Complications
I am excited, but scared of having surgery. Can anyone tell me any surgery related complications( for example anesthesia, etc) or any complications thus far. I think to myself what if...., and then I say it will be ok, back and forth I go everyday. Sorry to be morbid, but reading the concent form scares me, please help! I want to do this, but I am soooo scared.
on 5/21/07 11:05 pm - MT
Hun, it is normal to have these thoughts. This is a major change in ones life! Takes so much work to work your tool correctly! I have been very lucky and have not had anything really bad so far, I am almost 2 years out! I guess I went into this knowing of what COULD happen and prayed that what happens God give me the strength to deal with it. 
I knew this was something I had to do for my own health and life.
Take your time and read, knowledge is good and knowing the info can not hurt!
I wish you the best! Keep us posted!
http://www.danaise.com/bariatric.htm http://www.livingafterwls.com/Library.html
http://www.asbs.org/
http://en.wikipedia.org/wiki/Weight_loss_surgery
the above sites may prove helpful in your quest for info
_______________________________________
I didnt save the link to this but may help also..
Surgical Risks
Weight loss surgery is MAJOR ABDOMINAL SURGERY. There are many important and potentially lethal complications known to be associated with this operation, and surgery in general.
Some of the dangers are the same that are present in any operation that includes sedation of the patient. These operative risks are therefore not unique to this surgery, however, it is still important to review these risks. Please review these risks with your family or support system, and feel free to ask your doctor any questions that may arise.
Complications
Description
Allergic Reactions
From minor reactions such as a rash to sudden overwhelming reactions that can cause death.
Anesthetic Complications
Anesthesia used to put you to sleep for the operation can be associated with a variety of different complications up to and including death.
Bleeding
Surgery involves incisions and cutting that can result in bleeding complications, from minor to massive, that can lead to the need for emergency surgery, transfusion, or death.
Blood Clots
Also called deep vein thrombosis and Pulmonary Embolus that can sometimes cause death. It is imperative that you get up and walk around the evening of your surgery day to help prevent clots from forming in your legs.
Infection
Including wound infections, bladder infections, pneumonia, skin infections and deep abdominal infections that can sometimes lead to death.
Leak
After an operation to bypass the stomach, the new connections can leak stomach acid, bacteria and digestive enzymes causing a severe abscess and infection. This can require repeated surgery, and intensive care and even death.
Narrowing (stricture)
Narrowing (stricture) or ulceration of the connection between the stomach and the small bowel can occur after the operation. This can require emergency operation, intensive care and can sometimes lead to death.
Indigestion, Reflux or Ulcers
The operation can sometimes lead to severe nausea, vomiting, indigestion, abdominal pain, gastritis or ulcers. This can be severe and can last for days, weeks or possibly even longer. This is especially likely if you have had previous problems with nausea, abdominal pain or ulcers. Bile reflux is also a possibility, and may necessitate additional surgery.
Dumping Syndrome
Dumping Syndrome (Symptoms of the dumping syndrome include cardiovascular problems with weakness, sweating, nausea, diarrhea and dizziness) can occur in some patients after gastric bypass. This can be so severe that the surgery may have to be reversed.
Bowel Obstruction
Any operation in the abdomen can leave behind scar tissue that can put the patient at risk for later bowel blockage or obstruction. The bowel can twist, obstruct or even perforate leading to serious complications and even death.
Laparoscopic Surgery Risks
Laparoscopic Surgery use*****tures to enter the abdomen and this can lead to abdominal injury, bleeding and even death.
Side Effects of Drugs
All drugs have inherent risks and complications and in some cases can cause a wide variety of side effects, reactions and rarely cause death.
Loss of Bodily Function
The performance of surgery and anesthesia can stress the body’s systems leading to a variety of complications including stroke, heart attack, limb loss and other problems related to operations and anesthesia.
Risks of Transfusion
Including Hepatitis and Acquired Immune Deficiency Syndrome (AIDS), from the administration of blood and/or blood components. The illnesses are serious and can be fatal. Hernia Cuts and incision in the abdominal wall can lead to hernias after surgery. Hernias can lead to pain, bowel blockage, obstruction and even perforation and death in some cases. Treatment of hernias usually requires another operation.
Hair Loss
Many patients develop hair loss for some period of time following an operation. It usually occurs 3-4 months following surgery, and resolves at 7-9 months. This usually responds to increased oral intake of protein and vitamins, but it may be permanent.
