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When worrying about what vitamins we need lets try to nix the doc and nut for a moment and logically think about why we need supplimentation. Keep in mind the 2 main reasons we post op RNY peeps NEED vitamins, malabsorbtion and malnutrition, when contemplating whether today will be a compliant day or not.

1. Malabsorbtion - different parts of the intestines have been removed or bypassed so whatever their job was in the food digestion process, is now unfilled. Over time other parts of the digestive tract may compensate in calorie absorbtion but not neccessarily in nutritional needs so vitamins are for LIFE. Even if you are 10 years out, have regained 100% of your weight (or more) you still NEED vitamins. What's worse than being obese after RNY surgery? Being obese with malnutrition issues. Try explaining that one to your friends and family!

2. Malnutrition - A normal adults tummy holds 32 ounces pre meal and much more post. Many of us actually held a lot more than that. The day of surgery our stomachs became 1 ounce (give or take depending on surgeon) So if we hold 1/32 of our original volume its pretty obvious we are missing out on the amount of food it tales each day to get adequate nutrition.

Keeping these two things in mind look at what your doctor prescribed you for post op supplimentation. Does it already look meager and insignificant? Well it probably is. In my experience on this board most people arent given a good education on why, when, how or what vitamins are important. I wasnt overly impressed with my own docs regiment after doing my research but I see a year later he has revamped his online lists so maybe yours is too :)

So what am I taking?

Iron - Ferrous Gluconate is the best iron I have found for us. It is 100% absorbed in intestines we have not had altered. This iron is best taken on an empty stomach so I take mine first thing in the morning. For coffee drinkers this is no good since caffiene interferes with iron absorbtion. Caffiene and iron should not be taken within 2 hours of each other. Iron and other minerals have a tendancy to fight for absorbtion rights and can cancel each other out. So avoid calcium suppliments within 2 hours or your iron as well. Vitamin C increases iron absorbtion so a vit c and iron combo is preferable :)

Calcium - we do not absorb much of calcium carbonate, the most popular calcium suppliment available. Some places Ive read we absorb none to 40% of this calcium which even at peak conditions is not enough. Calcium citrate is absorbed without the aid of stomach acids and is what RNY patients should be taking. Daily FDA recomendation is 1400 units a day. Vitamin D and dairy products should be taken with calcium for optimal absorbtion.

Vitamin D - I have not thouroughly read up on this but it would appear we ONLY absorb dry vitamin D (dry doesnt mean what you think it does here) and the vit D in the citrical many of us take isnt dry D :( Im still looking into this, I will let ya know ;)

B's are water soluable and can be taken with your daily vitamin or minerals :)

B12 - time release and pill form are not good for us. Go for sublingual or shots on this :)

B1 - I get pill form (looking for sublingual)

Bcomplex - I have discovered the 100's are huge so when my bottle is gone Im going back to 50's and doubling up :P

Daily vitamin - children's vitamins are for children and very new post ops. Once you are healed get the chewable centrum silver or a similar high quality vitamin brand.

Extra supplimentation: Many protien bars and shakes have extra vitamins in them.. The right tasting protein bar can be your sweet tooth lover, protein suppliment and vitamin backup. Docs/nuts who recomend NOT taking protein bars post op can be sent to me so I can kick their ass for you ;) Its NOT always about them Hmmmph!

"They" say 64 ounces a day BUT who are they and how do they know how much fluid YOU need?? They dont but you do. If you feel yuck, thirsty, tummy grumbles, weak, constipated, have flakey skin etc You need more fluids regardless of magic numbers. You likely have a larger body than average, more body = more water. Humans are like 95% water. If you weigh 100 pounds more than average people thats 95 pounds of water which is ummm... Its too late for me to do the math, but its a lot of water ;)

I am 147 pounds, I do ZERO activity and I drink 120 - 150 ounces of water a day to feel hydrated. Some of that is due to medications I take and some do to massive horrific constipation I had forever post op that I am trying to keep from ever coming back :P At my size and activity level 64 ounces should be enough. I cough dust at 100 ounces so 64 isnt even imaginable anymore.

Just learn your bodys cues for hydration and go with it. If you are drinking all day you should be good :) As time goes by you will be drinking more and more easily :)

I count all fluids as fluids. I cant swallow water it feels like Im swallowing a rock. It is the weirdest thing. So I dont actually drink water ever. Crystal light and other drinks are my life line :)

MY MAN IS BETTR'N YOURS!!!!

When my pookey and I met almost 14 years ago I was 145 pounds, 19 and everything men (usually) want in a woman, physically and mentally. Things went very down hill after this! 

