Survival Guide Following Your Duodenal Switch Surgery

Written by: Lori Black

(Not to be intended as medical advice).

 

Arriving home after surgery is somewhat like bringing home your newborn baby and not knowing exactly what to do.  The nutritionists gave you guidelines, but you’re still not sure where to go from here.  Here are some simple things that I did in the beginning to transition into this new life of mine.

 

1)      Hydration is the number one most important thing. You have got to find a liquid that works for you and you need to be sipping most all of the time.  You won’t be able to gulp for quite some time, so with sips you’ll find you need to drink all day long to get in your required liquids.  You NEED 64 oz of liquids, however you can get them in.  Soup, broth, water, crystal light, Fruit2O, decaf tea~ warm or cold, sf koolaid…anything you can get down and keep down works.  You may have to play with the temperature.  Some can drink only warm, some only ice cold, others room temperature.  You have to find what works for you.  The liquids you use in your protein drinks and soups all count as fluid. 

 

2)      Protein is very important right now, and next in line after hydration.  You need to focus on each thing that you eat having some amount of protein.  You don’t have to eat 100g a day from the get-go, but you want to get there as soon as you humanly can.  Cheese, yogurt, cottage cheese, protein drinks, pureed or VERY WELL chewed meats are all good protein sources.  You have to find what foods work for you.  I went to the grocery with my husband and just walked the outside aisles looking for proteins that looked good and sounded like something I could/would eat.  Protein is very important after surgery as it helps to build, repair and maintain tissues in your body and in you major organs and skeletal muscles.  If protein is not kept up with over a period of time, you can develop protein calorie malnutrition (PCM).  This is a disease that is usually well advanced when discovered and does take time to occur.  You can avoid this by getting in as much protein on a regular basis after surgery as you can.  You should be getting no less than 30g of protein a day by 30 days out, 60g by 60 days out, and 90g by 90 days out.  This is just a guideline.  If you can get more, you should. 

 

3)      You need to eat something every 2 hours during the day and evening.  You don’t need to eat a feast every two hours, you just need to be eating “something” to get your stomach going.  When you wait to eat, the acid builds up in your stomach, and for me that meant that my stomach would have even less capacity to take in protein and fluids.  Even if you can only eat 2-3 bites of your chosen food, that’s okay.  Just keep trying to get in more nutrition

 

4)      Sleep is critical to your recovery.  This time is called recovery because it’s supposed to be used to RECOVER so if you’re trying to be a super-hero…STOP IT!!!  You have plenty of time to be saving the world once your body has healed!!

 

5)      I know all of this is a lot at first.  You’re going to feel like you’re eating, walking, taking vitamins, and sleeping all day long.  It’s a chore in the beginning for sure!  If you need to set an alarm to remind yourself of all of these things, that’s okay.  Even an egg-timer can help to keep you on track!  Don’t forget to do your incentive spirometor for two weeks following your surgery. 

 

6)      Walking is very important to your recovery.  You need to try to walk often after you get home.  Walking more often is more important than the distance you can walk.  Don't over-do it, but don't allow yourself to become complacent and get life-threatening blood clots.  I made myself use my breathing spirometer after walking for the 1st two weeks to avoid pneumonia.

 

7)      Vitamins are crucial to your life after the DS.  This does not mean you have to be taking them the first day out of surgery.  Your stomach will be very swollen in the beginning, so getting in vitamins can be a real struggle.  Do what you can, try to work up to your full vitamin plan by 4-6 weeks out.  In the beginning, try to at the very least, get in calcium several times through the day, your multivitamins, vitamin D, B-12 and B-1.  The rest will come as you are ready. Vitalady has put together a beginners vitamin schedule. Your labs will dictate if you need more or less of each of the suggested vitamins.  If you need a copy of the Vitalady vitamin supplementation list, just PM me your email addy, and I'll send you a copy.

 

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This is a list of frequently asked questions that I put on my OH profile some time ago and think it’s good to have on hand when you have questions. 