Vitamin and Mineral Deficiencies
After gastric bypass, there is a malabsorption of many vitamins and minerals. Patients must take vitamin and mineral supplements forever to protect themselves from these problems. You also need to have yearly blood tests to measure the blood levels of these vitamins and minerals. Common deficiencies that can occur after gastric bypass include iron and calcium deficiency, B12 and Folate deficiencies.This is very important: Patients must take vitamin and mineral supplements forever. In some cases the deficiencies are so severe that they can lead to nerve and brain damage and the bypass must be reversed!
Excessive Weight Loss
Some patients sustain excessive weight loss after the operation and may require reversal of the bypass to prevent severe malnutrition, nausea or vitamin and mineral deficiencies or death.
Complications of Pregnancy
Vitamin and mineral deficiencies can put the newborn babies of gastric bypass mothers at risk. No pregnancy should occur for the first one to two years after the operation. Gastric Bypass has been shown to cause multiple types of vitamin and mineral deficiencies including: iron, B12, Folate, calcium and many others. Many of these deficiencies have been shown to cause birth defects or are suspected to cause birth defects. We also know that many patients who lose weight feel that they are well after surgery and forget to take their vitamins. Patients MUST be certain not to miss any of their vitamins if they decide to go ahead with pregnancy later. Unplanned Pregnancy Warning to women using oral contraceptives (birth control pills): More than 80 million women worldwide take “the pill” to prevent pregnancy. Studies have shown that oral contraceptives affect a woman’s hormones. This surgery also affects hormones, and interferes with the bodies ability to regulate hormonal levels. Thus oral contraceptives or other hormonal types of birth control (i.e. Depo Provera) are NOT RECOMMENDED as a reliable prevention of pregnancy following a gastric bypass. A barrier method is recommended, but be aware that your body changes rapidly during the initial weight loss period, and a diaphragm would not be especially reliable, either.
Other
Major abdominal surgery, including the Laparoscopic Gastric Bypass, is associated with a large variety of other risks and complications, both recognized and unrecognized that occur both soon after and long after the operation. There is also a risk that you may not lose all of your excess weight before your body adapts to the bypass, and causes your weight loss to slow or even to stop prematurely.
Depression
Depression and anxiety are common medical illnesses and have been found to be particularly common after gastric bypass surgery. You must have a mental health plan in place, and make your family or support system aware of the signs and symptoms of depression, so that they can get you the help you need.
Death
This is a major and serious operation. It may lead to death from complications in some cir****tances, despite our best efforts on your behalf.
Deciding to have WLS is a major, life-changing event and shouldn't be made on impulse (I am not saying this is you I am saying this for anyone thinking about it!). I recommend anyone be 110% sure this is what you want to do because it is PERMANENT!
Things to think about:
- How long have you been researching WLS?**Hopefully at least a good 6 months or so****for many it is years!
- Do you understand the procedure, I mean really understand the nitty gritty of what they are going to do to your intestinal system! Not just it will help me lose weight but that they are going to cut your stomach in 2,make a small pouch, the old stomach hopefully is transected from pouch by staples and surgically cut in 2! Then the intestines are cut a few feet or so down and rerouted so you lose weight because the tummy is restrictive and bypassing the intestines decreases absorption....Know the risks involved with this!!!***(nutritional/metabolic/physical/psychosocial): ex B12 and vitamin deficiencies/protein deficiency/hernia/adhesions, risk of depression post op related to grief over loss of food and hormonal surge of estrogen/trauma of surgery, marital/relational difficulties/high divorce rate)...
- Surgical risks: (not all inclusive..
Bleeding
· Complications due to anesthesia and medications
· Deep vein thrombosis/clots
· Wound Dehiscence
· Infections
· Pulmonary problems
· Spleen injury
· Stenosis
· Hernia
- Depression possibly related to grieving the loss of food, decreased metabolism, and hormonal surges from estrogen being released into the body from rapid wt loss/fat breakdown....
- Gallstones....
- Long-term osteoporosis, vit./mineral deficiencies
- hair loss (temporary due to anesthesia, trauma of surgery but will continue if you are protien/vit and mineral deficient!)
