Answer 9   
Tired of Pureed Foods
For those of you on pureed foods who are getting sick of the same old thing, I just made a smoothie that really tastes good.  I used 1/2 container of vanilla low fat yogurt, 1/2 cup cottage cheese, 10 frozen strawberries (no sugar added), 1 cup of crushed ice, and 3 or 4 tsp of Splenda.  Whip it all in a blender.  This by no means has as much protein as a protein drink (which I normally drink), but I remember when I was first post-op, protein drinks made me so sick.  This may be a treat for some of you.

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Answer 7  
Getting a Referral from Your PCP
If you go to my website, http://www.wlscenter.com under the Weight Loss Surgery Research section are 3 articles by the National Institutes of Health.  I would print these out for your doctor to read.  They endorse weight loss surgery for those whose BMI are over 40.  They also explain the surgical procedures.  If your physician is not that familiar with weight loss surgery, these will certainly help.  And having documents from such a prestigious group will also help to get the referral that you need.  Much better than walking in with an article from People Magazine.  Hopefully, you have already done research on the type of surgery that you would like (this info can also be found in these documents) and then have an idea of what surgeon you would like.  Also on my site are listings of surgeons.  Click on the section, Gastric Bypass Surgeon Search.  There is a section for Laparoscopic RNY surgeons by State.  To find surgeons who do open RNY's and VBG, click on the other link which will take you to the Association for Morbid Obesity Support by State.

Give some thought as to why you want this surgery and what health problems that you have that will be improved by this surgery.  Try listing all of the diets that you have been on over the years and how they haven't worked.  You will eventually have to document all of this anyway, so you can start now.  Explain how you meet all of the National Institute of Health criteria for the surgery, which are: 
1) a BMI over 40
2) a history of failed attempts at dieting
3) co-morbidities aggravated by obesity
4) knowledge of the procedures and the risks
4) motivation to commit to follow-up.

Answer 6  
What about Leaks?
A leak was discovered in my pouch the day after my Lap RNY surgery.  It was detected via the "swallow" test.  It was a very small leak (the size of a pinhole) which closed by the next day when the swallow test was repeated.  My surgeon wanted  a third test to confirm that the leak was closed but he did not want the test done for a week, fearing that the pressure of the test could cause the hole to reopen.  So I was a week without anything by mouth until the 3rd test reconfirmed that the leak was gone. All of my nutrition was through IV's at home during that time. My leak was very minor, never was it life threatening because my surgeon had it under control.  Nevertheless, I was really scared at the time. 

So to answer your question, a leak which is in your new small pouch can be detected by the swallow test which is just a barium upper GI. You can also have a leak between your pouch and where the bowel is connected as well as a leak at the Y connection where the two parts of the bowel are joined.  These are more serious because the bacteria from your GI tract can leak into your abdominal cavity.  This will cause an infection which will cause a fever and usually abdominal cramps.  This is extremely rare.  It is usually corrected through surgery.  However some surgeons feel that surgery can make the situation worse by spreading the bacteria.  They prefer to keep the patient hospitalized, continuously drain the leak and wait for the leak to heal on its own. Again, this is not to scare anyone from surgery.  This is very, very rare.

But as a precaution, everyone should have an accurate thermometer when they return from the hospital.  I always see references to having ice cube trays, reclining chairs, and Popsicles, but few remember to have a thermometer.  That is one of the best ways to determine if anything is wrong after your surgery.  A fever indicates an infection.  An infection means there is something wrong.  When something is wrong, call your doctor.

Answer 5  
Smoking
This is a very valid question and a good point to bring up.  Yes, we are all aware of the evils of smoking, but what exactly does it do to our bodies and what exactly are the effects as they relate to weight loss surgery.  Let me site two studies that deal with this issue.  A 1998 study done by the Medical College of Wisconsin in Milwaukee found that people who smoked during the 24 hours before having surgery with general anesthesia were more than 20 times more likely than people who didn't smoke to have episodes of inadequate oxygen supply to the heart during the operation, which can result in angina.

