Patience with the WLS/weight loss process is key here Some people weigh only once a week or even once a month to avoid falling into the dissappointment that comes when one doesn't see a change in the scale every day. Fluctuations in weight are NORMAL, and it is not uncommon to see the scale stay stagnant (or even go up a couple pounds). What helps many is to measure their bodies (chest, waist, hips, thighs, arms, neck, etc.) weekly as you will most often find that while the scale is the same, you are still losing inches. Also, try to focus on the bigger picture. At 3 months postop, I was down "only" 60 lbs. I was very scared - ok, terrified that I wasn't losing fast enough and that the majority of the weight loss was in the first 2 months), but my fears have since gone unfounded - very unfounded. At 8 1/2 months postop, I'm now down 140 lbs and look back and realize that for some of us the weight APPEARS to come off slowly (and we expect that it will just drop off us), when in reality it doesn't. My advise to anyone feeling like they are losing slowly is to keep doing the right things. If you are doing all the right things, eventually the weight WILL come off. Take photos (full body photos), take your measurements, note all that you can do that you couldn't before your surgery, and probably most important, note how your relationship with food (and your taking care of yourself) is changing - it's these things that will help you remain committed to your success. Q: Why can I eat so much? Have I already stretched my pouch? A: Ask yourself how much you are really eating. Check to see if you have unrealistic expectations of what you should be able to eat. Many of us think "2 tablespoons and we should be full", and this is simply untrue. Perhaps it is true for a small minority of people and for those who are only a few days post-op, but as time goes on, you WILL be able to eat more. But you will never be able to eat like you used to before your surgery. Likewise, many use the "we should be eating no more than 2 oz" rule in the beginning, but what is rarely mentioned is that the 2 oz should be measured by volume and not weight. As for the pouch stretching, this is normal. It is said that the average size pouch a year out from surgery is about 8 or 9 oz (a cup of food). Also, know that soft or liquid foods/drinks go through our pouch faster (because we no longer have the pyloric valve that holds the food inside our stomachs), so we will be able to eat a lot more soft foods/liquids than solids. After the first couple months post-op, it is very important that we be eating solid, protein-dense foods as this will help to keep us full longer. Q: Can the pouch ever stretch to the point where I can eat normally again? A: Yes, the pouch stretches over time but it doesn't go back to the size it was before surgery. When it is said that it stretches to where you can eat a "normal" meal, this means a meal about the size of a lean cuisine, perhaps a tiny bit larger. It doesn't mean being able to eat what we used to eat before surgery which for the great majority of us was never "normal" to begin with. Q: Why is it that I'm not supposed to drink during or after meals? A: I try to think of the stoma and pouch as a funnel... The area where you pour the food into is the pouch, and then it takes time for the food to funnel through the stoma and into the intestine. By drinking during or soon after our meals, you are just washing the food out of your pouch and creating more room to keep eating which is in direct conflict to using your pouch as a tool to limit the amount you can eat. The end result is that you will be able to eat more and you will be hungry again faster (and thus eat more). Also, if you add food/liquid faster than it is funneling through the stoma, everything will just back up and you'll end up vomitting. Q: How do I know when I am full? Why do I never get that full/satisfied feeling anymore? A: Once we have the RNY Gastric Bypass, we experience being full differently. This is especially true for the first several months when the pouch (and all the nerve endings that send the message that we're full) is still healing. It used to be that full meant that feeling we got after sitting down to a big turkey dinner. It doesn't mean this anymore - now full means "feeling a ball (or knot) in your chest" just under the breastbone (where your pouch is) or "feeling as though food is stuck in your throat". If you continue eating past this point, chances are you will vomit as the food backs up. Also, those old eating until you are full/satisfied days are now history. (It's my theory that that is the true reason why the great majority of us were morbidly obese and super morbidly obese to begin with - because we were eating to feel satisfied/full, and for whatever reason, our bodies/minds didn't register "full".) Full does NOT equal satisfaction anymore. Early on post-op, chances are that you will be full before you are satisfied. As time goes on, you will begin to experience being satisfied early on and before being