Guest guest Posted July 9, 2003 Report Share Posted July 9, 2003 Kristi - don't know about weight loss, since I am 5 days out. But I am praying for you. I have heard that the loss of a child is the single most traumatic event anyone can suffer. I have 4 and they are the world to me. Love, J Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 9, 2003 Report Share Posted July 9, 2003 I agree. Watch your water intake and your protein intake. Also exercize more. I have been at a stand still. I was also told no exercize as I hurt my back and had to give it arest. I even started to regain a few pounds but now have been given the O.K. to exercize again and now I have seen the scale move back down for the first time in almost 3 months.4 more pounds and I will be back down to my lowest and I am not stopping there. I have about 35-50 more pounds to lose. You are in our prayers with the loss of your daughter but remember she is still watching over you and would still want you to succeed with your weight. Don't give it to the food and we are always here for you. email me anytime. I only had surgery about 10 days before you. Please if you just need to chat please email me. Tammy from MI almost 10 months post-op 137 pounds gone 317/180/??? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 9, 2003 Report Share Posted July 9, 2003 ((kristi)) check your email for my reply. lori h. > > Hi! My name is Kristi. I live in MN. I had gastric bypass (lap) on > September 26, 2002. Never in my life had I been so nervous and excited > about anything. > > In 1999 I had thyroid cancer and gained a ton of weight, which I could NOT > afford to gain in the first place. I tried to lose it but you know how > that goes. Being the mother of 4 children and NEVER being comfortable to go > ANYWHERE with them, I decided I needed to do something. Just once I would > like to take these awesome kids to the beach and actually swim with them. > (of course that was only the beginning) Being overweight was running my > life. I HATED it. > > My surgery went well. Of course I was selective about telling people. I > figured I'd make the decision whether or not to tell as the time came. My > oldest daughter (15) was so very supportive of and excited for me. Well the > first week I lost 12 pounds. Needless to say that was encouraging. The > weeks went along with daily weight loss...until October 26th. Exactly a > month to the day of my surgery. > > On that horrible day, my 15 year old daughter was killed in a car accident. > My world could have easily ended right then and there. No longer did the > surgery matter....why would it. She was a big part of the reason I wanted > to have it. Anyways, due to depression, I quit eating. My weight loss > slowed tremendously. ly, I didn't even care. As the months passed, I > started to eat more and the pounds started coming off again. Physically I > was feeling better than I had in years. > > Now for the reason I need help... Again my weight loss has STOPPED. As a > matter of fact, I have gained. I am scared to death. I have noticed an > increase in my appetite, I have also noticed that I can eat more food, and > that I am hungry sooner between meals than I have been in the past. I wake > in the middle of the night feeling like I am starving to death. I eat > animal crackers or dry granola by the handful when this happens. And I am > not just waking one time in the night, I am doing this all night long. Some > nights I see every hour. > > I am not sure what to do. Its hard to know if this is depression or if I > have failed my surgery or what. I do know that I have VERY bloated > stomachaches almost daily, and I feel extremely gassy (is that a word?!) I > am almost afraid to go to the DR. I do however have an app. scheduled for > the end of the month. > > Does anything I have told you sound familiar? Anyone?? Will I be my big > fat self again before long? I have only lost 70 lbs since my surgery almost > 10 months ago. I still have about 38 lbs to go according to the " ideal > weight " chart. > > My heart is so heavy. > > Please help if you can. > > Thank you so much. > > ~Kristi > > _________________________________________________________________ > Add photos to your e-mail with MSN 8. Get 2 months FREE*. > http://join.msn.com/?page=features/featuredemail Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 9, 2003 Report Share Posted July 9, 2003 Hi Kristi, First and foremost, I am so so sorry that you had to experience the loss of your daughter. I can only imagine the pain your must have felt and still feel. One thing that perhaps you could start out doing to keep down the hunger is watch your carb intake. Granola and animal crackers are VERY high in carbs, and by cutting these out, you will be doing yourself a big favor in terms of keeping the cravings and hunger at bay. If you are so hungry in the middle of night that you feel you HAVE to eat, try drinking water instead. And if after 1/2 hour you are still hungry, then try a piece of string cheese instead. You might find that this is a good start Wishing you only the best and keeping you in my thoughts, Caroline Lap RNY 5/2/03 367/312/150 www.tinyurl.com/bkld > > Hi! My name is Kristi. I live in MN. I had gastric bypass (lap) on > September 26, 2002. Never in my life had I been so nervous and excited > about anything. > > In 1999 I had thyroid cancer and gained a ton of weight, which I could NOT > afford to gain in the first place. I tried to lose it but you know how > that goes. Being the mother of 4 children and NEVER being comfortable to go > ANYWHERE with them, I decided I needed to do something. Just once I would > like to take these awesome kids to the beach and actually swim with them. > (of course that was only the beginning) Being overweight was running my > life. I HATED it. > > My surgery went well. Of course I was selective about telling people. I > figured I'd make the decision whether or not to tell as the time came. My > oldest daughter (15) was so very supportive of and excited for me. Well the > first week I lost 12 pounds. Needless to say that was encouraging. The > weeks went along with daily weight loss...until October 26th. Exactly a > month to the day of my surgery. > > On that horrible day, my 15 year old daughter was killed in a car accident. > My world could have easily ended right then and there. No longer did the > surgery matter....why would it. She was a big part of the reason I wanted > to have it. Anyways, due to depression, I quit eating. My weight loss > slowed tremendously. ly, I didn't even care. As the months passed, I > started to eat more and the pounds started coming off again. Physically I > was feeling better than I had in years. > > Now for the reason I need