 

Frequently asked questions from Pre-ops and new ops.... [Edit Post]
on April 8, 2008 10:15 am
Published

All of us have been pre-ops, or maybe you still are now.  We all have a million questions in the pre-op phase, but it's so easy to forget the answers once we've actually had our surgery.  There are so many crazy and confusing things that happen to us after we get our DS's.  Each of us have very different journey's, but in the beginning we all seem to have many of the same questions, concerns, and fears.  I have started a list of frequently asked questions and have weighed in on each of them with my opinion.  Please keep in mind that I'm not in the medical field and the following should not replace the advice of your surgeon or doctor...these are just the things I've learned along my journey by either reading or experiencing first hand. 

Is my poop going to stink, and/or am I going to get gas with the DS?

Well, yes.  We're human.  Poop NEVER smells good, and we all get gas,I don't care who you are.  I do believe that the smell changes after the DS, (as it does with ANY malabsorbtive procedure...just look at the RNY board or talk to an RNYer, they complain of this problem too) but it hasn't been something for me that has been uncontrollable. 

Ways to control gas and smelly poo after your WLS

I have found an air freshener that clears any smells I can possibly make from Walmart.  It is called Pure Citrus.  In addition, I take one probiotic daily called Culturelle.  It doesn't make my poop smell like roses, but it does seem to regulate things better.  There are also internal deodorizers like Devrom, Innermint, and of course there is always Flagyll.  We each have to find what works for us, no one person will be the same.  In the end, the thing that works the VERY best is watching for the trigger foods that give you gas and avoiding them if you need to be somewhere that having a bout of gas would cause you problems.  As a pre-op, beans, chili, and spicy foods gave me noxious gas.  As a post-op, those still get me sometimes, and white flour is an additional gas maker for me as a DSer.  I only eat it in the evening hours when I'm home for the night.  Often it is rumored that DSers have diarrhea for life.  This is *NOT* a normal condition after the DS and if you have diarrhea after the first few weeks post op, you should be talking to your surgeon ASAP about what to do.  Dr. Hess suggests taking 1 -3 teaspoons of Metamucil to add bulk to your stools and help to cut back on the frequency of them.  On the other side of the coin, if you find you lean toward constipation, there are things you can do for this as well.  You can take the full dose of M.O.M before going to bed as a first resort.  If this doesn't work, try upping your fat intake for the next couple of days.  (Add extra butter to the things you're eating, Lil' Smokies, pulled pork, kielbasa, KFC chicken, crab legs dipped in butter, popcorn swimming in butter and so forth).  Another remedy that people talk about using is Magnesium Oxide.  You can take 1,000 mg at bedtime and see if that will work for you.

This hurts so much!!!!!

There is no doubt about it, this surgery hurts!  You've just had your stomach cut open (whether you had your surgery open or lap, this is a big surgery) and it is definitely going to take you time to recover.  I know that we all want to be normal quickly, but having a large portion of your stomach removed, your intestines rerouted, your gallbladder, AND your appendix removed. This is a HUGE GIGANTIC surgery!  For sure!  You are going to have pains, and you are going to have weird little "ghost type pains" that are all of your nerves reconnecting, and things are going to be hard for some time.  Some of us heal more quickly than others, but we all take time.  The best thing you can do is take plenty of naps, stay hydrated, take your vitamins as religiously as humanly possible while your stomach is still swollen, get in as much protein as you can, and take lots of little mini walks throughout the day.  Walking is hard at first, but it does help us heal more quickly which is awesome!!!

***If you are having pain that concerns you, do not hesitate to contact your surgeon, night or day.  They are not going to get mad at you, they want you to be safe too.  If they didn't want middle of the night calls they could have been an accountant....it's their job and they're there for you when you need them, no matter how small the issue. 

How will I break my carb addiction?