full. Further out, you may begin to reexperience what you remember as being full before you had your surgery. I recommend measuring out your food into about 1/4 cup as an early-out post-op and focus on being aware how your body feels after having eaten that amount. That new feeling is what satisfied should feel like. Q: I had my surgery and weighed the same amount as (name person), yet he/she has lost so much more than me. What am I doing wrong? A: It is common for most of us to question our weight loss and compare ourselves with others. But this doesn't really help us. We all lose at our own rate according to our bodies and our metabolism and how we use the tool we have been given. It is important that we remember that we are not in a race, and providing we are eating healthy, exercising, taking our vitamins, etc., we WILL reach the finish line (in our own time). If we are eating like a 150 (name your own goal) lb person eats, eventually, we will get to our goal. Again, patience is key. Q: I am (fill in the blank) years post-op and am gaining weight. I am so scared and never want to go back to being MO again! What should I do? A: It is very important that we understand that some weight regain is NORMAL. Statistically speaking, 90% of people who've had the RNY Gastric Bypass are able to drop on average 85% of their excess body weight within the first 18 to 24 months of surgery. Long-term, however, the average weight loss maintained is 65% of their excess body weight. While weight regain is not inevitable (as shown by the many people who have been able to keep the weight off), it is not uncommon. If you find yourself gaining weight, it is important that you not beat yourself up about this. Simply "go back to basics" - protein first, no drinking with or until 1/2 hour after meals, no snacking, exercise, etc. Don't worry about whether you've stretched your pouch out or not. Again, this is to be expected. Our pouches will never be the size that our old stomach once was, and all it takes is for us to start using the tool we've been given yet again. Q: I feel hungry all the time. How do I deal with the physical hunger and head hunger/cravings? A: Many people find that once they begin to experiment with high carbohydrate & high glycemic index foods, they begin to experience (often intense) cravings. Even if you are able to eat things like bread, rice, pasta and other high glycemic index foods without dumping, doesn't mean you should be eating these things. As long as you are eating high carbohydrate foods, chances are that you will continue to feel both physically hungry and experience head hunger/cravings. I regularly remind myself that just because I CAN do something, doesn't mean I SHOULD do it. This is a very important thing to remember when it comes to our successes following WLS, and it doesn't only apply to high carb foods; it also applies to high fat foods, alcohol, carbonated drinks, caffiene, soft foods (for the longer term post-op), etc. Please don't mistake this as my saying that we should rid of all carbohydrates from our diets. Surely, we need carbohydrates, but as with everything, they should be in moderation. Also, in dealing with head hunger, as easy as it is to say why we shouldn't eat such and such, it is more effective to ask ourselves what the payoff is of eating such and such (name "off limit" food here). When we know what the payoff is for our unhealthy behaviors, we can find heathy substitutes that offer a similar payoff - then the "need" for the unhealthy behavior is decreased. (ie: I used to eat chocolate whenever I was stressed. Now I write or drink decaf coffee or decaf tea to destress myself.) To add to the question of hunger, while most new postops do not experience hunger, there are some (including myself) who experienced true physical hunger soon after surgery. (I actually woke from surgery hungry - physically hungry!) Over time, I found that this resolved itself, and since about 3 months postop, I only experience physical hunger when I haven't eaten for several hours or I haven't been drinking my water (thirst is often disguised as hunger). Q: Will I still lose weight if I eat vegetables and fruit? A: Yes... As much as some will push the super low carb diets, the reality is is that our bodies NEED carbohydrates! Granted sugar, white breads and rice and pasta, potatos and corn may not be the best choices (see above Q&A), but lower carb and low glycemic index veggies and fruits ARE very important. For one thing, we need carbs to utilize protein and for another, the fiber found in veggies/fruits is necessary for gastrointestinal health and to ward off certain cancers. As for whether or not you will lose weight as fast with or without the carbs, while I am sure some will swear otherwise, I have NEVER had a problem losing weight providing my carb grams were equal to or less than my protein grams. And yes, this means that when my protein was 70 grams/day, I could have as much as 70 grams of carbs and still lose weight VERY rapidly (125 lbs in 8 months prior to surgery). DO