help... Again my weight loss has STOPPED. As a > matter of fact, I have gained. I am scared to death. I have noticed an > increase in my appetite, I have also noticed that I can eat more food, and > that I am hungry sooner between meals than I have been in the past. I wake > in the middle of the night feeling like I am starving to death. I eat > animal crackers or dry granola by the handful when this happens. And I am > not just waking one time in the night, I am doing this all night long. Some > nights I see every hour. > > I am not sure what to do. Its hard to know if this is depression or if I > have failed my surgery or what. I do know that I have VERY bloated > stomachaches almost daily, and I feel extremely gassy (is that a word?!) I > am almost afraid to go to the DR. I do however have an app. scheduled for > the end of the month. > > Does anything I have told you sound familiar? Anyone?? Will I be my big > fat self again before long? I have only lost 70 lbs since my surgery almost > 10 months ago. I still have about 38 lbs to go according to the " ideal > weight " chart. > > My heart is so heavy. > > Please help if you can. > > Thank you so much. > > ~Kristi > > _________________________________________________________________ > Add photos to your e-mail with MSN 8. Get 2 months FREE*. > http://join.msn.com/?page=features/featuredemail Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 10, 2003 Report Share Posted July 10, 2003 Kristi, my heart goes out to you. I cannot begin to imagine the pain you must have gone through. You are doing the right thing by seening a dr. to make sure that everything in intact. I almost feel like, maybe it's not a bad idea to talk to a dr. about anti-depressants, but not a pill in the world is going to ease the pain of such a loss. I am attaching below, the pouch rules for dummies which I think might be of value to you, otherwise, all I can say is that I hope you have some faith or higher power and/or family that can support and help you through this time. May peace and blessings come to you and your family. ly, I think it's remarkable that you've done so well with your weight loss considering the pressure you've been under and I hope the below is of help to you. Marina (Los Angeles, CA) post-op 3/12/03 Pouch Rules for Dummies INTRODUCTION: A common misunderstanding of gastric bypass surgery is that the pouch causes weight loss because it is so small, the patient eats less. Although that is true for the first six months, that is not how it works. Some doctors have assumed that poor weight loss in some patients is because they aren't really trying to lose weight. The truth is it may be because they haven't learned how to get the " satisfied " feeling of being full to last long enough. HYPOTHESIS OF POUCH FUNCTION: We have four educated guesses as to how the pouch works: 1) Weight loss occurs by actually " slightly stretching " the pouch with food at each meal or; 2) Weight loss occurs by keeping the pouch tiny through never ever overstuffing or; 3) Weight loss occurs until the pouch gets worn out and regular eating begins or; 4) Weight loss occurs with education on the use of the pouch. PUBLISHED DATA: How does the pouch make you feel full? The nerves tell the brain the pouch is distended and that cuts off hunger with a feeling of fullness. What is the fate of the pouch? Does it enlarge? If it does, is it because the operation was bad, or the patient is overstuffing themselves, or does the pouch actually re-grow in a healing attempt to get back to normal? For ten years, I had patients eat until full with cottage cheese every three months, and report the amount of cottage cheese they were able to eat before feeling full. This gave me an idea of the size of their pouch at three month intervals. I found there was a regular growth in the amount of intake of every single pouch. The average date the pouch stopped growing was two years. After the second year, all pouches stopped growing. Most pouches ended at 6 oz., with some as large at 9-10 ozs. We then compared the weight loss of people with the known pouch size of each person, to see if the pouch size made a difference. In comparing the large pouches to the small pouches, THERE WAS NO DIFFERENCE IN PERCENTAGE OF WEIGHT LOSS AMONG THE PATIENTS. This important fact essentially shows that it is NOT the size of the pouch but how it is used that makes weight loss maintenance possible. OBSERVATIONAL BASED MEDICINE: The information here is taken from surgeon's " observations " as opposed to " blind " or " double blind " studies, but it IS based on 33 years of physician observation. Due to lack of insurance coverage for WLS, what originally seemed like a serious lack of patients to observe turned into an advantage as I was able to follow my patients closely. The following are what I found to effect how the pouch works: 1. Getting a sense of fullness is the basis of successful WLS. 2. Success requires that a small pouch is created with a small outlet. 3. Regular meals larger than 1 ½ cups will result in eventual weight gain. 4. Using the thick, hard to stretch part of the stomach in making the pouch is important. 5. By lightly stretching the pouch with each meal, the pouch sends signals to the brain that you need no more food. 6. Maintaining that feeling of fullness requires keeping the pouch stretched for a while. 7. Almost all patients always feel full 24/7 for the first months, then that feeling disappears. 8. Incredible hunger will develop if there is no food or drink for eight hours. 9. After 1 year, heavier food makes the feeling of fullness last longer. 10. By drinking water as much as possible as fast as possible ( " water loading " ), the patient will get a feeling of fullness that lasts 15-25 minutes. 11. By eating " soft foods " patients will get hungry too soon and be hungry before their next meal, which can cause snacking, thus poor weight loss or weight gain. 12. The patients that follow " the rules of the pouch " lose their extra weight and keep it off. 13. The patients that lose too much weight can maintain their weight by doing the reverse of the " rules of the pouch. " HOW DO WE INTERPRET THESE OBSERVATIONS? POUCH SIZE: By following the " rules of the pouch, " it doesn't matter what size the pouch ends up. The feeling of fullness with 1 ½ cups of food can be achieved. OUTLET SIZE: Regardless of the outlet size, liquid foods empty faster than solid foods. High calorie liquids will create weight gain. EARLY PROFOUND SATIETY: Before six months, patients must sip water constantly to get in enough water each day, which causes them to always feel full. After six months, about 2/3 of the pouch has grown larger due to the natural healing process. At this time, the patient can drink 1 cup of water at a time. OPTIMUM MATURE POUCH: The pouch works best when the outlet is not too small or too large and the pouch itself holds about 1 ½ cups at a time. IDEAL MEAL PROCESS (rules of the pouch): 1. The patient must time meals five hours apart or the patient will get too hungry in between. 