Wednesday, March 24, 2010

Writer's Block

I've been experiencing a case of writer's block lately. I have so much going on, yet nothing really inspiring or blog worthy. Does that make sense?

Sometimes I blog about the most boring and ridiculous stuff, but when my life is full of craziness- I don't feel like blogging. It's just weird.

So, because this blog is supposed to be a documentation of my journey, I am going to list a few things going on with me right now. Okay? Okay. So, here it goes:

  • My husband and I had to fire one of his employees yesterday. It sucked. Bad.
  • I had a fill of 4 ccs two Fridays ago to prime my band once again and to end my insane eating.
  • I gained 5 pounds in two weeks before my fills returned.
  • I had a fill of 2 ccs last Friday and have lost 7 pounds since Saturday. Hopefully there will be no plateau for me anytime soon.
  • We bought a wooden playset for my boys- I am so excited! Now, if we could just decide on who gets to put it together for us.
  • My boys have had the privilege to attend a wonderful private preschool over the past two weeks. But, their last day is Friday and I feel just awful that we can't afford to allow them to keep attending.
  • I am going to cry on the boys' last day of school. They love it there, and I LOVE their teachers! But more so, I LOVE what going to school has done for my boys. It's been a wonderful experience all around.
  • My husband is addicted to a "retarded" game on the computer called World of Warcraft. Embarrassing, but that's something going on.
  • My husband neglects the boys and me a bit to fulfill his WOW fix. It's irritating.
  • I run away from life by eating- he runs away by playing his game.
  • I AM WEARING A SIZE 18 AGAIN!!!! This is a good one, let me tell 'ya.
  • I bought myself some new undies yesterday.
  • Oh, oh! Yeah, I almost forgot- I got some new Spring/Summer tops and they were a size XL! Not 3x, or 2x or 1x, but just plain 'ole XL.
So, there you have it. My last few weeks in a nutshell. I hope I didn't bore you!

Tuesday, March 23, 2010


Is it just me or do you take it personally when someone de-follows you? I hate it when that happens!!!

Sunday, March 21, 2010

There are no words...

I just found out that a fellow blogger, and friend, has passed away. She passed away last night after suffering a heart attack. Bethany was a 33 year old wife and mother. Please pray for her family during this horrific time.

Saturday, March 13, 2010

She's Baaaaaa-aaaaack

My band has returned. I met with the FNP today at my surgeon's office and she helped mediate a compromise for the two of us. My band decided to return to her post with a whopping 4 ccs- 2.5 for the prime and 1.5 for restriction. I am so relieved!

I felt a difference immediately and hope to be back on track by next week's fill. I learned a few things this past week and a half:
  • I appear incapable of restraining myself (without the band) when it comes to food.
  • My stomach actually shrunk- a lot. I could barely eat "normal" portions. I was so excited to once again eat pizza and placed two whole slices on my plate settling in for a major chow down. Surprise! I could only eat half a slice.
  • I gained BACK 8 pounds in 1.5 weeks! 8 pounds. My body must have been starving for those extra calories.
  • My insomnia returned along with my fierce temper, hot flashes and irritability. It's amazing what eating yucky foods (ie. foods that are NOT band friendly) can do to your overall health and state of well-being.
  • It is so important to take better care of myself- see bullet above.
  • I don't ever want to be without the band again and plan on treating her with extreme caution and with a great degree of care.
  • It only takes 1.5 weeks to go from a size 18 back up to a 20. (Don't try this at home.)
  • All the foods that I have been "missing" over the past six months were SO not worth eating again. NOTHING came close to tasting as good as losing weight feels. As a matter of fact, I am totally grossed out by how disgusting all of my past favorite foods now taste. I need to make sure I remember this one.
  • The past six months has actually changed my mentality quite a bit. Instead of constantly dreaming about my next meal, I found myself forgetting to eat and not worrying about food. It was great.
Reading over all of your blogs has reminded me of how successful I can be if I truly put my heart into making this journey work. THANK YOU ALL for being here for me. I would be so lost without all of you.

FYI- "Remember Me" with Rob Pattinson is an excellent movie. It's a definite must see.

Friday, March 12, 2010

Guest post by Matthew Constantin, PhD (biochemist)

The Importance of Multivitamin Supplementation Following Bariatric Surgery

In a peer-reviewed article entitled “Nutritional Deficiencies following Bariatric Surgery: What have we learned?”, Richard Bloomberg, MD of the Mount Sinai School of Medicine, and his team study the importance of nutritional supplements following bariatric surgery. Research shows that following bariatric surgical procedures, vitamin and nutrient deficiencies are common. A close examination of these deficiencies after weight loss surgery shows that supplements should be a standard post-operative element so that potential nutritional complications will be minimized [1].