try to get in protein first but a few bites of vegetables are absolutely fine! BTW, zucchini is my all time favorite! Q: Why am I cold so often since I've had WLS? A: Believe it or not, that cold feeling is NOT because we are losing our insulation. I am sure losing body fat may account for a small part of it, but the major reason this happens is because of a low fat diet. The fat we eat is very important in our daily diet - it is responsible for keeping the skin, organs and other tissues of our body well moisterized and lubricated so to say. It also helps us to stay warm. When we eat very low fat diets, we can experience being cold. This is true even for people who start out super obese who are still morbidly obese (such as myself). And it is true whether or not we've had WLS. As long as one is eating a VERY low fat diet, chances are one will experience feeling cold (regardless of how much weight one has lost or has yet to lose). Similarly, low iron can make on feel cold, so it is very important to for WLS postops to take supplemental iron (check with your dr. as to how much as iron is stored in our bodies and too much of it can lead to toxicity). Q: Shortly after my surgery, my tailbone started hurting especially when sitting for long periods of time. Why is this and what can I do to help it? A: Tailbone pain (****yxdinia) following WLS is VERY common and given my personal experience and hearing that of others' experience, it is NOT due to losing the "padding" around that area. My guess is that it is related to posture and us needing to "relearn" how to sit. Perhaps, also, that with all the years we spent MO caused many of us to sit with bad posture which over time caused damage to the tailbone. Per my surgeon, it is also possible that the pain might be referred pain from some area in our body that was affected by surgery. While I am not sure of the reasons why we are likely to experience this pain, one thing that has helped me greatly has been getting a special pillow called a ****yx pillow that I use whenever sitting. See my "Post-Op Must Haves" in my profile and picturetrail (found at Q: I hate to exercise. Can I lose weight without exercising? A: Yes, absolutely you can. Exercise will NOT make a huge difference in the weight we lose. We CAN and WILL lose weight just by our very restricted diets. To clarify, to lose just 1 lb via exercise alone, a 250 lb person would have to walk over 15 miles or do vigorous swimming for over 6 miles! That's a lot of exercise! Exercise is not responsible for how much we will lose. HOWEVER, what it IS responsible for is helping to improve and maintain our muscle to fat ratio and our metabolism as we lose our weight. It's important to remember that with rapid weight loss, we will lose muscle and not only fat. If we lose too much muscle, we can face heart problems (as the heart is a muscle), increased sagging skin, lowered metabolism and thus slower weight loss, increased chance of weight regain, etc. While exercise will not in and of itself lead to large amounts of weight loss, it is nonetheless a VITAL component to our commitment to get healthier and to keep the weight off. Q: How do I deal with hunger in between meals? Is snacking ok? A: I basically do 3 meals a day and 2 snacks if I am needing (or REALLY wanting) to eat more. For snacks, I will do protein drinks, non-fat cheese, beef jerky, SF popsicles/fudgesicles or a couple frozen grapes, Atkins Crunchers, or sugar-free, non-fat decaf latte/coffee. Notice how each of these fills a "need" - protein for energy, cheese for creamy, jerky for chewy, popsicles/fudgesicles or grapes for sweet, Crunchers for crunching, and lattes for warmth & comfort. Generally, I make it a rule that I will not give in to snacks, but if I am physically hungery and it is before 9 pm, I may have a small snack as stated above. Also, be sure that you are drinking at least 64 oz of clear, non-caloric liquids (preferably water) each day. Often thirst is disguised as hunger. I follow a personal rule that if I am hungry between meals, I will drink water first. If I am still hungry 15 minutes later, than I will allow myself a small, high protein snack. Q: I am only a few weeks/months post-op and am having a very hard time getting in at least 64 oz of water per day. How do I increase what I am drinking? A: The first couple of weeks are the toughest in getting in enough liquid. For me (and I've heard from others who this was true for also), plain water sat heavy in the pouch and brought on nausea. What I've found works best was to experiment with the temperature of the liquids I was drinking. I've found I do best with either hot or room temperature liquids - ice cold liquid was (and still is) harder for me to get down. Each person is different in this respect and you may find that you do best with ice cold drinks. I also found that mixing in a little Crystal Light with my water (about 1 part Crystal Light to 3 parts water) helped to make the water "lighter" and easier to swallow and keep down. It is important to remember that