Why such different protocols for RNY's from Surgeons

 You would think after all the research and studies over the years on RNY's that it wouldn't vary much as to what is put into the pouch.  I am amazed at what people are eating according to their surgeon. I know we are to follow are own doctor's instructions and that is what I will do.  I have to prep tomorrow with magnesium citrate yet my friend back east (hi girlfriend!) doesn't. So if all these doctors with different rules on eating,  you put them all together right out the gate we would be eating just about everything, with the exception of sweets.  Seems some are allowed carbs, yet we are told that's a big NO for awhile. But as Kelly said there doesn't seem to be a problem except in the choices we decide to make.  I believe I have learned more on OH than the 26 weeks of classes for nutrition and 6 months of bariatric classes. They don't even begin to touch on subjects that I have found out through here. Why is that? What about the people who aren't on here?  I wouldn't have known about this site if my PCP's nurse hadn't had the surgery herself.  No one ever mentioned strictures, no one ever said what to do if it does happen.  So when I read about it I was like Whoa! That's good to know and not to mess around.  So many, many things I have learned from all of you.  I would deffinately change up the bariatric program as far as info.  I also read alot of great books.  One thing I think that really needs to be revised is more focus on the emotional end of surgery and for the rest of our lives.  Counseling is on my first things to do after I have my surgery to help me along.  I should have been doing this a year ago.  I believe maybe my stress might be less if I had some tools to utilize right now.  It's not enough to want the surgery. It's what you do afterwards that is going to set youself up for failure or success. Thanks to all of you for your great input.  thanks Nik for telling us to stop and take a deep breath and Kelly, in spite of all your pain you are in, you still post to help others.  Wow, talk about it takes a village to help WLS patients!

Here's what *I* think---

Surgeons are trained to cut and sew. In medical school, physicians have VERY LITTLE training in diet and nutrition---and that's because we, as a species, don't really KNOW much about diet and nutrition. (If you need convincing, do a Google search on  the Food Pyramid and how it's changed over the past century. We probably know more about animal nutrition---see Ralston-Purina's website---than we do about human nutrition.)

Biochemists are the people who are *beginning* to understand how diet and nutrition really works. Thirty years ago, we were told that pasta was a really healthy food---it was the meat-based sauce we put on it that was making us fat. (Yeah, really. *sigh*)

The bottom line is---we're still winging it. And we're all different. *I* do really well, both health-wise  and weight-wise, if I eat a diet high in protein and fat, with a moderate intake of both complex and simple carbs. If I eat too many simple carbs, I get gassy and my clothes get tight. When I cut them back, my gas goes away and my clothes get looser again. Complex carbs don't really seem to affect me much either way---I seem to like them in about the same amount that my body wants to eat them. (Post-op---pre-op, I couldn't get enough!)

Dr. Suh sponsors 4 support groups each month. I found them very beneficial in the post op process.  No matter how much you think you've learned, you'll still learn more at each support group. All you have to do is listen and you'll hear new info almost every meeting.  Counseling can help a variety of issues that include self image issues as you lose wt., deep seated reasons for overeating for years (abuse, rape, divorce, etc.), and a host of other issues will benefit from good counseling.  I know several members of one support group who had issues and they publically speak at these meetings on how much they benefited from counseling.  Good luck. DAVE

My surgeon covered strictures and most of the complications that can occur in his informational seminar.  He even told everyone to come to this site and read everything, which I did, I knew everyones profile for a very long time when I was new.  I was very well prepared, but then again I would never undertake a life altering surgery without knowing absolutely everything.  It scares me when people who know absolutely nothing about what wls is all about ask how long until the surgery once they start the process.  Sadly those people generally are unsuccessful because they don't understand what these surgeries encompass as far as the changes that need to be made....forever.  Otherwise you lose weight in the beginning of course, but once it falls back on you and you go back to eating as you once did, exactly what happened when you where overweight is gonna happen, you are going to gain weight.  If you want to lose weight, you need to know everything there is to know about what to expect, what you want, and how to achieve your goal.  It's fine to make goals, to enjoy your success and to have fun along the way, but know you will always need to take vitamins, to eat properly and stay on top of your weight.  Even the DS can be defeated if you want to live on ice cream and ho ho's. 

Surgeons have different protocols because most of it isn't based on science.  As far as I know, there have been no studies to see if staying on liquids for one week or two weeks post op leads to better outcomes.  If there has been such a study, I would bet most surgeons have not read it!  There have been studies on what calcium we absorb best or how much vitamin D is needed to reduce the risk of osteoporosis, but most surgeons haven't read those either.  It's not their area of expertise.  They are trained to cut and sew, and most are very good at it.  They don't get much training in stuff like nutrition, though.