I think it's important before even having your DS to make a lifelong commitment to getting in your daily protein.  Protein first is one of the most important rules with the DS.  Sure, that bag of potato chips might be screaming your name much louder than your plateful of protein, but if you can't finish your protein, then you have to make yourself a promise that you won't touch the potato chips.  (Or whatever carb is there screaming your name).  Protein first is a *must* after you get the DS.  If you can eat your protein and you then have room left over, it's okay to have the carb(s) that you want so bad.  By the time you've eaten your protein there won't be a lot of room left for the junk anyway.  Always try to only have a small portion of carbs while in your weight loss window and still trying to lose.    Our chemistry is changed when we focus on protein in our diets.  When you eat protein and fats, your body is satisfied longer...when you eat carbs your body craves food sooner and you'll typically crave another carby food because your chemistry is thrown off balance.  The DS doesn't have to be a "diet" but you will have to make some sacrifices at times if you plan to reach your weight loss goal.  Keeping your carbs low, and your protein and fat high will help the chemistry of your body to fight off carb cravings.  It is better to stay away from carbs as much as possible during the weight loss phase of your journey.  You've had this huge surgery to change your life, take every opportunity to make this work for you.  It may be hard at times for some, but once you adjust to your new way of life, it becomes much easier.  The weight loss phase isn't going to be your forever, but it *is* the key to whether you will reach your goal or not.

Stalls, weight bouncing back and forth and the such...

I've been a member on this board for almost a year and a half.  I've seen JUST about every single person talk about or experience a stall.  We all have different types of losses, but many of us seem to lose in "chunks."  There were times when I would lose steadily throughout the month, and then there were times when my weight wouldn't change for three weeks.  After those three weeks, a loss always came...and usually it came hard and fast!  My losses each month always looked good in the end, no matter what pattern I lost the weight throughout the month.  There were many times during those stalls that I'd look like I was actually gaining as the numbers would bounce between 6 pounds up and down, but like I said.....the stalls were always followed by a loss.

We all have things that work for us to break a stall.  Val likes her Krispy Kremes and Caesar Salad to flush things through, Haley likes crab legs in tons of butter and then buttery popcorn, many are big fans of KFC fried chicken to get things moving.  (I'm one of them).  Another thing that breaks a stall for some is to have 2 or 3 high carb days to shake their body up and then they go back to low carb, high protein, high fat.  Another thing that can really help is to up your fluids and really push them.  Try to drink double what you normally do, water is an amazing thing!

I think as SMO and MO individuals that we are so used to having success with our weight loss only to gain back, that it has become a pattern that makes it impossible for our brains to process that we are going to succeed.  Keep reminding yourself that you took the plunge and went for the strongest and best WLS available to us today, and believe that your DS *is* going to work.  There is so much truth to the power of positive thinking.  You've done your research and you chose this surgery because you felt it was the best fit for your life.  If you hit a stall, drop your carbs to under 50 grams a day, up your protein and water, and watch the magic happen!  Work the rules of the DS, and your DS will work for you!!!!

What are the rules of the DS?

In my opinion, there are very few rules to living with the DS.  Here are the ones I live by...

#1 You must have your labwork done every 6 months or every year (each surgeon is different on this) for the rest of your life....NO MATTER WHAT!!!  There is no way around this.  Labs tell you and your surgeon or PCP where your vitamin levels are.  With the degree of malabsorbtion that we have with the DS, this can mean the difference between life and death, losing body parts or keeping them.  I'm not messing with having things go badly for me after doing something so drastic to have a normal life again!  I want to live because life after the DS is sooo good.  The DS has given me what genetics slighted me.  My surgeon recommends yearly lab work, I'm choosing to go for my lab work every 6 months to always be on top of the game.  In addition, I have started my own file for my own copies of my labs to watch my vitamin levels and the trends that my levels are following.  Also, Gina has shared a wonderful spreadsheet with me that I will be able to plug my numbers right in and look at my results all in one place!  Thanks Gina!  You're awesome!