the required 64 oz of liquid need not be just plain water (although this IS prefered). Most clear, non-caloric (very low calorie), no caffeine liquids are fair game when it comes to getting in your daily 8 cups of water. One of my absolute must haves on my "Must Haves for Post-Ops" list is a 32 oz water bottle that one can keep nearby and sip from throughout the day. I have one from Starbucks that I simply love and Naglene's narrow necked 32 oz water bottle is similar and equally as wonderful. Q: Ever since my surgery, I've been dealing with severe constipation. What can I do about this? A: Some people take Colace daily to help although this does not help me at all. Using Benefiber in my drinks DOES help although figuring out how much to take per day so that it helps (but not too much) is tricky. I like the Benefiber as it does not swell and has no taste, color or texture so it does not alter my drinks. When the constipation get's so bad to the point that I am straining (which is NOT a good thing to be doing as one can rupture the bowel this way), I take Philips Milk of Magnesia and that helps tremendously. I tend to use the Milk of Magnesia as a last resort as it impacts my activity level for a day or two. Also, be sure to be getting in a MINIMUM of 64 oz of water per day and even with all the low carb craze, it is super important to be eating high fiber vegetables and fruits (as they are important for gastrointestinal health). Q: I am a recent postop and am experiencing terrible gas regardless of the foods I eat. Why is this, will it go away, and will anything help? A: Excessive gas following WLS (especially if done laproscopically) is the norm. It is worst right after surgery and resolves over time, and occurs primarily because of the gasses pumped into your belly during laproscopic surgery. Simply stated, it takes time for all this gas to leave your body. When I was an early out postop with this problem, I found that takin OTC Phyzeme helped a great deal. Also, walking and physical activity helped enormously. At 8 months postop, I still experience gas from time to time although it is no different or more than it was prior to my surgery. Q: I am early out postop and nothing tastes or smells good. I find that I have no appetite and could care less about eating. Is this normal and what can I do about it? A: Yes, this is absolutely normal for many if not most early out postops. If you are like most who experience this, you'll find that things start tasting (and smelling) more like they used to the further out you become postop. And while it may seem like a bad thing that you have no interest in foods right now, this is really is a GOOD thing! Consider this to be part of the "tool" we've been given to change our relationship with food. Q: I am between 1 month and 3 months postop and am having a very hard time keeping any food down. What am I doing wrong? A: Most postops (at least those who've had the RNY) find that this happens when they start adding solid foods into their diet. It DOES get better as one learns what foods are agreeable to them and new eating behaviors become habit, but in the meantime, here are a few helpful hints: - use baby spoons and forks to limit how much you put in your mouth at any one time - take a small bite, wait a couple of minutes and then if you are ok, take another small bite. - be sure to chew chew and chew some more everything to a pulp. You can't chew too much! - if you feel the slightest pressure/heaviness in your pouch area or food in your throat/chest, then stop. Even a TEENY TINY bit of too much food can push you over the limit to the point that everything comes up. Before WLS, we could eat past full. Now, one small bite too much will cause you to get sick. - going along with the above, if you feel that food in your throat feeling or heaviness or pressure in your pouch area while having food in your mouth that you're chewing on, then spit the food out. If you swallow it, there's a good chance you will get sick. - measure out your food before you start eating. Using measuring cups (not weighing ounces on a scale), figure on eating about 1/4 to 1/2 cup of food per meal. - do not drink anything for at least 15 minutes before your meals, with your meals or for at least 30 minutes after your meals. Either the liquid will force the food through your pouch allowing you to eat more than you need to (and negating the purpose of the pouch) or the food will block the liquid from going down and it will all back up and you'll vomit. - avoid any and all things with sugar in it, especially refined sugars. If your vomiting includes sweating, nausea or other symptoms, chances are you may be dumping. - avoid dry foods and bread/rice/pasta as these tend to get "stuck" easily and/or swell and will make us feel very uncomfortable especially during the early postop days. Q: Are protein shakes really necessary? Can't I just get my protein from food? A: Protein supplements definately have their place in a diet for one who doesn't get in the necessary protein per day (whether