I think they decide what type of diet and vitamins and stuff to recommended based on one or more of the following:
1.  What they were taught.  If they learned to perform RNY under a surgeon that always instructed patients to do liquids for two weeks and to take Flintstones vitamins, they might think, that surgeon seemed to know what he was doing, I'll tell patients the same things.
2.  They might base it on their experience.  If they had a patient that has some sort of complication from eating solid foods one week post op, they  may strongly discourage patients from doing that in the future - even if that complication was very rare and unlikely to happen again.
3.  Some of it, I think, is just personal preference or opinion.  for instance, some surgeons have told patients they recommend Flintstones because they assume patients will not want to spend more money for better vitamins.  Or maybe it just seems to make sense to them to keep patients on liquids for a while after surgery, even if they have nothing scientific to base that on.

And I'm not saying those are bad things to base recommendations on.  But you can see how different surgeons, trained in different places, with different experiences treating different patients, would come up with different "rules" if that's what they based them on.

It's OK to ask a doctor why he recommends a particular thing.  It doesn't mean you're suggesting he's wrong, and he shouldn't take it that way (unless you really say it that way).  But knowing why he recommends something can sometimes help you make your decision.  If a doctor told me he recommended X vitamin because a study published in whatever journal showed it was best in some way, that means a lot more to me than if he told me he recommended it because he assumed I wouldn't want to spend an extra dollar per month on a better vitamin, you know?

 Thank you everyone for your input.  Will be in touch after my surgery and will be glad to get this behind me.  This is going to be the easy part compared to the journey up ahead, and I say that in a realistic way.  Many are having their surgeries tomorrow and my thoughts will be with everyone out there having it done, no matter what type of surgery they are having.  I did get on the Sleeve forum one time though and they don't take too kindly to RNYers!   hahahha  They were just defending their territory! Very protective people those Sleevers!  Talk to all you guys when I get back!  :)  Jane from California

I knew nothing about OH until 1 month pre-op. Thank heavens my BFF told me about it. My surgeon's office had RealizeYourSuccess dot com which was sponsored by the makers of the Realize lapband (they recommended it although I had open RNY). That site was useless. Honest! It offered the pre-op & post-op patient nothing. It shut down on 4/10/2012 (no surprise there).

As far as food is concerned, the reams of paper I was given by my surgeon's office recommended things like mashed potatoes, scrambled eggs, hummus, & refried beans. It was tough for me to type the previous list because every single one of those things made me about urp. The refried beans caused me the worst gas pain I've ever had AND I was 5 days post-op (thought I was gonna die). Scrambled eggs are way too rich for my tummy, as are mashed potatoes (any kind of potato doesn't sit well with me so I've only tried a tiny taste once post-op & that was plenty). Some kinds of hummus are loaded with fat & way too rich for my tummy. I tried scrambled egg whites & they were okay... but just didn't feel right.

Here's one the nurses at the hospital (each of whom is a 100% complete angel BTW) recommended: eating Cool Whip straight out of the container. oh My GOSH NO!

"One thing I think that really needs to be revised is more focus on the emotional end of surgery and for the rest of our lives.  Counseling is on my first things to do after I have my surgery to help me along.  I should have been doing this a year ago.  I believe maybe my stress might be less if I had some tools to utilize right now."

Jane, believe me, I read so much before my RNY. But let me tell you this: I was completely stunned by the psychological affects of not having food - my go-to numbing drug of choice almost my whole life - to turn to when I was stressed. You hear about hormones running amok, anesthesia wearing off slowly, blah blah blah, but the food rug got pulled right out from under me overnight & it's thrown me for a loop.

I started seeing a LCSW 3 weeks before my surgery. That one step is one of 2 of the best things I could ever have done in my life. I see her once a week.

The second one is joining Overeaters Anonymous (1 1/2 months post-op). Yes, the RNY has given me a new life. But unless I excavate & deal with the reasons why I am a compulsive overeater (one day at a time), it's possible I could go through my RNY honeymoon period, lose 100 pounds, then start regaining because suddenly my old cunning, baffling & powerful "friend," food, would be at my beck & call again.

I highly recommend OA! I cannot sing their praises enough. I sometimes attend 3 meetings a week.

http://www.oa.org/

I'll be thinking of you Jane! Best wishes! Much love, prayers & good thoughts coming your way!