2. The patient needs to eat finely cut meat and raw or slightly cooked veggies with each meal. 3. The patient must eat the entire meal in 5-15 minutes. A 30-45 minute meal will cause failure. 4. No liquids for 1 ½ hours to 2 hours after each meal. 5. After 1 ½ to 2 hours, begin sipping water and over the next three hours slowly increase water intake. 6. 3 hours after last meal, begin drinking LOTS of water/fluids. 7. 15 minutes before the next meal, drink as much as possible as fast as possible. This is called " water loading. " IF YOU HAVEN'T BEEN DRINKING OVER THE LAST FEW HOURS, THIS 'WATER LOADING' WILL NOT WORK. 8. You can water load at any time 2-3 hours before your next meal if you get hungry, which will cause a strong feeling of fullness. THE MANAGEMENT OF PATIENT TEACHING AND TRAINING: You must provide information to the patient pre-operatively regarding the fact that the pouch is only a tool: a tool is something that is used to perform a task but is useless if left on a shelf unused. Practice working with a tool makes the tool more effective. NECESSITY FOR LONG TERM FOLLOW-UP: Trying to practice the " rules of the pouch " before six to 12 months is a waste. Learning how to delay hunger if the patient is never hungry just doesn't work. The real work of learning the " rules of the pouch " begins after healing has caused hunger to return. PREVENTION OF VOMITING Vomiting should be prevented as much as possible. Right after surgery, the patient should sip out of 1 oz cups and only 1/3 of that cup at a time until the patient learns the size of his/her pouch to avoid being sick. It is extremely difficult to learn to deal with a small pouch. For the first 6 months, the patient's mouth will literally be bigger than his/her stomach, which does not exist in any living animal on earth. (WHOA) !!!!!!!!!!! In the first six weeks the patient should slowly transfer from a liquid diet to a blenderized or soft food diet only, to reduce the chance of vomiting. Vomiting will occur only after eating of solid foods begins. Rice, pasta, granola, etc., will swell in time and overload the pouch, which will cause vomiting. If the patient is having trouble with vomiting, he/she needs to get 1 oz cups and literally eat 1 oz of food at a time and wait a few minutes before eating another 1 oz of food. Stop when " comfortably satisfied, " until the patient learns the size of his/her pouch. SIX WEEKS After six weeks, the patient can move from soft foods to heavy solids. At this time, they should use three or more different types of foods at each sitting. Each bite should be no larger than the size of a pinkie fingernail bed. The patient should choose a different food with each bite to prevent the same solids from lumping together. No liquids 15 minutes before or 1 ½ hours after meals. REASSURANCE OF ADEQUATE NUTRITION By taking vitamins everyday, the patient has no reason to worry about getting enough nutrition. Focus should be on proteins and vegetables at each meal. MEAL SKIPPING Regardless of lack of hunger, patient should eat three meals a day. In the beginning, one half or more of each meal should be protein, until the patient can eat at least two oz of protein at each meal. ARTIFICIAL SWEETENERS In our study, we noticed some patients had intense hunger cravings which stopped when they eliminated artificial sweeteners from their diets. AVOIDING ABSOLUTES Rules are made to be broken. No biggie if the patient drinks with one meal -- as long as the patient knows he/she is breaking a rule and will get hungry early. Also if the patient pigs out at a party -- that's OK because before surgery, the patient would have pigged on 3000 to 5000 calories and with the pouch, the patient can only pig out on 600-1000 calories max. The patient needs to just get back to the rules and not beat him/herself up. THREE MONTHS At three months, the patient needs to become aware of the calories per gram of different foods to be aware of " the cost " of each gram. (Cheddar cheese is 16 cal/gram; peanut butter is 24 cals/gram). As soon as hunger returns between three to six months, begin water loading procedures. THREE PRINCIPLES FOR GAINING AND MAINTAINING SATIETY 1. Fill pouch full quickly at each meal. 2. Stay full by slowing the emptying of the pouch. (Eat solids. No liquids 15 minutes before and none until 1 ½ hours after the meal). A scientific test showed that a meal of egg/toast/milk had almost all emptied out of the pouch after 45 minutes. Without milk, just egg and toast, more than ½ of the meal still remained in the pouch after 1 ½ hours. 3. Protein, protein, protein. Three meals a day. No high calorie liquids. FLUID LOADING Fluid loading is drinking water/liquids as quickly as possible to fill the pouch which provides the feeling of fullness for about 15 to 25 minutes. The patient needs to gulp about 80% of his/her maximum amount of liquid in 15 to 30 SECONDS. Then just take swallows until fullness is reached. The patient will quickly learn his/her maximum tolerance, which is usually between 8-12 oz. Fluid loading works because the roux limb of the intestine swells up, contracting and backing up any future food to come into the pouch. The pouch is very sensitive to this and the feeling of fullness will last much longer than the reality of how long the pouch was actually full. Fluid load before each meal to prevent thirst after the meal as well as to create that feeling of fullness whenever suddenly hungry before meal time. POST PRANDIAL THIRST It is important that the patient be filled with water before his/her next meal as the meal will come with salt and will cause thirst afterwards. Being too thirsty, just like being too hungry will make a patient nauseous. While the pouch is still real small, it won't make sense to the patient to do this because salt intake will be low, but it is a good habit to get into because it will make all the difference once the pouch begins to regrow. URGENCY The first six months is the fastest, easiest time to lose weight. By the end of the six months, 2/3 of the regrowth of the pouch will have been done. That means that each present day, after surgery you will be satisfied with fewer calories than you will the very next day. Another way to put it is that every day that you are healing, you will be able to eat more. So exercise as much as you can during that first six months as you will never be able to lose weight as fast as