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Managing GERD Longterm

As I’ve talked about several times, GERD is a fact of life after VSG surgery. I am averse to taking medications for the rest of my life, but it appears I’ll have no choice. I don’t mind taking supplements, I’ve done that for decades, but medications that alter my body make me uncomfortable. Even if I’d been told about the GERD (I WAS NOT), I’d still have gone for the surgery. The benefits far outweigh (ha! PUN!) the GERD.

That said, I’ve been on a quest to find the right balance of PPI and/or H2RA to manage the GERD with the smallest dose possible. In case you’re new or unsure about all these acronyms, here is a quick primer to bring you up to speed:

GERD – Gastroesophageal Reflux Disease
VSG – Vertical Sleeve Gastrectomy, often called gastric sleeve surgery (not an actual sleeve, refers to shape of stomach)
PPI – Proton Pump Inhibitor, a drug that binds with certain enzymes and prevents the pumps from producing acid in the stomach
H2RA – Histamine Receptor 2 Antagonist, an antihistamine that blocks acid production in the stomach
NAB – Nocturnal acid breakthrough
-zole drugs – any reflux drug that ends in -zole is a PPI class drug
-dine drugs – any reflux drug that ends in -dine is an H2RA class drug

There is a goodly amount of research and studies on both PPI and H2RA drugs, but there is still much unknown about long term use of them (paper HERE). Doctors tend to prescribe these drugs liberally, without taking into consideration their side effects and long term issues that will arise from taking them (paper on this HERE). I was not told a single thing about the PPI I was given, other than take it twice a day. That’s it. They also did not go into detail about other supplements a VSG patient should take for the rest of their lives. A passing mention was given to Vitamin B12, but no documentation was offered. The useless nutritionist never once mentioned Vit B12 supplementation, either.

Fortunately for any VSG patients reading this, you have ME to root through the reams of research and give you the info I’ve rounded up in a convenient blog post. :)

After finishing the initial month of Mexican omeprazole (Prilosec) in capsules, I switched to American omeprazole in tablets. I had already done the reading about the long term issues with omeprazole, such as calcium and magnesium blocking, which is very problematic. I tried switching to Zantac (ranitidine) twice a day and the side effects were horrible. I had ringing in my ears, constipation, diarrhea. I felt awful. And I still had some reflux. This lasted about two weeks, then I gave up and went back on omeprazole 20mg in the morning and famotidine 20mg (Pepcid) at night before bed. I spoke to the pharmacist about it and decided I’d split the difference (paper about PPI and H2RA HERE). I’ve been on this combo for about 2.5 months. The famotidine also gives me some buzzing in my ears, but milder than ranitidine. But it’s got to go.

Today I’ve been reading about using PPI and H2RA drugs together and mostly it’s a wash. There is little evidence that taking the H2RA at night will help with Nighttime Acid Breakthrough (NAB). It’s pretty much worked for me, but the last couple of weeks it has been less effective. Most of the studies I read indicated that taking a PPI twice a day is more effective in general than the combo.

I also read that Nexium (esomeprazole) is slightly more effective than Prilosec (omeprazole)(papers HERE and HERE) and the newer drugs Protonix (pantoprazole) and Aciphex (rabeprazole) are even better, but they are Rx and likely very expensive (Aciphex is $800/mo at retail and no insurance covers it, FYI). The good news is that Aciphex is available in generic, but there is a wide variety of quality amongst the manufacturers (more about that HERE). I will revisit trying them out if Nexium poops out on me in a few months. I’m betting it will, but I’ll save my $65 Dr visit for now. Article with comparisons HERE.

So I’ve decided to switch to Nexium 20mg once a day to see how the NAB is. (I ended up taking Nexium 20mg twice a day.) I hope I can keep the dosage to a minimum, although one study said that the dosage is irrelevant to the nasty side effects. Calcium and magnesium are blocked just the same with 20mg as 60mg+ (paper HERE). But hopefully the ear buzzing will cease when I discontinue the H2RA. (It did, mostly, but I still have light buzzing.)

