Good morning!

That's a new one to me, at least in phrasing. I've been told that you don't get the chance to absorb the fat soluble ADEK vitamins when the fat shoots through your system too quickly and causes diarrhea, so that could be one interpretation if it's part of your current experience. Not so much that the fat attaches to nutrients, just that everything flushes with it.

My clinic advised low fat just for the purpose of preventing the super quick movement, so to speak.

If you're losing weight quickly at 9 years out, is it purposeful or could something else be going on? I get the concern but that's some interesting feedback from the nutritionist. What are you eating?

Cheers!

Hello and welcome to the forums!

I'm just over one year post-op from a modified duodenal switch, also known as a loop switch/SADI/SAD/SIPS.

Congratulations on your upcoming procedure. I would advise not to wait to make changes. Do what you can now to work toward diet changes and where you want to be. I started right after my consultation and it made the liquid diet much easier to handle since I was already eating less food.

Detox off carbs by following your clinic's plan now if you can as it will help with the cravings during that time.

The two weeks after surgery included some sleeping in a recliner, limited lifting, and a lot of sipping and walking. It's an all-day procedure to get in your water and nutrition at that point. Walk as much as you can!

As for vitamins, I'd recommend following your clinic's plan initially until you heal and begin to work out what your path is. I've learned that the individual clinic plans vary wildly, so it's best to work with what your doctor tells you initially. I had follow ups at two weeks, a month, three, six, nine, and 12 so far with several including bloodwork. I'll have an 18 month and then move to yearly unless needed. I do have to go back for more bloodwork in a month since I'm low on protein.

Personally, only two family members and two friends are aware of my surgery. I don't share at work as a choice I made. Total strangers though? Yep, I had surgery.

Hope this helps. If you're looking for some daily support and feedback, consider joining the daily menu thread in the RNY forum. All surgery types are welcome and it's the most active place on the site. Best wishes.

Thanks for sharing your story! It's great to see long-timers come back with experiences. Glad things are going well for you.

Good evening everyone,

You've seen me posting here since my journey started last year. I'm continuing to share aspects of my story in case it helps someone else along the way.

I'd been having GI symptoms for a month and a half and reported them to my WLS clinic the whole time. Initially, they passed it off with the traditional feedback to take smaller bites.

After I wasn't eating solid food anymore, they ordered the EGD, which showed bile reflux. I got tossed a couple prescriptions and told to call them in 10 days after the Levsin course. The Levsin did help. I called back and asked for a refill. I carefully described my symptoms and evolution again and they tried telling me that by the time the new prescription was gone, I'd be all better. Yeah, I knew that wasn't happening.

Every day I'd been spending time massaging my stomach and intestines as a pain management technique. I decided to just keep calling them. They finally asked to schedule a CT scan for last Tuesday (over a week out from the call because full).

The scan showed mild thickening of the terminal iileum. They called me on Wednesday, May 3rd with a referral to a GI specialist to schedule a colonoscopy. Said it was indicative of Crohns or Ulcerative Colitis. I started calling the specialist to get scheduled.

I'd been on leave for the unexplained neuropathic pain and had tried to return to work that day. Early Thursday morning I had an emergency symptom. I'd eaten very little since Tuesday, drank less, and only took my supplements. I still felt massively full. Dr. Google told me pretty much the only reason for said symptom was a bowel obstruction.

Don't be me. I waited hours so I could drop my dogs off somewhere. I knew it wouldn't be a quick clinic visit, and it wasn't. The hour and change drive in to the ER was excruciating. They still dismissed my symptom until the second CT scan came back showing a bowel obstruction. They basically accused me of eating slabs of meat when I'd barely been on any food for weeks.

Anyway, they rushed me into an exploratory lapararoscopy to see what was indicated. Fortunately, there were no twists or hernias or other issues he could find. Thankfully, no resection needed. They inserted a tube into my stomach through my nose and proceeded with bezoar protocol. That part lasted two days and I do not recommend it.

Ultimately, I spent over five days in the hospital after fighting to be heard about my symptoms for over a month. The surgeon has no idea why I went from a clear scan Tuesday to obstructed Thursday. He's not convinced it's because of surgery but the likelihood is higher because of our rewiring.

His advice is the same things we all hear. Small bites, chew well. I'm not a fan of how it went down and I'll work on being an even more vocal advocate in the future.

Please, please say something if you have symptoms. It's scary how fast things can turn. Have a wonderful evening. Thanks for reading the ramble!

Thanks for this feedback and perspective! Yes, he knows how to do a traditional DS but their office doesn't offer it as an option because of the increased risk of health issues. It's part of why I'm surprised that's the solution they've come back with. Appreciate you sharing the info on the surgeon in New York. It can't hurt to ask, even if it would be out of network for me to use any other surgeon for a WLS procedure. GERD was definitely mentioned but I don't think bile reflux was discussed, so that's something to be aware of.

Your explanation for why a revision would work is super helpful. Thank you!

Sadly, this has been since my gallbladder came out, so I'd guess it's related. I'm hoping there's a way to attempt to treat it medically, first. Not exactly willing to jump back on the table for a third surgery in under a year.

Either way, appreciate you weighing in!

Randomly, if you're looking for some daily support or accountability, there's an active daily menu thread in the RNY forum. There are a few folks with different surgery types, and the crew is welcoming if that's something that might help you!

Hi there!