you can during this time. SIX MONTHS Around this time, our patients begin to get hungry between meals. THEY NEED TO BATTLE THE EXTRA SALT INTAKE WITH DRINKING LOTS OF FLUIDS IN THE TWO TO THREE HOURS BEFORE THEIR NEXT MEAL. Their pouch needs to be well watered before they do the last gulping of water as fast as possible to fill the pouch 15 minutes before they eat. INTAKE INFORMATION SHEET AS A TEACHING TOOL I have found that having the patients fill out a quiz every time they visit reminds them of the rules of the pouch and helps to get them " back on track. " Most patients have no problems with the rules, some patients really struggle to follow them and need a lot of support to " get it, " and a small percentage never quite understand these rules, even though they are quite intelligent people. HONEYMOON SYNDROME The lack of hunger and quick weight loss patients have in the first six months sometimes leads them to think they don't need to exercise as much and can eat treats and extra calories as they still lose weight anyway. We call this the " honeymoon syndrome " and they need to be counseled that this is the only time they will lose this much weight this fast and this easy and not to waste it by losing less than they actually could. If the patient's weight loss slows in the first six months, remind them of the rules of water intake and encourage them to increase their exercise and drink more water. You can compare their weight loss to a graph showing the average drop of weight if it will help them to get back on track. EXERCISE In addition to exercise helping to increase the weight loss, it is important for the patient to understand that exercise is a natural antidepressant and will help them from falling into a depression cycle. In addition, exercise jacks up their metabolic rate during a time when their metabolism after the shock of surgery tends to want to slow down. THE IDEAL MEAL FOR WEIGHT LOSS The ideal meal is one that is made up of the following: ½ of your meal to be low fat protein, ¼ of your meal low starch vegetables and ¼ of your meal solid fruits. This type of meal will stay in your pouch a long time and is good for your health. VOLUME VS. CALORIES The gastric bypass patient needs to be aware of the length of time it takes to digest different foods and to focus on those that take up the most space and take time to digest so as to stay in the pouch the longest, don't worry about calories. This is the easiest way to " count your calories. " For example, a regular stomach person could gag down two whole sticks of butter at one sitting and be starved all day long, although they more than have enough calories for the day. But you take the same amount of calories in vegetables, and that same person simply would not be able to eat that much food at three sittings -- it would stuff them way too much. ISSUES FOR LONG TERM WEIGHT MAINTENANCE Although everything stated in this report deals with the first year after surgery, it should be a lifestyle that will benefit the gastric bypass patient for years to come, and help keep the extra weight off. COUNTER-INTUITIVENESS OF FLUID MANAGEMENT I admit that avoiding fluids at meal time and then pushing hard to drink fluids between meals is against everything normal in nature and not a natural thing to be doing. Regardless of that fact, it is the best way to stay full the longest between meals and not accidentally create a " soup " in the stomach that is easily digested. SUPPORT GROUPS It is natural for quite a few people to use the rules of the pouch and then to tire of it and stop going by the rules. Others " get it " and adhere to the rules as a way of life to avoid ever regaining extra weight. Having a support group makes all the difference to h elp those that go astray to be reminded of the importance of the rules of the pouch and to get back on track and keep that extra weight off. Support groups create a " peer pressure " to stick to the rules that the staff at the physician's office simply can't create. TEETER TOTTER EFFECT Think of a teeter totter suspended in mid air in front of you. Now on the left end is exercise that you do and the right end is the foods that you eat. The more exercise you do on the left, the less you need to worry about the amount of foods you eat on the right. In exact reverse, the more you worry about the foods you eat and keep it healthy on the right, the less exercise you need on the left. Now if you don't concern yourself with either side, the higher the teeter totter goes, which is your weight. The more you focus on one side or the other, or even both sides of the teeter totter, the lower it goes, and the less you weigh. TOO MUCH WEIGHT LOSS I have found that about 15% of the patients which exercise well and had between 100 to 150 lbs to lose, begin to lose way too much weight. I encourage them to keep up the exercise (which is great for their health) and to essentially " break the rules " of the pouch. Drink with meals so they can eat snacks between without feeling full and increase their fat content as well take a longer time to eat at meals, thus taking in more calories. A small but significant amount of gastric bypass patients actually go underweight because they have experienced (as all of our patients have experienced) the ravenous hunger after being on a diet with an out of control appetite once the diet is broken. They are afraid of eating again. They don't " get " that this situation is literally, physically different and that they can control their appetite this time by using the rules of the pouch to eliminate hunger. BARIATRIC MEDICINE A much more common problem is patients who after a year or two plateau at a level above their goal weight and don't lose as much weight as they want. Be careful that they are not given the " regular " advice given to any average overweight individual. Several small meals or skipping a meal with a liquid protein substitute is not the way to go for gastric bypass patients. They must follow the rules, fill themselves quickly with hard to digest foods, water load between, increase their exercise and the weight should come off much easier than with regular people diets. SUMMARY 1. The patient needs to understand how the new pouch physically works. 2. The patient needs to be able to evaluate their use of the tool, compare it to the ideal and see where they need to make changes. 3. Instruct your patient in all ways (through their eyes with visual aids, ears with lectures and emotions with stories and feelings) not only on how but why they need to learn to use their pouch. The goal is for the patient to become an expert on how to use the pouch. EVALUATION FOR WEIGHT LOSS FAILURE The first thing that needs to be ruled out in patients who regain their weight is how the pouch is set up. 1) the staple line needs to be intact; 2) same with the outlet and; 3) the pouch is reasonably small. 