Roux-en-Y gastric bypass (RYGBP), biliopancreatic diversion with duodenal switch (BPD-DS), and biliopancreatic diversion without duodenal switch (BPD) are three commonly performed bariatric surgeries. These surgical interventions work by reducing the size of the stomach (restriction) and preventing the absorption of food in the gastrointestinal tract (malabsorption).

While bariatric surgery results in significant weight loss, the malabsroptive nature of the operation can severely compromise the ability of the body to absorb vital nutrients, such as protein and iron, causing nutritional deficiencies. Restrictive techniques, such as gastric banding or sleeve gastrectomy, are less likely to cause nutritional deficiencies comparing to malabsorptive techniques. This is because restrictive procedures do not directly affect food absorption in the small intestine. If a deficiency occurs after a restrictive procedure, this is usually the result of food intolerance or the tendency of the patient to avoid certain nutrient-rich foods postoperatively. This article focuses on the effect of malabsorptive procedures (RYGBP, BPD-DS and BPD) on the absortion of protein, iron, vitamin B12, folate, calcium, vitamin D, thiamine and fat-soluble vitamins.

Nutrients Deficiencies


Protein deficiency after bariatric surgery has been well documented. This is most likely the result of bypassing of the small intestine where protein is absorbed in the body. Protein deficiency occurs usually in BPD and BPD-DS surgeries. A study done by Marceau et al [2] found that there was a high incidence of protein deficiency after BPD and BPD-DS surgeries with 11% of patients having serum albumin levels lower than 3.5 g/dL. The normal serum albumin levels for adults are 3.5-5.0g/dL. In another study, 3.7% of patients who underwent BPD needed to be re-hospitalized because of the severe protein deficiency they presented. Dietetic counseling and increased protein intake aided in preventing further recurrences of the deficiency.


Iron deficiency can occur in both restrictive and malabsorptive operations. In the case of malabsorptive procedures, iron deficiency results from the fact that the duodenum and proximal jejunum (the part of the small intestine right after the stomach) is bypassed. Iron deficiency has been shown to increase in RYGBP patients during the first 5 years postoperatively [3]. Other studies however, such as the one by Rabkin, who studied BPD-DS patients, have found that iron levels were normal over a period of 3 years [4].

Vitamin B12 and Folate Deficiency

Bariatric surgery usually affects the absorption of vitamin B12 and folate. B12 is absorbed in the terminal ileum, the portion of the small intestine the stomach is connected to in the BPD procedure. Almost one third of all patients studied by Halverson and colleagues were deficient in B12 and two thirds were deficient in folate, one year after gastric bypass [5]. It is noteworthy that patients can present deficiency in these two nutrients even if their vitamin levels are normal preoperatively. Studies have shown that regular supplementation with B12 and folate after the surgery can prevent deficiency of these two vitamins.

Vitamin D And Calcium Deficiency

Vitamin D is absorbed in the jejunum and ileum, while calcium is absorbed in the duodenum and proximal jejunum. Since bariatric operations result in bypassing of these segments of the small intestine, vitamin D and calcium deficiencies are a common phenomenon in weight loss surgery patients. Calcium deficiency can lead to potential bone loss and increase the long-term risk of osteoporosis. In fact, some retrospective studies have shown evidence of postoperative metabolic bone disease. Calcium and vitamin D deficiency rates can be as high as 50% [6], and while many morbidly obese patients already suffer a lack of these nutrients pre-operatively, the deficiency is exacerbated after the surgery. Often, supplementation may not be enough to correct low calcium and abnormal vitamin D levels. A study of BPD patients by Slater et al showed significant deficiencies in calcium and vitamin D, despite supplementation [7].

Thiamine (Vitamin B1) Deficiency

The deficiency of this vitamin is relatively rare. Studies have shown that thiamine deficiency occurs in only 1 every 5800 bariatric patients [8]. Treatment with thiamine (intravenously or intravascularly) resolves the deficiency as quickly as one day and no more than four months after the surgery.

Other Fat-Soluble Vitamin Deficiencies

Vitamin A

Levels of Vitamin A were found to be low in 61% of patients undergoing BPD with or without duodenal switch, despite the fact that 4 out of 5 patients were compliant with vitamin supplementation.

