DS Questions and Advice Please

[Mirabella]

Last night we sat down and looked at many of the threads on this website and some other research regarding the DS procedure for our daughter. She even showed us some research that she has done on her own. And though the whole thing makes her father sick to his stomach, we have decided that the DS is the best procedure for her. I won't go into many details as she wants to join this site and I don't know how much she wants told, but we did find out last night that her BMI is almost 72 rather than 65.

Here are the questions that we have:

1. Knowing now what you know about vitamins and supplements, what would buy to have on hand day 1 out of surgery? I know that the vitamins are changed with the labs, and we don't have a copy of her most recent labs (yet, we will get a copy today), but we know she is low on iron and calcium. So, what do you think that we MUST have to start off with?

2. Is there any value to liquid vitamins? We saw that some people took them and we know an apothecary that can make anything into a liquid form, but is it worth the expense? Will she be able to swallow pills?

3. What, if anything, did you do to physically prepare for surgery? The surgeon requires no pre-op diet except for the day before. Did you start working out or eating a special way before the surgery?

4. Our research shows that the average hospital stay is 2 to 3 days. Was this true for most of you? How long until you were back at work/school? The timing of this will interfere with the start of her senior year. Are we looking at days, weeks, months? I know that each person varies, but we want an idea.

We are seeing the surgeon's office tomorrow to ask them some questions about the surgery itself, and there is a pre-op class that we will attend next week, but having these questions answered would really help us get an idea of what we should do.

My husband and I are so appreciative that you let us look into your lives and experiences to help our daughter. We want her to be healthy.

According to this site, we may also have to add another bathroom/gas chamber to accomodate her bowel movements after her surgery?

 

[Charris]

Hello. I would go to the vitalady site she has starter packs for every surgery.

Most of us take pills, many many many pills every day. We don't worry about then right after surgery. We focus on hydration.

A lot of the doctors take people off work for 6 weeks. But depending on if its done laparoscopic or open will dictate how long she will need off. Ive heard of people going back to work at 2 weeks after surgery. But then there are people like me who was off 3-months.

 

[GirlFriday]

I just want to say something about #2 and #3

#2. There is no reason to go through the expense of having liquid vitamins made for her. She should be able to swallow pills. I checked in with the apothecary on 71st street and his regimen for liquid vitamins was $130 per month. You should not need to spend that much. That is just my two cents worth.

#3. Cris needs to get off of the soda and caffeine NOW. She can't have it after surgery (the bubbles will hurt and cause gas), and it is better to go through the caffeine withdrawl now as opposed to when she is out of surgery. She needs to start drinking lots of water and any exercise that she can get to build up stamina and strength at this point will only serve her better after surgery.

 

[southernlady]

1. Knowing now what you know about vitamins and supplements, what would buy to have on hand day 1 out of surgery? I know that the vitamins are changed with the labs, and we don't have a copy of her most recent labs (yet, we will get a copy today), but we know she is low on iron and calcium. So, what do you think that we MUST have to start off with?

When she gets her labs today, post the labs (with the ranges) and we will see if anything needs attention based on our collective knowledge.

The first month after surgery her entire job will be to stay hydrated (a minimum of 64 oz a day of fluid) and walk (not long stretches but a few laps around the dining room table, then longer ones as she gets further out). Adding vitamins SLOWLY so that by the end of that month she is taking all she needs is the way we recommend. We suggest starting with the multivitamin and D, and then add calcium, iron, and then others as her labs indicate. It's easier to bring lab values down than it is to get them out of the toilet.

You want to have all her vitamins ON hand and ready but it may be a week before she can manage the multi.

See the Vitalady list in the Vitamins & labs section. Use that list to start...and we prefer to support Vitalady but realize cost and timeliness is an issue so other sources, esp Amazon work as well. The fat soluble vitamins (A, E, D, and K have to be in a dry formula and usually in amounts that make doctors absolutely CRAZY. After she is healed, her PCP can easily handle her lab work. There is a generic DS lab order in that same section.

