From the Desk of Susan Maria…

Thank you for your letters, cards, email, and phone calls asking about my condition after hearing of the motorcycle accident that Ty and I had last month! For those who don’t know– I broke my leg in an unfortunate incident that occurred on our way home from a fantastic weekend in Key West. The cast comes off in three more weeks (just two days after our Fort Lauderdale BE event weekend!) and after a couple of months of physical therapy I should have 95% mobility back in the ankle and be back up on those high heels in no time.

The big news was the osteoporosis the orthopedic surgeon found in my bones as he was placing the screws to affix my ankle. He said it was like putting a screw into a stick of butter. It appears that I suffer from a triple whammy for calcium deficiency as I have had thyroid disease for many years, went through a very early menopause, and then of course my gastric bypass seven years ago.

The lessons I learned this month?

Make sure if you are going to ride a motorcycle that you wear a full face helmet, Kevlar pants, jacket, and gloves – even if you are in Key West, it is hot, and you are the only dorks wearing full protective gear. It could save your life!

The other lesson is that taking proper vitamins and minerals after gastric bypass surgery is much more important than you think and what we believed sufficient may not be enough. I have been careful about taking vitamin supplements for the last five years of my bariatric journey and I have osteoporosis; what do you think could be happening to your body if you haven’t been as vigilant? I thought my bones were being protected by both my motorcycle gear and my calcium, but one let me down. We all need strong bones to carry us through our new and wonderful life.


I am excited about our first Florida event at the Gallery One Doubletree that starts November 1st. We have a lot in store for you. I am on crutches, but that isn’t going to stop me from having a good time. Fort Lauderdale is a fun place… sand, sun, shopping… and 75 degree temperatures. It will feel great if it’s already getting a little chilly where you live.

Ciao,




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NEWSFLASH ON VITAMINS & NUTRITION! The latest updates.
by Joselyn Postar-Baum, RN and Debby Olsson, RN

Joselyn Postar-Baum and Debby Olsson, who are both Registered Nurses as well as successful bariatric post ops, attended the American Society for Metabolic and Bariatric Surgery course on Nutrition in Philadelphia two weeks ago. BariatricEating.com is in attendance for major ASMBS conferences so we can stay both accurate and current regarding all aspects of our post op health. This is the first of several articles they are writing for our newsletter and website on order to share information they learned that is of great importance to all of us.

First – Protein absorption The commonly touted myth of only being able to absorb 30 grams of protein at one time is not true! In any 24 hour period, we can potentially absorb as much as 300 to 400 grams of protein. This is obviously not recommended because there are complications associated with this high amount of intake. Recommended range of protein per day can be up to 120 grams. Absorption of protein relies on many factors, including source of protein, length of the Roux limb, size of the pouch, and our intake of micronutrients like zinc.

Second – Calcium It’s not just the calcium; there are several surrounding factors that influence absorption and overall bone health.

How you take your calcium. Calcium should be taken with food—ALWAYS! Digestion begins in the mouth and calcium requires digestive juices to begin the breakdown and absorption.

Exercise. If we don’t exercise, we set ourselves up for BONE LOSS (osteopenia and osteoporosis). Weight bearing exercise is essential. Weight-bearing exercises include walking, running, and using weights as part of your routine.

The Vitamin D connection. Vitamin D is essential for proper absorption of calcium. With the widespread use of sunscreen, many of us do not absorb enough vitamin D through sunshine.

Caffeine and calcium. Caffeine leaches calcium from your bones that may not be replaced by your dietary intake. When calcium leaves your bones, it goes through your kidneys (which could result in kidney stones) and urine.

Alcohol and calcium. Alcohol interrupts the calcium and Vitamin D metabolism.

Foods containing calcium. Foods that contain high amounts of calcium are dairy products, tofu, and canned salmon which is better than fresh because the bones are edible and high in calcium.

Symptoms of calcium deficiency. The signs of calcium deficiency are: leg cramping, bone loss, cardiac irregularities, and tingling or spasms of the hands, arms, and legs.

How much calcium. 1200 mg of calcium is not enough to prevent bone loss. The daily requirement of Calcium for gastric bypass patients is truly unknown. The upper limit of 2500 mg can cause kidney problems and impair iron absorption. The current suggestion is 1200-1500 mg per day, split up in doses of 500–600 mg each. The usual amount of Vitamin D in multi-vitamins is 400IU, which is also not enough; daily recommended intake is 400-800IU. Ask your doctor if he/she is monitoring tests like Parathyroid Hormone, 25 Hydroxy-vitamin D, serum calcium, ionized calcium, urinary N-Telopeptide levels, and DEXA scan. Studies suggest a pre-op and annual DEXA bone density scan to monitor bone loss is a good idea.

