Dave's Bariatric Surgery

I graduated high school in 1964, weighing 165.  I attended a junior college, and weighed 185 after 2 years. In 1966, the Vietnam War was raging, and draft deferments for college folks were being altered, and a lottery system based on birth date was in effect for the military draft.  At that point I joined the Navy Reserve, taking tests, and ending up designated as a Communication Technician (R branch). The Navy later changed this rating's name to Crypto Technician.  This CT rating required a Top Secret Crypto security clearance, which had to be updated every 2 years and was maintained for 25 years. I attended Reserve meetings for 2 years, and then went on my 2 year active duty in the State of Washington at a Navy Communication Station in Marietta, WA.  After that I still had to attend Reserve meetings for at least two more years and I began schooling as a computer programmer. I worked in that capacity at Hughes Aircraft for less than a year, when government cutbacks cancelled the military contract I was working on, so I was laid off. I then joined the Carpenter's Union, in their 4 year apprenticeship program. At the Carpenter Apprentice ceremony in 1974, I was voted the Number One Carpenter Apprentice in the 11 Southern California Counties.  My skills as a carpenter came were instrumental in developing the majority of the cattery innovations at our cattery over the years.  I worked as a Union carpenter until 1991, when I developed heel spurs. I had two surgeries, and then developed other problems, and ended up on permanent disability in 1996. I smoked for most of the years between 1967 and 1991, but quit in the last year because I wanted to. The "magic bullet" for stopping smoking for me was to attend one session put on by a hypnotist.  I stopped smoking that night in 1991, so it worked very well for me. I also participated in the Naval Reserve program, having to retire as an E6 Crypto Technician, after 25 years in 1991, due to the heel spurs.  So the combination of quitting smoking, and the stopping of heavy activity at work, and stopping the Naval Reserve participation, led to a slow but steady weight gain. At my heaviest, I was 350. I had tried many "diet regimens" in the past. These included Weight Watchers, Healthy Lifestyles, and Herbalife. These offered temporary weight reduction, but that weight always was gained back over time.

    I almost forgot to mention that I suffer from major headaches daily. I've had many tests over a 5 year period of time, with no diagnosis as to the cause. This condition began around 1993, and has continued daily since. Although I've had an MRI, spinal tap, x-rays, and countless medical consultations with a host of different doctors, not diagnosis or cure for the headaches has been established.  I'm hoping "beyond hope" that these headaches will diminish as my health improves from surgery.

In mid 2005, I weighed over 325, and it was affecting my health. I had checked in to bariatric surgery (intestinal Roux-en-y) some 10 years ago, but found my health insurance did not cover the expenses.  Today this surgery, and the 2-3 day hospital stay cost my insurance company $27,000.    To fully understand what this surgery is about, please go to  http://www.crownsurgery.com/p158.html . In mid 2005, I discovered I might qualify for the surgery. I consulted my regular doctor, and found that I met the criteria for the surgery, and I signed up for the classes that were a pre-requisite for surgery.

Summer, 2003, Lake Powell Utah houseboat vacation, at 360 pounds.

photo of me in 2004 at about 350 pounds.

Photo of me 9/28/05, two weeks before beginning classes on surgery. Wt. about 340 pounds.

Photo of me mid summer, 2005, Wango Tango concert in Anaheim at 350-355 pounds.

Certain criteria must be met for this surgery. You either have to have a BMI (body mass index) of over 40, which is considered morbidly obese. Or you can have a BMI of 35 plus certain co-morbidity conditions. I had high blood pressure, sleep apnea, high cholesterol, and weighed 330, which put me into the co-morbidly obese category (for my 6 foot 3 inch height), with a BMI of 41.9 ,that qualified me for surgery. I signed up for the mandatory 8 classes that began in October 2005, and were completed in February 2006. I then went on a waiting list for surgery. In the middle of March, 2005, I was notified that I was scheduled for a surgery consultation with a Dr. David Sah, a general surgeon, who was selected by my Kaiser insurance to do any of their bariatric surgeries.  I had an initial consult on April 5, 2006, where the doctor said I was in good enough health for surgery.  On April 17, I had another consult with the doctor. I weighed 325 at this visit.  I had a pre surgery consult on May 1, where I weighed 314.5 pounds. I had made an effort to maintain or loose weight since the last doctor visit, as the doctor said he would not do the surgery if I gained weight, and if I lost weight, the surgery would be easier for him. I was scheduled to have surgery on May 10, 2006.

Photos morning of surgery,315 pounds.

I got to the hospital at 6 AM as my surgery was scheduled for 7:30 AM. This is the first in hospital surgery of my life, so I was somewhat nervous. I was prepped for surgery by the staff at the hospital, and I spoke to the doctor and anesthesiologist for a few minutes. At 7:30 I had the surgery.  I'm told the surgery lasted about 1 hour and 20 minutes.  I spent May 10 and 11 in the hospital, going home at noon on May 12. I was quite amazed at the fact I was not hungry at all. I was on a liquid diet for the first 2 weeks, which allowed me to eat chicken broth, pure fruit juices, water, and non sugar popsicles. I went back to the doctor  on May 18, where I found out I lost 14 1/2 pounds, putting me at an even 300. I was now allowed to eat semi soft food, such as cottage cheese, scrambled egg, yogurt in TWO OUNCE portions every 2 hours. I also have to drink a protein shake every afternoon to make sure I get enough protein. I bought some Isopure Whey Protein shake powder from GNC Stores, that has 25 grams of protein per scoop of powder. I normally have a 2 scoop shake (50 grams of protein) every afternoon about 3 PM.

    One month past surgery, my doctor visit put me at 290 pounds. I was feeling well. I guess I'm doing better than a lot of patients of this surgery, as I've only thrown up twice since surgery. Once was due to drinking a larger than normal amount just after eating, and a the second time was due to slightly over eating. Every meal must be 2-3 ounces at this point. I do eat some soft fruits, chicken, turkey, sliced deli meats, boiled and scrambled eggs, a little beef, cheese, and yogurt. Basically most of my current diet is almost pure protein.  I am due to go in for my 3 month check up with the doctor on August 8. My weight scale at home was calibrated as close as possible to the doctors, and I note that today I weigh 265 on 8/5/06. 

I do have to do some exercise every day. This normally is a brisk walk with my German Shorthaired Pointer (Madison) around the block in the cooler part of the day. This walk is about 1 1/4 miles. Some days I do this twice, and one day I had "extra energy" and I did 3 walks around the block.  But I'll see what I weigh in a couple of days.

Photos 8/5/06 at 266 pounds

    On August 8, my 60th birthday, I went to the surgeons office for my 3 months check up. Although my scale at home was calibrated as closely as possible, my official weight there today was 266. This meant that I had now lost 49 pounds since surgery. The surgeon stated that I was loosing an average amount for this time frame.

    BTW, there are some restrictions on this surgery as far as diet is concerned. Some of them are:

• You cannot drink carbonated beverages, such as soda or beer any more. The carbonation could cause the surgery to separate, meaning a trip to the hospital for emergency surgery.

• Most people have problems digesting white bread, most pastas and rice--primarily high carb type foods.

• A high protein diet is a daily requirement. After a few months, 3 ounce portions of protein (fish, chicken, cheese, etc.) are to be consumed first at each meal. Then you can have a very small portion of starch or vegetable, about 2 tablespoons of each. You eat the protein first, to make sure you get enough protein. You would not want to eat the starch or vegetable first, and then feel too full to eat the protein.

• You have to avoid refined sugar foods. These are candies, cakes, pies, etc. The new stomach area cannot digest the sugars, which are then fed into the blood stream in an undigested form. This causes a "dumping syndrome", which involves fainting, heavy sweating, rapid heart beat, nausea, anxiety, and possible diarrhea.  So you do have to give up your "sweet tooth", if you have one.