There is no magical formula that works for all of us. Vitalady's regimen is the closest anyone ever got to that, and it's not a magic bullet either. The key is taking the time to learn about nutritional needs, reading labs and accepting those differing opinions if only for reference. These surgeons maybe had a semester of nutrition class if they're lucky, and many are too arrogant to admit that they don't know it all. Many nutritionists are the same way, and never bothered to learn the differences between procedures, so they lump us all together. It's sad, but it's true.

Helping her is a great idea but as a DS'er she will need to be proactive with her own care.

2. Is there any value to liquid vitamins? We saw that some people took them and we know an apothecary that can make anything into a liquid form, but is it worth the expense? Will she be able to swallow pills?

If she is able to swallow pills now, she'll be able to swallow them after...okay maybe not the first few days but by the end of the week. Liquids taste nasty. Some chewables work but NOT the FLINTSONES, please NOT them, LOL. If she does gummies, she has to account for the carbs in them.

3. What, if anything, did you do to physically prepare for surgery? The surgeon requires no pre-op diet except for the day before. Did you start working out or eating a special way before the surgery?

Learn everything on this site, (grin) but seriously, she needs to read here, everything we've posted, esp the ones pinned at the tops of each section. Start going low carb...it will not hurt for her to lose some before surgery. So a low carb, high protein, high fat. Knowing exactly what the basic macros are and which foods fit in them helps. Learn to read labels, esp ingredient lists.

When any of you read something you think is very important, either print it or bookmark it so you can find it later. To bookmark something, there is a link called Bookmark at the bottom of a post to the left of the Like button. Fairly far left. You can chose to make them public or private. And give them a title that helps you remember them. Another option (a little more "old fashioned" is to print stuff and sort it in a binder. Something along these lines: http://bariatricfacts.org/threads/we-have-to-get-organized.2488/

4. Our research shows that the average hospital stay is 2 to 3 days. Was this true for most of you? How long until you were back at work/school? The timing of this will interfere with the start of her senior year. Are we looking at days, weeks, months? I know that each person varies, but we want an idea.

I was there 2 nights/three days. I am medically retired so my return to 'work" was more a return to normal activity. The first two weeks while I was on just liquids, I didn't trust myself to go away from the house. Once I added soft foods AND calcium, things firmed up. But it depends on her work...a desk job is much earlier than something that requires lots of standing and or heavy lifting. Her surgeon will be the best one to ask this. Best case for school is about a week to two weeks. But again, she needs to ask her surgeon. Something I was told LONG ago was to get a small luggage cart (similar to this: http://www.amazon.com/CTS-Folding-L...r_1_4?s=apparel&ie=UTF8&qid=1437571249&sr=1-4 )to carry her book bag because she will have a weight limit on lifting. I had had surgery that had me using one for three weeks. And even once her outside incisions heal (about 2 weeks), it will be a good 6-8 weeks before her guts heal.

My husband and I are so appreciative that you let us look into your lives and experiences to help our daughter. We want her to be healthy.

According to this site, we may also have to add another bathroom/gas chamber to accomodate her bowel movements after her surgery?

She is a lucky lady...getting this at such an early age. Gives her a chance to avoid the health issues that most of us had.

As long as there are at least two toilets in the house, and make sure hers has an extra heavy duty fan system, y'all will survive. My husband is also a DS'er and WE lived in a house with ONE bathroom/toilet for almost 2 years post surgery. Many bathroom issues are food driven, esp carbs. What goes in our mouth usually comes back to visit later. But remember, everyone's poop stinks. It will have a different odor and due to all the fat she will need as he lives with the DS, it will be a different texture/color as well. And speaking of fat: http://bariatricfacts.org/threads/fats-are-not-the-enemy.3185/ is a good thread to read.

