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RNY Tips & Pitfalls

Below is a few of my most recent postings I will be adding more so check back often..

Good Article and information about exercise from post-op and beyond..

http://www.beyondchange-obesity.com

Motivation for participating in a regular exercise program is an individual process. One of the most important factors is that you choose an activity that you enjoy doing. Most folks are more successful if they have an outside influence helping them to stay motivated. This influence could be a friend to exercise with, a dog to walk, an exercise program sponsored by your workplace, or a health club membership. There are many other methods that people use to help them stay motivated. Some folks are self-motivated and they are able to establish goals for themselves and follow through on a regular basis.

Why would anyone want to motivate him or herself to exercise? Most people exercise for weight control and other health related benefits. Evidence is accumulating that regular physical activity is more effective than dieting alone for long-term weight control. The benefits of exercising in conjunction with dietary restriction for weight loss are multiple. Exercise burns calories. It also raises our resting metabolism, i.e., we continue to burn calories even after we are finished exercising. Exercise increases the loss of body fat by preserving our fat free body mass (muscle). Additionally, regular exercise contributes to the long-term success of weight loss because it is a change of lifestyle.

How would you get started on an exercise program? The most important thing is to start slowly. Generally, persons who are obese lose fat and weight more readily with exercise than their counterparts of normal weight. This means that the initial stage of an exercise weight loss program should be progressive in nature, and not start out with a strenuous high-energy activity. In the beginning, you should adopt long-term goals and a restructuring of both your exercise and eating habits. During the first few weeks (or months) slow walking may gradually be replaced with brisk walking. At least a 12-week time period may be required before meaningful changes occur. Remember that this is a behavioral lifestyle change that can also be applied to your daily activities. For example, walking can replace the use of a car; steps can replace the use of an elevator; manual tools can replace the use of power tools.

When exercise is used for weight loss factors such as frequency, duration, intensity and the specific form of exercise must be considered. For weight loss, exercise should be a part of your routine 5-7 days a week. Planning on exercising every day is a good idea. This plan will help you incorporate exercise into your daily routine and give you an excellent chance to achieve your goal. The duration of exercise should be 30-45 minutes at a time. You do not have to exercise 30-45 minutes initially, but it should be your goal to work up to this duration over time. Exercise intensity for weight loss, does not have to be strenuous. It is better to exercise longer at a less intense level to achieve weight loss. You only need to raise your heart rate to 50-65% of your maximum heart rate in order to be at fat burning intensity. Your maximum heart rate is approximately 220 minus your age. If you are 40 years old, you would want to be exercising at approximately 90-117 beats per minute. There are many exercises that you can choose from when planing your program. Some examples are brisk walking, stationary cycling, swimming, stair climbing, rowing, and jogging. Below is a sample walking program. Remember to check with your physician or qualified health professional before starting any exercise program.

Week 1: Walk 5 minutes, then walk briskly for 5 minutes, walk slowly for 5 minutes

Week 2: Walk 5 minutes, then walk briskly for 7 minutes, walk slowly for 5 minutes

Week 3: Walk 5 minutes, then walk briskly for 9 minutes, walk slowly for 5 minutes

Week 4: Walk 5 minutes, then walk briskly for 11 minutes, walk slowly for 5 minutes

After 12 weeks of increasing your brisk walking by 2-3 minutes each week, you will be up to 40 minutes of continuous walking. Remember that this is a general program and should be modified to suit your individual needs.

One of the risks of exercising is muscle and joint injury. Listen to your body for early warning signs. Exercising too much too soon can cause injuries to feet, ankles, knees and legs. Fortunately, rest can heal minor muscle and joint injuries. Do not make the mistake of exercising beyond early warning pains or more serious injuries may result.

Wear a minimum of light, loose fitting clothing. Wear proper shoes if you are starting a walking program. Make sure that any extra gear you require is in good working condition and fitted properly for you. Drink lots of water before, during and after your exercise session.

How do you keep going? To stay physically active you should set short-term as well as long-term goals. If your long-term goal is to walk briskly for 20 minutes, then your short-term goal should be to walk briskly for 5 minutes. With short-term goals you will be less likely to push yourself too hard or too long. Also, think back to where you started. When you compare it to where you are now, you will see the progress you made. You may want to consider keeping a written record so you can objectively follow your progress. Discuss your program and goals with your family and friends. Their support will be an important resource to keep you going. If you are feeling bored or are not enjoying a particular activity, consider trying another one. Remember that physical activity is an important part of your health prescription. The effort you put towards planning and performing a program will reap benefits that last a lifetime!