• You have to eat protein with almost every meal. This means that a minimum of 75 grams of protein must be in your diet daily. This is almost impossible to do on the smaller portion sizes, so daily protein drinks are a must. A daily amount of protein drinks that provide 50 grams or more of protein are recommended.  I heartily recommend the Magic Bullet to mix your protein drinks. These machines are compact, come with mixing/drinking mugs, and are available from department stores (such as Target) or are available for ordering on TV ads.  The Magic Bullet is far easier to use than a conventional blender, are easier to clean up, cost less, and take up less counter space.  Sometimes I add peaches or berries to the protein powder, and mix it up in the Magic Bullet, making a smoothie.

• Chewable vitamins, at twice the RDA adult dose, must be taken daily.  The smaller "pouch" stomach area cannot dissolve some tablets, so vitamins in tablet form are not recommended. Also, chewable calcium is recommended. Calcium Citrate is the preferred form of calcium, as it is digested easier than Calcium Carbonate. The Calcium must be taken 2 hours later than the multivitamin, to avoid Calcium malobsorption, and depletion of iron in the multivitamin.

• Calcium Carbonate should not be used as your calcium supplement.  Tums are calcium carbonate, used as an antacid for upset stomachs.  Stomach acid is needed break down the calcium for absorption by your body. You have reduced stomach acids in your new small pouch. So using calcium carbonate will greatly reduce your smaller stomach acid levels,  but it also prevents full absorption of the calcium.  This is why calcium carbonate should not be use by RNY patients.  Calcium citrate is normally only 21-25% elemental calcium. I asked my surgeon about this and he told me the normal elemental calcium amount contained in calcium citrate was acceptable for RNY post op daily usage.

• Limit your calcium citrate intake to a maximum of 600mg at a time. Reason: stomach acid is needed to absorb the calcium. Too much calcium, and your limited stomach acid cannot absorb it, and it ends up not being processed.  So trying to take a days worth of calcium citrate (1500-1800mg) at one time is depriving your body of the amount of calcium your body needs, so split your calcium into 3 doses during the day.

• You have to drink 48-64 ounces of water daily. This is to prevent dehydration.  You may also drink no calorie beverages like iced tea, or Crystal Lite, but no sugary drinks, or you may spend a lot of time in the bathroom.

• You have to adopt some form of a daily exercise regimen. Exercise is a part of the process in loosing the weight. Without the exercise (walking at a minimum), the surgery will not be of benefit to you.

• This surgery is a new "lifestyle". Modifications of your old habits have to happen, or you will have problems. So I would recommend that you start some of the regimen prior to surgery, so that you are in practice. I know that I used to consume 4-6 cans of Pepsi 100, the no calorie diet soda. I stopped that prior to surgery, as I know it would probably be difficult to do after the surgery.

        On August 9, I saw the doctor that follows my progress with my insurance carrier. I had labs done on August 2, and got to see the results today. I guess I'm doing OK, as all of my blood levels were acceptable to the doctor. The doctor told me that they do worry about dehydration, B-12 levels, protein levels and a few other things with bariatric patients. All of my blood work came out acceptable, and the B-12 levels and protein levels were at the upper end of the acceptable levels. My doctor told me that this indicated I was doing well.  I asked about cholesterol levels, but that is checked at 6 months after surgery. If my B-12 levels were low, I would be required to take monthly B-12 shots at the hospital. Good news to me.

    On August 10, we had a nice surprise. The Ragdoll mink male, Ragnarok's Hershey Barr,  we saved from last year, produced 4 minks in one litter today. Nice way to start the day. I've decided to begin "stepping up" the exercise. I now go for two walks per day. It's a 100 degrees here now, and I have to do the walks at cooler times of the day. Last night I took a walk at 9:30 PM, as it was still about 85 degrees here.  This morning I took my walk at 8 AM, before it began getting to warm. Also of note today, my weight is under 260---so that is a total weight loss of 67 pounds in a little over 4 months since my first visit with the surgeon.  I've been taking two walks per day, one early in the morning and one in the evening. On August 13, I took 3 walks for a total of 3 3/4 miles.

    Weight seems to now plateau at a slightly over 260. I've dusted off my wife's exercise machine, the one she used during rehab after shoulder rotator cuff surgery. This is it: 

This is a Nu Step TRS 3000, Total Body Recumbent Stepper. The seat is fully adjustable, so that your legs feel comfortable against the foot platforms. The arms are also adjustable to fit your arm's length. There is also an 8-level  tension adjustment to control the amount of effort to push against the pedals. Thirty minutes on this will really make you sweat, so be sure to have either a ceiling fan or stationary fan on in the room. It does have a heart and pulse monitor that came with it too. Got on this machine for 20 minutes on 8-17, instead of doing my second walk. 20 minutes was enough for me for the first time in years. It's my wife's machine that she had used in rehab for a shoulder injury. She liked the machine so much in rehab, that she bought one for home usage. She told me that the therapists normally start people out for 10 minutes on the machine per day, and then step up to 20 minutes after a few days.  Anyway, I got up the next morning and now am at 258, so I'll probably adopt a new exercise regimen, one walk in the morning and a work out in the afternoon.

    I've been taking two walks daily as of this date, 8/24, one in the AM and one in the PM. Yesterday I did not do a walk in the morning due to a busy schedule, so I walked the dog on my standard 1 1/4 mile walk, came home and dropped off the dog. Then I continued on for another 35 minutes until 8 PM. So I had an hour walk, about 2 1/2 miles in the cool of the evening, ending about 9 PM. I rested very nicely last night.  I'm driving to LA Airport tonight, so that will preclude my normal evening walk, as I have to ship 3 cats on a "red eye special" to get around warm temperatures. 

    Today is September 3, 2006. I've been doing two walks daily since my last update. I think I'm loosing more inches than pounds at this point. Although I truly do watch what I eat and how much, weight seems to come off slowly, even though it is just under 4 months since surgery.  This morning my scale said I weighed 254.  This new weight puts my BMI at 31.9, which is the lower end of the "obese" category.  Once my BMI gets to below 30, I am then considered "overweight" which is far better than the morbidly obese condition prior to surgery. Currently my diet consists primarily of some of the following daily:

• 4 pieces deli meat, usually turkey, providing 20 grams of protein.

• 4 ounce portions of reduced fat raspberry or strawberry yogurt, about 5 grams of protein taken 1-2 times daily..

• reduced fat string cheese, 2-one ounce sticks, about 14 grams of protein, once daily.

• about 2/3 cup of Special K breakfast cereal, with 2 ounces of 1% milk, giving about 4 grams of protein, for breakfast.  I recently found Special K Protein cereal, which gives 10 grams of protein on a 2/3 cup serving. I only consume a 1/3 cup serving for breakfast.

• at least one 2 scoop shake of Isopure Whey Protein drink, giving about 50 grams of protein, normally about 3 PM.  Make sure to read the labels on the Isopure. You want the type that has 0 carbs and zero or minimal grams of sugar. They do have an Isopure powder that is for body builders that has a high carb level, and this is the one you DO NOT want. It currently comes in 4 flavors at my local GNC stores--vanilla, chocolate, strawberry, and peach-mango.  I normally mix one scoop of vanilla with one scoop of another flavor for my protein supplement.

• a couple of snacks per day consisting of a small peach, a few almonds, etc.

• and a dinner. Example: last night I had one chicken leg, 2 tbsp of oven roasted potatoes, and about 2 ounces of vegetables. This meal was probably about 15 grams of protein.  I have very little pasta, some fish, some beef--eating the protein portion first before the rest of the small meal.

• As a "treat", I sometimes have a "no sugar" popsicle or an "all fruit juice" popsicle, when I have my evening walk.

• A small cup of pre-made sugarless jello.

• I try not to eat past 7 PM, but sometimes have a 4 ounce reduced fat yogurt.