 

[DBmom23]

it is great that you are supporting your daughter on the right decision. You will hear more from veterans on this site. I am new--only 5 weeks out--but will give you my recent experience. It's important to note that everyone differs to some extent. Your daughter's age will help her recovery. On the other hand, her size may be an impediment.

Pre-op, the best thing she can do is start the vitamins now. I would do a multivitamin, calcium (1800/day), vitamin D to boost it up as it's probably low, and iron. As much as you can enrich her stores before surgery will help. Also exercise. Even if it's just walking and building up a little stamina, this will help her recovery.

Immediately postop, don't worry about the vitamins. Some people say don't worry for a month. I started slowly at Week 1 adding a multivitamin and adding something every week. I'm still not up to the full package but am taking the most important ones and will continue to add every week. For now it's multivitamin twice/day, calcium citrate 1800/day, vitamin D 50,000/day, heme iron 600/day and also Prilosec for stomach acid twice a day and Wellbutrin that I had been taking for a long time. I don't do as well with the pills so am taking a chewable multivitamin and will buy the calcium lozenges from barbaric advantage once I finish the big bottle I bought from vita lady of the pills. I have heard of people using liquid but the important thing is to get the right kind of everything (dry, not in oil) and ca citrate and the right amounts. Vita lady is a great resource as is the vitamin section on this website. I have bookmarked lots of these pages.

I was in the hospital 2 nights. Went back to work a week later which was too soon I didn't hurt myself or anything but was uncomfortable. Plan on 2 weeks really recuperating and then slowly easing back to things. Again everyone is different so you will have to see. It is important to walk around a lot after surgery to avoid blood clots and to keep your energy up.

Finally, as for the bathroom, don't worry too much. I am doing fine with just a good ventilation fan. I go about twice a day in the morning and it has not been so bad. I have heard that this can be really rough if you eat simple sugars or carbs which I have not done yet.

Good luck! I really think you are helping your daughter to save her life.

 

[star0210]

First....I think it's wonderful that you are supporting your daughter and want her to be healthy. At her BMI, DS is definitely the way to go if she can and will be compliant with meeting her nutritional and supplement needs for her lifetime. Sounds like you and her dad are willing to help her with that so that's a plus.

1. I started out with the full Vitalady DS regimen and I've tweaked what I take based on my labs and my needs. For example, the calcium citrate constipated me terribly so I switched to calcium hydroxyapatite which is less binding.
In addition to her tender carbonyl iron, I've added a heme iron on top of that because my ferritin levels were on the low side. My B vites had gotten high so I stopped all of them except for what's in my multi for a while and just recently added the B complex back but just one a week. I've also tweaked my A, D, and K doses. Her labs will be key, and it's very important that she get them drawn regularly and get all the correct things drawn.

2. I've never taken any liquid vitamins. I don't think there's any value to that at all. I swallow all my pills just fine.

3. I had to do a 5 day liquid diet before my surgery. If I were her, I'd start making the dietary changes now. Get rid of all carbs. Put the focus on protein. If she has any type of eating disorder or food addictions, I would get her into counseling. Surgery does not fix your head. It's just a tool and it only works if you use it correctly. I'd also encourage her to be as active as she can possibly be...the more she moves, walks, etc. the better shape she will be in for surgery.

4. I was in the hospital for 5 days but that's because I went to Mexico for my revision. I first had the sleeve back in 2010 and then revised to the DS last November. I was ready to go home and get on with my life on day 3. I was bored out of my mind. I recover from surgery very well. I found both of my WLS' to be very easy. I had my surgery on a Friday, flew home from Mexico the next Wednesday, and went back to work the Monday. It was also a laparascopic surgery which definitely makes a difference. I was also a lightweight for my revision and I think that made it easier too. I spent most of my time in the hospital up and walking around. Walking as much as possible helps so much. Also I only took narcotic pain medication for the first two days then switched to something non narcotic. It is MY belief that the sooner you can ditch the narcs the faster you will recover and be more active and normal. Open surgeries would probably require a bit more pain relief.

