What You Need to Know

I have mentioned that I'm part of a Facebook group called Windsor Weightloss Surgery Support Group. This has been a great source of knowledge, support and encouragement to me during this process. The Administrator of the group, Dawn Rudling Stefani, has a great blog and with her permission, I am posting a section here from her blog where she tells about the surgery and eating after. This should answer some questions that a lot of you have been asking me. (Thank you Dawn!)
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Short Overview of Roux en Y

Before you look into weight loss surgery, you need to know that there are many types of weight loss surgery and not just one. You need to choose your surgery CAREFULLY as they are all different. If you are over 300 lbs there are options that allow you to lose more weight than others. Please consider all the following when thinkng of weight loss surgery: Lapband, Roux En Y, Duodenal Switch, Mini Gastric Bypass, Vertical Sleeve Gastrectomy etc. Begin your research at obesityhelp.com.

I had RNY. Roux en Y is the standard bariatric surgery that you will hear the most information about. Most people choose this surgery than any other bariatric surgery. It works by being both restrictive and malabsorptive. Restriction means that you eat less - the size or portion is much smaller than the typical stomach. Malabsorption means that the foods you eat will not all be processed and some nutrients and calories basically will go "through you". That's why you have to take vitamins for the rest of your life if you go through theis surgery as food will be processed differently. The degree of malabsorption is higher at the beginning of surgery, which means eventually the malabsorption won't be as strong as it once was.

Typically as a roux en y patient for the rest of your life you will be taking 2 multivitamins a day, a b-12 strip or shot, and calcium. Some doctors also suggest iron but mine only said to take it if my bloodwork revealed that I needed it. Many doctors suggest flintstones or similar vitamins at first because they are easy for post ops to tolerate. Do yourself a favour and PLEASE eventaully move on to adult vitamins - you are not a child and should not be supplementing like one. Deficiencies can come on in a hurry and please supplement b-12! Get your thiamine levels checked at a year out and get a bone mass density test at a year out or more.

You can go to obesityhelp.com for information on the surgery itself and diagrams of it. I'm not going to get too technical here.

Once you have the surgery, you will be able to eat only small portions (for a while anyway.....). The great thing is that although you may only eat two tablespoons initially, you will feel as if you have eaten a whole meal and satisfied or full. It's wonderful to feel so full on so little. So you will physically eat very little and this will cause you to lose a lot of weight very quickly. As well, your body will not absorb all the calories it takes in so again, it will cause weight loss. Your pouch will slowly get bigger naturally after your surgery and by a year out, you should be able to eat a cup of food and by two years, a cup and a half to two cups of food. So you do progress to a normal portion - I hate when Oprah says all we can eat is 6 grapes. Now at 3.5 years out I could easily eat 5 big macs in a day if I wanted too. Not all at the same sitting but I COULD physically eat it. That's why you hear of people that fail with this surgery - YOU CAN FAIL. You have to make better choices. Eventually you will be able to eat like everyone else. If you go back to making the bad decisions you did before surgery, you can go back to the way you were. That's why you need to establish good habits like eating different, eliminating junkfood as much as possible, exercising regularly and becoming an active you! Therapy is also recommended for most to find new coping mechanisms rather than eating to deal with emotional issues, stress and boredom.

Roux en Y has a side effect called DUMPING. Typically it does not involve the toilet although it can. DUMPING is a reaction after eating things that are either too fatty or too sugary. Usually you feel your heart racing, sweaty, nausea, cramps etc. It is a side effect that it is unpleasant but that tends to help people make good choices about what to eat. After you have surgery, you CAN make bad choices and outeat the surgery - but dumping helps to keep most people on the straight and narrow after surgery. You will learn to read a label properly in order to know if a food will possibly cause a reaction and you'll avoid junkfoods for this reason. A word of note: about 40% of patients do not dump and usually after a year or two, this reaction totally goes away. Please note that you can avoid dumpng. - that's why we read nutritional labels and watch sugar/fat content. That processed stuff is bad for you anyways and is avoided after surgery as much as you can. If you read labels chances are that you won't dump.

Although you will lose weight through surgery alone, it is recommended that you start to exercise once coming out of surgery. Typically if you let the surgery do all the work you will not get to goal. If you set up exercise as part of your lifestyle after surgery, you will develop successful habits that will help you through your maintenance phase. Typically the last 20 lbs of weight loss are worked off at the gym. At about 18 months out of surgery, your weight loss from the surgery stops. The first year to year and a half are your "window of opportunity" where the weight will come off easily and fast - that is your time to work the surgery the most! As you get more naturally mobile, exercise will not be as big of a struggle and you might find that you actually enjoy challenging your body physically.