they are newly post-op, vegetarian, not able to tolerate meats or dairy, etc.). If one CAN get all their protein from regular foods without having to consume more than they want or are able to, then by all means that is wonderful. But protein supplements CAN be a wonderful tool in one's daily diet. For example, my hubby and I are going to a dinner party tonight for his job. I do not know exactly what will be served or if (and how much) I will be able to eat. For a late breakfast, I had a little of my ham, cheese and corn bake that I'd made last night in my crock pot. I ate probably about 1/2 cup and focused primarily on the ham (about 20 grams protein). Then for lunch, I wanted to avoid carbs and make this a super high protein "meal" that was still low calorie and low fat (assuming I will eat more tonight), so I decided to have one of my VHT protein shakes (35 grams protein). I plan to stop at Starbucks on the way there for a SF vanilla latte which will give me an added 15 to 18 grams of protein. Because of the protein shake being so high in protein and low in carbs and calories, I won't have to worry so much about what I eat tonight. I have already gotten in my necessary protein for the day, not many calories and not many carbs so it will all balance out with whatever I eat tonight. There is NOTHING else outside a can of tuna fish that I know of that would give me 35 grams of protein and less than 5 grams of carbs and 0 grams of fat. And being that I can't even eat a whole can of tuna (it sits VERY heavy in my pouch and the most I can do is 1/3 of the can at a time), the protein shake is the way to go. This is not to say that one should drink protein shakes ONLY throughout the day. Rather, when used strategically to ward off hunger and increase daily protein, while keeping calories, carbs and fat down, protein drinks can be a wonderful tool towards one's weight loss and weight maintenence. Q: Does carbonation really stretch the pouch? Do I really need to avoid it? A: Whether the pouch is stretched or not is not the only part of our new anatomy that is in question - so too is the stoma. And while the jury is still out for me as to whether or not carbonation stretches the pouch/stoma, I figure, "why chance it?" Also, what IS known is that carbonation does affect calcium levels, and that increased calcium is related to increased weight loss. Given that there is no harm done in avoiding carbonated drinks, my feeling is that we should just avoid them altogether. What many do not mention is that drinking carbonated drinks can also physically hurt. For many, it literally hurts to drink them. Q: When will I be able to start taking pills again without having to cut them into pieces or crush them? A: It is my understanding that we will never be able to take large pills again (anything larger than a pencil eraser). Part of the reason is due to the stoma being small and if the pill gets stuck in our stoma, it could either cause a blockage or can stay stuck in our pouch and when it dissolves cause an ulcer. The other reason is that some meds will have a hard time dissolving or being absorbed without stomach enzymes. For capsules (liquid or powdered), we can take these right from the start (assuming it isn't a medication we shouldn't have as a post-op such as ibuprofen), but some people have a really hard time keeping them down especially if they are the larger ones (ie: Trinsicon, potassium, antibiotics, etc.). To make them go (and stay) down easier, one should take them with hot liquids as the hot temperature will help the capsule dissolve much faster. Also, don't be mislead by "gel tabs" or "gel caps" (as put out by Tylenol). These are NOT capsules that will dissolve at body temperature. Rather, gel tabs/caps are simply solid pills with a gel coating. Q: What about vitamins? What should I be taking, how often, and when? A: What I'd recommend doing is going to www.BariatricAdvantage.com and ordering their chewable multivitamin, chewable chocolate calcium citrate, chewable iron, and sublingual B12. I've been taking these vitamins since 2 months postop and LOVE them. They give us all the necessary vitamins we need with out giving us too much of any vitamin (which could be toxic depending on the vitamin). All are chelated which helps with absorption, and all are sized (and created) specifically with the bariatric patient in mind making it easier to take them (and better for us). Here's what I take and when: Morning when I wake: 1 multi-vitamin and 2 calcium Afternoon: Iron & B12 Evening: 2 calcium Bedtime: 1 multi-vitamin and 2 calcium It's important to not take iron and calcium together as they negate each other. Feel free to let them know I referred you My patient ID is PT2942. And nope, I don't get any kickback from referring - I am just a SUPER satisfied customer of BariatricAdvantage's! Q: What's with all the talk about protein? Is it really all that important and how much do I need? A: The great majority of us are advised (by our bariatric surgeons, nutritionists, PCP's, etc.) to always eat "protein