Who is her surgeon? Please know that MOST surgeons and their nutritionists give terrible advice to DS patients. So be prepared to get conflicting advice from DS'ers and the medical team. I'd listen to the DS'ers.
I aim for 100g of protein, 100g of fat, and I keep my carbs at 30 total grams per day or less. Everybody's needs will be different as far as how much carbs they can eat and still lose weight and how much fat they can handle before it causes bathroom issues.

As for bathroom issues, 95% of that is easily controlled by diet. Carbs will give you stinky gas and bloating and possible diarrhea. Too much fat can give you diarrhea, not enough fat and you can get constipated.
I NEVER have diarrhea...I suffer from bad constipation. My poop and gas don't smell any worse than they did pre-DS unless I eat something bad.

I'm so glad you found us and I look forward to seeing posts from your daughter.

 

[DianaCox]

You'll be getting different answers from different people - that's OK - it just shows that there are variable ways to deal with these things.

1. Knowing now what you know about vitamins and supplements, what would buy to have on hand day 1 out of surgery? I know that the vitamins are changed with the labs, and we don't have a copy of her most recent labs (yet, we will get a copy today), but we know she is low on iron and calcium. So, what do you think that we MUST have to start off with?
​

I am a PhD scientist - and I developed an aversion to swallowing pills after surgery after I gagged on a pill. I didn't start my vites until THREE MONTHS after surgery when I had a "scared straight" moment with myself. I wouldn't worry about taking them after surgery until at least a couple of weeks out - let her stomach heal from the cutting first. But try to get started as soon as she is comfortable swallowing them, and don't let it become a "thing" like I did.

2. Is there any value to liquid vitamins? We saw that some people took them and we know an apothecary that can make anything into a liquid form, but is it worth the expense? Will she be able to swallow pills?​

NO - she will be able to swallow pills. And some of the B vitamins taste HORRIBLE.

3. What, if anything, did you do to physically prepare for surgery? The surgeon requires no pre-op diet except for the day before. Did you start working out or eating a special way before the surgery?​

Ask the surgeon which vitamins he's OK with her taking ahead of time to build up her reserves, and when to stop them before surgery. Especially her iron should be tanked up pre-op. My surgeon only required a liquid only diet the day before as a clean-out - I highly recommend that, because going into surgery cleaned out will make her feel comfortable during the purge afterwards.

4. Our research shows that the average hospital stay is 2 to 3 days. Was this true for most of you? How long until you were back at work/school? The timing of this will interfere with the start of her senior year. Are we looking at days, weeks, months? I know that each person varies, but we want an idea.​

That's about right - I was almost 50 when I had surgery but not as heavy, and spent three nights - it depends on how she does. I was back at work (desk job) on day 20, starting 4 hours/day on Monday, 5 on Tuesday, etc. - I was full time by the next week.

According to this site, we may also have to add another bathroom/gas chamber to accomodate her bowel movements after her surgery?​

If it is an internal bathroom with a lame underpowered fan, you might want to replace it with a stronger one. My bathroom has a window, and I can open it - that suffices, but it is in a back corner of the house and my husband prefers using the hall powder room. One REALLY nice thing you could do for her is to install a Toto Washlet or similar device - it will help her clean up by herself. I needed help wiping my butt for a week, and didn't get the Washlet until about 3 years ago - I LOVE THAT THING - not only cleans best, but is much more gentle on tender butt parts. It's expensive, but worth it.
http://www.kbauthority.com/Toto-SW5...WiZjJx2n51Ll9lbWV4wU5-P-Tdfga99DqoaAuQQ8P8HAQ

 

[southernlady]

Cris needs to get off of the soda and caffeine NOW. She can't have it after surgery (the bubbles will hurt and cause gas), and it is better to go through the caffeine withdrawl now as opposed to when she is out of surgery. She needs to start drinking lots of water and any exercise that she can get to build up stamina and strength at this point will only serve her better after surgery.