• And this yields  a target diet of 75-80 grams of protein that I must have daily at this time.

`My current daily routine also consists of a 1 1/2 to 2 hour nap daily around 1 PM. I adopted this routine several months prior to surgery. Taking the nap allows me to get through the balance of the day without major headaches, which I have daily.

    I attend monthly bariatric surgery support group meetings in Corona, CA. These meetings have pre-op patients as well as post-op patients in attendance. I feel that attending these meetings is important to stay "on track" with the post operative diet and exercise program. We share experiences, and often have dieticians or surgeons that speak at these meetings.  One thing I learned on the September 12 meeting, was that a doctor at a recent Obesity Helps seminar had recommended a minimum of 100+ grams of protein daily, especially for men. So now I'm adopting the practice of having two of the 50 gram protein shakes daily, one in the morning, and the other mid afternoon. These meeting have some of my surgeon's staff in attendance, with the $2000 Tanika scale to check on our weight progress. This is the same scale the surgeon charts are post surgery progress. I weighed 255.5 pounds on his scale that evening.

    Today is Sept. 15. I got up at 4:15 AM as my nasal passages were plugged and I could not breathe with my CPAP machine. I weighed myself this morning. Good news--I'm now 251. Yesterday I had one walk in the morning, spent 30 minutes on my Nu Step machine, and took another walk at 6 PM last night. Each walk was around the block, 1 1/4 miles. Diet of yesterday consisted of: 3 ounces of Wheat Chex/Sugar Twin/2 ounces of 1% milk at 6:30 AM, one 50 gram protein shake at 10 AM, one small peach at 11:30, 4 slices of deli turkey sandwich meat, a second 50 gram shake at 2:30 PM, one small serving of sugar free Jello at 5 PM, another serving or Wheat Chex at 6:30 and one 6 ounce serving of low fat strawberry Yoplait yogurt between 7:30 and 8 PM (ate it slowly).  I think I'll try the same eating and exercise program as yesterday, and hopefully my next entry will be at 250 pounds. Just checked my weight at 5 PM and it's 249, and that was before my evening walk. I'm really hoping tomorrow morning weight will still be under 250.

    Sunday, Sept. 17. Woke up today, and I'm now at 249.  Did two walks yesterday, and spent 30 minutes on the Nu Step machine. Only had one 50 gram shake yesterday, had my normal mid day diet, but "splurged" and had an order of 5 beef taquitos, no guacamole, and dipped them in mild sauce (no calories in sauce). Ate 2 1/2 of them and was full. Guess I'll have the second half for lunch today.

    Today is Sept. 29. Got a new electronic scale the other day to make sure my weight is measured accurately. It's Health O Meter digital scale. Before you weigh yourself, you just tap on the corner, and it calibrates itself. Weight today on this scale is 248. The other scale became difficult to get consistent readings, so my wife got me this new scale the other day. I was wearing 4X and 3 X shirts, but they were getting too loose. Now I fit into 2X shirts, and 1X shorts instead of 2X shorts.  Keeping up the twice daily walks. Went to the post office today to make a large envelope, and got compliments from staff there who had not seen me in a few weeks. Then I went to the local small hardware store to get a plumbing part. Women staff there also noted the difference in my appearance. Got many questions on the surgery, that I was very glad to answer.

    Today is October 10, 2006. This is exactly 5 months past surgery. New photos below:

October 10, 2006

In this photo taken today, I'm wearing a 2X shirt and 1X shorts.  When I started I was wearing 4X shirts and 2-3X size shorts.  Today I weighed in at 245. This is a total loss of 70 pounds since surgery 5 months ago, plus the 10 pounds I lost the two weeks prior to surgery, for a grand total of 80 pounds. My goal weight is 220-225 pounds, my normal weight when I was working many years ago.

The photo above shows some items of my daily routine. The four left bottles are the Isopure whey protein drinks I drink twice daily. Two scoops of these powders, mixed with about 6 ounces of water and two ice cubes, provides a 50 gram serving of protein.  The black/silver item on the extreme right is the Magic Bullet machine that works very well for mixing these protein drinks. The clear plastic shape on top is the mixing and drinking mug for the protein shake.  Second from the right, is an individual cup coffee maker, where I make decaffeinated coffee every morning. Not seen in this photo is a "non sugar" French vanilla coffee creamer.  These items are a way of life for me now, and they are quick and convenient to use.

    Today is Saturday, Oct. 14. Friday the 13th was a busy day here. I had cat litter delivered, had a return call for my exterminator service due to poor service, and then had a cat client here for 5 hours. Then I had to pick up cat food, as I ordered it too late for delivery.  So yesterday was a productive day. Today I weigh 244. This past week I had some minor constipation problems. Due to the smaller amounts of food, most people with this surgery only have bowel movements every two days. At my support meeting this past Tuesday, we discussed this issue. A member of the group, who had surgery 18 months ago, stated that she takes two generic Colace stool softener gels every morning and every evening. I've used this sporadically since surgery. But now, I've adopted her routine too, and have not had any problems since.

    My surgeon's office gave us a card to keep in our wallet. It states we have had this surgery, in case of a medical emergency. On the back of this card, is a note addressed to eating establishments. It simply explains that the cardholder has had this surgery, can only eat about one tenth of a normal meal, and asks the establishment to offer a child's menu, senior menu, or some form of reduced cost meals. Several member I've spoke to at the support meetings have said that they seldom choose their own meal, but eat a portion of their spouse's meal on a separate plate. I recently went to a Mimi's Restaurant, and ordered off of the child's menu that they were promoting that week. Even though I showed the waitress and the cashier this card, they still charged me $2 extra, since I was over 9 years of age. So not all restaurants will offer this reduced cost menu. 

    Just checked one of the Body Mass Index calculator indexes over the Internet. I'm 6' 3" and 244 pounds, and that means a BMI of 30.5 today. When I started I had a BMI of 39.5.  This current number is still in the "obese" category, according to US standards. Once I get to a BMI of 29.9, then I will only be considered overweight. Once I loose 5 more pounds and get to 239, that equates to a BMI of 29.9, putting me out of the "obese category", into the overweight category. Checking these BMI sites further, in order for me to get to the "normal" BMI category of 24.9, I would have to weigh just under 200 pounds. My goal weight was 220-225 pounds, which was my weight when I worked as a carpenter for many years. I have my doubts if I can get down below 200 pounds, so I'll probably never be in this "normal" weight category. The doctors tell you that few patients get down to their "ideal weight" but most are successful at a major weight loss, and the health benefits that are a result.

    This next week I get lab work done for my 6 month check up since surgery. I'm hoping my cholesterol drops significantly, which means I can now get off of one more medication. My blood pressure has been about 109/73, as I monitor it twice a week or so.  With the doctor's permission, I may be able to get off of that one last blood pressure pill I take daily. Prior to surgery, I would take two blood pressure medications, totaling 3 pills daily. I'm down to one pill daily now, and with any luck, I can get off of that tablet shortly.  From my support meetings, I've learned also that the vast majority of diabetes patients are off of their diabetes medications within 2-6 months past surgery, and these patients feel significantly better almost immediately past surgery.

    It's early on October 15. Today I weighed in at 243.5 pounds. I spent 4 hours straight working on my cattery management book last night. It now has 65 pages, with 54 photos, and the book is less than 50% complete.  I stopped using my CPAP machine this week. I seem to sleep well, and feel fully rested in the morning. So sleep apnea is no longer a problem.

    On October 22, I had a few "dizzy spells", falling down one time at home. I called my general practice doctor, and I am now off of all blood pressure pills. My BP was about 96/66 that day. I began monitoring my BP for several days, and had to get a new BP monitor, as my old one just failed. New BP tests around Oct. 27, are around 117/76. I've just had my 6 month lab work done, and I see the surgeon on November 7 for my 6 month check up.