To offset the calcium/magnesium issues, I take a cal/mag supplement as well as a D3 and Vit K2 supplement. D3 and K2 (NOT just K, but K2) help a lot with absorption of calcium and magnesium. I’ve listed details of what I take daily here.

I’ve found that taking Kyolic Kyo-Dophilus daily has helped with my gut issues. Taking PPIs and H2RAs wreaks havoc on your gut. Diarrhea, constipation or BOTH should be expected. Taking the gut flora caps seems to offset some of this. I recommend taking probiotics! Your gut is a mess after VSG. Between no food, antibiotics and taking 40mg of Prilosec a day, you pretty much kill off your gut flora. I wish I’d started the Kyo-Dophilus immediately after surgery, but of course, Drs (and apparently nutritionists) are not trained in supplements, so it was not mentioned. You should start this before and right after surgery. Get the yogurt with probiotics in it at the very least (Activia, I think it is).

My adventures in managing GERD after VSG have been informative if nothing else. I know more about how the stomach works that I ever did! I hope my blog posts are helping others who have gotten VSG and not been told all the facts. I know that Drs here AND in Mexico are extremely uninformed about the long term use of PPIs and how to supplement. I’ve spoken to people who’ve gotten VSG in both places and they have been told ZERO about what to take afterwards. Vitamin B12 supplementation is VITAL. So is calcium and magnesium! Not getting these vital nutrients can cause terrible side effects in the long term. B12 deficiency has been linked to dementia and of course calcium deficiency means osteoporosis. Magnesium imbalance can cause heart issues. So do your reading and TAKE YOUR SUPPLEMENTS. It is important to your long term health!

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5 Month Under 200# Achievement Unlocked!

I did a video the other day to celebrate my first big goal: under 200#! Squee! It’s a long video at 26 minutes, but I cover everything up to now. I thought I’d also write a blog post to back up the video and give all the facts succinctly.**

Current stats:
Weight at beginning: 250 40 BMI, which is the minimum to get VSG.
Weight at surgery: 238
Weight at last weigh in: 196 (which was skewed) Actual weight: right at/below 200. BMI 34.4.
Waist at start: 51″
Waist now: 44″
Jeans at beginning: 18/20
Jeans now: 14 fat, but these are loose. I think I’m in a straight 14 now.

I had surgery May 17, 2016; exactly 5 months ago today! Happy surgical anniversary to me! The surgery was very easy for me. I had no gas, no pain, no issues. I think it was because I was at the minimum BMI and very healthy to begin with. The biggest thing to happen right after surgery was that all inflammation in my body ceased immediately. It was stunning. I am convinced that inflammation MUST be somehow linked to the stomach and gut. It’s the only explanation I have for the sudden and complete cessation of the inflammation pain I had.

I had one incision dehisce – which means pop open. It was a big deal because no one knew what to do about it. The Drs in Mexico blew up my phone checking on me (which was AMAZING!), but neither they, nor my dermatologist had any idea what to do. Luckily for me, I’ve got Amy as a friend and she is also a nurse. She recommended wet to dry dressing, which worked perfectly. I went for my gyno exam and my gyno knew exactly what to do and she said, “Of course you use wet to dry! Doesn’t everyone know that? We see this often with C Section incisions.” I love my gyno! That healed up fine once I started the correct dressing. No big.

You’ll be on an antibiotic and a double dose of omeprazole (Prilosec) for a month. They have omeprazole in capsules in Mexico, so you open these and the antibiotics and take them that way (tastes like FEET). Typically you are not cleared for pills until the 2 month point. I’ve listed the bariatric vitamins I used here.