With surgery, you could lose between 75 and hundreds of pounds on your own. Add exercise and you are talking much more. The heavier you are, the greater the loss. I have a chart down on my page entitled REALISTIC EXPECTATIONS that will give you an idea of what to expect as your loss goes.

Warning though - if you don't follow the rules and make the most of what you've got with the Window of Opportunity the first 12 to 18 months, you may never get to a healthy goal, body weight or get the results that you desire. A huge part of this surgery is about making healthy choices and creating a new lifestyle - especially in the first year as after a few years, it becomes SIGNIFICANTLY harder to lose weight. You need to absolutely make the most of your first year. I cannot emphasize this enough!

Eating After Surgery

Because your new stomach is inflamed, readjusted and tender, there is an eating plan that you must do after surgery. All surgeons tend to be a little different, but most plans somewhat are the same and this is what you can typically progress to.

You will typically start with fluids for 2-3 weeks. That means liquids that usually include broth, cream soups, protein shakes, crystal light, water,no sugar added puddings, jello and popsicles. It will not be hard typically to do liquids because your pouch is so tender and swollen that you are pretty much not feeling physical hunger. (You might feel head hunger which is the "oh that looks good!" but typically you don't feel real hunger).

The primary goal at this time is to let your stomach heal. To do so, you will need to make sure that you cget a certain amount of protein in each day. Your surgeon will give you a protein goal for the rest of your life and it is the most important thing. For the rest of your life you will eat proteins first in your meal (meats, cheeses, that sort of thing). Carbs and veggies will be secondary. At this stage, two good protein shakes should get you at goal or close to goal each day. My goal was 62 grams of protein. My shakes were about 30 grams each. Do not settle for a shake with 15 grams! Get a good shake!

After the 3 weeks of liquids which isn't as hard as it sounds, you will move on to purees which are foods that are ground up so that you will tolerate them well or at least, well chewed. For instance, i had egg beaters for breakfast and didn't actually puree them, but ate them very well. The opening from your stomach to your intestines (called your stoma) is small at this stage, so you need to make sure that whatever you eat is VERY WELL chewed so it fits through the stoma opening...or it will come back up!

After a week of purées, then you move to soft foods for a week and then regular foods - this is where you will slowly incorporate more and more foods into your diet and get to eat like a normal person albeit in smaller portions.

This phase of moving from liquids to mush to regular foods is important - it reminds your new stomach about foods by presenting food in a format it can manage. It slowly reintroduces food back into your system. I recommend not cheating at this time. People that cheat and eat something they aren't supposed to find that they typically will end up barfing more than they should.

Other side effects of roux en y that you may/may not have:

-vomiting if something doesn't agree with you

-eating different foods - some people find that after surgery they are no longer tolerant of certain foods. Some people find they become lactose intolerant or can never eat beef again or pasta or whatever because certain foods don't feel right or make them ill. Its' very individual. Some people also vomit if they eat too much of something.

-foamies - foamies are a warning that you are going to throw up if a food is stuck and not passing through the stoma. You'll develop kind of a foam in your throat and it will tell you to get to the bathroom quick.

I was an exception to all the rules. I have never had any of the unpleaseant side effects of surgery and have never vomitted in 2 1/2years.

AN IMPORTANT FACT ABOUT WEIGHT LOSS SURGERY:

It is virtually impossible your first year to screw up surgery. Even if you "cheat" the surgery and eat things you should not, you will lose weight. This surgery allows you to lose a lot of weight the first year regardless of how you "use or abuse it". The key is this: if you continue to eat unhealthy and stay on the couch, you will gain MOST OR ALL of your weight back. PLAIN AND SIMPLE. You will totally hear stories of those who completely fail this surgery out of choice. Let that scare you to make your first year the YEAR ABOUT LOSING AS MUCH AS YOU CAN. Work your surgery if you want to get to goal. After the first two years, the weight loss will stop considerably and you may even start to gain weight. A weight gain of 15% is average after your first two years. It can be more if you don't follow rules. For every person who has this surgery and does well there is someone who doesn't because they choose not to make the change. Make the change for you!