#2 Vitamins are a forever commitment after the DS.  Each person has to decide what their own vitamin regime will be, and labs will dictate much of what you take over the years.  You need to read and learn as much as you can about the vitamins that your body will need for optimal health, and you need to stay up on the latest information as we all figure things out.  (One of my biggest reasons that I plan to hang on OH over the next, Oh, I don't know.....70 years!)  I take my vitamins 5 times a day.  Some think that this is not manageable, but for me it's a cinch!  If I'm eating, I'm taking vitamins.  If I'm taking vitamins, I'm eating.  These two things go hand in hand.  I take my pills at breakfast, lunch, dinner, bedtime, and I take vit C and my iron at 3 am when I'm ALWAYS awake to go pee.  I have two pill reminders that I got at Walmart.  They each have 28 compartments.  4 compartments for each day, and there are 7 days in each compartment.  I have a tupperware container where I store all of my vitamins, and twice a month I fill both of my pill minders with everything I'm going to need for the next two weeks.  When I run out of a vitamin, I set the empty bottle on my microwave as a reminder that I have two weeks to get those pills purchased at the store or online.  When it is time to take pills, I just dump the compartment that it's time to take into my hand, and it's totally fool-proof.  I typically grab my pill reminder anytime I walk out the door to make sure that if I'm gone longer than planned that i have my pills with me.  I also carry a one week pill minder in my purse that has tons of calcium and multi's in it, just in case I didn't bring my big pill container.  This is the system that works for me. 

****Important****  THERE WILL NEVER BE A TIME IN YOUR LIFE AFTER YOUR DS THAT VITAMINS WILL NOT BE IMPORTANT.  This truly is a matter of LIFE AND DEATH.  Just because you THINK you're getting all you need from your foods because you maybe have the perfect diet, I promise you that it isn't so.  I for one, like having all of my arms and legs, and all of my innards functioning correctly.  I value my life and vitamins are not something that you can become lax on just because you don't feel like doing it anymore. 

#3Protein, protein, protein!  Protein is a building block for MANY functions of our bodies.  After the DS we DO NOT absorb all of the protein we eat, so it's important to shoot for 100 grams of protein or more a day.  Of course for many new-ops, that number is hard to hit.  Some of us are able to do it, and some of us aren't.  So long as you get 30 grams of protein by 30 days, 60 grams by 60 days and 90 grams by 90 days, you should be fine!  Always STRIVE for more, but don't come down on yourself if you can't get more.  It's okay to not be perfect in the beginning, you're starting out with a new life and it takes time to adjust.  My suggestion is to find a protein drink you can tolerate and try to get two of them in everyday until you can eat the protein from all of your food.  My favorite is Champion Nutrition Banana Scream.  The New Whey vials are tolerable, but I don't recommend actually ever TASTING them.  I plug my nose, drink it down, and follow it with something like a glass of milk and a couple of cubes of cheese...all the while still plugging my nose.  If you really wanna taste the stuff, don't worry!  You'll get a preview of it when you burp in a few minutes!  Lol!  Vitalady has lots of sample proteins on her website and I recommend having several already waiting for you when you get home from the hospital to try and see what suits you best.  Don't spend a ton, just have enough to sample and get you through a week or two, and then when you find the one you like, order it pronto! 

#4Low carbs. This one is most important during the weight loss phase of your journey.  The DS really is an amazing surgery and works quite well for most of us.  Carbs really are the nemesis during the weight loss phase of your journey.  Keeping them low will get you to goal faster, and by keeping them low you're also keeping cravings at bay.  Our chemistry changes when we keep our carbs low, and doing this after the DS is relatively easy.  When you focus on getting in all of your protein, there is little room for much else for many, many months.  If you start getting a taste of carbs early out, the carbo man or sugar slut can take hold of you and prevent you from getting to your goal.  I haven't been perfect about avoiding carbs through my weight loss phase, but I've done pretty good.  I stayed under 50 grams a day from day 1 through 2 months, I stayed below 75 grams of carbs from months 2-4, and I stayed below 100 from months 4-6.  At 6 months out I could see that I needed to start upping my carbs to SLOW my loss, and I've been eating around 200-300 grams of carbs a day since then.  This will vary for everyone....you have to find your own comfort zone.  LadyDi made a comment to me when I was a pre-op that has always stayed with me.  She said something like, "Make the commitment to stay as low carb as possible until you reach your goal.  When you're at goal, you can start toying with carbs then.  At that point you'll already be thin and you can watch your scale closely.  If you see your weight creeping up, cut back on the carbs."  It's that easy.  The weight loss window is said to be between 18 months to three years.  It's an easy commitment to make to have a lifelong freedom with eating.  You can cut back on carbs, and doing so will help you to reach the goal we all so desire to be at.