first" following surgery, and to eat vegetables only after we've eaten our protein for the meal and only if we still have room left. Then if we still have room, we can eat fruit and then if there's still room left, we can have bread. It is similar to the Adkins diet (and some shy away from carbohydrates all together), but minus the fat. Specifically, most are advised to eat high protein, low carb, low fat for all our meals and snacks. The reasoning behind this is that a low carb lifestyle (specifically with high glycemic index foods being avoided) amounts to regulation of blood sugar and therefore appetite. Also when the body runs out of carbs to burn, it breaks down the fat stores for energy. When carbs are high, the body burns the carbs first (as carbs are most easily converted to sugar) and while fat will still be burned but to a lesser extent, muscle will also be burned. High amounts of protein also helps promote faster healing (especially important for new postops), helps preserve muscle (especially important during the weight loss process), and helps to the body to have a lower body fat percentage (important for metabolism among other things). Most are advised to eat 60 to 70 grams of protein per day (hard to do especially for newer postops unless protein is the primary focus throughout the day) and some are advised to eat 1 gram of protein for ever lb of lean body tissue (which can mean as much as 120 grams of protein on up per day). Every now and then you might hear of a "protein train" within various online and inperson support groups. In a nutshell, a "protein train" is a set period of time where a person will focus on going back to liquids and getting in a high amount of protein for a set number of days. This is usually done through protein drinks and/or meal replacements and is not unlike a liquid fast. The reason for it is to help people "get back to basics" when eating habits start to go awry (as happens over the holidays for many) and to jump start weight loss for those who've been "stuck". Likewise, back in my HMR days, falling back on shakes was a tool in maintenece to help balance out "bad" eating days. Q: Are the candies with sugar alcohols and "low impact carbs" ok to snack on? While true that sugar alcohols do not affect blood sugar/insulin levels as much as regular sugar, we can most definately still dump from them. I can tolerate more sugar alcohol (about 20 gms) than I can sugar (about 10 gms) per sitting, but I am still limited in my intake of them. Besides still being able to dump from them, sugar alcohol can also cause symptoms similar to lactose intolerance (cramping, diarhea, etc. - not pleasant at all. Also, most of these candies still have calories - lots of them... Given that they also have little to no protein, it's my opinion that it's best to stay away from them. When I DO snack, I try to always make it a healthy, high protein snack (such as non-fat cheese, beef jerky, etc.) And with this said, I try my best to avoid snacking altogether. Rather than giving in to snacking, I will drink some decaf hot tea, exercise, read, watch a movie, draw, etc. Q: Help! I am a few months post-op and am losing my hair! Will I go bald and how can I stop this?! A: Welcome to the club! Hair loss is COMMON between months 3 and 8 & most often starts around the 3rd/4th and becoming noticeable in the 5th/6th month. If you are like the great majority of us, your hair loss will slow down a few months after it starts and your hair WILL grow back (sometimes even fuller than it started out). Vitamins/supplements and protein are VERY important and too few/little are thought to be one of the reasons for the hair loss, although I have seen MANY people lose hair on very low calorie/low fat diets even when protein and nutrients were very high. To be on the safe side, make sure to increase your protein (at least 60 to 70 grams per day), and it is said that Zinc and Biotin will help to prevent excess hair loss. Both of these can be found in Bariatric Advantage's Multivitamins I mentioned just above. Also, I have been using Nioxin products and really like them. I'm not sure they have made a huge difference in my hairloss or regrowth, but I figure it can't hurt to use them. Many swear by the Nioxin line (especially their cleanser shampoo and scalp therapy conditioner). Q: Even though I've been doing great weight-wise, I am having a really hard time with depression. How do I best cope with this?A: Anti-depressant medications may certainly help, but they may not completely rid of the depression. Chances are that if you dealt with depression before your surgery, you will deal with it after your surgery as well. Some may experience depression even more following surgery since food is no longer being used to cope and stuff feeling, memories, etc. inside. Counseling can be of benefit in terms of learning alternative ways to cope, and being able to nurture and be gentle with ourselves is VITAL if we are to find peace and calm in our lives. For myself, I've come to realize that sometime it's ok to