    Today is November 7, and I went for my 6 months checkup.  One of my doctors noted that my labs showed that I was slightly low in Vitamin D, even though I do daily walking. So, I'm taking a prescription level Vitamin D for 3 months, and then I will have a new lab test. Photos below are from today, just after I had my late afternoon walk.

    The surgeon's office weighed me today, and the result is 237 pounds.  I recently have had a few dizzy spells, and asked the surgeon about this. He said that I may not be drinking enough water, and that I probably need to eat a better combination of carbohydrates and protein, as these are the primary reasons for feeling somewhat dizzy. Blood pressure today was 125/80, pulse of 63. Below is a chart showing blood levels before surgery and at 12 months post surgery:

                                        1/20/2005                2/2/2006                    10/20/2006            5/31/2007

Cholesterol (total)                   183                        174                               109                       134

Triglyceride                              152                        199                                78                         71

HDL (good cholesterol)             43                          42                                43                         52

LDL (bad cholesterol)             110                          92                                 50                        68

Cholesterol/HDL                       4.3                        4.1                                2.5                      2.58

    As you can see the cholesterol levels have come down significantly. This means I can now stop taking my cholesterol lowering tablets. I've been taking these for over 5 years.  Today's doctor visit also reflects a total weight loss of 88 pounds in 6 1/2 months.

    Today is December 13. Today I weigh 228, making a total weight loss of 97 pounds. I will post photos when I make the "century mark", loosing 100 pounds.

    Just prior to Xmas, I hit the "century mark", loosing 100 pounds. I now weigh 225 pounds. This is the weight I hoped to attain from this surgery. The surgeon also told me I would continue to loose a little more weight in the next 6 months.   In late November, I had an accident with my table saw. The material I was cutting fractured, and I cut my left thumb, requiring 7 stitches. I was put on antibiotics for 7 days to prevent infection. After a few days of using the antibiotics, I had constant diarrhea, even though my diet remained the same. Foods I had eaten for weeks now caused diarrhea. I went to my doctor a few days later to get help. I discussed my surgery and diet with him at length. Then he noticed on my electronic record that I had been seen in the emergency room. He asked me if I had been prescribed antibiotics. I said yes, and he said that was the answer. He verified the antibiotic, and told me that my good bacteria in my lower tract was killed off by the antibiotic, causing diarrhea.  I now know to be cautious of antibiotics, and to mention my bariatric surgery when a doctor prescribes them. I went to the doctor on December 27 for another minor problem, and the "urgent care" doctor prescribed antibiotics. I told him of my surgery, and he changed the antibiotic he was prescribing, noting that the chosen one would not cause "gut problems". So, if you do have bariatric surgery, please keep this in mind. Antibiotics can prevent infections, but they can also have other side effects. So, it's important to let the doctor know of you surgery when antibiotics are prescribed.

    I consulted with my general doctor about the dizziness. He ordered a Holter Monitor study for me. This is a machine that records your heart's activity for 24 hours. These dizzy spells had me worried. I finally got the results of the Holter Monitor study. The results showed a condition called  PSVT, which stands for Paroxysmal Supra Ventricular Tachycardia. This condition is a sudden rapid heart beat, which is causing the dizziness. It has a sudden onset, and disappears within a few seconds. Sensors in my body "trigger" this condition, such as stress, etc.  My doctor told me to begin taking a small dose of my blood pressure medicine once daily, and that seems to be helping.  I was worried about these dizzy spells, but my doctor assured me that my condition was not serious. On this low dose of blood pressure medication, the dizzy spells are now almost non-existent.

    I just had my one year checkup. All of my blood work was excellent, except I'm having some problems with Vitamin D. My doctor has put me on another 3 months of 50,000 units of Vitamin D once weekly, and we will retest in 90 days.  All of my protein levels, other vitamin levels are well within normal levels--only the Vitamin D seems to be a problem.  Blood pressure was 118/76 with a pulse of 60.

    On September 11, 2007, I had a review of my recent blood test.  My doctor had ordered another 3 months of the same Vitamin D units as noted above. My weight checked in at 218, and my blood pressure was 118/76.  I began taking a new higher standard dosage of calcium and standard vitamin D, with 1800 mg of calcium and 800 units of vitamin D about 4 weeks ago--taking 4 "horse pills" daily.  My doctor explained that the normal range of vitamin D was 30 to about 80 units.  My previous blood tests had shown a vitamin D result of only 14.  My most recent test show a new level of 37 for vitamin D, so now I was finally in the "normal" range.

    I also take two of my blood pressure pills (Verapamil--generic Calan) daily. I had experienced an occasional dizzy spell under stressful times, even while taking one blood pressure pill daily.  Taking two of these blood pressure pills seems to prevent any dizzy spells at this time. I take one pill when I get up each morning, and the second when I go to sleep at night.   Even though most patients go completely off of blood pressure pills, I've resigned myself that these pills will probably be necessary for the rest of my life.

    My weight does fluctuate slightly. I seem to stay between 218 and 222 pounds at this time.  My diet and my activity level vary slightly, as I do not eat the same menu daily, and my exercise routine (walking) is sometimes disrupted by a change in my daily routine.

    One important factor to remember is vitamins.  I've been taking the GBG 10-in-One Liquid Multi Formula for a few weeks now. I attend monthly bariatric surgery support group meetings. These meeting are designed for pre and post operative patient, so that they can learn the most knowledge on how to daily deal with the results of the surgery.  I brought the GBG Multi Formula to a recent meeting, and gave out free samples. Everybody loved the taste. I gave a copy of the Supplement Facts of the GBG Multi Formula to the office manager of my surgeon, to get his opinion. I received a phone call from the office manager 2 days later. I was told that my surgeon had reviewed the Supplement Facts sheet, and found nothing that would be detrimental to by-pass surgery patients.  The surgeon was impressed enough with the vitamin levels that he has authorized me to hand out brochures on the product at the monthly bariatric support group meetings. By-pass (bariatric) patients have to be cautious of their diet, and must take a daily regimen of a high quality vitamin supplement daily for the rest of their lives. So finding a good one can be difficult. I've tried several types over the past 1 1/2 years. I began with another brand of liquid vitamin, called Vemma, but found the $59.95 price per month to be expensive. I compared the supplement fact sheets between the GBG Multi Formula and the Vemma I had used for 3 months, and I found the GBG product to have higher RDA levels of almost every vitamin !  UPDATE: GBG has had many changes since May, 2008:

• Many supplements were either removed or decreased.

• Calcium citrate is no longer used.

• Two sets of delivery delays.

• And 3 changes in formulation that affected flavor.

   In mid June, I became aware of a brand new liquid vitamin--that has 2 GRAMS OF PROTEIN per daily serving.   Epic Ultra liquid vitamins became available to the public in August, 2008.  I now use EPIC ULTRA liquid vitamins, as noted further down in this story. The EPIC ULTRA vitamins have even higher supplement levels than the original formula of GBG vitamins and has 2 grams of protein and 15% RDA of calcium citrate per serving.  Click HERE to see a comparison chart between the new version of the GBG compared to the EPIC ULTRA liquid vitamins. There is a big difference in the supplement levels of the original GBG liquid vitamin formula of Summer, 2007 and the current one being sold.  Better nutritional levels in the EPIC ULTRA !!  ON August 1, 2009, GBG changed their price to $29.97 per bottle, about $10 more than EPIC ULTRA.

Refer to the chart below to see what NRH offers against other brands:

Adult RDA: A=5000 IU, C=75 to 90mg, D = 400 IU, K = 80mcg, B1 = 1.5mg, B2 = 1.7mg, B12=6 mcg

  Go to www.BariatricLiquidVitamins.com or www.LiquidBariatricVitamins.com for full details on why EPIC ULTRA liquid vitamins work so well for bariatric surgery patients.