Congratulations on maintaining your loss for all of these years. Sorry to hear about your absorption issue.

I don't have answers for you. I'm only 7.5 months out, though I just checked all of my bloodwork and copper isn't something they're checking for. Unless it's under a name I don't know/recognize. Plenty of things I've been working to calibrate due to deficiencies but if that's one, it's unknown.

I hope others are able to weigh in, and that you're doing okay! Welcome back.

I will say that after 3.5 months on a very low fat diet, I did have all the things you mentioned. My skin and hair were dry, dry, dry. I was taking Miralax every day and had several malabsorptive issues with my fat soluble vitamins. So, I get it. Moderate fat had been working better for everything until my gallbladder went. My vitamin numbers were largely back in range. It did make a difference.

Dropping an update in here in case it helps someone down the line. I did have my gallbladder removed laparoscopically on February 10th. My two week follow up was Wednesday.

The PA introduced herself by saying she was the person who was holding my gallbladder during surgery. Good times. She also said there were signs of chronic inflammation, so in their opinion surgery was the right choice. Even though it didn't show on the ultrasound, I did have a lot of stones in addition to the sludge. Nothing weird on pathology and they were cholesterol stones.

Since I'm over seven months out from my initial SADI, they checked everything while they were in the area. No adhesions and everything looks good. It was nice to get the bonus review.

I do now have a diagonal dent in my stomach running from the big incision where the removal was to the next lowest incision. Apparently it's from the deep sutures they place and it may or may not stay with me when they dissolve. She said if they had seen it like that, they would have fixed it. Hard to know at the time.

So yeah...if your body tells you something is out of the ordinary, listen to it! I got lucky to have reacted to it early but it was inflamed by the time it was removed. Take care, everyone!

Yep, they absolutely do! My surgery wasn't a revision but it took me five days to start losing and my first stall was at just over two weeks. Now I'm stalling for an average of three weeks a month, followed by bursts of losing. Our bodies do weird things to adapt. Congrats on your revision. Stay the course, follow the plan...the loss will come!

Good morning!

I'm providing a bit of an update for any of the folks *****ad these boards.

Since surgery my biggest vitamin deficiency has been K. I had no baseline pre-surgery. As listed here, my first test came back at 55. I started eating more greens and got some dry K supplements (K1 and K2) that were started the first week of October, even though my dietician says you can't supplement K. My numbers in October tested in the 60's.

I bumped up my K supplements to double each day, plus a lot of seaweed and greens. My six month follow up was a couple weeks ago and my K level is now at the bottom of the normal range at 167 out of a range of 130-1,500. I'm going to keep taking at least double dosage until my one year follow up.

The easy bruising and sensitivity/pain have not changed. My clinic has now referred me to my PCP about it since my vitamin levels are within range. The last blood draw included coagulation testing, which also came back normal.

Make sure you take your supplements!

Hi there,

Good to hear. One of the things I did to help with nerves was to go armed with a whole list of questions for the things I was nervous about. I had lists for the surgeon, dietician, and nursing staff. By the time my pre-op bloodwork was done, I felt a lot more educated.

Hopefully your clinic has educational information and diet advice/requirements they're sharing with you. The plans by clinic can vary greatly, so not sure if yours will have the same diet/stages mine does. I was on two weeks of high protein liquids after surgery before being moved to the next phase by my surgeon. If yours is similar, it might include some of the things on the list I'm including below about the stage 2 diet.

It's got some good info about that stage overall and suggestions about schedules. Some people set timers or use one ounce cups...I just always had a bottle of liquid with me. To meet my goals, I was sipping literally all day the first couple of weeks. Some people set alarms. I couldn't take big sips, though, so just kept working at it.

It also includes some typical fluids that might be on your clinic's plan. I don't like sweet things, so mostly stuck with water, Unjury chicken soup protein, my clinic's required vitamin protein, and decaf tea. They should give you protein and fluid goals, which I've also learned can vary. Initially, I was aiming at 64 ounces of total liquid with 80g of protein.

Definitely use your clinic's standards, but this might give you some idea of what to expect. Hope it helps!

Hi there!

Congratulations on your upcoming surgery! I'm six months post op from SADI (modified duodenal switch) myself and was also a bundle of nerves going in. I personally have not had buyer's remorse for the surgery, not even a little. I'd tried unsuccessfully for decades to control my weight on my own. Surgery was my chance at a tool to make a difference while I still could. I got lucky with recovery- almost zero pain and no complications.

DS surgeries are the most malabsorptive WLS, so I'd reinforce being mentally prepared to ensure you take all of your supplements and keep up with labs regularly.

As to losing too much, I hear it can happen, but it's more rare. My manual says DSers control their weight with carbs, and I've seen some people post here with similar feedback. There is a balance you have to find along the way, and I'm definitely not far enough along to have my own feedback there yet (complex carbs reintroduced last Monday).

I will say that the way I've lost weight this time has been more uneven compared to my self-paced efforts. My face looks massively different and my cheekbones are showing more than they ever have. My knees are knobbier. And I still have the spare tire and hips to lose from. Advice from others here says that you may look more gaunt for a bit but that it evens out over time. Personally, I'd rather be working through it this way than continuing to deal with the extra weight and health conditions it was contributing to.

All of this to say, losing too much is uncommon, but can happen. If you work with your clinical team, they can help respond to things if you communicate with them regularly. It's good to research and be informed. Best of luck!