Protein, Bromelain, Quercetin, Arnica Montana, etc. etc. etc.

Me, again. 

So I bought everything many of you suggested and stuff I read on the internet in prep for surgery July 30.  27 days, OMG.  ANYWAY... here is my list, I would love your dosages and your feedback as far as what worked for you and what you had trouble with.  My kitchen counter rather resembles a pharmacy at the moment! I am planning 100g of protein daily, 1 month before through 1 month after surgery... have others advised you to consume more?

Quercetin

Bromelain

Arnica Montana

Zinc

Glutamine

B-complex

C

(Along with usual D3, iron, multi, calcium)

Best of luck with your surgery!!!

I was advised 120-140g protein

For the arnica montana, zinc, C, B, multi, calcium I took as indicated on the bottle.

I stopped iron for a short period of time after surgery because I had severe problems with constipation. I did this w/o consulting my surgeon - So I want you to be aware of that. 

I take twice the dosage of D3... one pill twice a day.

I took twice the amount of glutamine after surgery as indicated on the bottle.

I did not take Quercetin or Bromelain.

I hope this is helpful.

Thanks!

I take gentle iron, never had any trouble with constipation (from that, lol).

What did you eat to get in so much protein in a day?  I can still only eat about 1/3 cup of food at a time, I guess I will be doing a lot of protein drinking

Yes, that is what I did. Lots of protein powders. I have just about depleted my 3rd large canister already. Initially I had a problem with phlegm after surgery that was triggered by certain foods, the milky protein powders being one of those trigger foods. Coughing is a NIGHTMARE. In hindsight I would have tried one of the Syntrex or Unjury powders -- figure maybe they would not be "milky."

Just a word of caution, the pain killers can be constipating. I went through HELL. 

I just found out about this Vitamedica plastic surgery pack. It sounds great and I will probably use it next time. Anyway, if you scroll down, it has the dosing instructions for the arnica Montana, etc.

http://www.makemeheal.com/mmh/product.do?id=13517

Surgical nutrition was a huge part of my general surgery, trauma, and burn patients' care. We had to order the enteral or parenteral nutrition every day based on their needs every day.  That part of my general training really helped with caring for patients whio have had any form of metabolism-altering surgery. In plastics, we rely on good healing of the body's largest organ for best results !

Vitamins

I personally like the VitaMedica program because it is "heavy" on the water-soluble B vitamins that quickly deplete during the healing process. There is also some decent science behind the AM and PM dosing based on the body's circadian rhythms.

Iron replacement makes no sense unless you test the blood for serum iron, ferritin, transferrin, and some other levels.  This deficiency can be "silent" and also very ahrd to correct short-term, especially if patients have not been keeping up with supplements. Sleeves, RNY, and lap banders can all have significant iron deficiency.  

Protein

I am always confused when patients talk about eating 100g of protein supplements, or more, per day.  A high estimate for women is 45g a day, and say we add another 50% for malabsorption after RNY and another 10% for surgery recovery.   That's about 72g of protein per day.  Taking over that amount is going to stress the kidneys with more nitrogenous waste, and if it interferes with getting the remainder of your calories in the form of fat and carbs, that is bad too. The Institute of Medicine recommends we get at least 10% and no more than 35% of our calories from protein.  

What really matters is your percentage of calories as protein, because protein is useless without the energy source from carbs and fat to use the building blocks to repair the skin after surgery.  The resistance I will get from patients is temporarily converting their eating habits from weight maintenance to surgery recovery.  The fluid and weight gain after surgery plus swelling often reinforce the fear of gaining weight, and I work hard to re-assure that these are temporary and for a month its OK to get those extra calories.

Anyway, just a few observations that I hope are helpful :-) 

This is fascinating. Thank you very much, Dr. 

Dr. L, I spend a fortune on supplements. I am wondering if you like the science behind the other Vitamedica packs for very day use for gastric bypass patients. Much of what I take is "self prescribed" and each supplement purchased separately. It would be easier if I could just buy a package of what I need. Thank you.

First, congrats on taking charge and being proactive. As you know, too many doctors are STILL just not aware of the special nutritional needs of WLS patients. I can only say my experience is with the postop recovery "AM and PM formula" Vitamedica products and their Arnica and Bromelain products. Those have been reliable and well-tolerated by patients and I use them on patients who do not already have their own program going.  Iron is my big challenge, and a prescription called Tandem (which is iron plus ascorbic acid to aid in absorption) has been very useful to get iron levels up. Happy healing !

Thanks again for your perspective. I appreciate you taking the time on your day off to respond 

BTW, having suffered through a bout of iron deficiency anemia I can attest to how difficult recovery from that can be.