1) Use thick barium to confirm the staple line is intact. If it isn't, then the food will go into the large stomach, from there into the intestines and the patient will be hungry all the time. Check for a little ulcer at the staple line. A tiny ulcer may occur with no real opening at the line, which can be dealt with as you would any ulcer. Sometimes, though, the ulcer is there because of a break in the staple line. This will cause pain for the patient after the patient has eaten because the food rubs the little opening of the ulcer. If there is a tiny opening at the staple line, then a re-operation must be done to actually separate the pouch and the stomach completely and seal each shut. 2) If the outlet is smaller than 7-8 mil, the patient will have problems eating solid foods and will little by little begin eating only easy-to-digest foods, which we call " soft calorie syndrome. " This causes frequent hunger and grazing, which leads to weight regain. 3) To assess pouch volume, an upper GI doesn't work as it is a liquid. The cottage cheese test is useful -- eating as much cottage cheese as possible in five to 15 minutes to find out how much food the pouch will hold. It shouldn't be able to hold more than 1 ½ cups in 5 - 15 minutes of quick eating. If everything is intact then there are four problems that it may be: 1) The patient has never been taught the rules; 2) The patient is depressed; 3) The patient has a loss of peer support and eventual forgetting of rules, or 4) The patient simply refuses to follow the rules. 1) LACK OF TEACHING An excellent example is a female patient who is 62 years old. She had the operation when she was 47 years old. She had a total regain of her weight. She stated that she had not seen her surgeon after the six week follow up 15 years ago. She never knew of the rules of the pouch. She had initially lost 50 lbs and then with a commercial weight program lost another 40 lbs. After that, she yo-yoed up and down, each time gaining a little more back. She then developed a disease (with no connection to bariatric surgery) which weakened her muscles, at which time she gained all of her weight back. At the time she came to me, she was treated for her disease, which helped her to begin walking one mile per day. I checked her pouch with barium and the cottage cheese test which showed the pouch to be a small size and that there was no leakage. She was then given the rules of the pouch. She has begun an impressive and continuing weight loss, and is not focused on food as she was, and feeling the best she has felt since the first months after her operation 15 years ago. 2) DEPRESSION Depression is a strong force for stopping weight loss or causing weight gain. A small number of patients, who do well at the beginning, disappear for a while only to return having gained a lot of weight. It seems that they almost on purpose do exactly opposite of everything they have learned about their pouch: they graze during the day, drink high calorie beverages, drink with meals and stop exercising, even though they know exercise helps stop depression. A 46 year-old woman, one year out of her surgery had been doing fine when her life was turned upside down with divorce and severe teenager behavior problems. Her weight skyrocketed. Once she got her depression under control and began refocusing on the rules of the pouch, added a little exercise, the weight came off quickly. If your patient begins weight gain due to depression, get him/her into counseling quickly. Encourage your patient to refocus on the pouch rules and try to add a little exercise every day. Reassure your patient that he/she did not ruin the pouch that it is still there, waiting to be used to help with weight control. When they are ready the pouch can be used once again to lose weight without being hungry. 3) EROSION OF THE USE OF PRINCIPLES: Some patients who are compliant, who are not depressed and have intact pouches, will begin to gain weight. These patients are struggling with their weight, have usually stopped connecting with their support groups, and have begun living their " new " life surrounded by those who have not had bariatric surgery. Everything around them encourages them to live life " normal " like their new peers: they begin taking little sips with their meals, and eating quick and easy-to-eat foods. The patient will not usually call their physician's office because they KNOW what they are doing is wrong and KNOW that they just need to get back on track. Even if you offer " refresher courses " for your patients on a yearly basis, they may not attend because they KNOW what the course is going to say, they know the rules and how they are breaking them. You need to identify these patients and somehow get them back into your office or back to interacting with their support group again. Once these patients return to their support group, and keep in contact with their WLS peers, it makes it much easier to return to the rules of the pouch and get their weight under control once again. 4) TRUE NON-COMPLIANCE: The most difficult problem is a patient who is truly non-compliant. This patient usually leaves your care, complains that there is no 'connection' between your staff and themselves and that they were not given the time and attention they needed. Most of the time, it is depression underlying the non-compliance that causes this attitude. A truly non-compliant patient will usually end up with revisions and/or reversal of the surgery due to weight gain or complications. This patient is usually quite resistant to counseling. There is not a whole lot that can be done for these patients as they will find a reason to be unhappy with their situation. It is easier to identify these patients BEFORE surgery than to help them afterwards, although I really haven't figured out how to do that yet… Besides having a psychological exam done before surgery, there is no real way to find them before surgery and I usually tend toward the side of offering patients the surgery with education in hopes they can live a good and healthy life. This rewrite was done exclusively for the people of this spotlight obesity support group. It should not be sold for any reason. " Dummies " version rewritten by Sally Original article written by: Mason. EE, Personal Communication, 1980. Barber. W, Diet al, Brain Stem Response To Phasic Gastric Distention. Am J. Physiol 1983: 245(2): G242-8 Flanagan, L. Measurement of Functional Pouch Volume Following the Gastric Bypass Procedure. Ob Surg 1996; 6:38-43 Rosemurgy, A. In a message dated 7/9/2003 