However, it is also very harmful to smoke after surgery.  Here is the second study.  This was a study done in 1995 at the Baylor College of Medicine in Houston.  Smoking constricts blood vessels.  They found that smoking blocks oxygen from going to the site of the wound, thereby severely slowing healing of the wound.  Especially with an open incision for weight loss surgery, this is significant.

Answer 4   
Exercise
There are several things that you can do.  One is water aerobics.  That is an excellent way to get in exercise. Or you could try an recumbent exercise bicycle.  They provide very good exercise and are very easy on the back.  Another is to try some of the exercise tapes for those who are totally out of shape.  There are some excellent exercise videos for larger people, people who are totally out of shape and people who have bad knees and backs.  Here are some titles that you might want to look into getting. As always, check with your doctor prior to starting any exercise program.

Stolove, Jodi, Sit Down and Tone Up.
An excellent video for those who have bad knees, legs, or back.  Allows you to exercise all the major muscle groups from a chair.

Sansone, Leslie, 40-Plus Walk Aerobics Workout
Easy to perform session, one half hour in length.  Appearing on the video are people of all shapes and sizes and levels of fitness.

Big on Fitness: Full Figure Aerobics
A 50-minute video for large women.  It is divided into five sections so it is easy to just do a short workout if you want to.  Suitable for any fitness level.

Powell, Sharlyne, Women At Large - 30 Minute Workout.
Workout tape aimed at larger women.  Includes low impact aerobic dance and flexibility exercises.

Dr. Rosenbaum, Aerobics on the Easy Side.
Dr. Rosenbaum, Director of the American Aerobics Association, conducts the first medically sound , fun, and health-generative exercise program for beginners, people over 45, and overweight people.

Smithey, Greg, Startin' Simple Series - Easy Aerobics.
Thirty minute workout with simple moves.  Good for people with bad knees.

Great Changes - Low Impact Workout With Carnie Wilson.
A beginner, low-impact video that is great for getting you going.

Simmons, Richard, Sweatin' to the Oldies.
Dance party exercise video by the king of motivational exercise.  People of all sizes exercise along with Richard.

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Answer 3   
Plastic Surgery
Plastic surgery is covered by insurance just as weight loss surgery is cover by insurance if it is deemed medically necessary.   For instance, if you have an apron that is causing you skin irritation or infection, or if your apron interferes with you sexually or causes you back problems, then it is usually covered.  A breast reduction is usually covered if the excess skin is causing you back or neck problems.  Less common are the leg plastic surgeries unless there is so much excess skin that there is severe skin irritation.  Arm (or batwing) plastic surgery is almost never covered.

Look at these sites from the American Society of Plastic Surgeons for further information.

Answer 2   
Head Hunger
What you are experiencing is called "head hunger." Your body and more important, your mind is used to eating a certain amount at certain times.  Your head and body are reacting as they normally do.  They have not as yet gotten the message that your stomach holds only 2 ounces.  They will soon get the message and your hunger will abate.

As far as eating about 3 ounces of soup and 3 ounces of mashed potatoes, don't let that concern you.  The soup is liquid so it will flow out of your pouch faster.  Once you are eating more regular food, however, you may not want to be eating 3 ounces of mashed potatoes.  Eating carbohydrates will make you feel hungrier faster.  Remember the suggestion to eat your protein first.  Your body has a lot of healing to do and protein is very important in that process.

I am very careful about eating as much protein and as few carbs as possible.  I don't know if this is why I had no hair loss, or if it was the luck of the draw.  But there is no denying the importance of protein.  I wish you the very best and try not to worry.  I know it is a scary time.

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Answer 1 
Problems Eating: Post-Op
Your pouch is probably swollen from the trauma of the surgery.  First thing to do is to call your surgeon and make sure that he or she knows.  You want to be careful of not getting dehydrated.  At this point you don't need nutrition, but you do need fluids.  Try sipping very slowly.  You may want to try Pedialyte which will work well to get your electrolytes in balance.  Just take it slowly.  It will all work out.

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