Types of calcium. Types of calcium treatments include primarily calcium citrate, use of calcium acetate (for those with impaired kidney function), and/or the use of Microcrystalline Hydoxapatite for the possible building-up of bone.

Preventing bone loss. Prevention techniques include dairy in your diet, weight bearing exercise, smoking cessation, bone scans, and moderate sun exposure (provides natural Vitamin D), and limited use of caffeine and alcohol.

Third – Iron Iron deficiency is the most common nutrient deficiency in the world. Iron levels decline naturally after weight-loss surgery. 74% of Roux-en-y post-ops patients are iron deficient. The reason for this percentage is the iron absorption site is bypassed. Thus, there are decreased receptors available to reduce and transport iron. After weight loss surgery, we need supplements. There is also a reduction in transportation time, reduction in intake of iron rich foods, and a decrease in hydrochloric acid. While there is plenty of iron in foods such as meats, chicken, and fish, we cannot eat large enough quantities to build up our iron stores and this is why we become anemic. Eating berries and kiwis can provide us with Vitamin C that can help with iron absorption.

Do not take Iron and Calcium the same time as both will pass through your system unabsorbed if you take them together. Taking Iron on an empty stomach is best for absorption. Patients with gastric sleeve or band may not need additional iron as their receptors are uninterrupted.

Our quality of life depends on our compliance with our new lifestyle. After our first post op year, when we no longer have regular visits with our bariatric center or surgeon, it becomes our responsibility to monitor our own nutrition, find a primary care physician who is familiar with bariatric needs or is willing to research or learn, and be aware of the changes that are potentially taking place in our body. We had this surgery in order to stay healthy; we need to take the right vitamins and supplements to stay healthy.


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News from our New Mommy!
by Lisa Purmort

We at the BElieve Newsletter are THRILLED to announce the birth of Lisa's baby, Devin Lawrence! He is here, he is healthy, and Mom is doing well! Devin came into the world on Friday, August 24, 2007 at 11:27pm. He was one week early, after Lisa was induced due to low amniotic fluid.

I celebrated my two-year anniversary a few weeks ago on September 19th. I can’t believe how my life has changed since my surgery 2 years ago. I have lost 125 pounds, I am very healthy, and now have a new addition to our family--the most beautiful 5 week old baby boy in the world! Life is good!

The last trimester of my pregnancy went by so fast. The only concern that came up was my iron being way too low, my iron supplementation was tripled, and my levels came back up for the remainder of the pregnancy. I gained a total of 45 pounds with this pregnancy, 30 of which I have already lost and I am now trying hard to lose the last 15.

I feel I am very lucky to have had the most awesome pregnancy as a WLS post-op. I did not have morning sickness, I stayed on top of my protein and vitamins the whole pregnancy, and I felt great the whole time. Devin Lawrence came into the world on Friday, August 24, 2007, one week early. I was induced at 39 weeks during a routine check up when we found out my amniotic fluid was a little too low. Even though my labor lasted 14 hours from the time they induced me, it was a wonderful experience. We chose to have a natural child birth using a mid-wife, doula, and a technique called hypnotic childbirth (www.hypnobabies.com), which uses self-hypnosis and deep relaxation instead of pain medicine to handle pain. I was able to stay relaxed through the entire labor and the drug-induced contractions. At 11:27pm, Devin literally flew into this world, with my last push, we caught everyone off guard, and my husband barely had time to scramble to catch him.

My advice to anyone wanting to get pregnant after WLS is just stay on top of everything and work very closely with your OB/GYN and your doctor monitoring your WLS progress. Keep them both informed for the entire pregnancy. I was able to maintain a healthy diet. I had to eat carbs because it is not healthy to be in ketosis when you are pregnant, but I chose “healthy carbs” and maintained my protein at 80-100 grams a day (I still had my protein shakes through my entire pregnancy!) Most important is to be your own advocate—if something doesn’t sound right or seem like something you should do being post-RNY, speak up and ask about it! Research everything and ask questions.

Thank you for following me in through this pregnancy!