5:48:09 PM Pacific Standard Time, aoni4@... writes: Hi! My name is Kristi. I live in MN. I had gastric bypass (lap) on September 26, 2002. Never in my life had I been so nervous and excited about anything In 1999 I had thyroid cancer and gained a ton of weight, which I could NOT afford to gain in the first place. I tried to lose it but you know how that goes. Being the mother of 4 children and NEVER being comfortable to go ANYWHERE with them, I decided I needed to do something. Just once I would like to take these awesome kids to the beach and actually swim with them. (of course that was only the beginning) Being overweight was running my life. I HATED it. My surgery went well. Of course I was selective about telling people. I figured I'd make the decision whether or not to tell as the time came. My oldest daughter (15) was so very supportive of and excited for me. Well the first week I lost 12 pounds. Needless to say that was encouraging. The weeks went along with daily weight loss...until October 26th. Exactly a month to the day of my surgery. On that horrible day, my 15 year old daughter was killed in a car accident. My world could have easily ended right then and there. No longer did the surgery matter....why would it. She was a big part of the reason I wanted to have it. Anyways, due to depression, I quit eating. My weight loss slowed tremendously. ly, I didn't even care. As the months passed, I started to eat more and the pounds started coming off again. Physically I was feeling better than I had in years. Now for the reason I need help... Again my weight loss has STOPPED. As a matter of fact, I have gained. I am scared to death. I have noticed an increase in my appetite, I have also noticed that I can eat more food, and that I am hungry sooner between meals than I have been in the past. I wake in the middle of the night feeling like I am starving to death. I eat animal crackers or dry granola by the handful when this happens. And I am not just waking one time in the night, I am doing this all night long. Some nights I see every hour. I am not sure what to do. Its hard to know if this is depression or if I have failed my surgery or what. I do know that I have VERY bloated stomachaches almost daily, and I feel extremely gassy (is that a word?!) I am almost afraid to go to the DR. I do however have an app. scheduled for the end of the month. Does anything I have told you sound familiar? Anyone?? Will I be my big fat self again before long? I have only lost 70 lbs since my surgery almost 10 months ago. I still have about 38 lbs to go according to the " ideal weight " chart. My heart is so heavy. Please help if you can. Thank you so much. ~Kristi _________________________________________________________________ Add photos to your e-mail with MSN 8. Get 2 months FREE*. http://join.msn.com/?page=features/featuredemail Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 10, 2003 Report Share Posted July 10, 2003 Hi Kristi, I cannot even imagine the pain you have experienced this past year and I wish all my prayers for you, your family and your children..How old are the other children? I had my surgery on 9-16-02 and have loss only 73 lbs and have 40 lbs to go. I think when you have 100 or so lbs to loose it does come off slower. I went 4 months with no weight loss, no matter what I tried and just recently when I came off the insulin my weight has started to move slowly!!! There is a support group of just sept. 2002 wls people WLS-September2002. There you may find some answers about where you are and what is going on since everyone is from the same month.and year. I happen to love both groups and take a lot of support to all the loosers..present and future! I also wonder if you are on any anti depressants? Or other medication which can cause weight gain or blotting depending on which medication..Also the absorbtion is different so you can have some not so common side effects that others dont frequently get. Feel free to email me if you want to chat...Also the only thing I can think of is follow the pouch rules and try not to graze in between. Take it slow and for everything life has thrown at you do not beat yourself up for the weight not being as fast as you would like it to be. Talk to your Doctor at the end of the month and see if he has any answers.. Bless you and your journey! > > Hi! My name is Kristi. I live in MN. I had gastric bypass (lap) on > September 26, 2002. Never in my life had I been so nervous and excited > about anything. > > In 1999 I had thyroid cancer and gained a ton of weight, which I could NOT > afford to gain in the first place. I tried to lose it but you know how > that goes. Being the mother of 4 children and NEVER being comfortable to go > ANYWHERE with them, I decided I needed to do something. Just once I would > like to take these awesome kids to the beach and actually swim with them. > (of course that was only the beginning) Being overweight was running my > life. I HATED it. > > My surgery went well. Of course I was selective about telling people. I > figured I'd make the decision whether or not to tell as the time came. My > oldest daughter (15) was so very supportive of and excited for me. Well the > first week I lost 12 pounds. Needless to say that was encouraging. The > weeks went along with daily weight loss...until October 26th. Exactly a > month to the day of my surgery. > > On that horrible day, my 15 year old daughter was killed in a car accident. > My world could have easily ended right then and there. No longer did the > surgery matter....why would it. She was a big part of the reason I wanted > to have it. Anyways, due to depression, I quit eating. My weight loss > slowed tremendously. ly, I didn't even care. As the months passed, I > started to eat more and the pounds started coming off again. Physically I > was feeling better than I had in years. > > Now for the reason I need help... Again my weight loss has STOPPED. As a > matter of fact, I have gained. I am scared to death. I have noticed an > increase in my appetite, I have also noticed that I can eat more food, and > that I am hungry sooner between meals than I have been in the past. I wake > in the middle of the night feeling like I am starving to death. I eat > animal crackers or dry granola by the handful when this happens. And I am > not just waking one time in the night, I am doing this all night long. Some > nights I see every hour. > > I am not sure what to do. Its hard to know if this is depression or if I > have failed my surgery or what. I do know that I have VERY bloated > stomachaches almost daily, and I feel extremely gassy (is that a word?!) I > am almost afraid to go to the DR. I do however have an app. scheduled for > the end of