I'm needing suggestions, please.....

You're my hero, Kelly! I'm only 6 days post op and have zero appetite, but I'm gonna let your post serve as a reminder for me during my mushy phase, that I too, have to eat.

Thanks!!!!  Kyle

Now don't be stressing that new tummy of your's getting all enthusiastic.

The guidleine is 30-60-90. 30 grams of protein by 30 days, 60 grams by 60 days, and 90 grams by 90 days. Some people manage to get it all in shortly after surgery, some people have a struggle. For the majority, though, it's easily doable.

As early out as you are, it's more important that you're getting in at least 64 ounces of water/liquid a day.  If you only have room for one thing, make it liquid. This should ease up for you bit by bit in the next couple of weeks as the swelling in your stomach from the surgery begins to go down.

For the first few weeks, I could either drink, eat, or take my vitamins at once. I couldn't take vitamins and eat at the same time. I had to spread them all out or it would all just come back up.

It IS important to find a protein supplement of some sort that you can manage to gag down. If you're very lucky, you might find one you like. I was able to manage Unjury unflavored protein powder in decaf coffee very well. But, there will be plenty of days when you just can't eat enough and you'll need to supplement. You can't afford to let it slide.

The DS is a miracle, but it comes with a price. And the agreement we made to forever supplement, take in adequate protein, and drink at least 64 ounces of water is absolutely non-negotiable. The consequences for not holding up our end of the bargain can be deadly.

(and I'm not a hero, shucks. I'm just passing on info. But, thanks!)

My advice is to do every single thing that goodkel just told you. She is right on the money. You are suffering from malnutrition and dehydration, which is the likely cause of your nausea. You need fluids, all day every day.

I don't think you have anorexia. I think you just never learned to eat and drink properly after your surgery, and the problem has spiraled because you have become comfortable with some really bad habits. 

Get a timer and set it for two hours. Eat some protein when it goes off, and then reset it. Drink constantly.  Use a tracker like sparkpeople.com or fitday.com to keep up with how much protein you are consuming, how much water you've had, etc.

I'm glad you came to the boards and I really hope you break this cycle soon.  Please keep us posted because I'm really worried about you, Caprice.

Caprice,

Doesn't matter what has happened in the past, you've got to start taking care of this NOW. The only thing that you can do is work on what happens from here on out.  You know what you were supposed to be doing, but didn't, now it's time to put your plan in ACTION! 

No more excuses.  Starting now.  There is never a reason, at 10 months out that you should be missing your vitamin, not drinking your fluids, or getting your protein in.  You need to get yourself to Vitalady.com and order any vitamins you don't have.  Here is her basic plan, you need to be doing AT THE VERY LEAST this much.  You may need to do more because you've allowed yourself to become deficient from the sounds of what you're describing.

12105 – 78th Ave East Puyallup, WA  98373-4863   Phone (253) 848-5118  Fax (253) 445-5143 [email protected] or [email protected] Web Site www.Vitalady.com

2/7/08

Vitamin & Mineral Schedule and Shopping List for

Distal RNY, BDP, BPD/DS

 

The following is NOT to be construed as medical advice.  This Schedule has been known to work for most Distal RNY Patients and not intended to replace your doctor's instructions.

 

Our prices on our products, roughly figured for Distal RNY, not considering sales, specials or applicable taxes or shipping and handling fees.

 

SCHEDULE:

 

AM:                2- Vitamin C; 2- Iron (Polysaccharide) or 12 Tender Iron (Carbonyl)

Lunch: 1- Vitamin A; 1- Vitamin B-12; 1- B Complex; 1- Vitamin E; 2- Calcium Citrate; 1- Multi;

1- Zinc

Evening:         2- Vitamin A; 1- B-1; 1- Vitamin E;  2- Calcium Citrate;  1- Multi;  1- Zinc; 1 Vitamin D-3

Bed Time:       1- Vitamin A;  1- Vitamin C;  2- Calcium Citrate

 

Initial Shopping List:

 

Qty                              Item                                                                            Price     Will Last   Avg Cost/Day

1          Dry A (25,000IU)                                           100 Cap            $  7.49         25 days          =   .30

1          Vitamin B-1 (Tender Thiamin)                     200 Cap                9.99       200 days          =   .05

1          Vitamin B-12 Sublingual (5000mcg)            60 Loz               28.99         60 days          =   .48

1         Vitamin B Complex                                       200 Cap              19.99        200  days        =   .10