I'm scared I will I lose my hair....

This one hits close to home for me.  My hair thinned from about months three to five after my DS, and then I had to have a hernia repair during my fifth month post op. After the hernia repair, my thin hair started falling out in clumps instead of strands.  The stress of 2 surgeries in 5 months time, in addition to a huge weight loss in a short amount of time did me no favors.  If there was anyone that wasn't going to lose their hair...it was me!  I was getting 90+ grams of protein by my 6th day out from surgery.  By the end of week two, I rarely got below 100 grams of protein and never ever under 90 a day.  I always got in my 64 oz of fluid from week 2 on, and I even took Biotin, Selenium and Zinc.  I was doing everything the way I was supposed to, to avoid hair loss.  But I still lost.  Ten days out from my hernia surgery in Dec. I bought my first wig.  I loved it!  It didn't look perfect, but it looked better than staring at my practically bald scalp.  If you'd like to know more about buying a wig, check the blog posted 2 below this one and I have info there.  I wore my wig from Dec 14th until April 2nd when I went and got a very sassy and short do.  It looks pretty okay too!  Now that I have lost my hair, worn a wig for months, and now have had to have my hair cut extremely short, ask me if I'd do it all over again.  Go ahead.  HELL YES!!!  I'd do this every single year of my life to be free from obesity.  Hair is JUST hair and it's GOING to grow back eventually.  Now I get to start over with a new crop of hair and I'm really enjoying it!  The bonus is that I'm thin enough now to pull off a short hair cut for as long as I need to.  I would've never done this at my highest weight! 

What about loose skin?  I don't wanna have loose skin........

Okay, chances are, if you are big enough to qualify for WLS, and you then have WLS, you're going to have some loose skin.  It isn't normal for skin to stretch the way we've stretched it when we are MO or SMO, and it's impossible to think that you're going to have a perfect body without some type of plastic surgery in your future.  Some of us have a lot of loose skin, some of us only have certain problem areas, and many go on to live a normal life with their loose skin without issue.  I for one, would rather have loose skin and go on to live a long healthy life, than to have continued being MO and having skin that fits me perfectly, but dying young from my comorbidities.  I've never heard of anyone dying from having loose skin.  Believe me, it's WELL WORTH the trade off.  Something that I'm doing until I'm able to have an abdomnioplasty is wearing Spanx.  This is a hose-like undergarment that goes from just below my bra to the mid thigh.  These are very comfortable, moveable and breathable...and it really helps to tame all of the loose skin in my mid-section.  You can also get an identical product made by the same company as Spanx at Target.  The line there is called Assets.  These really help to slim me and feel confident with my excess skin issue. 

Have I broken my DS?? I haven't lost weight in XX amount of time.

Refer to the stalling question above.  And also, chances are that you're not going to be the person that breaks their DS.  I know that we all feel insecure at different times in our journey's, but if you feel like things aren't going well with your DS, sit down and make a list with two columns.  One side listing what you're doing right.  The other side listing what you may be doing wrong.  Then you need to re-evaluate what you're doing and figure out why things aren't working.  If you're doing everything right and you're stall just won't end, have some patience.  Chances are, if you're eating low carb, high protein, and high fat, you will eventually see progress.  Be patient with your body, you're going through a lot.  Your body is changing at a rate that it has probably never seen before. 

Is this going to get better, EVER??