the month. > > Does anything I have told you sound familiar? Anyone?? Will I be my big > fat self again before long? I have only lost 70 lbs since my surgery almost > 10 months ago. I still have about 38 lbs to go according to the " ideal > weight " chart. > > My heart is so heavy. > > Please help if you can. > > Thank you so much. > > ~Kristi > > _________________________________________________________________ > Add photos to your e-mail with MSN 8. Get 2 months FREE*. > http://join.msn.com/?page=features/featuredemail Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 10, 2003 Report Share Posted July 10, 2003 Kristi: My heart aches for the pain you've gone through with your daughter's death. I cannot even begin to fathom the depth of that pain and loss. Your daughter would want you to succeed at this and you have to believe that you can. Know in your heart that you will and you will. I'm a firm believer in visualizing your body becoming what you want it to be and that that positive thought and firm belief provides the extra step up that some people seem to have. As for the practical application stuff, I really can't help. I'm only three weeks post-op and haven't hit a plateau yet. If you ever need a shoulder, the group is here and if you'd prefer one-on-one talks, my email and messenger are always open. Hugs, please help... Hi! My name is Kristi. I live in MN. I had gastric bypass (lap) on September 26, 2002. Never in my life had I been so nervous and excited about anything. In 1999 I had thyroid cancer and gained a ton of weight, which I could NOT afford to gain in the first place. I tried to lose it but you know how that goes. Being the mother of 4 children and NEVER being comfortable to go ANYWHERE with them, I decided I needed to do something. Just once I would like to take these awesome kids to the beach and actually swim with them. (of course that was only the beginning) Being overweight was running my life. I HATED it. My surgery went well. Of course I was selective about telling people. I figured I'd make the decision whether or not to tell as the time came. My oldest daughter (15) was so very supportive of and excited for me. Well the first week I lost 12 pounds. Needless to say that was encouraging. The weeks went along with daily weight loss...until October 26th. Exactly a month to the day of my surgery. On that horrible day, my 15 year old daughter was killed in a car accident. My world could have easily ended right then and there. No longer did the surgery matter....why would it. She was a big part of the reason I wanted to have it. Anyways, due to depression, I quit eating. My weight loss slowed tremendously. ly, I didn't even care. As the months passed, I started to eat more and the pounds started coming off again. Physically I was feeling better than I had in years. Now for the reason I need help... Again my weight loss has STOPPED. As a matter of fact, I have gained. I am scared to death. I have noticed an increase in my appetite, I have also noticed that I can eat more food, and that I am hungry sooner between meals than I have been in the past. I wake in the middle of the night feeling like I am starving to death. I eat animal crackers or dry granola by the handful when this happens. And I am not just waking one time in the night, I am doing this all night long. Some nights I see every hour. I am not sure what to do. Its hard to know if this is depression or if I have failed my surgery or what. I do know that I have VERY bloated stomachaches almost daily, and I feel extremely gassy (is that a word?!) I am almost afraid to go to the DR. I do however have an app. scheduled for the end of the month. Does anything I have told you sound familiar? Anyone?? Will I be my big fat self again before long? I have only lost 70 lbs since my surgery almost 10 months ago. I still have about 38 lbs to go according to the " ideal weight " chart. My heart is so heavy. Please help if you can. Thank you so much. ~Kristi Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 10, 2003 Report Share Posted July 10, 2003 We had surgery on the same date as you did. Looks like you are doing great also. I tried to get into that group that you talked about and I never got to finally get into it. Maybe I should try again. Tammy from MI almost 10 months post-op 137 pounds gone 317/180/??? --- Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 10, 2003 Report Share Posted July 10, 2003 My son died almost seven years ago and I got some wonderful advice when he died. Our therapist said that for a death of someone like an elderly parent we should give ourselves a full year for going through and recovering from the loss. For a death of perhaps a spouse or a child whose death you knew was coming, say after a long illness, at least three years was necessary. And for a traumatic, sudden death like ours, whose son committed suicide at the age of 20, that we were to give ourselves at least five years. And we kept telling ourselves during that first five years that we knew we were crazy still because it hadn't yet been five years. And after the five years was up, we kind of knew we had survived the death and could still live. But it is still hard. I just had my WLS in May. Grief is a very real and difficult thing that isn't the same for everyone, but the process should not be rushed or minimized. We were also told NOT to do anything rash within the first year, you are just way too out of it. Don't sell your house, don't buy a car, just stay stable. I would not recommend WLS to someone within the first year of a traumatic death of a child or spouse. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 10, 2003 Report Share Posted July 10, 2003 Kristi, I am so sorry for the loss of your beautiful daughter. My heart goes out to you. The only advice I can give you as far as weight loss goes would be in regards to snacking. " I eat animal crackers or dry granola by the handful... " Both of these foods are not good choices. If you're truly hungry, that's fine, but you need to find something better to eat. My suggestion is protein shake or bar. If you have to have something, it will fill you up better and you probably won't be hungry after the first time. You can also try sipping water to load your tummy until morning. My other thought is that you are feeding your emotions, and not your appetite-- which it totally understable in your situation. Perhaps a visit to your doctor could get you some help in the way of anti- depressants or a referral for counseling. You are very close to goal, Kristi. I'd love to see you succeed and be happy again. You still have 3 awesome kids who need you and love you very much. God bless you. - > > Hi! My name is Kristi. I live in MN. I had