     Good news again. Today is October 10. My weight has leveled at 215 for the past 10 days. So it appears that I'm still loosing a small bit of weight, even when it exactly 17 months since the day of my surgery. Many bariatric surgery patients consider their surgery day as their new "birthday", as it's the beginning of a new chapter in their life.

Today is November 6, 2007. This morning I weighed 210.  I've been doing the same daily routine as far as exercise and diet, but I'm again slowly loosing weight. The only thing I've done differently in the past two months is I began using the GBG Liquid Vitamins.  Liquid vitamins work faster in your body, as they bypass the digestive process, and are working in your body in 3-4 minutes after drinking them.

Even though it seemed I had "plateaued" at around 220 pounds for months, I'm again slowly loosing weight some 18 months past surgery.  I'm guessing it that I may have been missing some needed nutrients with the chewable vitamins that I now get with the Liquid GBG. Anyway, I'm feeling great. Here are some new photos:

These photos were taken on 11-6-07 after I got home from a local bariatric support group meeting. I find these meetings very important to proper weight loss after surgery. Photo was taken in front of my 52"screen Sharp LCD TV that was my Xmas present.  It was a present to myself at Xmas, 2006 for loosing my 100 pound target weight that I had mentally established at the time of surgery. Using a index tool on the Internet, my new Body Mass Index is 26.1.  I'm wearing a XL shirt and XL shorts in the photo above. This is a massive difference from the 2-3X size shorts, and the 4X shirts I had to wear prior to surgery.  I weigh 207 pounds in the photos above. 

    Today is December 12, 2007. I now weigh 200 pounds, with a BMI of 25, which rated as healthy on BMI charts.  I take my vitamins daily, do my exercise, drink water, and take my calcium supplements. My doctor changed my blood pressure meds to an ace inhibitor, as he felt that my slow pulse (now around 45-50) could be subject to problems with my old blood pressure meds.  I now attend 4 support groups monthly, which I find to be beneficial to my weight loss.

    Shortly before Xmas, 2007, I passed out in my kitchen. I'd mentioned I'd been having problems with faint feelings. I went to my GP early in January and he did an ekg in his office. He noted my pulse was slow, and said to case taking the Verapamil blood pressure tablets, as they could stop the heart on a patient with a slow pulse. In in mid January, 2008, I was fitted for a 2 week Event Monitor. When they initially monitored the unit, my pulse was 38, far below normal. I wore the Event Monitor for the two weeks and nothing showed. I got a referral to a cardiologist the end of January.  The cardiologist ordered another Holter Monitor test, which recorded my heart activity, etc. for a full 24 hours.  One week later I had a consult with the cardio doctor. On that day, my pulse was 45, still below normal. the cardio doctor showed me a readout of the Holter test. It showed periods of rapid heart beat of around 130 beats per minute, then back to normal, then elevated, then sometimes there was a lag in my heart rhythm returning to normal. According to the doctor, this lag in my heartbeat was probably when I felt faint or actually passed out.  This consult was on February 8, 2008.  The cardiologist said we could fix the rapid heart beat with using Verapamil again, and that I'd need a pacemaker implant surgery to fix the slow pulse rate.

    On February 12, 2008, I was admitted to the hospital.  The pacemaker surgery took about 1 hour and 15 minutes, under local anesthesia.  I spent the night in the hospital for observation. I came home and felt fine. I returned to the cardiologist on Feb 19 for a check of the pacemaker. My pulse is now a steady 60, and my blood pressure is 124/83 under medication.  My chest felt bruised for a few days from the surgery, and the surgical glue used to close the wound was very difficult to wash off. Otherwise, everything is wonderful. I walk daily again, after a 3 day rest from surgery. My only restriction is that I cannot lift my left arm higher than my chest for 4 weeks. This is to prevent the two wires of the pacemaker from becoming dislodged from my heart. I will return in 2 months for another recheck from the cardiologist. 

    On April 21, I had an appointment with my cardiologist. Everything was looking great she said. The pacemaker would not need another check for 6 months. Nor more dizzy spells, YES !!

     I had blood taken for my 2 year lab work done on 4-24. I have an appointment for 5-13 to have them reviewed with my doctor. I will announce the lab reports here, once I receive them.

    I had a "man WOW moment" last week.  I'm now in "Onederland", meaning I'm under 200 pounds. Just barely, being 198-199, but that's OK.  I was on my walk the other evening, when a woman came out of her home to ask me something. She asked me "aren't you the guy who raises the Ragdoll cats down the street?" and I replied yes. She said that it looked like I had lost a lot of weight, and she wanted to know how. I told her I had RNY. Her reply, was "me too". I didn't recognize the woman, but she reminded me that she had purchased a dog run from me about 2 years ago, just before my surgery. She said that she lost 100 pounds in 5 months, but had some problems with kidney stones too. Once she told me about the dog run, then I remembered her. She was 285, and was now 185 and will probably still lose weight. She told me she'd do the surgery again "in a heartbeat" as she feels so much better now that before surgery. 

May 2, 2008: I knew I'd lost a couple of pounds on Saturday from weighing myself Sunday morning. Tuesday I got up, weighed myself, and I almost cried.  I weighed myself again late afternoon, same weight--195.4 pounds. So it's official, I've lost 150 pounds since I started this journey. I announced my progress at my support group meeting on Tuesday I was so happy. Today is Wednesday, and I weighed myself, scale showing 194.8 pounds. It's official

   Dave's a happy camper.  Oh, Happy Day.

    On May 13, 2008, I had my two year lab work reviewed by my doctor.  The doctor was happy with my lab results, and wanted to know what I was taking for vitamins. I told her about the liquid vitamins I used, and was asked if I had any literature on them. I retrieved a supplemental fact sheet on the original GBG liquid vitamins and provided it to the doctor, as requested.  I was extremely interested in these lab results as I'd been taking the liquid vitamins for 7 months. Results:

Cholesterol, 135 (normal <200), Triglyceride 86 (normal <150), HDL (good) 60 (normal >/=40), LDL (bad) 58 (normal <100), cholesterol/HDL 2.3 (normal <5.0).

Albumin was 4.6, normal 3.3 to 4.8----Calcium 9.7, normal 8.5 to 10.5----Creatinine 1.3, normal 0.7 to 1.3,  Electrolytes (Sodium was 142, normal 135-145, Potassium was 4.8, normal 3.5 to 5.0, Chloride was 103, normal 101-111, CO2 was 29.5, normal 21-31),--- Glucose (fasting) was 84, normal 70-99, Iron was 107, normal 60-170---- Total Iron Binding Capacity was 290, normal 250-420----Iron Sat was 37%, normal 20-50%----Ferritin was 416.8, normal 30-400----Folate was 13.95, normal >5.38----Parathyroid was 57, normal 15-65----Thiamine (B1) was 192, normal 87-280----B12 was 584, normal 200-910----Vitamin D was 33 (25 for D3 and 8 for D1), normal total is 30-100.

    As you can see everything tested was in good standing except the vitamin D, which was low normal reading. Even with walking daily in the sun, and calcium citrate/D, the 600IU of D in the liquid vitamins and one 400IU D supplement, my body still has a problem with maintaining higher levels of vitamin D. In most of my previous labs, I was way below normal in vitamin D.   So I'm very happy with the results using the liquid vitamins instead of taking pilled vitamins.  I do NOT take any sub lingual B12, only the liquid vitamins. So you can see that liquid vitamins can be absorbed and provide good levels of B12, right in the middle of the normal range.  One ounce of the liquid vitamins provided these results, with the minor exception of the small amount of extra vitamin D taken to try to help my long standing  issues with normal levels of vitamin D.  Further proof that liquid vitamins are absorbed well and provide good vitamin levels.