He never once even hinted or pretended to be upset about the breast reduction I had 18 months later. I had 10 pounds removed from my breasts. The lady who shared the room with me was NOT so lucky. Her husband cried over the lost boobie luvin. I mean really he wasnt supportive or caring to her post operation needs at all, bawling over her breasts!! I know MOST men are sooo NOT that shallow BUT Im very happy mine is one of the most on this occaision.

I told pookey I was insane when we met and that anyone who loves me is loving me through a lot of crazy over the years. He promissed he would never leave me and would always take care of me no matter how bad or good I got. He has had MANY opportunities to get fed up with me but he has never gone back on his word.

Over the years I gained and lost weight. All together it was hundreds of pounds. I lost it through starting every diet I came across and gained it by giving up every diet I came across. When I was high on a new diet aid, book, pill he would support me without making me feel stupid or reminding me of all of my failed attempts. When I quit the gimick of the week/month/year he acted like it never happened. Even getting the money for this operation. He had evey confidence in me that it wasnt a waste of money (unlike my parents) and didnt hesitate to support me through these trials since.

Pookey never gets mad at me. We bicker or squabble regularly enough but we never fight. We talk through everything even if the resolution is to agree to disagree. 

Pookey will drop EVERYTHING to help me when I need him. He has had to take care of my physical illnesses and left work/meetings on several occaisions to come home and nurse me, get me pills, help me through a sugar incident even to give me an enema... Thats love ;)

On top of all of this Pookey does the bills, grocery shopping, helps with all chores and even does them all when Im too ill. He brushes my hair for hours, gives me pedicures, buys me presents and dotes on me like a new lover. 

Everyday with my Pookey is a GOOD day!

Bcomplex has 
B1
B2
B3
B6
B12
biotin
folic acid
pantothenic acid

Most vitamins dont work alone they work in conjunction with other vitamins, usually as they are found in their natural food form, in our bodies.

The B complex is a balance of the vitamins that work as a team called the B TEAM baby ;) No its not but its funny :P 

We malabsorb a LOT more than what our docs lead us to believe :( B1 B6 and B9 deficiencies are dead common post op as well as B12. Some docs are catching up on this and some arent...

They all do pretty much the same things in the body though:

B-complex supplements are promoted to build red blood cells, for healthy blood vessels and nervous system, and to maintain body metabolism. Most B-complex supplements contain vitamins B1, B2, B3, B6, and B12. Some also contain the B vitamin folic acid. B vitamins are important for the breakdown of foods and nutrients to yield energy. Vitamin B1 (thiamin) is key for changing carbohydrates into energy and helping the body produce proteins. Vitamins B2 (riboflavin), B3 (niacin), B6 (pyridoxine) are important to fuel reactions in our cells. Folic acid and vitamin B12 are essential for making red blood cells. Niacin can be used to help lower high cholesterol and fat levels in the blood.

It's important that women of childbearing age take folic acid daily to prevent birth defects in the event they become pregnant. B-complex vitamins aren't recommended for this purpose since many products also contain high levels of vitamin B3, which can be toxic to the developing baby. Regular multiple vitamins and prenatal vitamins are a better source of folic acid.

There is some evidence that vitamins B6, B12, and folic acid can help prevent heart attack and stroke by lowering the amount of homocysteine in the body. Homocysteine is an amino acid that can build up and clog blood vessels. People with high levels of homocysteine may benefit from a daily B-complex supplement that contains B6, B12, and folic acid. People with stressful, high-energy lifestyles who don't eat well-balanced meals may also benefit from a B-complex vitamin. Others who may benefit are people who are recovering from surgery, suffering from serious medical conditions, or participating in strenuous workout programs. Ask your doctor if a B-complex vitamin is right for you. 

ALSO:

Vitamin B complex comprises a number of vitamins that exist as a family. They should not be taken individually. In this modern era, millions of people suffer from a deficiency of vitamin B for several reasons, chief among which are:

• Stress: emotional, physical and spiritual
  
  
• Processed foods in the diet: these are not real foods and so they tax the body
  
  
• Refined sugar. The average person consumes at least 140 pounds of sugar a year which robs the body of its vitamin B stores
  
  
• Drugs: both recreational and prescription drugs deplete vitamin B
  
  
• Toxins: poisons in the environment and personal care products deplete vitamin B complex
  
  
• Malnutrition. Most people are malnourished because they are not eating the right kinds of foods
  
  
• Cooking. Most people do not eat enough real, raw foods, so vitamin B is killed or so depleted that people are not getting enough of it in the diet

DO YOU HAVE ANY OF THESE SYMPTOMS?