Yes, but not right away.  You need to give yourself the gift of 4-6 weeks to recover.  (This time varies by each person, and whether you have your DS laparascopically or open.  Mine was open and I felt pretty good around 2 weeks, but I still needed time to adjust and get used to my new routine). Take care of yourself and take time to adjust to this new life you've been given.  The DS is a blessing, and if you follow the simple rules it can set you free from your obesity.  During your recovery you need to really focus on you.  It's okay to not be a super-hero during this time, no one should expect you to be normal yet.  My routine went something like this.  Wake up around 8am.  Take vitamins, eat protein rich breakfast, take a walk to get the food to move down, I would try to drink at least 12 oz of water during and after my breakfast, and do incentive spirometer.  If I felt like taking a shower, I would do that.  If not, it was back to the recliner in my bedroom for a nap.  I set my alarm to make sure to wake up and get started all over again.  I'd wake up, take vits, eat protein lunch, walk, do incentive spirometer, and try to drink 12 oz fluids.  Sometimes I'd feel like hanging with the kids, sometimes I'd head back for another 1-2 hour nap. Then I would usually do a protein drink around 4 in the afternoon and take my vits.  Back out for another walk, trying to get in 12 oz fluids and doing my incentive spirometer.  I was usually ready to eat some more protein or another protein shake by 7 pm and would be trying to drink the remaining amount of my fluids through the evening hours.  I would get in one more protein snack around 10 pm and then when that had digested I'd take my bedtime vits and head to bed.  It *is* a full time job, but if I can do it, I promise anyone can! 

 If you feel like things are never going to get better, just come onto OH and look at all of the post ops that are living life to it's fullest.  It *DOES* get better, just believe that it will....and in no time you'll be chugging along like the rest of us.  There really is a light at the end of the tunnel, even if it isn't shining brightly for you right now. 

More on Vitamins….

 

I think you already get the point that you're going to have to take vitamins everyday, several times a day, every day after your DS.  Let's attack how to completely dumb proof the system so it doesn't seem so hard.  (This is what I've had to do for myself and it works like a charm!!!)  I have 5 different pill reminders/containers that you can get from any pharmacy, mine are from Walmart and only cost $4 each.  There are 28 boxes in each container.  There are seven days, with 4 compartments for each day.  I take all of my vitamin bottles and have them in a medium sized rubbermaid tub/container.  I sit on the floor with 4 of the 5 pill minders in front of me open and ready to fill.  I take out one bottle of vitamins at a time and fill each and every compartment with the needed vitamins daily.  Then that bottle is finished, and I move on to the next until I've gone through every vitamin bottle in my rubbermaid container.  When I run out of a certain vitamin, that bottle gets set to the side to be re-ordered after I'm done filling my containers.  You may need to keep a schedule of the vitamins you plan to take in front of you at first, but in no time this becomes easy!  My 5th pill minder is used to make my batches of iron/vitamin C/and copper.  I only use one of these compartments for each day, so one container lasts a month.  After each and every pill is filled for the month, I put my pill boxes and vits back in the closet.  I set the first box of vits on the counter where it stays at all times.  When I leave my house, it comes with me....ALWAYS!  I throw it into my front seat, and that way I'm never far from my vits. 

Now, when I first wake up I take my iron/vitamin C/copper batch.  I have this in a 5th pill minder, with each batch ready to take, on my bathroom vanity.  I take this first thing every single morning.  I take the pills an hour before I eat, and 2 hours before I take any other pills.  Vitamin C helps aid in the absorption of iron, but calcium and iron should never mix because the effectively cancel each other out.  The rest of my vitamins are all ready to go in my pill minder and I take them with breakfast (2 hours after iron), lunch, dinner, and at bedtime.



In closing....

Try to relax and enjoy this amazing ride!  Try not to worry about every little thing that is happening, or not happening.  You're going to have good days and bad days, some of us will get to goal and some of us won't, in the end we are all just striving to have healthier lives than we have/had as Morbidly or Super Morbidly obese people.  I'm always happy to help anyone in any way that I can!

Great links for more info on the DS......................

Carolyn M is an RN on our board that has had the DS.  She has LOTS of great info posted on her profile as well.  Here's the link....

http://www.obesityhelp.com/member/spadequeen_10/

(Thank you Anne S for these great links!!!)

dshess.com (be sure to look at the patient blue book, LOTS of valuable    info there!!! Also there is a great PowerPoint presentation as well!)