    I had mentioned NHR Epic Ultra liquid vitamins briefly earlier in my story. These have 2 grams of protein, 15 % RDA of calcium citrate, high in antioxidants, taste goo--like apple cider, and have several additional advantages over traditional pilled vitamins. They begin working in your body quickly as they bypass the digestive process, are only $19.95 a month (plus shipping and handling), and can be either ordered as a preferred customer, or shipped to you on a auto-ship basis.

Why take all of these tablets? When you can take ounce of ?

If you click HERE, you can see a video presentation on Epic Ultra liquid vitamins.

Click http://nldbc.com/nopillvitamins3 to place your order of the Epic Ultra liquid vitamins, the NRG energy capsules, the Herbal Klenz Tea, or other Greenwood Health Systems products on a secure ordering link.  No confusion about selling, this is a straight forward RETAIL ordering link.

• The page that comes up will say Natural Longevity Discount Buyers Club. 

• Click "Claim Your totally Free Membership" link.

• This takes you to the ordering page, where you just place an order to become a member. No membership fees whatsoever.

• There are over a dozen products offered here, all used by health professionals. You can read more about these products on the products available at http://www.greenwoodhealth.net/nopillvitamins3 .

    You can also elect to have multiple bottles delivered at one time to save on shipping. Shipping and handling on one bottle is $9.95 a month with autoshipment, but shipping 2 or more bottles at one time as a retail customer costs only $15 for the shipping and handling fee. This means that if you order 6 bottles at one time, your net cost per bottle is $22.45.  This is a savings of $7.50 per month on your vitamins, when compared to having one bottle shipped each month.  If you would like to place a single or multiple bottle order as a retail customer, please go to http://nldbc.com/nopillvitamins3.

    I have a special web site, explaining the full benefits of Epic Ultra at www.liquidbariatricvitamins.com with comparison charts with other higher priced vitamins, as well as other data on the Epic Ultra liquid vitamins. There is a link within this web site where you can order them on an AUTO-SHIPMENT BASIS at www.greenwoodhealth.net/nopillvitamins ,assuring you get a delivery every month (so you don't forget to order your daily vitamins) . There is also a small business opportunity offered, where you get free a free web site, no monthly hosting fee, and no purchase of large quantities of vitamins is needed. Details on the link provided or you are more than welcome to call me at 951-846-9179 to ask any questions you may have about these vitamins, or the business opportunity. I bring these vitamins to my support groups and fellow members like the apple cider taste very well. At a support meeting in November, 2008, I had two fellow members state to the large group that their 6 month lab reports came back excellent, after taking the Epic Ultra liquid vitamins since August or September.  Further proof as to how well they work for RNY patients.

    Many people have asked me about a good protein source. Normal meals are the primary sources of protein for most post ops, but I've found a very good protein rich snack. My wife had a RNY revision from a gastric bypass of 1980. When the revision was done, a good portion of her "unused intestines" were reattached. The intestines had atrophied from the diameter of your thumb to the diameter of your small finger. This made eating a major chore for her, and quite painful. I searched for something small in size and easy to pass through the intestines. I found DRIED PEAS.  Yes it's the green veggie from your dinner table, but dried, and it has 6 grams of protein per 1/4 cup.  Stats and photo:

Close up of dried peas, this one pound bag has 108 grams of protein, and the chart below gives the nutritional value:

I've had many people ask me where I got these, and I said I buy them locally but you can find the over the Internet. Then I hear about prices like $3.60 for 4.5 oz., $8.69 for 9.5 oz, etc. I have them available for $5 a pound plus $5 for flat rate 2 day priority mailing. Two one pound bags will fit into the Flat Rate envelope for $5 shipping. Each one pound bag comes in an 8" x 10" 2 mil bag, that is FDA and USDA approved for food usage. Or you can buy as many as 7 pounds and save on shipping, as multiple pounds are shipped in flat rate boxes for the sum of $12, including shipping, insurance and delivery confirmation from www.dried-peas.com    

    Recent studies indicate that over half of the US population is low in levels of D vitamin. This has been the case with me too. Low levels of D lead to a large list of health issues, some of which are:

• calcium is absorbed from your bones, leading to bone density issues and bone fractures

• Maximum calcium absorption from your calcium supplement is not realized until your vitamin D levels have reached 75-80 nmol/L.

• rickets, especially in children

• cancers are at higher risk--including colonrectal, breast, prostrate and others.

• MS can develop--individuals with the highest D levels (100 nmol/L) had a 62% lower risk of MS than those with a lower level of 63 nmol/L.

• auto immune diseases can develop

• cardiovascular disease

Daily recommendation of D levels today are 1000 to 2000 IU daily. Watch your routine lab results for D levels. A D level of 50 is necessary for proper function of the body's cells and organs, with a range of 78-100 for good bone health, fracture prevention, and chronic disease prevention. Levels of D that exceed 80, offer a 50% reduction in the colorectal cancer risk.  The risk of prostrate cancer is reduced by 50% when D levels are greater than 50.

Risk of diabetes in children increases when vitamin D is deficient. Vitamin D is integral to the normal function of the immune response. Knowing these facts, I take 3 of the 5000 IU dry D3 daily. Dry D3 is absorbed better than the form of D as seen in pilled vitamins. The D is Epic Ultra is readily absorbed and will increase your D levels higher than will pilled vitamins, but to get levels of 70-80 on your labs, D3 supplementation is a MUST. I recommend getting D3 from Vitalady.com for the best prices and quick delivery. Several strengths of D3 are offered there, from 1000 IU to 50,000 IU.

I recently discovered dry roasted edamame. This is a soybean, that is harvested at about 80% of it's maturity, so it's green in color. Dry roasted edamame is crunchy, slightly salted and they have 14 grams or protein per 1/4 cup, and 1 lb. has >224 grams of protein. No refrigeration needed. My edamame tastes like peanuts or pistachio nuts (from tasters at my local support groups), and  people at my support groups agree that it tastes better than the commonly available brand that can be found locally. Edamame has the protein of meat, the fiber of a whole grain, and the antioxidants, vitamins, and minerals of the best vegetables and fruits.  To read more about dried edamame, the "wonder food",  go to www.dried-edamame.com .

This is a photo of dry roasted edamame, with a paler green color due to roasting. 

 From attending support meetings for 2 years, and participating in forums on multiple weight loss forum sites, there seem to be a couple of common complaints. One is that energy is down for many people, and many people have difficulty reaching their attainable goal weight.  Another new product that I've tried (just offered for sale in August, 2008) is the Epic NRG energy booster, made by NHR Epic Ultra liquid vitamins. It has about 160 mg of caffeine per capsule and I would recommend that you be at least 6 months post op before trying. It does offer an energy boost of about 12 hours with one capsule for those weighing less than 250 pounds, as well as curbing your appetite.  Free samples from epicnrg.com/nopillvitamins .  If I know I'm going to have a long busy day, I take one capsule about noon, and I'm set for energy for the rest of the day, and not feeling very hungry in the process either. I have no issues with caffeine, so this works well for me.

Over the past year I've been using stool softeners to help with constipation. But recently they've ceased to help.  Doing some minor research, I've noted that stool softeners and stimulant laxatives are only for short term usage. So I began to research other methods of way to help with constipation.  Oe of the products the company now offers an HerbalKlenz tea, that works very well. I make a cup of hot tea each evening at about 10 PM, and no more constipation issues the next day.  I also mix it a gallon (using 3 tea bags), allowing to steep overnight, and store in a gallon jug in the fridge for cold drinks during the day.  It has a slight peppermint taste and is a blend of several teas--very pleasant tasting. Go to http://greenwoodhealth.net/nopillvitamins3 to read more on this tea.