Yes, THIS!!!

My husband and I both adore coffee...leaded not unleaded. BUT in the 6 months before surgery we weaned ourselves off leaded by buying both and mixing them in ever changing amounts. Started with very little decaf and by the end of 4 months we were on straight decaf. Made not drinking coffee for awhile so much easier.

I am not a big soda drinker, never have been. But I did find out that soda after surgery HURTS for awhile. Even now I have issues with canned or bottled soda. I can drink fountain soda easily now but that was not the case the first year. I had to let it sit and go flat first. And there is nothing more nauseating to me than flat soda.

And while it doesn't have to be water, it should be. I don't handle straight water well...but flavored or infused water works. In the summer I live on homemade lemonade.

Do NOT stock up on any foods fluids, or protein powders IN BULK unless the place you buy them has a liberal return policy (like Costco who will let you return opened products). What she likes now may be the most hated thing after. Best protein...well, whey isolate BUT whatever protein she will drink AND can afford is best.

DON'T be surprised if she becomes lactose intolerant, at least for awhile. My FIRST protein shake after I got home from surgery was made with my normal whole milk...OMG, I was beyond miserable. I am over 4.5 years out and still can not drink pasteurized milk. I use heavy whipping cream in my coffee and in cooking. I still also take a lactaid pill daily. But my husband who had his DS 5 weeks before I did, can drink copious quantities of pasteurized milk. So make protein shakes with water at first or heavy whipping cream or maybe almond milk (I hate those as they taste fake to me). I DID find out that I can handle raw milk tho.

Most of this is trial and error...we find out what WORKS for each of us. Very much a YMMV situation. If something isn't working ask around here and you will get some ideas. If it's something that makes you think "ask the surgeon" then ask the surgeon and while you wait, ask us. If it's dehydration...don't mess around. GO GET FLUIDS.

 

[Larra]

I'm so very glad your daughter will be having the DS and that she has the support of her parents.

Regarding pills, I'm one of those people who has trouble with large pills, sometimes even with not so large ones. It's not a mental thing with me, they actually get stuck. So for calcium citrate, which is a very large pill, I use the lozenges from Bariatric Advantage. She could either chew them or suck on them til they dissolve. The chocolate and cherry ones taste pretty good, honest. The mint is too minty for my taste. The texture is chalky but really, they are not bad, and saved me when I was a new post-op and couldn't manage calcium pills at all. There are also calcium citrate chewies from Bariatric Advantage, some of which taste good as well, though that is more expensive, and some have only 250 mg or calcium citrate while others have the full 500, so you have to check dosages. They also contain a small amount of sugar alcohols, which not everyone tolerates. So the lozenges might be her best choice.
I have never tried liquid vitamins. Even as a difficult pill swallower, I haven't needed them. If she does decide to try the big old calcium pills, a pill cutter is cheap, easy to use, and very helpful.
For the fat soluble vitamins, the emphasis should be on D, A, and K. I have yet to hear of anyone being deficient in E. The "dry" form is the only way to go. For multis I use the regular ones from Costco, and for zinc I use whatever is on sale at the drug store and that seems to work fine, at least so far.
Get her started taking iron now. Given that she probably has many years of periods ahead of her, iron supplementation may prove to be very important. If she has heavy periods, this is something that could be addressed with an ob-gyn. A lot of young women take birth control pills not for birth control but for heavy periods. OK, not what you asked about and maybe tmi but if her iron is already low this may be a real concern. It's hard to catch up if you are not absorbing iron well AND losing it at the same time.

Physical preparation for surgery - activity of course, but also deep breathing exercises. Some people find blowing up balloons a good way to practice deep breathing. Even with the surgery being done lap this is a very important issue post-op to prevent complications.