Susan Arbogast, M.S., P.T [issue: January 2000]

Sent by Victoria Bowen(OK)who you can email at VBowen1067@aol.com...

"Diets" most often fail because they do not incorporate a mechanism for overcoming human nature. Only an extremely disciplined person can exercise every day, count every calorie and resist the powerful attraction of the sights and smells of their favorite foods. Let's face it; the vast majority of us are just not that disciplined. I sure wasn't... Even if I did manage to lose 30 to 40 pounds I would gain it right back and then some more on top it was a vicious cycle...

The reason gastric bypass surgery is so effective in helping you lose weight is that your reconfigured digestive system:

Reduces the amount of food you are able eat at any one meal (restriction).

Absorbs less of the food you do eat (malabsorption).

Makes you intolerant to foods you should avoid anyway (i.e. concentrated sugars and fats).

In other words, the surgery imposes discipline by forcing you to change your eating habits. Fortunately, the overwhelming majority of those who had gastric bypass report that learning to eat smaller meals, chew thoroughly and avoid sweets and fats was not nearly as hard as they had imagined. After the recovery/adjustment period, you will be able to enjoy a wide range of foods again. As a bonus side-effects of gastric bypass surgery, you should no longer feel hungry all the time and will no longer be bothered by indigestion or "acid reflux." Well at least the majority aren't bothered by it.. I have never been bothered by it before or after surgery...I have (as of today) lost 115 pounds...This is the MOST I have ever lost..and the pounds keep melting off wek by week.. This tool called RNY for me has saved my life..I have never been sorry that I had it and I'm dedicated to working with this tool the mechanics is up to me for the rest of my life,however, RNY gave me what I needed a helping hand. ;-)

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By Victoria Bowen on Tuesday, June 9, 2000 - 02:00 pm:

Anti-inflammatory drugs.

Drugs commonly used for the treatment of arthritis, bursitis, tendonitis, and for many back problems will cause irritation to your stomach lining. This could develop into a bleeding ulcer. Consult your surgeon before taking any of these drugs: Advil Alka Seltzer Anacin Ascriptin Aspirin Bufferin Coricidin Cortisone Dolobid Empirin Excedrin Feldene Fiorinol Ibuprofen Meclomen Motrin Nalfon Naprosyn Norgesic Tolectin Vanquish.

Drugs you can take safely:

Anacin 3 Datril Fioricet Panadol Tylenol

Note: Do NOT confuse anti-inflammatory drugs with anti-biotics.

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By Victoria Bowen on Tuesday, June 6, 2000 - 03:04 pm: Tips & Pitfalls:

sabariatricTips&Pitfalls

High calorie liquids will defeat the operation. Sugared soft drinks, ice cream, whole milk, apple juice, and sweet tea (with sugar) can provide enough calories to prevent weight loss.

Avoiding sugar. If you read labels carefully you will find it is nearly impossible to avoid all sugar. A good rule of thumb is to stay away from products that list any of the following in the first three ingredients: sugar, maple syrup, honey, molasses, corn syrup, corn sweeteners, glucose, lactose, maltose, dextrose, high fructose, sorghum, sorbitol, or mannitol.

Nutrasweet and other artificial sweeteners generally work OK with the gastric bypass.

Each meal should take between 30-45 minutes. Taking less time means the meal has been eaten too quickly, or is too small, and the patient will be hungry again soon. Taking more than 30 minutes to chew your meal means too much food will be eaten at one sitting.

Liquids must be taken before solids. If breakfast consists of a scrambled egg and coffee, drink the coffee, then eat the egg (or half of it). Trying to drink the coffee after eating will cause vomiting. Also, eating and drinking together is a no-no. This will convert the egg, for example, into a liquid. Consequently, this liquid will pass through your outlet faster, allowing greater food intake which you want to avoid.

A patient who is prone to nibbling should find a snack food which is solid, thereby preventing constant eating. Examples would be beef jerky rather than Cheetos, or apple pie rather than cookies. Don't eat ice cream! One further word on snacking; anything you put in your mouth that has calories (including healthy stuff) needs to be counted as a meal - remember to eat only 3 or 4 times per day.

Quit when you are full. Each patient will quickly discover the feeling of discomfort when the pouch has been stretched. It is important to stop eating at the first sign of fullness (or even before - see below). You will discover the feeling by paying attention and looking for that "full feeling" Ė you should recognize it as a "Quit Eating" signal.

When in doubt about a new food, try it! Some patients can eat anything, whereas others may not be able to tolerate certain foods. You won't know for sure, unless you try.