give in to a day (or even a few) at home and just take care of me. I think of myself as a turtle - sometimes I hide in my shell and sometimes I venture out to explore, some days I move fast and other days I crawl... And on the days that I crawl, I try to accept this and not be too hard on myself. Q: I deal with dissociation which has been a major contributor to my being morbidly obese to begin with. Will I be able to succeed with WLS considering this? A: While I can't answer for everyone who dissociates, speaking for myself, having had the RNY is the BEST thing I could have done. The surgery made it so that my body gives me instant feedback and consequences about what I eat/drink, and it is now MUCH harder to dissociate while eating. A couple things to consider though for those with DID - everyone in your system should agree to the surgery as everyone needs to "follow the rules", and following surgery, it is possible that other means of coping/dissociating (such as SI) might come more into play. Also, it is not uncommon for flashbacks to start surfacing or surface more as one is no longer turning to food to keep the memories at bay. If you are like me and have DID, I think it is most important to have a good therapist (who is more than familiar with DID) to help you work through issues, memories, etc. as they arise. Q: Even though I've lost (fill in) lbs, I am having trouble seeing the weight I've lost. Is this normal, and how do I deal with this? A: When I was thin (130 lbs), I thought I was fat. When I was 210 lbs at age 19, I thought I was the biggest person in the world (now I'd be happy to be just 210 lbs LOL). When I was 370 lbs, I thought I looked like I weighed 250 lbs. I knew I looked big, but never did I realize just how big I really was (the width of a door - not exagerating here). Now that I am losing the weight, some days I see myself as thinner than I am. Some days I still feel huge. This experience is not unique to us and occurs for many people following losing a huge amount of weight especially for those who've lost it in a short period of time. It seems the only time I can TRULY see my size is when I look at photos taken of me. Thus is the reason for all the photos I've taken or have had taken of me since my WLS. I wish I'd taken photos of me at my heaviest before surgery, but I rarely let photos be taken - I was always the photographer, only allowed photos from my shoulders up, or I stood between people hiding behind them. I SOOOOOO recommend that everyone take full body photos every month as this will help your mind "see" your progress. And if you are reading this and are preop, take as many photos as you can now before you start losing weight. While you may cringe at the thought of it, these photos will be more valuable than your "thin pictures" ever could be as it allows you to see just how far you've come... Q: I had my surgery but am still extremely heavy and still require a seatbelt extender when on a plane. How do I ask for one without drawing attention to myself? A: Nothing personal, but when I was over 300 lbs, the least of my concerns was needing a seatbelt extender. Whether I asked for an extender or not, it was OBVIOUS to others that I was extremely fat. At 370 lbs with over 70 inch hips, I've no doubt my peers already realized the fact that I was very heavy. If they were to cast judgement on me, I am sure they had already done so before my asking for an extender. Thinking that I could hide my obesity by not asking for a seatbelt extender was similar to my thinking that wearing black clothing made me look thin. LOL Being so heavy, the greater concerns for me were being able to walk through the aisle, making sure I wouldn't have to use the restroom during the flight (because I couldn't get down the aisle because I was wider than the aisle and bathroom), making sure I ate something before the flight (because I couldn't use the pull down tray from the seat in front of me), taking some pain reliever before hand (to help ease the pain from the bruising that always occured on my hips), etc. One thing that I always found DID help me was to preboard the plane (usually occurs before or at the same time 1st class boards). I've never been asked why I needed to preboard, and I was always able to get the extender before many other passengers were even on the plane. Also, be sure to get an aisle seat (as they tend to be a little bigger) and never get the seats by the emergency exits (as they are smaller on most airlines). When all else fails, keep remembering that this too will be another bad memory of what it's like to be MO/SMO as you become closer to your goal. Let the memory keep you honest with yourself and let it help you stick to your resolutions towards continuing your weight loss and keeping the weight off... Q: How do I choose a goal weight? or I still have (name number) lbs to lose to reach my goal (name weight). Everyone's been telling me I am getting too thin and that I shouldn't lose any more. Should I continue trying to lose to my goal weight? A: Even for