I made my own diet for the recovery. The crappy yogurt, canned meat and refried beans diet given to me by the idiot Mexican “nutritionist” was tossed immediately. Not only did it have no actual nutrition, it had stupid amounts, like a cup of each item. Um, apparently no one told this person that post op patients can NOT eat a cup of anything. More like 1/3 to 1/2 cup. I made gobs of chicken stock, lots of pureed veg for soups and had the ubiquitous whey protein for shakes. I drank gallons of Vitamin water because it has vitamins and calories, which I needed because I could not eat. I was on solid foods (as in: not pureed, but still soft) at week FIVE. I ate lots of canned tuna and chicken and other canned veg because it’s soft. Also, eggs are your friend. Eggs are the perfect protein and they are easy to digest. I also ate a lot of cottage cheese.

I hit the weight loss stall early: at about one month. This stall depressed me and made me regret the surgery. This happens to everyone who gets VSG. Your body freaks out and tries to hold onto its weight because it thinks it is starving, so a stall WILL happen, it’s just a matter of when. But it also stops after 2-4 weeks and then your loss starts.

I did NOT lose a bunch of hair. I was bracing myself for this because everyone was screaming about it on the boards. Didn’t happen to me. You lose 150 hairs a day, people, so I think the hair loss is probably not as bad as everyone thinks. Also: you can lose hair after ANY surgery, not just bariatric.

Once I was cleared for pills and capsules, I began to bring back in the supplements I’d taken before surgery. Here is my current regimen. You MUST take supplements after VSG. You need Vit B12 in copious quantities, calcium/magnesium to offset the Prilosec and Vit D3 and K2 to help absorb the calcium. I took a vegan iron supplement (the vegan one does not make me sick like regular ones do) a few times, but it tasted nasty, so I stopped. When I get my blood tests in a few weeks, I’ll find out if I’m anemic. I’ve NEVER been anemic, so I doubt I will be, but if you tend towards that, you should take an iron supplement.

Reflux and/or GERD will be a part of your life after VSG. Just accept it. They don’t say much about it when you are given info, but it will be there. They expect you to take Prilosec for the rest of your life and it looks like that is accurate for me. I tried getting off it and that was a miserable failure. I take 20mg omeprazole in the morning and 20mg famotidine (Pepcid) at night. These drugs are NOT good for you. Prilosec (omeprazole or any -zole drug) blocks calcium absorption and is just not recommended for long term use. Too bad we have to take it forever. :( I just supplement the calcium/magnesium and hope for the best. I can’t stop taking it, the reflux is too severe. I am convinced it is the shape of the VSG tube/pouch that forces the acid up to the esophagus. I think they’ll eventually change the shape of the VSG to alleviate this.

You’ll also have to radically change your eating habits – which is the point, really. They want you to eat anywhere from 50-80 grams of protein a day. I counted protein like crazy for the first 3-4 months to make sure I got enough, but honestly? I stopped that shit. It’s too much like dieting, which I REFUSE to do ever again. You’ll need to stock up on Premier Protein shakes (30 grams protein, no carbs) and drink those every day for the first few months. I switched to the Premier Protein bars (30 grams protein, 29 grams carbs) about a month ago because I was sick of those shakes. I have to admit, tho, that I don’t eat a bar or shake every day. My average protein intake w/out a supplement is probably around 30 grams. I don’t have any idea of my caloric intake, nor do I care. I don’t drink a gallon of water every day, either, but I didn’t do this before surgery, so I drink what is normal for me. I drink no calorie flavoured fizzy water, 2-3 cans a day (La Croix!). YES you can drink fizzy water and beer – well, I can. No issues. Use your pee as a guide: if it is dark, you need more water.

The hardest thing to learn is when you are full. The pouch feels very different than your stomach did, so this definitely has a learning curve. I just recently got the hang of eating until I am full but not TOO full. As you’ll find out, overeating is an odd and unpleasant sensation. I drink while I eat, too. NOT MUCH, mind you, but a little. You’ll find your own balance. I eat anything I want, just not much of it. :)

Overall, this was the best decision I’ve ever made. The way I’m losing weight is different than any other time I’ve lost. I’m becoming overall slimmer, my legs are looking different than they ever have. I tell you what: if my calves get small enough to wear boots – I’m getting some expensive ass cowboy boots. Assuming I can find a pair that I can get my high instep into! Sadly the instep will never go away!