I just became aware of a new whey protein supplement called BariCare. It just became available in early August, 2008, and is normally sold primarily through bariatric surgeon's offices for $22 to $25 for a pack of 7 servings. My surgeon's office made me aware of it, and agreed to allow me to sign up as a representative for the company who makes this new supplement. It's made by a nutritional company that has been in business over 30 years. I got some samples on Tuesday, Oct.21, and I mixed up the chocolate version for other post ops to try. My support group leader, my surgeon's office manager, and about 10 others tried this new product. We were all impressed. The chocolate tastes like a fudge brownie batter, not gritty. I tried the custard /pudding version the next day, and it was creamy, and had a faint taste of butterscotch. I also tried the vanilla flavor the next day, and it has more of a neutral taste, and would lend itself to the addition of sugar free flavors you might prefer. Photos of Baricare below, left to right, chocolate, vanilla, and the custard version.

BariCare has 20 grams of protein, and 5000% RDA of B12 per serving. Comparison chart below shows how it compares to other products. I just ordered several cases of BariCare, and will be offering it for sale to my support group friends. I'm also offering it on a mail order basis for $15.50 per 7 serving box, plus shipping. Paypal will be payment method, sending to dave@ragdoll.com ...Shipment is here on 10-30-08. I can fit 4 boxes in a normal flat rate box ($12 for shipment), and 7 boxes in a LARGE flat rate box ($15 for shipment). One local OH member came over and got 4 boxes and some NRH vitamins two days after shipment arrived, and I sold 5 boxes after at a recent support group, after members tasted samples. BariCare offers a vitamin fortified whey isolate protein, can be mixed with water, and comes in convenient packets--ideal for taking to work or traveling.  More nutritional details at www.liquidbariatricvitamins.com/baricare.htm

See how BariCare Measures Up

   On December 9, 2008, I got a trial shipment of a new unflavored whey protein to try. I was surprised at how easily this one mixed with foods or water or non fat milk. It blended much easier than other "name brands" I've tried over the past 31 months.  Designed for using in baking, this generic whey protein offers a very affordable alternative, and is available as "unflavored". All unflavored proteins have some type of flavor however, and this one is not gritty and has a mild taste of evaporated milk. The taste is virtually undetectable in SF puddings that I've tried over the past few days.  I now have it in one pound bags for $20. Each one pound bag makes 35 of the 25 grams servings (or 58 of 17 g servings). Since whey isolate protein is the best for RNY post ops, this is best type of protein to use and definitely the most affordable. This works out to under $1 per serving, while Unjury and others charge at least $1 per serving. Go to http://liquidbariatricvitamins.com/liquidbariatricvitamins/unflavored%20whey%20protein%20isolate.htm for more details.

I do hope the holidays went well for everyone. Here's a photo of our tree for Xmas, 2008:

I'm hoping that that 2009 is going to be a good year. I still continue to attend 3 support groups per month, and this is instrumental in my support system. Through the Holidays, I've gained about 5-6 pounds back, but this is also the time frame (2 1/2 to 3 years) where some "wt. rebound" is possible.

This is a photo of me taken on 1-10-09 in my office. We had a speaker from a bariatric product sales group speak about vitamins at a recent support group meeting. His statement that only sublingual B12 would be absorbed in RNY patients caused me to do further research this week. I found an article on the Internet, and got some feedback from the researchers for BariCare protein supplement on this topic. Both of these sources stated that "food bound" B12 is the one at issue here concerning mal-absorption for RNY patients. Crystalline forms of B12 (not food bound, ie, contained in foods) can be absorbed properly for 95% of RNY patients if given in 100mcg to 135mcg doses.  The NHR Epic Ultra liquid vitamins I use do contain 100mcg per daily dose. BariCare has 300mcg per serving. So either of these products to provide B12 that can be properly absorbed by almost all RNY patients. Suggestion: when taking my liquid NHR vitamins, I do the following:

• Place daily one ounce dose in small water glass, and add one ounce of water. This is done to "moderate" the temperature of the refrigerated vitamins.

• Place 1/2 of the mixture in your mouth, and do NOT swallow.

• Raise up your tongue and let the mixture remain in your mouth for 20-30 seconds. This allows the B12 to begin immediate absorption through the mucous membranes in your mouth, assuring maximum B12 benefits.  This absorption process is commonly called sublingual.

• Swallow the mixture, and repeat for second half of vitamin mixture.

• This recommendation came directly from the head of the NHR vitamin company.

• The mixing of the vitamins and water is my personal recommendation. I initially tried a full one ounce daily dose of refrigerated vitamins under my tongue. After suffering the agony of a "brain freeze" due to the cold vitamins under the tongue, I began mixing them with water. The mixing of the NHR and water does make this process very easy to tolerate.

• Since the NHR vitamins are so full of vitamins, the taste is a slightly concentrated apple cider flavor. The taste is almost identical to traditional apple cider when mixed with water this way. Your taste buds will be somewhat different after surgery, and you may find some flavors too strong. I do offer "taste tests" of NHR at my support group meetings, and some post ops find the mixture of NHR and water to taste better. Personally, I like the taste of NHR either way.

Only your lab results will be a true indicator of how well you absorb any vitamin or mineral. So keep tabs on your lab work. Do NOT rely on a nurse to give you lab results. ALWAYS do a consult with your surgeon or PCP concerning lab results, and get a printed copy of the results for your records.  I've seen instances on OH forums where patients have been given inaccurate lab results over the phone, causing anxiety in some post ops. YOUR LAB RESULTS are the true indicator of how well your body is absorbing vitamins and minerals. Even taking the best vitamins available, your labs results may indicate that you need additional iron or B12, or may indicate other vitamin deficiencies. You can increase your intake of these deficient vitamins or minerals, based upon suggestions from your doctor.  My labs indicate my D levels are in the 30's, low normal range. But I do want my D levels to increase to above 70 for optimum health, so I do take 2-3 of the 5000 IU  dry D3 daily.

    At the 3 support groups I attend this month, we had a speaker from Bariatric Advantage, speaking about the importance of vitamins. Once statement that only B12 can be absorbed sublingually interested me, so I did further research. I showed these studies to the BA speaker to make sure he understood. He said he had seen the one study--and I pointed out that on page 12 of the study was the statement about B12 supplementation.  Studies I did find indicated that FOOD-BOUND B12 (the B12 that was an actual component of foods consumed) was at issue, as the B12 from food sources had major malabsorption issues. BUT, I found two studies that indicated that B12 in crystalline forms is absorbed readily. The older study indicated that 100-135 mcg per day would provide enough B12 for 95% of RNY patients. The second study, from 2008, indicated the same form of B12 in quantities of 350-500mcg (also expressed as ug) had the same effect. Of note: the NHR has 100mcg per daily serving, and the BariCare has 300mcg per serving. So a combination of these two would suffice for the majority of B12 that your body needs. Foods and an occasional sublingual B12 would make up the difference. Either daily use of NHR or using a high protein supplement with a very high B12 component will help you make sure your B12 stays at adequate levels. NOTE: NHR has 17 times the RDA of B12, and BariCare has 50 times the RDA of B12.

I saw a kitchen cooking appliance that I thought looked very useful for post ops. Here are some photos of it:

Sunbeam RocketGrill from QVC.com or Sunbeam.com

A photo of the RocketGrill next to some frozen Tyson.skinless chicken thighs. Rocket Grill cost about $30 from QVC or $40 from Sunbeam. Chick thighs are 4 oz portions, 17 gr protein, 170 calories.

Right photo has chicken thing on top of cooking parchment bag.

Left photo above shows cooking bag, after cooking 9 minutes (from frozen). Note grilling marks on bag, and the bottom of the bag clearly shows the fats that drained off of the chicken in the cooking process. Right photo shows grilled chicken breast, ready to eat—again note grilling marks. Chicken is very moist and tasty also. You can also cook the frozen chicken on the "non frozen" mode, cooking for about 10 minutes. It comes out slightly moister this way.  The Rocket Grill can be used for beef, fish, making hot sandwiches, grilling veggies, etc.  I get the frozen chicken thighs from Smart and Final, costing about $11.50 for a 5 pound bag.