If a food can not be eaten at all, wait a month and try it again. Be cautious with unpeeled fruits and the membranes of fruits. Fruits with thick, white membranes, like grapefruits and oranges, should either be juiced to strain out the membranes, or eaten carefully to just eat the soft, juicy parts.

Knowing how much to eat

This issue is understandably a source of significant concern for gastric bypass patients. There is not a single answer that fits everyone at all times following surgery, so guidelines are going to be laid out instead of a list of amounts and types of food.

First, during the recovery phase from surgery (first 4-6 weeks) it is normal to have little or no appetite. During this time you are likely to consume far less food than you would need over the long haul to stay healthy, but in this limited time period it is OK. Your surgeons want you to be sure you consume adequate fluids (zero-calorie) to stay well hydrated, but they do not want you to force food. At this stage, food should be used to begin to teach yourself new eating habits that will help you feel well and lose weight over the following year.

Next, a few teaching points about knowing when you have eaten enough:

Donít eat until you feel full Ė this is absolutely serious. The reason has to do with the fact that the nerves of satiety (feeling of stomach fullness and eating satisfaction) are "slow" nerves. There is a delay of around five minutes from the time your stomach pouch gets comfortably filled to the time that your brain becomes aware of that fact. If you swallow even one additional bite then the pouch will be overfilled and you will experience painful nausea. Realistically, every patient will experience this overfilled feeling at least once or twice, and it will not damage your stomach if it does not become a pattern. The goal is to learn from the experience Ė remember how much was consumed and what kind of food it was. Next time, use your memory and your eyes to know when to stop eating, before you feel full.

An irritated stomach stays irritated for a day or so. If you overeat or if you eat something that does not agree with you, the stomach pouch will be irritated or "P**** off" for 12-24 hours. While it is p*** off it will be less tolerant of food and liquid than usual, and even small amounts of food can cause the overfull feeling to recur. The lesson here is that if you have an overeating episode, give the stomach pouch a chance to recover by taking only clear liquids for the next meal or two. You can apply this principle to any situation where your stomach pouch is irritated Ė if medications or an illness makes you feel unable to eat, simply consume liquids alone to maintain your hydration.

Your capacity will increase over the first 6-9 months following surgery. The pouch and small intestine learn how to work together and become more pliable over a period of months after gastric bypass. Many patients notice a dramatic increase in the amount of food they can handle comfortably. This is normal in the vast majority of cases. THIS is the time that the good habits developed in the first few months will support further weight loss. If a patient has gotten away from the old habit of using fullness as a signal to stop eating, then they will comfortably continue to eat restricted amounts of food and will continue to lose weight. On the other hand, if a patient has depended on the physical limitation imposed by the pouch to tell them when to stop eating, this relaxation of restriction will come as an unpleasant surprise as their weight loss slows and then comes to a halt.

So the bottom line on how much is the right amount is to make a habit out of the type and amount of food that works well about three months following gastric bypass. Stick with this amount over the next several years to obtain excellent weight loss and health.

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By victoria Bowen on Monday, June 5, 2000 - 04:25 pm: Reducing risk of complications

Rest assured that the surgeons and hospital staff do everything they can from their end to reduce the occurrence of complications. They stay abreast of the medical literature and they pay attention to what goes on with their patients so (unfortunately) All of us have either seen or read about the vast majority of potential problems. Surgeons use prophylactic measures (such as antibiotics or anticoagulation therapy) where they benefit the patient, and remain vigilant for the remainder. I have seen members frequently ask what they can do to reduce their risk, and there actually are a few important answers.

No smoking

- smoking has a truly significant influence on your outcome, including the chance of dying around the time of surgery. Obviously it's best if the patient has never smoked; however, if a patient does smoke they insist that you abstain from all tobacco products for at least one month prior to surgery. Following surgery it's best if the patient never resumes smoking, but that is not a primary issue between the surgeon and the patient.

Get out of bed -

after tobacco freedom, the most important influence a patient has on outcome is to get moving around the ward as soon as (and as much as) possible following the surgery. The surgeons will do their best to control the surgical pain, the nursing staff will assist, and they aim for the patient to be walking out in the hallway on the afternoon of surgery or as I did in the ICU 8 hours after surgery. The main important benefit of this plan is to restore normal circulation in the veins of the legs, but it also helps lung function, maybe gut function, and overall attitude.