Lisa (Keoni)


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The Singles Corner
The Post-op Guide to Break-ups
by Malia Robinson

Malia is our resident message board goddess. She has a new found love for life after dropping over 140 pounds and she isn’t finished yet. Malia has chosen to share her adventures and self discovery as a single woman in the world of dating. Just don’t make her take off her earrings!

Okay, everyone, remember when I wrote last month about the really great guy that I met? Well, he is still a great guy, but he is not the man for me--at least not in a romantic sense. You thought everything was going great? Me too! Then we went out one evening with some friends and I saw some things that confirmed all the little doubts that were running around my head. We both came to the conclusion that we would be much better friends than lovers.

If you are expecting me to go on and on about how he lied to me and what a jerk he is…stop reading now! I honestly think that "J" is a good guy. He is just a good guy that has some things he is working on. Since they aren't my issues, that is all I will say about it. I have no problems airing my own dirty laundry but I'll let him keep his privacy. We actually sat down and had a long conversation about why we aren’t best-suited for each other. I assured him that I would be okay and that, yes, we could still be friends. Then I hung up the phone, had a good cry, and posted the most pitiful post I have ever made. I really appreciate everyone who took the time to respond. You really made me feel better.

Breaking up with someone post-op is a little more complicated. For one thing, I didn't have my friends, Ben & Jerry, Mrs. Fields, or Little Debbie to console me. Since I know I am an emotional eater, I had to make a point to be even more mindful of what I was eating and why! I won't lie and say that I didn't have some missteps but my eating did not spin out of control like it has during past break-ups.

Also I couldn't fall back on my old excuse, "I must have been too fat for him," which would have been followed by, "No one is going to love me because of my weight.” The truth is, I am at the lowest weight in recent memory, so weight actually wasn't an issue at all. I sat back and did some serious thinking about my behavior in this relationship. Was I always honest with him? Yes, I was. Did I change my basic values in any way? No, not at all! Did I make an honest effort to present my true self? Yep, warts and all! So I came to this earth-shattering conclusion: It just didn't work out. I didn't do anything wrong and neither did he.

So, I'll call my first time up to bat in the game of romance an “out.” I have a great friend, but once again, I am "Everyone's buddy and nobody’s honey." However, I have learned how to end or change a relationship in a drama-free way and without doing damage to myself! And I am still in the game!

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From the Exercise Expert
by Lisa Hall Certified Personal Trainer

Lisa, also known as 'LittleLisa' on our boards, continues to contribute to our newsletter with her monthly exercise article. Lisa is excited to announce that she has recently become a certified personal trainer! What a transformation—to go from once being morbidly obese to teaching people how to be healthy (she already has several full-time clients)—awesome, Lisa!

Hello Fellow BE'ers!

I really wanted to write an article about my recent recovery from my arm surgery. I know many of you are considering this procedure and there are some things I REALLY WISH I would have known prior to surgery. Now, I'm not saying I would have not done the procedure, because as you all remember from various posts that my arms were horrible! So, yes, I'm glad I had brachioplasty, but I am still really just starting to heal; now at over 5 weeks out, I'm still on my way to recovery.

It's not a terribly painful surgery. I came home and maybe took two pain pills while home the first 24 hours and then was fine just taking something over-the-counter for pain. However, what I didn't know is that, over 5 weeks out, I'd still be in a lot of discomfort. My arms just feel exhausted all the time and at night swell from use. I find it necessary to sit with a pillow still propped up under my arms because my elbows are painful if resting on the arms of the chair.

Driving is a whole other story. The doctor told me I could drive as soon as I was off pain pills - HA! I wasn't able to drive for about 2 weeks, and when I made short trips to take kids to school and such I had to put small pillows under my elbows to support my arms. I would drive one-armed while resting one arm and change up. I still haven't driven more than a few miles from my house and really don't think I'd be ready for a long drive yet.

Sleeping is another issue I wish I had thought about. I'm a side sleeper. I knew I'd have to sleep in an easy chair for a few nights, but I really didn't think I'd be sleeping in bed propped up to almost a sitting position with pillows around me to support my arms this far after the surgery. Needless to say, I have not had a full nights sleep since Aug 25th! This part of the process is truly driving me nuts—so beware of this if you find it hard to sleep on your back.

Healing has been slow. I still have spots on my arms that swell and cause pimple-like spots on my incision and find I have to wear gauze pads under my wraps so the oozing won’t soil my clothes. I've been in to see my doctor every week since surgery and he is aware of this and says it's normal. Don't get me wrong—most of my wounds are healed but each arm has a couple of spots that are taking a while to heal, mostly by my elbows because of having to bend them. Just another thing I want you all to be aware of...I’m not kidding when I say I've spent about $150 on bandages, Neosporin, and Mederma so far!