1         Vitamin C (1000mg)*                                    500 Tab               17.99       166 days          =   .11

1          Vitamin D (50,000IU)                                   100 Cap               24.99       100 days          =   .25

1         Dry Vitamin E (400IU)                                  250 Cap               26.99       125 days          =   .11

1         Calcium Citrate w/ D & Mag.                       240 Cap               16.99         40 days          =   .42

                             (500mg, 200IU, 250mg)

1         Iron (150mg Polysaccharide Iron)*              100 Cap              24.99         50 days           =   .50

1          Multi-Vitamin/Mineral*                                  500 Tab              18.99       250 days           =   .08

1          Zinc (50mg)                                                   250 Tab                6.99       125 days           =   .06

                                                             Average cost per 30 Day Month  = $73.80          Per Day    =  2.46

 

*If chewables are desired we can substitute:

            1          Iron (Tender Iron) (25mg Carbonyl)             400 Tab               15.99            33 days       =    .48

1          Chewable Vitamin C (500mg)                     500 Tab               15.99         166 days       =    .10

1          Chewable Multi-Vitamin/Mineral                 300 Tab               14.79         150 days       =    .10

                                                            Average cost per 30 Day Month  = $73.50          Per Day    =  2.45

 

This is to help you to calculate & budget your monthly cost for basic vitamin and mineral needs.

Pricing based on current prices on date printed above and subject to change without notice.

 

Basic Distal Plan.doc

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(I'll pm that to you if the format comes out wrong.)

While you're there, you need to order some protein samples.  Champion Nutrition's Banana Scream, and Chocolate Stacks are my favorite flavors.  You need to find what works for you.  It's not an option, as you'll need to be getting in upwards of 125 g of protein to reverse what is happening to your body.  (I would suggest more than 150g of protein to help, but do what you can in the beginning to get through this).  I would look at protein shakes as now a necessity to get you back to health.  I got back to drinking protein in June and cannot tell you how much better I'm feeling, even though I've not missed a day of getting in 100 g of protein from food, I very simply feel better and stronger now. 

Like Goodkel said, you need to have a bottle of water or SOMETHING with you at all times to combat dehydration, it may be the reason for your "harfing." 

As for work, you need to get a mini-cooler and take things like cheeses and deli meat with you to snack on throughout the day.  Since you feel you're too thin, add in some trail mix for good carbs, just put them in a sandwich bag to keep with you all day.  (Yogurt covered raisins, M&M's, LOTS of nuts of all kinds, dried cranberries...all delish together!)  You should be eating 3-4 ounces of protein dense foods every couple of hours to keep your stomach acids low so you don't end up harfing. 

If the harfing continues after a couple of days of a sincere effort of trying to eat every couple of hours, you need to get in touch with Dr. Anderson, Dr. Maguire, or Dr. Teel in the Dayton area and find out if they will help you with followup.  You could be dealing with strictures since you haven't been eating enough food.  When you don't use your stomach, it can close up on you by creating strictures that will need to be opened up with an endoscopy.

All of this is fixable/reversible, but you need to take action now hon. 

I'm glad you're here for help, and I'm not trying to be harsh with you...I'm concerned for your health from the things you described.  You've got to get this under control before the problems take over your life.  I think you know how serious it is from the way you're feeling, please keep coming here for support...you can do this but it doens't have to be alone.

Big hugs,

Lori

Hi Caprice!

I would suggest calling Dr. Teel and Dr. Maguire's office TODAY. Here's their numbers:
1-866-338-SLIM (7546)
937-208-5300
Tell them that you're a DS patient in Ohio that had her surgery done out of country but need good follow up care.  If they aren't taking any patients, you also have the option of Dr. Rita Anderson who is also in Dayton.  Dayton is the closest place for you that has good DS surgeons.  It will be about a 2 hour trip but it's certainly worth it for your health.

Kelly is right...you need to do what you need to do to get in your protein.  But, the good thing is that at this point, carbs and sugars shouldn't be an issue of concern for you.  So, you can drink milk without the worry of adding extra carbs to your diet.  There's also other protein faves like eggs, cheese and lean shaved meats (I think Kelly mentioned that too) that are lighter in the tummy. Peanut butter is also easy to get down...and stays down. 