- Food intolerances (possibly meats, esp. red meat, lactose intolerance, sugar, fats, fried food)
- Dumping syndrome (Nausea/vomiting/diarrhea/chestpain/palatations/sweating/tiredness for minutes/hours/days)
- EXCESS SKIN....OK my philosophy is you fit in your skin or you don't...Do say you don't want to feel bad after, ask yourself do you feel bad now? If yes are you healthy now as a MO person? Yeah many insurance companies pay for some plastic surgeries if medically necessary it may be a fight, but you can get some of it removed possibly....If though this will deter you I say the chances are great you will have some amount of excess skin, no one knows how much...Age, gender, prior diet/weight changes, pregnancies all affect this and the best chance on has to control this is (although limited) exercise, water and protein....So if this is a huge issue don't have surgery.....Perhaps join : http://health.groups.yahoo.com/group/ossg-plasticsurgery/ a great site and look at before pictures and after....Excess skin may be by far the most distressing side-effect for people as we already come with altered self-esteem/body image!!!
- What type of research have you done? (Internet, in-person support group meetings, talking with others who have had surgery, surgeon consult, surgeon seminar, articles, books?????)***Knowledge is power and is the best tool we have for success and happiness afterwards****
- What are your present support systems? Friends, Family, co-workers.....**Although not 100% necessary if others are on board it sure as heck makes the ride all that much easier!!!***
- What are your current stressors? ***WLS is a time when you need to be as stable as possible, going through a divorce, bankruptcy, death of a close relative, job loss...well WLS may be a good option but pick the optimal time as it is stressful enough if everything is good, when you are going through something extra stressful you are hampering your success possibly and not having the old standby of food to rely on can be HELL!***This is not to say there ever is a right time and things can happen post-op but be kind to yourself and do what’s best for you, waiting 3 months may make all the difference in the world! After all this is about forever!!!
- What is your nutritional/obesity/diet history?***WLS is not for everyone, it is for the Morbidly obese (BMI above 40 or 35 with major comorbdities such as sleep apnea, Coronary disease, Diabetes....)This should be no ones first attempt at dieting (*I know this is not yours again just general guidelines)...Anyone who says this is the easy way out, KNOWS NOTHING about the surgery or the struggles you will endure and lifestyle changes necessary post-op for success! They are usually ignorant, jealous or both! Again your education and knowledge here goes a long way...Everyone seems to know someone who 'died' or had a 'terrible experience' with WLS...BUT no one seems to have a name or number to call that person!!! It is again based on hearsay alot of the time and their own fears and insecurities...You are doing this for you remember that, it is nice to have support, so educate friends and family, bring them to a support group!!! It can only help! Many programs require wt loss preop...I know many people disagree with this or don’t understand why..IMHO I think it is a generally good idea to start instilling dietary, exercise and overall lifestyle changes preop, there is nothing magical about the surgery that makes u wake up and think like a thin person (*I WISH!!!!) So making small changes are helpful pre-op...EXERCISE is one of the biggest keys to success (IMHO again) and anything you can do preop will help you keep up with this and be healthier for surgery!! (and a better surgical risk!)...Start eating smaller portions, it is hard if you go from eating super sized fast food today to clear liquids for 2 weeks (*this is my equivalent of psychological hell/torture!!!) Start slowing down when you eat, put that fork down in-between bites, cut up your food to small pieces, stop drinking and eating at the same time (cant do it or shouldn’t postop so start now!) Start taking in 64 ounces of fluid a day if u aren't already, will need to postop! Cut out carbonation, caffeine, sugar, alcohol and chocolate (these are 5 recommended things to avoid postop for many esp. in the first year) again make postop life easier on yourself not harder start ahead!!!!Try on new coping skills for size, they wont miraculously appear postop! Stock the house with clear liquids, crystal lite, diet kool-aid, broth, diet jello etc so u are ready when u get home!!!!Try and avoid the 'last supper syndrome' you will eat most everything again eventually, perhaps in smaller quantities, so don’t have a feast each night of things u think u will never have again!
- Ask yourself: What is my ability to make lifestyle changes? Be compliant with post-op recommendations???
This is only a tool....(*sorry can't say that enough!)....
a. Need to exercise daily for health/wt loss and help with excess skin
b. Need to supplement with B12, multivitamin, folate, Iron, Zinc, Calcium citrate, protein shakes possibly give or take things.
c. Need for LIFELONG FOLLOW UP!!!!
- Know that extended release medications may not be as effective or absorbed well (**esp. birth control pills in woman of childbearing age use alternative form of BC)
I could probably ramble on all day about this..I hope some of this helps you! Any specific ? email us or me offline! Take care and good luck it is an awesome journey!! *not perfect and a positive attitude helps!