And finally, you must start to exercise. You lose fat and muscle when you do this (which is why protein is so very important), so exercise will build your muscles back and keep the fat burning. I can tell I’ve lost muscle – I am very weak now. I’ve started back walking and doing light weights.

Oh, and one last thing: get a blood test, full panels, done at six months. This is the best way to see where you are with iron and mineral levels and all the rest. It’s just a good thing to do. If you watch cholesterol or any of that, I’m sure you’ll see a massive improvement.

As in my video, I’d like to give a BIG shout out to Nick! He has lost FORTY POUNDS since my surgery!! He has been working his ass off every morning and he has joined me in the Eat-Like-A-Child club. Good job, baby!! XOXO

That’s it. I’m at five months, I feel great and I am very happy with the way I look. I highly recommend VSG – despite the reflux issues. It is totally worth it. :)

**My usual disclaimer: all these things worked wonderfully for me. Your mileage may vary. Listen to your body.

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Real Talk About Being Fat

I know it’s en vogue right now to be “body positive” and all that shizz. But I have to tell you something: I hate being fat and I do not think it is ever pretty.

There. I said it.

I am still fat, but just getting my face back has been a revelation. You can see my eyes! I have only one chin!

I’ve been reading a lot of fat positive blogs and books and while I agree that you should wear whatever the fuck you feel like wearing, I do not agree that it is cute. I just don’t think obesity is a pretty sight, no matter what you’re wearing. I’ve tried really hard to accept being fat, but ultimately, it just never worked for me.

Which brings to mind a girl at DragonCon about 15 years ago. She was easily 300# and she wore the LeeLu Dallas white strappy thing ALL WEEKEND. I saw her and I was all at once hugely impressed and grossed out. It was impressive that she had no fucks to give and she rocked that minuscule cosplay despite the jeers and mean looks. I’ve never forgotten that girl and her bravery. Wonder what happened to her? Is she still fat 15 years later? Is she still as fierce?

Anyway, back to me. When I look at the few pics I have of me at 250#, I am stunned by just how horrible I looked. I knew it was bad, but dayam. All you fuckers who told me I looked great can SUCK IT. LIARS!! While I appreciate your support, I feel it was more for my feelings than the truth. So, thanks for the support despite your lying to my face. :P

I’d also like to publicly apologize to Nick, for ignoring his gentle nudges to be more active and try harder to lose the weight. And I’d like to acknowledge his continued love and support for all these years, during all the sizes and all the mood swings. I love you, honey, and I couldn’t have done this without you. Yes, I wanted a better life for myself, but I also did the VSG for you. I was tired of being an old fat wife. I’m still old and currently still fat, but soon I’ll be old and average rather than fat. And I’ll be much more able to be the partner Nick needs me to be. He deserves that.

I’ve only lost 44# so far, but I already feel SO much better. I’ve still got issues with the new stomach (Pouchie is an ASSHOLE), but I think I eat enough to start exercising again. I just ordered a NuBand Activ+ and I plan to start walking every day again. Starting today!

I like that I’ve dropped from an 18/20 to a fat 14 (Avenue is a fat store, so their 14 is bigger than a straight 14). But I can tell I’ve lost lots of muscle mass. I’m going to ask a bodybuilder friend for some guidelines to get my muscle tone back. I’ve got a lot of weight to go, but the carrot is wearing straight sizes again and being able to cosplay next year at DragonCon. I’ve always responded better to the carrot than the stick and this is no exception. The fact that I did Dragoncon this year and only had a sore lower back (no muscle tone) is AMAZING.