Dr. Husted (animated DS)
(look for animation link - scroll down)
http://johnhustedmd.com/switch.htm

Dr. Ungson (animated DS)
http://www.drungson.com/eng/obe/swi.htm

Dr. Smith (streaming video image)
http://tinyurl.com/y6ey9y

Dr. John Rabkin (gives an excellent speech with PowerPoint presentation, and explains the pros and cons of the Lap Band, RNY (gastric bypass), vertical sleeve gastrectomy, and the Duodenal Switch
http://www.paclap.com

Dr. Buchwald (text description)
http://www.university.fairview.org/Clinical_Services/Weight/c_126333.asp

Cornell University in NYC (text description)
http://tinyurl.com/2odovv

Dr. Kesheshian (click "procedure image")
http://tinyurl.com/y7w3ab

Dr. Cirangle (description)
http://tinyurl.com/y27ejl

Dr. Baltasar 
www.bodybybaltasar.com

A Website Dedicated to the Duodenal Switch ONLY
http://www.duodenalswitch.com/procedure/procedure.html

More great links courtesy of Blackthorne:

http://www.medpagetoday.com/PrimaryCare/WeightManagement/tb/4162
http://www.americansurgical.info/abstracts/2006/28.cgi
http://www.breasthealthonline.com/cgi-bin/mwf/topic_show.pl?tid=10392  
http://www.mgwater.com/calmagab.shtml
http://www.dssurgery.com/generalinformation/comparison.php  
http://sri.sagepub.com/cgi/reprint/12/2/115.pdf  
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1360120  
http://www.harvardmagazine.com/on-line/050465.html  
http://www.nature.com/ncpcardio/journal/v2/n11/full/ncpcardio0349.html 

~Chicken Enchilada Soup~

1 can of Cream of Celery
2 cans of Cream of Chicken
2 cans of Cheddar Cheese Soup
1 can of Chicken Enchilada soup (found in the Mexican isle) You could use enchilada sauce or powder if you can find it
1 can of Mild Rotel drained (if tomatoes bother you, sub a can of Fire Roasted Chili's)
1 large Rotisserie Chicken (I get the biggest one I can find) - I use the savory, herb, garlic & herb flavors. Any of them are good.
1 box of Chicken broth (32oz) (I use the organic one, its less salty IMO)
ATLEAST 10 cups of shredded cheese- I use the Mexican blend
3 crushed cloves of garlic
Chili powder- I just sprinkle it on top. Use more if you want it spicy

Pick the chicken apart (putting the skin aside for you to eat after you are done) I make sure I get every nook and cranny. I also take the juice that’s in the bottom of the chicken container and pour it into the pot.
Put in the Cream of Celery, Cream of Chicken, Cheddar cheese soup, Chicken Enchilada soups in the pot and mix with the chicken. It will be very thick. Turn on the heat to high. Continue to stir. Slowly add the chicken broth. When about half of the chicken broth is in the soup mixture, add the Rotel. Let it cook a few min and slowly add the rest of the broth. By now the mixture is hot. Turn down the heat to low and add 4-5 cups of cheese. Mix very well. Let cook for about 15 min. add 2-3 more cups of cheese and stir well. Let cook an additional 5 min. Add the rest of the cheese. Cook 5 more min.

I think you already get the point that you're going to have to take vitamins everyday, several times a day, every day after your DS.  Let's attack how to completely dumb proof the system so it doesn't seem so hard.  (This is what I've had to do for myself and it works like a charm!!!)  I have 5 different pill reminders/containers that you can get from any pharmacy, mine are from Walmart and only cost $4 each.  There are 28 boxes in each container.  There are seven days, with 4 compartments for each day.  I take all of my vitamin bottles and have them in a medium sized rubbermaid tub/container.  I sit on the floor with 4 of the 5 pill minders in front of me open and ready to fill.  I take out one bottle of vitamins at a time and fill each and every compartment with the needed vitamins daily.  Then that bottle is finished, and I move on to the next until I've gone through every vitamin bottle in my rubbermaid container.  When I run out of a certain vitamin, that bottle gets set to the side to be re-ordered after I'm done filling my containers.  You may need to keep a schedule of the vitamins you plan to take in front of you at first, but in no time this becomes easy!  My 5th pill minder is used to make my batches of iron/vitamin C/and copper.  I only use one of these compartments for each day, so one container lasts a month.  After each and every pill is filled for the month, I put my pill boxes and vits back in the closet.  I set the first box of vits on the counter where it stays at all times.  When I leave my house, it comes with me....ALWAYS!  I throw it into my front seat, and that way I'm never far from my vits. 