DO this for you and only you!!!!Start journaling now www.obesityhelp.com is a great site, start your own profile there! Also if you haven’t seen this document (pouch rules) print and read! A good basic guide to things that will help you use the tool and be successful as possible (*for most of us!!!)
http://www.digitalhorsewoman.com/pouchrules.htm
http://www.danaise.com/bariatric.htm http://www.livingafterwls.com/Library.html
http://www.asbs.org/
http://en.wikipedia.org/wiki/Weight_loss_surgery
the above sites may prove helpful in your quest for info
_______________________________________
I didnt save the link to this but may help also..
Surgical Risks
Weight loss surgery is MAJOR ABDOMINAL SURGERY. There are many important and potentially lethal complications known to be associated with this operation, and surgery in general.
Some of the dangers are the same that are present in any operation that includes sedation of the patient. These operative risks are therefore not unique to this surgery, however, it is still important to review these risks. Please review these risks with your family or support system, and feel free to ask your doctor any questions that may arise.
Complications
Description
Allergic Reactions
From minor reactions such as a rash to sudden overwhelming reactions that can cause death.
Anesthetic Complications
Anesthesia used to put you to sleep for the operation can be associated with a variety of different complications up to and including death.
Bleeding
Surgery involves incisions and cutting that can result in bleeding complications, from minor to massive, that can lead to the need for emergency surgery, transfusion, or death.
Blood Clots
Also called deep vein thrombosis and Pulmonary Embolus that can sometimes cause death. It is imperative that you get up and walk around the evening of your surgery day to help prevent clots from forming in your legs.
Infection
Including wound infections, bladder infections, pneumonia, skin infections and deep abdominal infections that can sometimes lead to death.
Leak
After an operation to bypass the stomach, the new connections can leak stomach acid, bacteria and digestive enzymes causing a severe abscess and infection. This can require repeated surgery, and intensive care and even death.
Narrowing (stricture)
Narrowing (stricture) or ulceration of the connection between the stomach and the small bowel can occur after the operation. This can require emergency operation, intensive care and can sometimes lead to death.
Indigestion, Reflux or Ulcers
The operation can sometimes lead to severe nausea, vomiting, indigestion, abdominal pain, gastritis or ulcers. This can be severe and can last for days, weeks or possibly even longer. This is especially likely if you have had previous problems with nausea, abdominal pain or ulcers. Bile reflux is also a possibility, and may necessitate additional surgery.
Dumping Syndrome
Dumping Syndrome (Symptoms of the dumping syndrome include cardiovascular problems with weakness, sweating, nausea, diarrhea and dizziness) can occur in some patients after gastric bypass. This can be so severe that the surgery may have to be reversed.
Bowel Obstruction
Any operation in the abdomen can leave behind scar tissue that can put the patient at risk for later bowel blockage or obstruction. The bowel can twist, obstruct or even perforate leading to serious complications and even death.
Laparoscopic Surgery Risks
Laparoscopic Surgery use*****tures to enter the abdomen and this can lead to abdominal injury, bleeding and even death.
Side Effects of Drugs
All drugs have inherent risks and complications and in some cases can cause a wide variety of side effects, reactions and rarely cause death.
Loss of Bodily Function
The performance of surgery and anesthesia can stress the body’s systems leading to a variety of complications including stroke, heart attack, limb loss and other problems related to operations and anesthesia.
Risks of Transfusion
Including Hepatitis and Acquired Immune Deficiency Syndrome (AIDS), from the administration of blood and/or blood components. The illnesses are serious and can be fatal. Hernia Cuts and incision in the abdominal wall can lead to hernias after surgery. Hernias can lead to pain, bowel blockage, obstruction and even perforation and death in some cases. Treatment of hernias usually requires another operation.
Hair Loss
Many patients develop hair loss for some period of time following an operation. It usually occurs 3-4 months following surgery, and resolves at 7-9 months. This usually responds to increased oral intake of protein and vitamins, but it may be permanent.
Vitamin and Mineral Deficiencies
After gastric bypass, there is a malabsorption of many vitamins and minerals. Patients must take vitamin and mineral supplements forever to protect themselves from these problems. You also need to have yearly blood tests to measure the blood levels of these vitamins and minerals. Common deficiencies that can occur after gastric bypass include iron and calcium deficiency, B12 and Folate deficiencies.This is very important: Patients must take vitamin and mineral supplements forever. In some cases the deficiencies are so severe that they can lead to nerve and brain damage and the bypass must be reversed!