myself, I go back and forth as to what my goal (pounds-wise) should be. I'd LOVE to be 135 lbs and a size 3/5 which is what I was in high school (age 18) before weight was ever an issue for me. And being that 134 is the "ideal weight" for someone my height (according to the medical charts), perhaps this is a reasonable goal. But to make sure my goal is reachable, I say it is to be 150 lbs or less... Then again, what is my goal, really? Is it to be 150 lbs (or other arbitrary number on the scale?) Is it to get back to wearing a size 3/5? Honestly, no... Rather, my goal is to not have my weight limit me in the things I want to do in life. I want to be active and be able to fully participate in life. I want to be able to rollerskate, do gymnastics (if my since-aged-15-years body will allow me), cross country ski, horseback ride, bike, do yoga, etc. I want to be completely free of the addiction to food, and I want to be as healthy as I can possibly be along with have a healthy lifestyle. Of course, I want to look good as well, but who says a size 3/5 looks better than a 10/12? If I can do all the things I want to do, then how can I say that I haven't reached my goal? Can I say that I haven't reached my goal because the number on the scale is more than that arbitrary number I "pulled from a hat" when I was still MO? Of course not... If I can do all the things I want to do, then I HAVE reached my goal, and rather than obsess about some arbitrary number on the scale, I will choose to take full advantage of the new life I've been given Q: Why does the weight loss slow down the further out from surgery one becomes? What about the window of opportunity? A: There are many who talk about "the window of opportunity" which is stated to be the period of the first 6 up to the first 18 months postop where the weight seems to just "fall off". The truth of the matter is that the "window" will stay open for as long as one needs to still lose weight and one keeps doing the right things in terms of their eating/exercise. As for weight loss slowing down the further one is out from surgery, there are a few things that account for this: - the lower the weight one gets to, the less calories required to maintain body weight so the less the caloric deficit and the less the weight loss - the lower the weight, the lower the number of calories burned with weight bearing activities, the lower the caloric deficit and the less the weight loss - the further out postop one becomes, the more volume one is physically able to eat, the higher the calories taken in, the less the caloric deficit the slower the weight loss - the further out postop one becomes, the more types of food (including more sugar and fats, breads, etc.) one is able to tolerate and eat, the higher the calories taken in, the less the caloric deficit the slower the weight loss - there is a return of appetite for many people somewhere between months 6 and 12 postop. If not diligant in healthy eating patterns, old behaviors (such as grazing, night-time eating, eating sugary foods, etc.) can resurface, food intake will be higher, calories will be higher, the lower the caloric deficit will be and the less the weight loss will be - finally, there has been some research indicating that the common channel of the intestine grows more cilia to make up for some of the bypass and therefor the malabsorption component to the surgery (RNY) decreases. This would explain why distal patients have better chance of keeping the weight off. Q: How much does malabsorption (from my RNY surgery) play a role in the number of calories I can eat per day? A: From all that I've read, there is no way for surgeons (or anyone) to know exactly how much malabsorption takes place in terms of it's impact on the absorption of calories. What I can say is that even with 150 cm bypassed, I am not losing any faster than I would expect to lose had I not had surgery and had just been taking in the same number of calories as I've been since WLS. I would venture to say that my weight loss was more dependant on restriction of food intake and calories as opposed to any malabsorptive factor. This being said, there ARE people who've had distal RNY or DS who have needed to go in for revisions or reversals due to not being able to stop losing weight. The purpose of the revision in this case would be to lengthen the common channel and thus decrease the malabsorptive component to their original surgery. For myself, I don't use malabsorption in the equation. I use only my basal metabolic rate (BMR) in figuring the number of calories I need per day to maintain (or lose or gain). BMR, by the way, is the number of calories your body requires per day to maintain its weight. The multiplying factor for BMR is 11 calories per lb for the great majority of women and 12 calories per lb per day for the great majority of men. To get a more exact BMR, I would advise having a body composition test done through your surgeon or PCP. There are more common questions,and as I hear them,I will add to my list. Hi jacked from Sally Perez