Once your body has been deprived of the vitamin B complex due to reasons stated above, it begins to show symptoms (signs) of altered, diminished or poor health. This is because the vitamin B complex (within foods, not vitamin pills) is responsible for such a wide variety of activities, including cellular differentiation, transmission of nerve electricity, health of nerve cells, heart pulse rate, muscular contraction, digestion, brain function, thought processes and energy production. Without adequate vitamin B complex from foods, you can experience one or more of any one of these symptoms:

• mental problems
• heart palpitations
• heart arrythmias
• fibrillation
• indigestion
• chronic fatigue
• chronic exhaustion
• paranoia, vague fears, fear that something dreadful is about to happen
• nervousness
• ADD (attention deficiency), inability to concentrate, irritability
• feeling of uneasiness
• thoughts of dying
• easy agitation, frustration
• inability to sleep (insomnia)
• restlessness
• tingling in hands
• tingling fingers and toes
• rashes
• crying spells, inability to cope
• soreness all over
• and so much more.

CHRONIC VITAMIN B DEFICIENCY

Vitamin B deficiency can sneak up on you, because it doesn’t have to create serious health problems right away. In fact, medical researchers have discovered that very often there can be no detectable signs according to scientific instrumentation, that you are experiencing a deficiency. For example, “memory impairment due to vitamin B12 deficiency can precede blood symptoms of deficiency by years. Evidence that vitamin B12 deficiency accounts for some cognition deficits in older people comes from a study that revealed abnormal short-term memory in more than two-thirds of clients with pernicious anemia…The researchers recommend that a diagnosis of senile dementia should not be made, even in the absence of anemia, until vitamin B12 status is determined biochemically.” (Hamilton, p. 476) This means that it is possible that certain mental disorders can be directly attributable to vitamin B complex deficiency, and it is easier to first start replenishing stores of vitamin B complex than to begin treating difficult mental illnesses with drugs, therapy or psychological counseling.

When vitamin B deficiency becomes chronic (long-lasting), other problems can occur, including troubles with your adrenal system. The adrenal glands serve many purposes, but in relation to this topic, they are the back up system for making energy. When there is a chronic lack of vitamin B complex then the adrenal glands are called upon to produce quick energy by injecting certain hormones like adrenaline into your system so that you can cope with life. If this goes on for a long time, then the adrenal glands become impaired or worn out, leading to even more health problems.

I gotta say, being loved/hated just because Im "PK" has gotten old. You want to know why so many people like/hate me? Its no great secret, anyone can do it really. Its cause Im here. Its not because Im special, beautiful, ugly, friendly, mean, whitty, boring, bitchy, deserving, undeserving... Im here. Im here when the DSers want to fight, Im here when your bored and lonely, Im here when your cat died, Im here when you think about eating that piece of cake in the fridge your hubby brought home from work, Im here when you need someone to hate, Im here when you need someone to love, quite simply Im here through it all.

I didnt strut into this forum and take it by storm. Many and most of you have come after me. Most of the people who were here when I started posting have moved on. If you look at my "recent posts" under my avie you will see I am a prolific poster with almost 4000 posts on this forum in less than one year. These have been funny posts, informative posts, stupid posts, congratulatory posts, egotistical posts, insane moody posts, drama queen posts, and micsilanious posts of every kind. PMs??? OMG I have no idea how many emails I have gotten from people seeking advice, I even try to answer them all, though I admit I do miss a few, sorry if it was *yours*.

BUT why am I here? Im here for many reasons. Im lonely. Im alone. Im scared. Im weird. Im bored. Im insane. I have no where else to go to share with people like me. We people of a new species called RNY. No one else gets us. I dont particularly like hanging with the bandsters/DSers etc cause often we have extremely different philosophies in life. Sometimes an atheist and a theist can be best friends but most of the time its like water and oil. Its easier to just let it all hang out here than pretend to be like everyone else in the world by leaving.

Someday I will move on and someone else with no life will fill my spot around here... this is the way of online communities. There are a few things I will be taking with me when I go that I didnt have when I came. 1. knowledge! reading your questions often gets me to resurching more cause if I dont have the answer Im curious to know it now. 2. friends! Call it a clique if you want but I have made REAL friends here. These people I will talk to on the phone, on cam, on messenger and in real life. These friends I will be keeping for life.

RNY surgery has A LOT of issues, in some ways more than other surgeries. We need a forum to learn, confess, purge, journal, and be friends in. IF you want to get friends, be a friend. It has always worked for me :)

There are several things KEY in appetite control.