Excessive Weight Loss
Some patients sustain excessive weight loss after the operation and may require reversal of the bypass to prevent severe malnutrition, nausea or vitamin and mineral deficiencies or death.
Complications of Pregnancy
Vitamin and mineral deficiencies can put the newborn babies of gastric bypass mothers at risk. No pregnancy should occur for the first one to two years after the operation. Gastric Bypass has been shown to cause multiple types of vitamin and mineral deficiencies including: iron, B12, Folate, calcium and many others. Many of these deficiencies have been shown to cause birth defects or are suspected to cause birth defects. We also know that many patients who lose weight feel that they are well after surgery and forget to take their vitamins. Patients MUST be certain not to miss any of their vitamins if they decide to go ahead with pregnancy later. Unplanned Pregnancy Warning to women using oral contraceptives (birth control pills): More than 80 million women worldwide take “the pill” to prevent pregnancy. Studies have shown that oral contraceptives affect a woman’s hormones. This surgery also affects hormones, and interferes with the bodies ability to regulate hormonal levels. Thus oral contraceptives or other hormonal types of birth control (i.e. Depo Provera) are NOT RECOMMENDED as a reliable prevention of pregnancy following a gastric bypass. A barrier method is recommended, but be aware that your body changes rapidly during the initial weight loss period, and a diaphragm would not be especially reliable, either.
Other
Major abdominal surgery, including the Laparoscopic Gastric Bypass, is associated with a large variety of other risks and complications, both recognized and unrecognized that occur both soon after and long after the operation. There is also a risk that you may not lose all of your excess weight before your body adapts to the bypass, and causes your weight loss to slow or even to stop prematurely.
Depression
Depression and anxiety are common medical illnesses and have been found to be particularly common after gastric bypass surgery. You must have a mental health plan in place, and make your family or support system aware of the signs and symptoms of depression, so that they can get you the help you need.
Death
This is a major and serious operation. It may lead to death from complications in some cir****tances, despite our best efforts on your behalf.
Deciding to have WLS is a major, life-changing event and shouldn't be made on impulse (I am not saying this is you I am saying this for anyone thinking about it!). I recommend anyone be 110% sure this is what you want to do because it is PERMANENT!
Things to think about:
- How long have you been researching WLS?**Hopefully at least a good 6 months or so****for many it is years!
- Do you understand the procedure, I mean really understand the nitty gritty of what they are going to do to your intestinal system! Not just it will help me lose weight but that they are going to cut your stomach in 2,make a small pouch, the old stomach hopefully is transected from pouch by staples and surgically cut in 2! Then the intestines are cut a few feet or so down and rerouted so you lose weight because the tummy is restrictive and bypassing the intestines decreases absorption....Know the risks involved with this!!!***(nutritional/metabolic/physical/psychosocial): ex B12 and vitamin deficiencies/protein deficiency/hernia/adhesions, risk of depression post op related to grief over loss of food and hormonal surge of estrogen/trauma of surgery, marital/relational difficulties/high divorce rate)...
- Surgical risks: (not all inclusive..
Bleeding
· Complications due to anesthesia and medications
· Deep vein thrombosis/clots
· Wound Dehiscence
· Infections
· Pulmonary problems
· Spleen injury
· Stenosis
· Hernia
- Depression possibly related to grieving the loss of food, decreased metabolism, and hormonal surges from estrogen being released into the body from rapid wt loss/fat breakdown....
- Gallstones....
- Long-term osteoporosis, vit./mineral deficiencies
- hair loss (temporary due to anesthesia, trauma of surgery but will continue if you are protien/vit and mineral deficient!)
- Food intolerances (possibly meats, esp. red meat, lactose intolerance, sugar, fats, fried food)
- Dumping syndrome (Nausea/vomiting/diarrhea/chestpain/palatations/sweating/tiredness for minutes/hours/days)
- EXCESS SKIN....OK my philosophy is you fit in your skin or you don't...Do say you don't want to feel bad after, ask yourself do you feel bad now? If yes are you healthy now as a MO person? Yeah many insurance companies pay for some plastic surgeries if medically necessary it may be a fight, but you can get some of it removed possibly....If though this will deter you I say the chances are great you will have some amount of excess skin, no one knows how much...Age, gender, prior diet/weight changes, pregnancies all affect this and the best chance on has to control this is (although limited) exercise, water and protein....So if this is a huge issue don't have surgery.....Perhaps join : http://health.groups.yahoo.com/group/ossg-plasticsurgery/ a great site and look at before pictures and after....Excess skin may be by far the most distressing side-effect for people as we already come with altered self-esteem/body image!!!