Now, when I first wake up I take my iron/vitamin C/copper batch.  I have this in a 5th pill minder, with each batch ready to take, on my bathroom vanity.  I take this first thing every single morning.  I take the pills an hour before I eat, and 2 hours before I take any other pills.  Vitamin C helps aid in the absorption of iron, but calcium and iron should never mix because the effectively cancel each other out. 

2 hours after that, I take the rest of my pills from my pill minder in the kitchen. 

Here are the vitamins that I currently take every single day:

My daily vitamins, month 12-18 (REVISED on 10/12/08)

  This is what I take everyday...

  *2 hours before breakfast~

                      150mg polycarbonate Iron (Vitalady)
                      150 mg (6 pills) Vitalady Tender Iron (Carbonyl Iron) (Vitalady)
                      1500 Mg (3 chewables) Vitamin C (Costco)
                      2mg copper

*Breakfast~   

                     1 Costco Multivitamin
                     2 pills- (630 mg) Citracal Calcium Citrate (Costco)
                     1 super B-complex  (Costco)
                     400 I.U. Dry E (Vitalady)                    
                     1 hair, skin, and nails vitamin (Walmart)
                     2 Digestive Advantage Lactose Intolerance w/ probiotics

*2 hours later~ 2 pills- (630 mg) Citracal Calcium Citrate (Costco)

*Lunch~       

                      1- Costco Multivitamin
                      2 pills- (630 mg) Citracal Calcium Citrate
                      2-100mg zinc {Hair} (Walmart)
                      1 hair, skin, and nails vitamin (Walmart)

 

*2 hours later~ 2 pills- (630 mg) Citracal Calcium Citrate              

 *Dinner~     

                   2 pills- (630 mg) Citracal Calcium Citrate
                   200mcg Selenium (CVS) {Hair}
                   400 I.U. Dry E
                   1 hair, skin, and nails vitamin (Walmart)
                   1 thiamine (B-1) capsule, 100 mg  (Vitalady.com)
                   1 dry vitamin K

 

*Bedtime~      

                   1 Costco multivitamin
                   3 Costco Calcium Citrate + Mag 750 mg
                   25,000 I.U. Dry A (vitalady.com)
                   50,000 I.U. Dry D (vitalady.com)
                   sub-lingual b-12 2500 mcg (Walmart)
                   1  Critical Care Probiotic, 50 billion organisms

Okay so maybe that seems like a lot....but think of it this way.  I only take pills 5 times a day. (Okay, 7 to be technical).  I just open the little compartment that it's time for (the pill minder is marked break, lunch, dinner, bed) and dump it into my hand.  Then I just take them along with my water in a couple of swallows.  I had to dumb proof the system because before surgery I could've NEVER remember to even take my damned birth control pill!!!!  I take pills when I wake up, and then each time that I eat through the day, and then at bedtime.  Also, whenever I refill my tea or water cup, I check the time to see if it's time for a calcium dose.  ( I take a couple of extra doses to boost my calcium thru the day, you can only absorb 500-600mg at one time so it's better spread out).

I know this seems like a lot now, but you can do it too!  I've gotten to the point now where I carry a pill  minder strip with me in my purse with calcium and multivits, just in case I leave home without my vitamins.  Vitamins equal life after the DS, remembering them can be challenging at times, but you do it because you have to.

I'm sorry it's all confusing.  I completely understand and have not forgotten how frustrating vits were in the beginning!

Lori

Just wanted to put a picture of our Indy DSers in here!  I love my Indy peeps!!!!

September 2008 at Famous Dave's BBQ