HIGH protein diets are more hunger satisfying, this is why atkins, protein power, south beach diets tend to work. People eat less when they are satiated early. So if my daily protein count is 80 - 100 ish I can tell the difference in my "munchie" feelings. If its 60 - 70 like my NUT recommended Im much much more hungry.

People need a pause point to stop mindless eating. MOST people will overeat if given a large portion size versus people who arent. Example person 1 is given a plate of cookies, person 2 is given the same number of cookies all individually wrapped. Both are told eat as many as they want. Person 1 will eat more almost every time because person 2 has to stop and think about having another cookie by the barrier of the wrappers. THIS is why measuring your food out and taking it away from the source to eat it is essential. Even with a small pouch we can overeat at every meal beyond the point of satiation if we just eat out of the bag, over the sink or dump food on our plates expecting to finish when we want. This is why I portion ALL of my snack type foods out at once and seal them in zippies. NO eating out of the box.

I eat when Im hungry. There is no but to this.. I simply eat when Im hungry even if I ate an hour ago. 

Some foods make us feel hungrier more often. Trigger foods can be anything. Salt, refined flour and sugar are the leading ones. IF you eat these at every meal you will be hungry feeling more often. I limit trigger type foods to once a day and eat them all together. Like I might have 50grams cashews, 30 grams crackers, and 30 grams of cheese as a night time meal while watching tv. No its not a snack, it LOOKS like one. BUT its a meal. This is 530 calories, 8 fiber, 20 protein. It satisfies my munchies without making me feel munchie...

My answer is more than likely yes, but it can/does lead to weight regain if you arent mentally prepared for it.

Pre op I would JUST eat. I ate whatever I wanted, good, bad and tasteless. I cant even begin to imagine all of the foods I ate without tasting or even liking. I ate things because I should, because it was there and just because. 

Part of my post op relearning how to eat is learning how to think about what I eat. When I try a food I take a very small taste, if it doesnt delight my tastebuds I spit it out ad give the rest to hubby or the trash. This is one of the hardest but most valuable things I have learned to do for myself.

I had sweets and comfort foods this Christmas some were good and didnt do a thing to me and others were good and made me very ill. All in all it was a good Christmas with yummy food but even better was the ability to enjoy Christmas as a thin person :)

Its true, NOTHING tastes as good as thin feels :)

Well over all it has been a GREAT year for me :) I like to journal to help me remember the things I shouldnt forget so here's my year in summary:

January was a terrible month for me, I was so depressed I barely got out of bed, yay for weight loss hormones!

February high light was the begining of my wonderful friendship with Melissa F :) I also started leaving the house again at this time. I began house shopping too :)

March high light was my 6 month surgiversary and 100 pounds LOST!!! Also we bought our first house :)

April was a topsy turvey month, moved into our new home on the 13th and have been VERY happy here :) The month went downhill on the 26th when my mom had a heart attack and spent the rest of the month on a ventilator without good chances of survival.

May was a tough month I stayed with my mom in the hospital for another week and then took her home to care for her as she detoxed from morphine, cigarette, food and other drug addictions. Strangely during this extremely stressful time I had an 18 pound weight loss month. My first real acceptance that RNY is my saviour. My natural unchopped up self would have gained a minimum of 10 pounds binging on food but the new me found new outlets to relieve my stress. One of which is you guys :)

June had 2 weeks at moms and then I came back home to get reaquainted with my new house! 

July was a great time with my sister, niece and nephew visiting me and then my nephew and I going to Montreal and Gatineau to visit with sis, niece and inlaws :)

August was a restful do nothing month, much of which spent with nephew, shopping and hanging out before the new school year. I did go to my first "party" since wls and since becoming a shut in :) Jenny R and I made up this month so that was pretty sweet (thank you DSers) :)

September was my 1 year surgiversary where I recieved a dozen cards via mail and over 100 ecards from my beautiful OH family :) I made goal of 170 pounds this month too!

October was HALLOWEEN :) I had MUCH fun decorating and dressing up all month long :) This was definately my best Halloween since I was a teen! My big highlight was buying, fitting in and wearing an off the rack costume!

November was spend crafting and making all of my own Christmas tree decorations. 