- What type of research have you done? (Internet, in-person support group meetings, talking with others who have had surgery, surgeon consult, surgeon seminar, articles, books?????)***Knowledge is power and is the best tool we have for success and happiness afterwards****
- What are your present support systems? Friends, Family, co-workers.....**Although not 100% necessary if others are on board it sure as heck makes the ride all that much easier!!!***
- What are your current stressors? ***WLS is a time when you need to be as stable as possible, going through a divorce, bankruptcy, death of a close relative, job loss...well WLS may be a good option but pick the optimal time as it is stressful enough if everything is good, when you are going through something extra stressful you are hampering your success possibly and not having the old standby of food to rely on can be HELL!***This is not to say there ever is a right time and things can happen post-op but be kind to yourself and do what’s best for you, waiting 3 months may make all the difference in the world! After all this is about forever!!!
- What is your nutritional/obesity/diet history?***WLS is not for everyone, it is for the Morbidly obese (BMI above 40 or 35 with major comorbdities such as sleep apnea, Coronary disease, Diabetes....)This should be no ones first attempt at dieting (*I know this is not yours again just general guidelines)...Anyone who says this is the easy way out, KNOWS NOTHING about the surgery or the struggles you will endure and lifestyle changes necessary post-op for success! They are usually ignorant, jealous or both! Again your education and knowledge here goes a long way...Everyone seems to know someone who 'died' or had a 'terrible experience' with WLS...BUT no one seems to have a name or number to call that person!!! It is again based on hearsay alot of the time and their own fears and insecurities...You are doing this for you remember that, it is nice to have support, so educate friends and family, bring them to a support group!!! It can only help! Many programs require wt loss preop...I know many people disagree with this or don’t understand why..IMHO I think it is a generally good idea to start instilling dietary, exercise and overall lifestyle changes preop, there is nothing magical about the surgery that makes u wake up and think like a thin person (*I WISH!!!!) So making small changes are helpful pre-op...EXERCISE is one of the biggest keys to success (IMHO again) and anything you can do preop will help you keep up with this and be healthier for surgery!! (and a better surgical risk!)...Start eating smaller portions, it is hard if you go from eating super sized fast food today to clear liquids for 2 weeks (*this is my equivalent of psychological hell/torture!!!) Start slowing down when you eat, put that fork down in-between bites, cut up your food to small pieces, stop drinking and eating at the same time (cant do it or shouldn’t postop so start now!) Start taking in 64 ounces of fluid a day if u aren't already, will need to postop! Cut out carbonation, caffeine, sugar, alcohol and chocolate (these are 5 recommended things to avoid postop for many esp. in the first year) again make postop life easier on yourself not harder start ahead!!!!Try on new coping skills for size, they wont miraculously appear postop! Stock the house with clear liquids, crystal lite, diet kool-aid, broth, diet jello etc so u are ready when u get home!!!!Try and avoid the 'last supper syndrome' you will eat most everything again eventually, perhaps in smaller quantities, so don’t have a feast each night of things u think u will never have again!
- Ask yourself: What is my ability to make lifestyle changes? Be compliant with post-op recommendations???
This is only a tool....(*sorry can't say that enough!)....
a. Need to exercise daily for health/wt loss and help with excess skin
b. Need to supplement with B12, multivitamin, folate, Iron, Zinc, Calcium citrate, protein shakes possibly give or take things.
c. Need for LIFELONG FOLLOW UP!!!!
- Know that extended release medications may not be as effective or absorbed well (**esp. birth control pills in woman of childbearing age use alternative form of BC)
I could probably ramble on all day about this..I hope some of this helps you! Any specific ? email us or me offline! Take care and good luck it is an awesome journey!! *not perfect and a positive attitude helps!
DO this for you and only you!!!!Start journaling now www.obesityhelp.com is a great site, start your own profile there! Also if you haven’t seen this document (pouch rules) print and read! A good basic guide to things that will help you use the tool and be successful as possible (*for most of us!!!)
http://www.digitalhorsewoman.com/pouchrules.htm