Another items I didn't even consider…shaving!!!! Okay, first off, because they more your skin around, the area where your hair grows under your arm changes shape and location (kind of weird) and at 5 weeks out my scars have just now started to heal enough to where I feel comfortable shaving. I was looking very hairy let me tell you! Not a huge downfall of surgery, but something that didn't cross my mind.

As far as clothing goes...yes, my arms are still wrapped most of the time, especially when I'm training. So, I highly recommend this surgery in the early fall when it's time to start wearing sleeves. However, dueto oozing, bleeding, and the stains from Neosporin, have a few tank tops to wear around the house when you are home relaxing. Make sure these tops are not your favorites and ones you can part with, because once you are ready to stop wearing them they will need to go in the trash! I usually wear a T-shirt for training and over it a lightweight sweat jacket to cover my arms and bandages. I do get hot and depending on where I am, I will slip off the jacket, but it's again something to be aware of. I had a wedding to go to last weekend and had to shop for a long sleeve dress to wear.

Exercise has been hard, because I am a personal trainer! I went back to work at two weeks and probably caused the infection I suffered from at three weeks because I was trying to do too much to soon. I really didn't have fell I had a choice, though. No work, no pay. Now, I really haven't been able to work out myself. Bouncing when I walk causes my arms to swell and hurts like heck! I am now just starting to do leg exercises while standing. Laying on the floor to exercise my legs just won't work because it requires me to lay on my arms. I am just now able to begin doing sit-ups and crunches, but still no real cardiovascular exercise to speak of. This is really driving me crazy—I’m addicted to exercise!

I think that's mostly what I wanted you all to be aware of. I'm not trying to discourage anyone. I'm so happy I did this and would do it again, but I do wish I had been aware of how long the healing process would be and how drawn out recovery would be. I would have prepared more frozen meals, found a way to take more time off work, and found someone to help get my kids to and from school.


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Dolly's Star

Dolly's corner is written by BariatricEating's own Teresa White. Teresa is an amazing example of how WLS can truly change one's life in many ways. She has come a long way on her journey--losing 230 lbs. since her surgery on September 11, 2003, which was performed by Dr. Robert Shin.

This month’s star shines brightly on our BeforeAndAfterHelp message board. Marty Hoover, whom we know by the screen name GoLarge, had his life saving vertical or sleeve gastrectomy on 09/01/2006, as performed by Dr. Paul Cirangle.

Marty was 34 years old at the time of his surgery and father of a young daughter. He has been involved in his daughters activities her entire life. The difference is how he is involved as he’s is no longer sitting on the sidelines coaching, he is now out there involved in every adventure.

Before coaching soccer meant standing in one place while verbally coaching the team and telling them what to do. After weight loss surgery, he can get out there and show the team how to play. At his daughters recent 11th birthday party, Marty participated in a scavenger hunt, and going from house to house laughing and running with the kids opened his eyes to see just how much his life has changed.

Marty knows that all kids love it when their parents are there to support them but they love it even more when you're able to participate with them.

Like so many bariatric post-ops, Marty’s only regret regarding his weight loss surgery is not doing it sooner. He lives by the standard of using the surgery as a tool and changing ones lifestyle. There are many post-op’s that fail to grasp this premise.

Marty also believes that if you’re looking for a reason not to have a bariatric procedure you will find horror stories out there to steer you away to convince you to not have surgery. He challenges those considering bariatric surgery to find successful post ops who have completely changed their life and learn from them.

Marty’s ‘a ha’ moment that helped him to see his need to survive and have weight loss surgery was in
September of 2006. His daughter had her first “crush” on a boy at school. Playing the role of the protective dad, he was laughing, joking, and giving her a hard time. As he dropped her off it clicked with him that he needed to be arond for her, to see her grow up and to get married someday. Mart decided to have the procedure, he paid for it out of pocket, and has never looked back.

When asked how has weight loss surgery has changed his life, Mart simply states that it has given him his life back. We all can relate to how much obesity takes away from how we live our lives; with the weight gone now we can jump up off the couch and participate. We can live and not just exist.

Mart you are a great asset to the message board, your family, and to the world. Your positive attitude is inspiring and uplifting. You are definitely a star in my eyes.