To all the fat and fabulous out there: good for you! I’m really happy that you are fine with your body and rock it daily. That just wasn’t me. I was never fine with being fat. Which is why I did VSG. I’d had enough of the fat and the inflammation and the sore joints. I’d had enough of my face looking like a bloated balloon. I’d had enough of the huge belly. I’d had enough of not wanting to go out because I hated the way I looked.

VSG is not for everyone, true, but for me, the surgery was a breeze and despite the reflux, it has been worth it. I feel SO MUCH better about myself as I come to my 51st birthday than I did at my 50th. Last year, I was beyond unhappy. This year, I feel a glimmer of hope that our future will work out. I’ve not had hope for a VERY long time. I feel like throwing a party! And I just might. My cooking mojo is coming back – thank the gods. The loss of my desire to cook was pretty devastating after surgery. But it’s coming back and that is another reason to rejoice!

I’m happy to leave behind the world of the fat girl. More power to those that are rockin’ it, but it just ain’t me. I hope to reach my ultimate goal of 150, but I’d be happy with 170. Even at 170, I’ll be in a 10 or 12 straight size. And THAT, my friends, is what I’m after.

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Vitamins for Long Term Bariatric Health

UPDATED AGAIN April 2018 to give accurate list of my vitamins, below.

I am big believer in vitamin, mineral and herbal supplements. I’ve used them since my 20s and I believe that they are the reason for my overall good health. I study vitamins and supplements, so I tend to get very technical when I am putting together my personal vitamin and supplement regimen.

I’ve posted about the various supplements I take, but I wanted to update that to what I am taking right now, plus some interesting information I’ve found about Vitamin K. First, the Vit K info!

Vitamin K, which is promoted as a helper for calcium absorption and often found in calcium supplements, has several forms. Turns out, the form most often found in calcium supplements, K1, is not the one that helps with calcium. Who knew? I came across this article about Vitamin K that I found very enlightening. What I learned is that K2 (menaquinone) is the vitamin supplement you need to help calcium, NOT K1 (phylloquinone). Here are the K vitamins and what they are for:

•Vitamin K1, or phylloquinone, is found naturally in plants, especially green vegetables; K1 goes directly to your liver and helps you maintain healthy blood clotting

•Vitamin K2, also called menaquinone, is made by the bacteria that line your gastrointestinal tract; K2 goes straight to your blood vessel walls, bones, and tissues other than your liver

•Vitamin K3, or menadione, is a synthetic form I do not recommend; it’s important to note that toxicity has occurred in infants injected with this synthetic vitamin K3
(Excerpt from “What You Need to Know About Vitamin K2, D and Calcium” by Dr Mercola, from previous cited article.)

There is more technical info in that article, but suffice it to say that you need K2 to assist calcium absorption when taking calcium supplements. ALL BARIATRIC PATIENTS should take calcium supplements, especially if you are on omeprazole (or any -zole drug), since these drugs block calcium absorption. You also need Vitamin D3 to assist with calcium absorption, but that is in pretty much every supplement out there. I will add that you should also balance the calcium with magnesium citrate (2:1 ratio). You should also be on high doses of Vit B12 since your stomach was the source of the absorption and is now a fraction of its normal size.

What all this boils down to is you need to be aware of this balancing act when you start taking calcium and vitamin D supplements. Lucky for YOU, I’ve done the math and found the right blend of products to achieve this balance of Calcium, Mangnesium, Vit D3 and Vit K2 for longterm bariatric use.

I’d also like to remind you that reducing the size of your stomach will SEVERELY affect your vitamin B12 absorption. If you take nothing else, TAKE VITAMIN B SUPPLEMENTS. I read a paper that links Vitamin B deficiency to Dementia. My father seems to bear that out. He had “ulcer” surgery in the 70s (before they figured out that it was a bacterial infection). They removed 80% of his stomach. Sound familiar? Yep, he had VSG before they even knew what VSG was. He was never told to change his eating habits and he never took a vitamin. This explains why he’d always go lay down in pain after every meal. We were in the steakhouse business and he’d eat an 8oz steak… Can you imagine the pain? I can. But, anyway, he did not take any vitamin supplements at all and his brain has been swiss cheese since he was around 70. He is now 80 or so and is completely incoherent. I feel that this is because he did not take B vitamins. //my theory//

