6 days out--some questions

Just some things that I've been wondering about this past week.  I do intend to discuss some of them with my surgeon at my follow-up on Wednesday.

I feel like I have something stuck in my throat. Not in my pouch, it's too high for that. It's right at the base of my throat. Is this some sort of heart burn? Do I need to have someone pick up some prilosec or something similar for me? I've had it pretty much since the barium from the leak test, though it does come and go a little.

BMs...everyone's favorite topic, I'm sure.  I've noticed most people on OH have to take suppositories, milk of mag, or something similar to help them use the bathroom. I have the opposite--I have diarrhea. It started on Thursday (surgery on Monday), and I'm going at least 3 times a day. That said, I'm used to frequency since I had my gall bladder removed in 2008. Three times a day was normal for me following my chole, just more solid. However, buying milk of mag was a pre-op prep step required by my surgeon. It just strikes me as odd that, if constipation is so common, I have diarrhea. I did not have the milk of mag as I was having massive bouts of gas from Tuesday on, and I'd had a BM on Monday, prior to surgery. 3 days without a BM would have been Thursday.

Protein...How do you make sure you get enough in? I'm only remembering about 20 grams a day. I have no appetite, and I get tired of sipping after having about 2 oz. Unless I have my hand to my mouth every second of the day, I can't begin to imagine how I can get enough in.

Tiredness...This probably ties in with the protein, but I'm tired ALL.THE.TIME.  I haven't made it a day yet without napping. I'm sure some of it is recovery from the trauma of the surgery, but, come on. It makes it difficult to do as much walking as I know I should be doing. Just taking a shower (and sitting on a shower stool while doing so) makes me dizzy and light-headed.

Sipping without swallowing air.  How do you do this? I never realized how much air I swallow when I sip. How do I minimize this? I'd wondered if that might be part of the sticky feeling in my throat, but, again, it seems high to be that. I am not drinking from straws or bottles. Open-mouth glasses only.

Back pain.  Any ideas or tips how I can relieve some of the stress on my back? I was rear-ended twice in 2007, and my back has never fully recovered. I did not realize how much I would be using my back to compensate for the lack of abdominal use (due to pain). It's killing me. I'm taking a pain pill only at night, and only so that my back will quit hurting long enough to allow me to sleep about 4 hours. When it wears off and I wake up, I go sleep on the couch in a sitting position. 4 hours later, I'm awake again and wanting to lie down to relieve some of the stress on my back.

The stuck feeling could be you taking too big of drinks.  Or it could be a stricture.  I'd call your doctor's office.  They may need to scope.  Monday is probably ok as long as you're still able to sip and get in nutrition and liquids.  If you can't then call today.  I'm especially concerned since you mentioned dizzy and fatigue.  You may already be low on nutrition and dehydrated.  Listen to your body.  You know it better than anyone!!

Protein, no doubt about it. The first few weeks you will be sipping all day long.  No options here.  You MUST get it in.  Do not walk or sit without a drink in your hand. 

Do not use a straw.  This can cause you to suck in air.  If you're siping from a cup you'll have to concentrate on making your mouth smaller.  You're used to gulping.  It takes practice.  You'll get there.  I did.

I think you're doing all the right things for the back pain.  Move around a lot, use pillows, a recliner, or anything else you can to be comfortable.  Walk a lot to build back up your abdomainal strength and your back will get better with time - especially as your weight starts to drop.

The BMs...I assume you're on liquids only.  If so, this is completely normal.  The constipation comes later for some, but not all.  You may not ever have an issue.

You're doing great.  Hang in there.  Every day it'll get easier and you'll be stronger. 

MEL-Hang in there, girl-and vut yourself some slack-it's ONLY been 6 days!!!!

I totally concur with everything TAWNYA told you (she's mucho smarto). Just do the VERY best you can with fluids and protein-your best is all you can do--and it will get MUCH, MUCH easier as time goes on.