While I'm no medical professional, I would compare this to a slippery slope that you're going down....you need to get off it now. I don't think its a DS malfunction and I don't think you're anorexic. I think it's the same "I'll do it tomorrow" philosophy that allowed you to become obese in the first place.  It used to be "I'll start my diet tomorrow" and now it's "I'll eat better tomorrow".  It looks like that time has come. Tomorrow just won't work.
I've heard that vegetarians have a hard time stomaching meat after not eating it for so long...that might be what's happening here too. Whatever the case, there comes a point where you have to FORCE yourself to do certain things.  Again, that time has come.

Hey sweetiepie!!  I've been wondering about you.  The first year or two and even sometimes today, if I don't eat enough -- I too might lose my appetite.  I even had the nausea if I went too long to eat, but never heaved.   I had to wrap my head around the idea that I needed to eat to nourish myself whether I felt like it or not.  I even went as far as to set Outlook reminders to eat and take my vitamins.  Perhaps if you eat a little something several times a day, you won't experience the nausea so much.  Also, make sure you're gettng plenty of fluids, too, as that can cause nausea. If you've already tried this to no avail, I'd suggest calling the surgeons here in Ohio to see if one of them will agree to see you and help figure this out.  You can also (if you haven't already) hook your PCP up with your surgeon and perhaps your surgeon can suggest what tests to give you, etc. 

Hey, you've gotten some great advice here.  I would add that it does sound like dehydration could be the biggest problem.  A simple test I was told about was to pinch the skin on the back of one hand, if it doesn't go back flat quickly, you are likely dehydrated.  This can be life threatening.  So  call one of the Dayton surgeons or your PCP.  There are lots of us Miami Valley Area DSers around, so if you need transportation, let us know. 
Take care!

Worst case scenario I would go to the ER and if you are dehydrated they will hook you up to an IV. I know what you mean about teh nausea, heaves and the not having an appetite. I have to make myself eat regularly, and I DID get dehydrated and ended up in the hospital. I felt sooo much better after I was rehydrated. I have to really work at making myself eat.
I have not gone back to work yet becasue I know I will do like you did, and keep putting off eating..it is what I used to do. I am taking care to make a routine and stock up things I can keep in my office, my car, my purse etc that I can snack on.

You can take care of this...I still worry with the edema and you haveing no energy that a trip to the ER may not be a bad idea.

you have gotten great advice

take care

Jacqui

While it is rare strictures do happen to DSers, as do ulcers.  While this may very well be an emotional or compliance issue, a case can be made for a mechanical issue as well.  If you cannot see a DS surgeon, see a good GI doc and get everything checked out.  If there is a mechanical issue going on -- you will only be more traumitized by redoubling your efforts to eat and that could make things worse. 

Red

Hi there. I believe you need a hematologist with experience in nutritional deficiencies/malnutrition. RIGHT NOW. You are in serious trouble and must not put off getting into treatment a single day longer.

It might be a good idea to get evaluated by an eating disorders team with experience in post bariatric surgery issues of this nature. Mind and body are inextricably intertwined, so there comes a point where you can't address just one side of the equation. It's important for you not to allow yourself to be pushed into a therapy-only approach to what is at least partly a medical problem that is specific to a very small subgroup of people, namely malnourished DS'ers. There aren't a lot of mental health or medical pros who are experienced with folks like us in general, and when you through in the malnourished part, then it gets that much tougher to find good treatment.

All of that to say: You have very severe medical issues. Chances are you *also* have psych issues. But don't let ANYONE tell you this is "all in your head." It *is* in your head to the degree that your brain is starved, though. See how it gets intertwined?

I don't know how much you can push your body to accept intake without medical intervention at this point. But to the degree that it works, you MUST change your intake, immediately. You need incredible amounts of protein. This makes supplements absolutely mandatory right now.
 
The smallest supplement I know off the top of my head is the 42-gram protein "bullet," put out by several different manufacturers. You can get them at places like GNC or Vitamin World, or you can order them online at www.protica.com .

My suggestion is: Put one of these on your nightstand every night. As soon as you wake up in the morning, chug that sucker down, before you even go to pee.

Find other protein supplements you can get down--this does not mean they are palatable, this means you can hold your nose and gag it down if necessary--and aim for 6-8 servings a day.

You MUST hydrate yourself. Actually, this is probably more important than the protein first. Get your body all "plumped up" with water. Go get IV fluids if you have to.

Chances are you might need an inpatient stay to get nutrition into your body anyhow.

Do not delay. You are in a near emergency situation. Your life is at stake. This is not about weight loss or gain. This is about treating malnutrition. Get help NOW.