December I shopped!!!! Like seriously I shopped a lot! heheh I made it through all of the Christmas cookies, celebrations and snow without gaining any weight. I have to say that's pretty awesome. I admit I ate MUCH food that is not in my regular diet and could have gained a few pounds which would likely come off once back to my normal routine, something to expect next year maybe but for this one Im good :)

I lead a quiet, boring little life. Im too content for words at this point. 2007 I owe to WLS because it is a year that wouldnt have existed for me without it. My life as an obese person was over in 2006 with or without losing weight. I am eternially greatful for this gift I have been given (even though I paid 20K for it so technically its not a gift) I have already got more than I had ever dreamed possible from it :)

Now onward to 2008!!! The year of meeting my OH WLS friends, as many as I can whenever I can :)

http://www.obesityhelp.com/member/339427/
Last Edit: 12/31/07 10:38 am
Topic: RE: Surgery Flame Wars: Why are we here to sell surgery?

I fully agree that each procedure approaches the issue a different way, and depending on a person's circumstances, health issues, emotional issues, etc, one of the procedures may clearly be better suited for them than any of the others.  Also, in the interests of full disclosure, I made an expedient decision and chose what I felt was the best procedure of those my insurance company did not consider experimental.  My reason for doing so was a 'one in the hand, two in the bush' thing...  I felt the best tool for me was the one I could start using right away, and a Ford Taurus may not equal a Mercedes or Lexus, but it sure beats walking.  That being said, here are some things to consider regarding the changing of insurance company policy regarding what procedures are covered.

Increasing the popularity of a procedure is not likely to get it approved by an insurance company.  More than popularity of a procedure, more than cost of a procedure, approval or lack thereof is driven by not putting the insurance company in a position of being sued.  The major part of that is an AUTHORATATIVE reference source to point to should they pay for a type of procedure, someone have adverse health consequences, and they be sued for responsibility of the results (and yes, that happens regularly) because they "should have known better" than to approve that procedure.

The addition of lap banding to the list of commonly approved procedures is a perfect example.  Insurance companies all added that when Medicare initiated being willing to cover that procedure.  That enabled insurance companies to point to a governmental authority should such litigation arise, and say the NIH (national institute of health) is a higher authority than we are, so we just followed their lead.

The CIGNA "Coverage Position" (their written policy of guidelines for approval) is a classic example of this.  You can see it at this link - http://www.cigna.com/customer_care/healthcare_professional/c overage_positions/medical/mm_0051_coveragepositioncriteria_b ariatric_surgery.pdf.  PPages 3 through 13 of 28 reference the NIH definitions and guidelines issued by the NHLBI.
That is followed by references to reviews and studies on bariatric surgeries by California Technology Assessment Forum (CTAF), The Cochrane Review, National Institute for Clinical Excellence (NICE), Blue Cross Blue Shield Technology Evaluation Center (TEC), Buchwald and collegues, The Australian Safety and Efficacy Register of New Interventional Procedures - Surgical Review Group, 2003, US Government - Dept of Health and Human Services' Agency for Healthcare Research and Quality (AHRQ) Evidence Report, The Centers for Medicare and Medicaid Services, and O'Brian and collegues.

Your assumption that "By our efforts to make these procedures known, we are raising the popularity of the procedure to a common knowledge status and getting the insurance companies to realize the benefits of adding these other procedures to their approved list, thus paving the way for people in the future to get something that will work best for them without putting up the same fight that some people out here have had to do."  will have any bearing on insurance company decisions when weighed against such peer reviewed medical studies, often by governmental agencies is, though clearly well intentioned and enthusiastic, naive at best.

When you couple that with the litigation consideration that unless someone has unique MEDICAL circumstances that preclude the approved procedures, warranting an exception to policy as a medical necessity, an insurance company is not going to make an exception for an insured driven by the insured's desire for a non-approved procedure because to do so would make them liable to being sued by every person who wanted that procedure and an exception wal not also made for them.

To hold out the hope that if you just "fight the bastards" you can prevail will delay the possession and utilization of a WLS tool for years in some folks cases, and with the health issues of morbid obesity, there are going to be those that choose that fight, delaying their having any tool for years, who will die of a heart attack prior to that eception's approval occurring.

If even one person dies because of that, it is too many. Though I willl always defend your perrogative to say anything you want about any procedure, good or bad, I do not agree that to do so is benefitting those you seek to inform, because your perspective ignores the possibility that you could be causing someone to delay having a tool for years and therefore increasing the possibility of a life changing or life ending adverse health impact as a consequence of that delay.

By Shari S
 think we focus entirely too much on the weight loss, you know? 

It reminds me of the girls I new when I was younger who spent years planning their weddings, but gave no thought to how to conduct a marriage.

Weight loss after surgery is a no-brainer. Frankly, it'd probably happen whether you are vigilant and compliant or not. I like to do the best I can, but even at half power I'd probably have pretty good results.

I'm spending all of my psychic agitation these days on my marriage, not worrying about my honeymoon.

You?