As for your back pain, some of it may be trapped "anesthesia gas". Do move around as much as you can stand to, but ALSO get adequate rest. You say you're taking a pain pill "only at night"...WHAT THE HELL??? Girl, where's there is true pain, there ia reason, and that's what MEDICATIONS are for. You'll notice I said MEDICATIONS and not DRUGS. MEDICATIONS are what we take when we have an actial medical NEED..DRUGS are what we take when we don't need anything, but like the way they make us feel...if that makes any sense at all....People who are having TRUE pain do not get "addicted", if they use their medications properly. Besides, most pain meds tend to be a little constipating too, and that will help your other "problem"...lol

I was on clear liquids the first 2 weeks post op, so my poop was loose/liquid that whole time...and so stinky I had to repaint the bathroom later...As you progress to "real food" things will bulk up and return to normal--whatever "normal" turns out to be for you.

Now...take a deep breath...take a drink of protein and some water...take a pain pill...and go take a nap!!!

Gina AKA Nurse Diva

I know all about constipating pain meds! I was young and didn't know to talk to my doctor about it, but I had kidney surgery in 2004. I spent two and a half days on a morphine pump and had two surgeries in three days. It was a week before I had a BM after being released from the hospital.

I'm not a good sick person, as if it wasn't already obvious. I either spend all my time sleeping or else moaning about being forced to be lazy. When it's my choice to spend the day  in bed reading, I'm thrilled. When I'm forced to do so because of illness, it is one of the hardest things for me to do with any grace.

Hey Mel! Congrats on having your surgery!!! YAY!!!!!!!!!! 
As far as protein goes...it took me 2 1/2 months before I was able to get it all in and get a system going. I had to go to GNC and constantly try different brands to find what worked for me. I ended up buying EAS Carb Control Cafe Caramel from HEB. It is the cheapest at HEB and it has coffee and the best part- it does not taste like a thick clumpy PROTEIN shake like the others. It has the consistancy of a coffee. & the coffee kept me awake too. The tiredness- yep. I feel ya. That lasted about 2/3 months for me. It is from the surgery. I had it after all of my surgeries (2 c-sections, 2 back surgeries, and RNY). It will eventually go away and your vitamins will help too.
Hang in there... it will get better and you WILL hear that all the time. LOL. You will be beating yourself up for 2 months but it really does get better. You will learn your new body and your new system and what works for you. What will make you dump, what doesn't, how much you can tolerate and when, etc.
Good luck!
Michele

Mel, it takes time to feel better, many get tired initially mine didn't hit til week 3.  As for protein, it takes time and you may not get it in everyday, you just have to TRY hard; yes lack of protein will make you tired.

Not dehydrating is more important from my reseach then getting in 60-80 grams of protein right now; you do have some protein stores from pre-op.  I don't remember how long they say you have "storage", my guess is we are all different here too.

The BM issue is "more uncommon" but it's rare.  Others have experienced the same thing instead of not going they go allot.  Your body should settle down in a couple of weeks if not before.

The stuck feeling might be a stricture but could also be air.  Watch it until Monday and see if you sip smaller drinks if it gets better.  If you can't get your liquids down DEFINITELY call your surgeon.

Congrats!

Hi Mel,

I had the same thing with my throat and had trouble swallowing the first week.  I struggled to get my fluids and protein in because I had to take such baby sips.  Suddenly one day it was gone and it was like night and day!  I think it was swelling from the surgery and after the first week I was fine.

It gets better - I PROMISE !!!

As for constipation - it usually comes later when you are on regular food and mine is from the iron I have to take.  I forgot it on a vacation once and had no constipation.  I use stool softeners now - couldn't take colace early out - burned my pouch - but I can tolerate it now and it is much cheaper than Miralax.

The protein is important but it is definitely hard to get it in the first few weeks - just keep trying.  I used a lot of the unflavored Unjury in soups and mashed potatoes until I was on regular food.

As for swallowing air - oh my, did I have trouble with this one!  I spent all my meals burping up the air I swallowed.  All I can say is it too gets better but mine never completely went away.  In fact, that is my "signal" my pouch is full - I start burping.  Now it is only when I am ready to quit eating, but the first few months it seemed like every bite I took I burped up air.