gastric bypass (lap) on > September 26, 2002. Never in my life had I been so nervous and excited > about anything. > > In 1999 I had thyroid cancer and gained a ton of weight, which I could NOT > afford to gain in the first place. I tried to lose it but you know how > that goes. Being the mother of 4 children and NEVER being comfortable to go > ANYWHERE with them, I decided I needed to do something. Just once I would > like to take these awesome kids to the beach and actually swim with them. > (of course that was only the beginning) Being overweight was running my > life. I HATED it. > > My surgery went well. Of course I was selective about telling people. I > figured I'd make the decision whether or not to tell as the time came. My > oldest daughter (15) was so very supportive of and excited for me. Well the > first week I lost 12 pounds. Needless to say that was encouraging. The > weeks went along with daily weight loss...until October 26th. Exactly a > month to the day of my surgery. > > On that horrible day, my 15 year old daughter was killed in a car accident. > My world could have easily ended right then and there. No longer did the > surgery matter....why would it. She was a big part of the reason I wanted > to have it. Anyways, due to depression, I quit eating. My weight loss > slowed tremendously. ly, I didn't even care. As the months passed, I > started to eat more and the pounds started coming off again. Physically I > was feeling better than I had in years. > > Now for the reason I need help... Again my weight loss has STOPPED. As a > matter of fact, I have gained. I am scared to death. I have noticed an > increase in my appetite, I have also noticed that I can eat more food, and > that I am hungry sooner between meals than I have been in the past. I wake > in the middle of the night feeling like I am starving to death. I eat > animal crackers or dry granola by the handful when this happens. And I am > not just waking one time in the night, I am doing this all night long. Some > nights I see every hour. > > I am not sure what to do. Its hard to know if this is depression or if I > have failed my surgery or what. I do know that I have VERY bloated > stomachaches almost daily, and I feel extremely gassy (is that a word?!) I > am almost afraid to go to the DR. I do however have an app. scheduled for > the end of the month. > > Does anything I have told you sound familiar? Anyone?? Will I be my big > fat self again before long? I have only lost 70 lbs since my surgery almost > 10 months ago. I still have about 38 lbs to go according to the " ideal > weight " chart. > > My heart is so heavy. > > Please help if you can. > > Thank you so much. > > ~Kristi > > _________________________________________________________________ > Add photos to your e-mail with MSN 8. Get 2 months FREE*. > http://join.msn.com/?page=features/featuredemail Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 10, 2003 Report Share Posted July 10, 2003 > > Hi! My name is Kristi. I live in MN. I had gastric bypass (lap) on > September 26, 2002. Never in my life had I been so nervous and excited > about anything. > > In 1999 I had thyroid cancer and gained a ton of weight, which I could NOT > afford to gain in the first place. I tried to lose it but you know how > that goes. Being the mother of 4 children and NEVER being comfortable to go > ANYWHERE with them, I decided I needed to do something. Just once I would > like to take these awesome kids to the beach and actually swim with them. > (of course that was only the beginning) Being overweight was running my > life. I HATED it. > > My surgery went well. Of course I was selective about telling people. I > figured I'd make the decision whether or not to tell as the time came. My > oldest daughter (15) was so very supportive of and excited for me. Well the > first week I lost 12 pounds. Needless to say that was encouraging. The > weeks went along with daily weight loss...until October 26th. Exactly a > month to the day of my surgery. > > On that horrible day, my 15 year old daughter was killed in a car accident. > My world could have easily ended right then and there. No longer did the > surgery matter....why would it. She was a big part of the reason I wanted > to have it. Anyways, due to depression, I quit eating. My weight loss > slowed tremendously. ly, I didn't even care. As the months passed, I > started to eat more and the pounds started coming off again. Physically I > was feeling better than I had in years. > > Now for the reason I need help... Again my weight loss has STOPPED. As a > matter of fact, I have gained. I am scared to death. I have noticed an > increase in my appetite, I have also noticed that I can eat more food, and > that I am hungry sooner between meals than I have been in the past. I wake > in the middle of the night feeling like I am starving to death. I eat > animal crackers or dry granola by the handful when this happens. And I am > not just waking one time in the night, I am doing this all night long. Some > nights I see every hour. > > I am not sure what to do. Its hard to know if this is depression or if I > have failed my surgery or what. I do know that I have VERY bloated > stomachaches almost daily, and I feel extremely gassy (is that a word?!) I > am almost afraid to go to the DR. I do however have an app. scheduled for > the end of the month. > > Does anything I have told you sound familiar? Anyone?? Will I be my big > fat self again before long? I have only lost 70 lbs since my surgery almost > 10 months ago. I still have about 38 lbs to go according to the " ideal > weight " chart. > > My heart is so heavy. > > Please help if you can. > > Thank you so much. > > ~Kristi Hi my name is adrienne and if i were you, if i couldn't do it for myself, i would do it for my daughter. she wouldn't want you failing at this if she were here.i am so sorry for you loss, a daughter is a beautiful gift from god, i know i have 2 girls and 3 boys. but you must go on and you suffering. you owe that to her and you owe it to yourself.i know this sounds harsh but if i were in your shoes this is what i would want someone telling me.love yourself the way your daughter loves you. don't give up b/c if you do you'll give up on her, the reason you got the surgery and support from in the beginning. we love you already, don't let yourself down and most of all don't let your daughter down, she will always be with you. > > _________________________________________________________________ > Add photos to your e-mail with MSN 8. Get 2 months FREE*. > http://join.msn.com/?page=features/featuredemail Quote Link to comment Share on other sites More sharing options...
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