These are my favorite recent ‘Go Large’-isms. You’ve got to love a guy who says stuff like this!

‘Protein, protein, protein, baby!’

‘Hitting the gym is just another tool to have in the tool belt to help you to hit your goals.’

‘I used to be the guy who was bitching that the AC was never up high enough......now I bitch all the time that it's freezing at work, home and the cigar shop. The way I look at it, better to be cold now than sweat at the slightest movement like before. I guess it's all a trade-off.’

‘WLS is a tool to use, but you still have to work for your weight loss and make real lifelong changes in the foods you eat.’

‘As for the gym being out because it's full of leotards and breasts – you’ve got to get over that! The whole point of WLS is to change your life for the better. Are you really going to let thoughts in your head about what other people will think stop you from working out and hitting your goal weight? Who cares if you're bigger than some of the other folks? You won't be for long! ‘

‘Working out will help you lose weight more quickly but you also have to work out to be healthy. Thin people drop dead of heart disease too!’

‘If you want to lose more weight get your butt to the gym. I know this board is all about support and that's why everybody including myself loves it, so I hope you don't take this the wrong way… but if you want to lose weight and get healthy faster get your body moving. It makes a huge difference.’

‘We read a lot on this board that you have to adopt new eating habits for life if you want long term success post WLS. You can't just eat right until you hit goal and then stop; many people will never will hit goal by just changing eating habits. You have to incorporate workouts as well. Just like we have to accept eating right forever, we have to accept exercise forever. So come on... get to it.’

‘Get busy living or get busy dying.’

Congratulations, Marty--you are a star in my eyes!

 

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Couple Talk
by Shelley Meyers

Shelley is active on the Before and After message boards. Shelley and her husband have had WLS; Shelley has decided to share their story as a WLS couple with us.

One of the great benefits of being a WLS couple is that of built-in accountability. Living under the same roof as someone who is walking the same (or similar) road as we are certainly makes post-op life a little easier. I was Shayne’s support system even before he had the surgery. I researched the pros and cons, information regarding the procedure itself, the nutritional guidelines for bariatric patients, the various brands and forms of proteins and vitamins, and the list goes on and on. I wanted, well, needed, to know that the person I loved most was doing the right thing. After all of my research, I felt that he was.

The support didn’t end there. In fact, I’ve become quite the pain in the rear end! I’ve tracked his weight change over these last 11 months, helping him to realize that he is definitely not a “fat guy” anymore. I encourage him to work out. I help him to monitor his protein intake. I remind him about his vitamins and minerals and, true to my anal-retentive style, have even posted a chart on the refrigerator. I make sure we have protein supplements, bariatric-friendly vitamins, and plenty of Greek-style yogurt in the refrigerator.

You would think that all of this would make me the model WLS patient. Sorry, but (unfortunately) I talk the talk but don’t always walk the walk. Now I have an accountability partner to come to my aid. “Did you take your vitamins today? Let’s go take a walk or ride bikes. Did you get enough protein?” My own words are coming back to haunt me! But you know what? I need a kick in the pants sometimes.

Obviously, not everyone who undertakes this surgery will have a spouse who does the same. Everyone who has surgery, though, CAN find someone to partner with him or her for success. Do you have a spouse, friend, or family member who is willing to help guide you along your journey? I’ve come up with a few ground rules to get you started.

For the post-op:

1.Honesty is the best policy. C’mon, what did you REALLY eat today? Are you where you need to be regarding protein, vitamins, exercise, etc?

2.Take constructive criticism well. Your accountability partner cares about you and wants you to be healthy and strong. Help them to help you by not making them afraid to talk to you.

3.Make the commitment to have daily contact. It is easier to slip up when we allow time to get away from us.

For the accountability partner:

1.Be honest, tactful, and non-judgmental. Most people really don’t like to be told what to do so firmly but gently give your feedback.

2.Help your buddy avoid temptation. Is Subway really the best place to meet for lunch? Avoid phrases like “Just a little won’t hurt you…”

3.Prepare to get moving! Exercise is important, even for those who haven’t had surgery. It will be a lot easier for your post-op friend to exercise if you’re willing to go along!

4.If you haven’t already, learn about WLS and the special needs of a post-op. Things will go a lot smoother if your friend doesn’t need to continually explain what dumping is or why they can’t have that dinner roll.

I hope all of you have someone you can trust to walk with you on this journey. Actually, I KNOW you do…just check out our message board!