    The Rocket Grill makes a nice grilled cheese sandwich in 3 minutes too. I use 3 slices of real cheese (no imitation), normally calorie reduced and Oroweat 7 grain bread. No shortening is used on bread either. I place 1 1/2 slices of cheese on 1 piece of bread, and add some left over roast beef.  I slice the beef really thin, and take poultry shears and cut the beef into small pieces (about 1/2" square) and place randomly over cheese. I then cover beef with 1 1/2 slices of cheese, place second half of bread on top and insert sandwich into parchment pouch. Cook for 3 minutes. Tastes just like a beef and cheese sandwich I used to love in high school. Protein from bread, cheese, and beef. Whole grain bread adds roughage without high amount of refined flours, as with traditional "store bought" breads.  No added calories from shortening, as with a normal grilled cheese sandwich.

Daily Vitamin/Protein Cocktail

    I begin each day with my vitamin cocktail. One woman I know uses the NHR vitamins too and recommended the following, which does taste very good. She uses the same generic whey isolate protein noted on this story:

• Into a small glass, add one ounce of NHR vitamins, and 3 ounces of tap water.

• Add a pinch of cinnamon.

• Add one 3T serving of the generic whey isolate protein, 25 grams.

• Mix with small whisk for about 12-15 seconds.

• You've now got your vitamins, and a protein boost to start the day. Taste is similar to the New Years apple cider I had when I was a kid--the cinnamon brings back those memories.  2 gr of protein from the NHR vitamins, adn 25 gr of protein from the whey isolate powder.

• This starts my day off with a protein punch, and allows me to take my vitamins at the same time.

• I then eat a small breakfast some 45 minutes later or so, as data indicates a breakfast is so important to start your metabolism, especially if you are watching your weight.

Dave's Two - Plate cooking method.

        I love my Rocket Grill for cooking some foods, but I created the two plate method for others. Many times, I'm eating a different menu than the rest of the family, and the Rocket Grill or the Two Plate method is great for cooking individual servings for the RNY post op.  Here it is:

I buy the fish in the individually sealed packets. Fish packaged like this can be cod, red snapper (my favorite), talapia, salmon, etc.  Use a pair of poultry scissors to open the package, remove from plastic wrapper,  and place fish on plate.

 Place a second plate upside down over the first, so it resembles the "flying saucer" picture above. Place plate assembly in microwave. I cook the red snapper filets for 5 to 5 /12 minutes, depending on size. Talapia is cooked about 4 minutes, as those filets tend to be thinner.  Use pot holders when removing from microwave, as plate assembly will be hot. Use a fork to separate plates, and be careful of the hot steam. Use potholder to remove the hot top plate.

 This is red snapper that was cooked for 5 minutes. Add mild seasoning to taste, and it's done. No fats or oils were used, which makes this cooking method that much better.

    Thicker filets of fish can be cooked in the oven easily. I take one 4-5 oz. piece of salmon, and place on piece of aluminum foil, about 10 x 12 inches. You can add some lemon juice or small baby corn or carrots in the foil too.  Fold up two opposing sides of the foil, and fold over itself, like a lunch sack. Then take the other two foil sides and fold over, so that the fish in enclosed in a "steam packet". Place aluminum foil packet on baking sheet, in pre heated 350 degree oven. Cook for 25 minutes. It's done, and add seasoning to taste. When I cook fish for my family, I always cook it this way. The fish is basically poached, with no fats or oils used in cooking.

    A similar technique works well for standard leftovers that you cook in the microwave. Place leftover food on plate. Place bowl (ceramic or plastic) upside down over food. Cooking foods this way in the microwave in this manner retails the moisture in the foods, so that the food is not dry.  If the food is dried out to begin with, sprinkle a little water on top of the food or on the plate, and this little amount of water will help to rehydrate the food while cooking.  This works extremely well for chicken or beef that appears to have dried out somewhat while in your fridge.

    During my first post op year, I tried the NOW brand of powdered calcium citrate. Although this brand offered an alternative to swallowing pills, the highly gritty texture was not really a powder--more like sand in texture.  I can swallow normal sized pills easily, but the TWO LARGE pills of calcium citrate needed to get 600mg per dose (as shown in photo) are still difficult to swallow. 3/4 tsp of the powder, providing the same amount of calcium citrate, is shown for comparison.

 Depending on the brand of calcium citrate, the size of the pills will either be large or even extra large. Doing some research, I've found a truly powdered calcium citrate. It mixes well with foods or drinks with some substance (not just water), and 3/4 tsp provides nearly 600mg of calcium citrate. This calcium citrate is MUCH FINER in texture than the NOW brand.  I now have this calcium citrate powder available, at $10 for 125 servings of 600mg, costing about $2.50 per month.  Shipping is additional. Photo of product below, and you can go to http://liquidbariatricvitamins.com/liquidbariatricvitamins/calcium%20citrate.htm for additional data on this calcium citrate, and some brief info on elemental calcium seen in calcium citrates.

Left photo is a 12 oz bag of dried wasabi peas, 7 gr protein per 1/4 cup serving with a SPICY flavor.  Photo on right is a 12 oz bag of "veggie trail mix", containing dried peas, dried edamame, dried carrots, dried taro, dried green beans, dried yams and dried sweet potatoes. Has 7 gr protein per 1/4 cup serving. Either bag is $5 each, more details at www.liquidbariatricvitamins.com .  Also available are veggie chips, 5.3 oz for $5.  Even though the dried veggie chips are very delicious, it's highly recommended that due to lower protein level, these should be mixed with edamame, peas, wasabe peas or soynuts for a much high protein content.

Roasted Soynuts

These are roasted soynuts. These are mature soybeans, roasted to make them crunchy, and lightly salted so they taste like peanuts. Edamame are the same soybeans only harvested at 80% of mature growth.  High in protein, and taste like peanuts. Sold in 1 pound bags for $5.

Nutritional comparison of Roasted Soynuts and Spanish Peanuts:

Just a drop of this:   in here keeps the odors "under water".  One drop of this liquid forms a film on the water in the bowl, sealing the odors below the water level.  This product works extremely well in a home with one bath or for someone who works in a small office. We all know that most RNY post ops have issues with odorous stools after surgery, and to use on of my fellow weight loss group members sayings, "this is one of the world's best secret". No more embarrassing moments, when you were the last to use the restroom, and a fellow workmate or a family member says, "boy, someone died in here".  One bottle is purse sized, handles 200 flushes, and is priced at $8, and comes with a small plastic case.  Can be ordered with other products listed here, with no additional shipping fees due to very light weight.

   This is a online grocery buying service that I belong to. They offer over 10,000 items at excellent prices. Shipping is free via Fedex, arriving about 5 days after your order is placed. This service offers an excellent way to  save money, college students with transportation issues, and would be also very helpful for elderly people who have transportation issues or when bad weather effects your locale. If you go to www.myharvestamerica.com/groceriesforless you'll see more details. Examples:
Bumble Bee Tuna in water, 5 oz can, $.20 vs  $.98 locally.
Jello SF pudding, $.64 vs $.98 locally.
Starbucks decafe ground coffee, 12 oz bag, $5.19 vs $7.98 locally.
Silk soymilk, 1 qt., $1.61 vs $2.48 locally
Rosarita veggie refried beans, 16 oz, $1.03 vs $1.58 locally.
Sunsweet pitted prunes, 18 oz, $2.78 vs $4.28 locally.
Crystal Lite, SF Rasperry Ice, 3.2 oz, $3.24 vs $4.28 locally.
Product catergories include: baby, Spices & Baking, Beverages, Breakfast, Jar & Canned, Sauces & Condiments, Dessert Mixes, Drugstore, Health & Beauty, Household & Misc., International, Pasta &

Additional examples will be posted on my www.liquidbariatricvitamins.com site shortly.