My current supplement regimen (My vendor is Vitacost. Use THIS LINK for a $10 coupon!):

1 200mcg Selenium (hot flashes)
1 Kyolic Kyo-Dophilus (reflux and gut health) Not currently taking this one.
1 Vitacost Synergy Once Daily Multivitamin
1 CoQ10
2 Vitacost Calcium/magnesium (dose is 3, so 2/3 regular dose)
1 QuickDots Vit B12 chewable (also has some other Bs in there)
1 Quickdots D3 and K2 chewable (to get the K2) DID YOU KNOW that most people are Vit D deficient these days? They are, due to the use of sunscreen. It is probably a good idea for most people to take a D and K supplement.

This has been my regimen for almost a year now. I still get a little reflux when I take them all at once, but not too bad. It rarely happens if I take the vitamins with food.

One 20mg Kroger brand Nexium (esomeprazole) capsule in the morning and half a 20mg Nexium pill at night. They stopped making the pills, so when my stash runs out, I’ll go to two caps per day. I still cannot get off esomeprazole. I guess I’m on it for life. Sigh. Hopefully my kidneys won’t get damaged and/or my bones won’t dissolve. Sigh.

Side note:
Since surgery, my inflammation issues are GONE. (Still true, 2 years out!!) I no longer take naproxen. I’m very happy that the inflammation has disappeared – it is a nice bonus from the VSG.

As I’ve mentioned, I had to go back on omeprazole (Prilosec 20mg) esomeprazole (Nexium 20mg 2x/day) to keep the reflux in check – more on this HERE. This is why I am trying to find the absolute BEST calcium plan I can, because any -zole drug (PPI) blocks calcium absorption and has lots of BAD long term effects. I’d rather not have my bones dissolve, so I’m trying to work out the best strategy.

Protip: you can’t really check your calcium or other vitamin levels with blood tests. All these tests show is your SERUM levels, which are the levels in your blood, which is not the same as the absorption levels. So just take the dang vitamins and hope for the best.

As always, I hope this information is helpful to other bariatric patients out there who are trying to navigate the maze of supplements like I am.

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More from the land of reflux

I’ve been taking H2 blockers for about a month now. Last week, I noticed a buzzing in my ears. Come to find out, the buzzing is a side effect of the H2s. So is the horrible constipation and diarrhea. Great.

So I spoke to the pharmacist at Kroger. She was in her 20s, so I don’t think she grasped the depth of the issues with side effects, but she confirmed what I already knew: it’s either H2 or PPI. Or both. That’s it. She said since my side effects were rather intense with the H2, I should probably go back to the PPI. Fuck. She said that cutting the H2 to once a day should alleviate the buzzing in my ears and hopefully the diarrhea/constipation, too.

So what I’m going to try is PPI in the morning and H2 at night. Just to keep the PPI dose to a minimum. I’ve no other option.

I am VERY conservative when it comes to Rx (or OTC that was Rx) drugs. I just don’t like them and if I have to take them, I do extensive research. Unfortunately for me, it means I know too much. My mother has serious osteoporosis, which is why I’m worried about that side effect of PPIs in particular – and don’t want to take them.

BUT it doesn’t matter, I have to get the reflux handled. I have to get to feeling better. I wish I was the type of person who could just take whatever drug is handed to me without question, like most folks, and not worry. But I am not that type of person. I don’t trust Drs or drug companies to have my best interests at heart.

Today, I start PPIs again. I’m not happy about it, but I MUST get my life back. I did this surgery to lose weight and feel better, not sacrifice my life to it. If there was another option, I’d take it. Alas, there is not. I just hope better drugs will be developed in the future – ones that don’t block calcium or have other nasty side effects.