Vitamin E

Vitamin E deficiency is uncommon and occurs after malabsorptive operations, usually BPD. Patients who receive multivitamin supplementation can effectively sustain normal levels of vitamin E after the surgery. A study by Slater showed that 96% of BPD patients who were taking vitamin supplements had normal levels of vitamin E even 4 years postoperatively.

Vitamin K – Magnesium – Zinc

There has been no substantial evidence to suggest deficiency of vitamin K after surgery.

Magnesium levels do not seem to be significantly affected by bariatric surgery. One study found that magnesium concentration remained normal 4 and 10 years after BPD surgery, while another one found that only 5% of patients had low magnesium levels 2 years after surgery.

Zinc deficiencies have been found in as many as 50% of BPD-DS patients and in only 10.8% of BPD patients. Interestingly, 80% of these patients where taking multivitamins.


Clearly, there is a great deal of clinical research that indicates that vitamin and nutrient deficiencies do occur after bariatric procedures. It is because of this that the use of supplements may be more commonly recommended after the surgeries. Additionally, it seems that more research should be done to investigate the impact of such supplements on the deficiencies and the resolution rates.


1. Bloomberg, RD, Fleishman, A, Nalle, JE, Herron, DM, Kini, S. Nutritional Deficiencies following Bariatric Surgery: What Have We Learned? 2005. Mount Sinai School of Medicine. Obesity Surgery 15: 145-154.

2. Marceau S, Biron S, Lagace M et al. Biliopancreatic diversion, with distal gastrectomy, 250 cm and 50 cm limbs: long-term results. Obes Surg 1995; 5: 302-7.

3. Skroubis G, Sakellaropoulos G, Pouggouras K et al. Comparison of nutritional deficiencies after Roux-en-Y gastric bypass and after biliopancreatic diversion with Roux-en-Y gastric bypass. Obes Surg 2002; 12: 551-8.

4. Rabkin RA, Rabkin JM, Metcalf B et al. Nutritional markers following duodenal switch for morbid obesity. Obes Surg 2004; 14: 84-90.

5. Halverson JD. Micronutrient deficiencies after gastric bypass for morbid obesity. Am Surg 1986; 52: 594-8.

6. Brolin RE, LaMarca LB, Kenler HA et al. Malabsorptive gastric bypass in patients with superobesity. J Gastrointest Surg 2002; 6: 195-203; discussion 4-5.

7. Slater GH, Ren CJ, Siegel N et al. Serum fat-soluble vitamin deficiency and abnormal calcium metabolism after malabsorptive bariatric surgery. J Gastrointest Surg 2004; 8: 48-55; discussion 4-5.

8. Chang CG, Adams-Huet B, Provost DA. Acute postgastric reduction surgery (APGARS) neuropathy. Obes Surg 2004; 14: 182-9.

About the Author

Matt Papa, PhD, has dedicated a great deal of his research time to better understand the elements of bariatric surgery as well as the benefits and complications. He is excited he was given the opportunity to share some scientific facts with the BlubberyBlogger community. In his website he presents research findings  and posts practical information on the topic of weight loss surgery, and offers a coupon for Medifast and a coupon code for Nutrisystem.


Tuesday, March 2, 2010

Farewell Band, Please Hurry Home

As I type this entry, my band is somewhere over the Atlantic Ocean- far, far, far away from me. Our distance deeply saddens me and fills me with a horrific anxiety. Why did she leave me you ask? I don't know. All she said right before she walked out the front door with my 7 ccs of saline was this, "I need a holiday". Because we have only been apart now for ten hours, her words still haunt me; still so fresh in my mind. When will this hurt, this wound heal? I have been told to expect her to be gone for at least two weeks.

She has served me hard and served me bravely over the past six months. She was tired and she was too full. She tried as hard as she could to firmly grasp my stomach, but she was just too tired of trying to hold on while my stomach continued to swell resulting in my inability to keep anything down over the past four days. The ulcerated and painful environment that she was working in was just too much for her to bear. Her gallant efforts resulted in a ten pound weight loss in the past four days, but even for her that was too much.

I am hoping that in two weeks time she will be willing to re-access our situation and once again join me in this battle of the bulge. Maybe this "Band Holiday" is just what the doctor ordered. But until then, to ensure that her working conditions are as satisfactory and as comfortable for her as possible, I will be taking a daily regimen of ibuprofen, steroids and a proton pump inhibitor.

How will I deal with this sudden separation of such a crucial "person" in my life? I am hoping to deal with my pain through exercise and focusing on my health rather than indulging in copious amounts of food to drown my sorrows.

I do hope that she hurries home. I am so scared to be apart from her. So scared.