It isn't necessary to start vitamins right away. Her body has vitamins and protein stored up (except for areas of deficiency, which you are checking now) to get her through the first few tough weeks. She can then start adding in the vitamins.

 

[Mirabella]

I just got off the phone with the surgeon's office. We are postponing the surgery by one week. We feel that this extra week will give us the time that we need to prepare for this since we are switching horses midstream. We are still meeting with the nurse practioner tomorrow to have the questions answered. Apparently they do this surgery with a DaVinci robot. I have to admit, it looks cool as hell.

Since @Larra mentioned it, we had purchased Kirkland multi-vitamins from Costco for her to take before and after her sleeve surgery. Are these still OK for her to take for the DS as well? The rest of them we are checking into to find the best prices. I know that the pre-op class is supposed to give us all of this information, and we will go and take notes, but I also understand that it isn't the best information that we can get.

I will talk with Cristella tonight about the caffeine and the soda. Right now, she drinks three Red Bulls a day - that I know about.
I cannot tell you how much I appreciate the information and support that you have given our family. I am still waiting for the labs to be faxed over to me, if I can't get them today, I will pick them up tomorrow at the surgeon's and get them posted.

Thank you all so much. So very, very much.

 

[southernlady]

we had purchased Kirkland multi-vitamins from Costco for her to take before and after her sleeve surgery. Are these still OK for her to take for the DS as well?

YES, but not just one a day. I take 3 a day, others take 2 but they are cheap enough and fill in the blanks of the odd things we usually don't need much of.

There are two vitamins/minerals that do NOT want to be even high normal...(that I can remember off the top of my head), and that is B6 (NOT B12 but B6) as high levels of B6 and low levels of B12 cause the same issue...neurological damage. The other is PTH which is the gland that regulates calcium in the bones. You need a calcium level mid normal range, a D level high normal (as close to 100 as possible) to keep the PTH as low normal as possible. It's like a three legged stool...one gets out of balance, the whole thing tilts.

Yeah, the Red Bulls need to go NOW. And she is gonna have major caffeine withdrawal but they are not good even without surgery.

 

[DianaCox]

http://energydrink-us.redbull.com/red-bull-calories

They are essentially LOADED with sugar, and
"One 8.4 fl oz can of Red Bull Energy Drink contains 80 mg of caffeine, about the same amount as in a cup of coffee."

Both of those are going to be uncomfortable to stop cold turkey.

 

[aaa]

Welcome. I sent you a Private Message regarding documentation that might help. It'll give an idea of how my surgical team handles the vitamin/mineral & protein requirements.

 

[Larra]

Regarding the multi's, I have been taking the Costco multi's ever since my DS over 9 years ago and they seem to do the trick. @southernlady takes 3/day, I only take one, and that seems to be sufficient for me. I don't know how many will be sufficient for Cristella (lovely name, btw), and you and she won't know until post-op labs start rolling in.

3 or more Red bulls/day sounds like a lot of caffeine for someone so young. Well really for anyone, but esp at her age. It may help to cut back gradually, and the extra week should give her time to get going on this, but she needs to start now or she will be miserable post-op.

 

[DSRIGGS]

Regarding the multi's, I have been taking the Costco multi's ever since my DS over 9 years ago and they seem to do the trick. @southernlady takes 3/day, I only take one, and that seems to be sufficient for me. I don't know how many will be sufficient for Cristella (lovely name, btw), and you and she won't know until post-op labs start rolling in.

3 or more Red bulls/day sounds like a lot of caffeine for someone so young. Well really for anyone, but esp at her age. It may help to cut back gradually, and the extra week should give her time to get going on this, but she needs to start now or she will be miserable post-op.

Energy drinks are a problem for the younger generation according to this old Dad. I really dislike those energy drinks for kids and I had a drink of a red bull one day and about gagged...horrible tasting.

I will admit I drink a lot of coffee but I also drink a good amount of water as well. Caffeine doesn't bother me and it never has.