Mental preparation

try to approach the surgery as the beginning of a whole new phase in life. The Gastric Bypass procedure is a watershed event in life; if the patient approaches it with thorough education and with determination to make the best of the opportunity, the chances of success are high. If the patient slides into the operation and aims for it to have minimal impact on his/her life then the prospects are not as good. One concrete thing that a prospective patient can do along these lines is actually practice the gastric bypass diet. I did this few days before..This will give you a practical idea of what you're getting into, with the side benefit of some weight loss. Also, there is some "soft" data that suggest that risks are lower for patients who come into a gastric bypass having lost 5-10 pounds, versus those who have eaten many "last meals" in preparation for the surgery. I chose not to have the LAST meal I drank broth two days prior to surgery.. I'm not saying that's why I had no complications, only that I chose to go this way to maximize my chances..Another practical suggestion for mental prep is to attend a monthly gastric bypass support group - much can be learned from other patients that the surgeons and staff cannot teach. This site has been an excellent tool for me lots of information and support.. Thanks Jerry & Eric..

Comparison of these risks to no surgery

Taken as a group, patients who undergo gastric bypass surgery do better than equally heavy people who work hard on nonsurgical means of weight loss. Because surgical weight loss tends to be successful and nonsurgical weight loss tends not to be, the risks of the gastric bypass are outweighed by the benefits obtained in terms of improvement/resolution of the many medical problems for patients considered as a group. This has been statistically demonstrated to be true. This fact is the main reason that I had this surgery I tried many diets and weight loss programs each time with some weightloss, however, gaining it back. This yo-yo weight loss is not only dangerous physically, the mental anguish is crippling.

I know I'm only 5 months post-op, but, I can truly say this surgery saved my life with no doubt in my mind.. I have lost 115 pounds as of June 4th, I feel better than I have in many years.. No longer on any blood pressure medication, no longer diabetic, no longer in congestive heart failure, I have not had any more asthma attacks, I can go on and on .. The plus side and mind you this was not my main concern when I decided to have this surgery, is that I have went from a size 5x to a normal off the rack size large.. :-)

An excellent source of information on the risks of surgery is on the website for the American Society for Bariatric Surgery. (www.asbs.com)

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By Victoria Bowen on Wednesday, May 31, 2000 - 03:02 pm:

You Need to Drink 64 oz. of Water, Every Day! Drink more "Water" Why you ask!!!

When the heat of summer is on and you are active outside, it is easy to drink more water to quench your thirst. But during the cooler weather or if you work in an air-conditioned office and donít get out in the heat often you might not reach for that drink of water as often, even though itís just as important.

Why is water important? Water helps move nutrients to where our body needs them and helps to transport waste products out of the body. Water functions as a lubricant around joints and a shock absorber around cells. Water enables countless chemical reactions to take place and helps regulate body temperature. Water is especially important during weight loss because your body needs increased fluids to help get rid of wastes from the breakdown of fat and to help control regularity. Increased fluid intake can also help maintain satiety between meals.

You know you should drink at least eight 8 oz. glasses of water each day, but did you know that water in other drinks also counts towards your daily intake? You can meet up to half of your daily water requirements (32 oz.) with low calorie drinks such as a non-alcoholic, sugar-free flavored drinks, coffees or teas, crystal-lite, sugar free Country Time Lemonade. Such beverages offer great tasting flavors and satisfy your thirst.

Remember, donít wait until you feel thirsty to take a drink. By then, your body has already begun to dehydrate. Instead, practice preventive maintenance -- drink before thirst sets in.

Try these tips to increase your water intake:

* Drink one 8 oz. beverage before a meal or snack and one with each meal or snack to help curb your appetite. Remember WLS post-op patients should not eat and drink at the same time.

* Keep a 32 oz. pitcher of sugar-free flavored drink or water in the refrigerator. Strive to finish the entire pitcher within one day to meet half of your daily water needs.

* Take it with you! Carry a filled water bottle with you when youíre running errands, driving your car, going for a walk, etc.

* Use your daily food diary to track your water intake

My Favorite Links & Web Sites

Gastric Bypass Information, Recipe, and Support Page
Victoria's Recipes for gastric Bypass Patients
My Pictorial Journal
Surgery Types
Abdominoplasty Journal
Husted's Food List Post-Op
ASBS - OBESITY - Bariatric Surgery
John Husted, M.D. -
Victoria's WLS Obesity Support Page
3 reasons - The Roux-en-Y Gastric Bypass
Alvarado Center for Surgical Weight Control
BeyondChange
Benefits and Risks of Surgical Treatment of Serious Obesity
PROS & CONS
ThinnerTimes Gastric Bypass Surgery for Morbid Obesity
The Surgical Clinic of Central Arkansas
Divided Gastric Bypass
DOCTOR in Your House(tm).com

Email: vbowen1067@aol.com