As for being tired - that is normal.  You have major internal healing to do which saps your energy and you aren't feeding your body many calories right now so you will feel tired.  Plus your back pain isn't allowing you to sleep well.

Thanks for the feedback, everyone! I decided to switch to a higher amount of protein for every 8 ounces. I figure if I can get closer to 40, it will be better.  When I go on soft solids later this week, I'll be adding unflavored unjury to a lot of things. This morning is Nectar's fuzzy navel flavor.  I've been doing the EAS low carb advantage shakes (chocolate, vanilla, and strawberry--I haven't seen the caramel) prior to now. While they go down well, they only have 17 grams of protein in one shake. I was only getting one in a day.  I also tried isopure, but it's SO sweet! It tastes like drinking liquified jolly ranchers, only not as pleasant tasting as I remember jolly ranchers being.

Well, I discovered (through being completely stupid and forgetful) that the tight feeling in my throat is worse when I take too big of a swallow. Last night, for the first time since before surgery, I had milk. It was so good, I took a gulp. Can I just say OUCH!   I've made my sips smaller today (couldn't handle any more after that. It hurt for awhile, probably because of the cold, too), and it hasn't been as bad. I did have more liquids with my evening medicines, though.

I'm able to sip and swallow and everything, it just feels tight. I think I'll give it until Wednesday and hope it's just swelling from the surgery. If it's still there, I will definitely ask the surgeon about it.

I think I swallow less air drinking from a bottle. The size of the opening naturally makes me make my mouth smaller (I never put my lips around the entire mouth), and I think I swallow less air that way. I'm doing more burping this morning drinking my protein shake from my magic bullet glass than I did last night after taking my pills.

I started toying with the idea of trying other liquids, especially after I found the milk so refreshing, besides water and CL.  I was looking in our fridge at some of the things they had me buy for my day before surgery liquid diet. I about croaked when I saw how much sugar was in one serving of apple juice. Good grief. I used to drink 16 oz. of that with breakfast.

As for my BMs, they're starting to take on a more normal pattern, for me at least. After I have a few sips of a protein shake, I have to go. I almost always had to go after eating prior to WLS but post chole, so that makes sense.

Edited to add this question:  The rule is, no drinking 30 minutes before or 30 minutes after a meal. Do I have to follow this while I'm on a liquid diet? I know the reason is to keep from pushing through food too quickly so that you feel full longer. It makes sense. However, my doctor's/NUT's guidelines are 4 oz of water an hour, every hour. If I'm losing an hour before and after meals and I'm having to drink my protein on an almost constant basis to get it in right now, can I break this rule temporarily. I know it becomes very important as I move to solid foods, but since they're all liquid right now anyway, I don't see how it makes a difference.

No, it doesn't apply now - you are doing the right thing by pushing as many liquids and protein shakes as you can handle.  Once you progress to solid food and regular small meals, then it applies.

Hey Mel,

Congrats on your surgery.  Sounds like you're doing great. 

I just want to tell you that that feeling of something stuck in your throat is kind of normal for me.  If I keep my carb intake as low as it should be I still get that feeling.  It's like some small amount of food is stuck in the back of my throat.  It even tastes bad.  I think it's somehow related to ketosis.  I used to get it when I did the Adkins Diet pre-surgery. 

I also had the feeling of tightness that hurt in my back.  At first it was attributed to trapped gas left over from the surgery.  But it didn't go away.  It was like my back just tightened up across the middle, kind of below my shoulder blades.  My surgeon said it was related to posture and rapid weight loss.  Basically, he thought my frame had to learn how to compensate as I lost weight.  It eventually went away, mostly.  I was never truly satisfied with the doc's explanation.  I have no history of back injury or back pain, but, if I get really tired, it still comes back.  The only thing that ever has helped that pain is walking while swinging my arms enough to loosen it up. 

Keep up the good work.  You're doing great.  Can't wait to see you at the conference.  We're roomies you know.