Post op

What is Lovenox? Why do I need it and how do I do the injections?

Blood clots after surgery are a risk for any patient, and being overweight can increase the risk significantly. Lovenox (generic: enoxaparin) is a short-acting, injectable blood thinner that is frequently used after surgery to prevent deep vein thrombosis (DVT). Some surgeons use it in 100% of patients, and others use it selectively based on the patients risk. In any case, if your doctor prescribed Lovenox for you either before or after surgery, it is IMPORTANT that you use the medication as directed by your physician!

DVT’s can be serious after surgery as sometimes they can travel to the lungs, which is called a pulmonary embolism (PE). In addition to blood thinners such as Lovenox, frequent walking after surgery will also reduce the risk of DVT.

Lovenox (generic: enoxaparin) is dispensed in pre-filled syringes matching the dosage your doctor wants you to have. Injecting is pretty simple and causes minimal discomfort. Please view the information below from the Lovenox® web site to learn more about how to do your injections properly. Note that significant black-and-blue bruising can occur around injection sites, this is normal. If you have any signs of significant bleeding please call your doctor immediately!

Note: You may have received heparin if Lovenox was too expensive on your insurance plan. Heparin is an older medication that is cheaper and a reasonably acceptable alternative to Lovenox. The protocol for injecting heparin is different. Please click here for instructions on heparin injections.

When you start your injections is based on what time your surgery started:

If your surgery started before 3pm, start your injections at 8pm on the night of surgery
If your surgery started after 3pm, start injections the following AM

Vitamin supplements after bariatric surgery

by DrCurry 1 Comment

Vitamin supplements after bariatric surgery are an important post-op consideration. It is critical that you follow our guidelines in terms of recommended vitamins as well as post-op labwork to reduce the risk of vitamin or micronutrient deficiencies! We recommend only pharmaceutical-grade vitamins for our patients. Check our eStore for all your vitamin needs!

DO NOT START ANY VITAMINS UNTIL DISCUSSING WITH OUR TEAM AT YOUR FIRST POST-OP VISIT!

Vitamin Supplementation for RNY, Sleeve Gastrectomy, ESG, SIPS, Band

Vitamins & minerals start one month after surgery. The exception is sublingual vitamin B12 which starts one week after surgery. Your dietitian will discuss with you which vitamins & minerals you will need to take.

The following are required to be taken after your surgery:

1 week post surgery:
- At 1 week out you will begin taking Sublingual B-12 (1,000 mcg) daily until your 1 month visit.
1 month post surgery
- Begin chewable multivitamin
- Iron (26mg/d),
- Vitamin D3 (15,000 IU/weekly)
- Calcium Citrate (1000 mg/d, ONLY take 500 mg at one time to increase absorption)
- Decrease sublingual B12 to 1,000 mcg/week.

JourneyLite Physicians highly recommends Bariatric Advantage vitamins. They are high-quality, pharmaceutical-grade products that are designed specifically for surgical weight loss patients!

Vitamins are not tolerated on an empty stomach. Always take your vitamins later in the day. Best time to take your multivitamin is after lunch or dinner.

After 3 months you may begin taking capsule supplements based on your tolerance.

B-12 must remain sublingual or injectable long-term. Oral tablets will not be absorbed.

Vitamin Tips and Information:

The form of iron that you need to take is either Ferrous Fumarate or Ferrous Gluconate. Ferrous Sulfate is the most commonly prescribed form of iron but it not well absorbed after your surgery. It is also recommended that you avoid taking iron supplements at the same time as consuming coffee, tea, or antacids.

If you are ever required to take Vitamin D, you want to make sure it’s Vitamin D3.

The form of calcium you should choose is calcium citrate. This is due to the lack of stomach acid being produced by your new pouch. Calcium carbonate is the most common form found, but it is not absorbed well because it does require a larger amount of stomach acid to be absorbed.

Calcium and iron need to be spaced 2 hours apart. They actually compete for the same absorption sites and can interfere with each other’s absorption.

Products to Avoid:

Centrum
One-A-Day
Flintstones
Generic store brands
“Gummy” type vitamins

Bloodwork after duodenal switch/SIPS

by DrCurry 4 Comments

Duodenal switch and the SIPS Procedure are the most powerful weight loss operations out there, but due to the amount of small intestine bypassed, patients are at highest risk for developing potentially severe vitamin/nutrient deficiencies if they don’t take their vitamins and get their labs checked. It is very important that you come in for your post-op bloodwork visits every 6 months! We recommend checking the following labs:

Starting at 6 months post-op, then every 6 months
- Complete blood count (CBC)
- Comprehensive metabolic profile (CMP)
- Vitamin levels
- Vit D25, folate, B6, B12, and whole blood thiamine
- Iron – TIBC, Serum iron
- Albumin and Pre-albumin
- RBC folate
- Fat-soluble vitamins (6-12 months)
- Vitamin A
- Vitamin D, 25-OH
- Vitamin E
- Vitamin K1 and INR
- Trace elements
- Zinc,selenium, copper, calcium, magnesium
- Optional
  - Hemoglobin A1C
  - Thyroid: TSH
  - Lipid profile

Bloodwork after gastric bypass

by DrCurry Leave a Comment

Gastric bypass patients can be at risk for vitamin and nutrient deficiencies after surgery. Especially those that are not taking their vitamins!

We recommend the following labs starting at 6 months post-op, then every 6-12 months
- Complete blood count (CBC)
- Comprehensive metabolic profile (CMP)
- Vitamin levels
- Vit D25, folate, B6, B12, and whole blood thiamine
- Iron – TIBC, Serum iron
- Optional
  - Hemoglobin A1C
  - Thyroid: TSH
  - Lipid profile

Bloodwork after gastric sleeve

by DrCurry Leave a Comment

Even though the gastric sleeve is not technically a malabsorptive procedure, vitamin deficiencies can rarely arise. For this reason we recommend:

Starting 6 months post-op, then every 6-12 months
- Complete blood count (CBC)
- Comprehensive metabolic profile (CMP)
- Vitamin levels
- Vit D25, folate, B6, B12, and whole blood thiamine
- Iron – TIBC, Serum iron
- Optional
  - Hemoglobin A1C
  - Thyroid: TSH
  - Lipid profile

Soft calorie syndrome: what is it?

by DrCurry Leave a Comment

So I thought I’d use my recent food photo from the recipe I made to talk a little about something I talk about a lot: soft calorie syndrome. What is it? It’s when patients (especially Lap Band but also sleeve gastrectomy, gastric bypass, and duodenal switch patients) eat soft, high-carb, calorie-dense foods over protein. Think mashed potatos or ice cream.

Lots of times I’ll ask Lap Band patients if they think they need a fill and they will say “I can eat way too much.” Then I ask them if they can eat chicken, and they say no…beef…no…pork…no. So what are you eating “too much” of? Potatos, ice cream, potato chips and lots of other junk!

Look at the following picture below of a recent recipe blog post I made about bacon-wrapped guacamole-stuffed chicken breast. Here you can see it’s served with mashed potatos. Not something I would recommend if you are planning a meal, but many times we are served meals and we have no choice in the planning.

Next look at the picture of what the plate will look like in a patient who has soft calorie syndrome.

soft carlorie syndrome results in eating mashed potatos and ice cream — Looks like the mashed potatos were a hit…

What you see here is that the patient ate A LOT of mashed potatos, and only a few bites of the bacon/chicken entree.

Why did this happen?

In a Lap Band patient it usually means their band is too tight. Sometimes they can’t even tolerate any type of meat so they go for the soft carbs. Then they gain weight. Then they think they need a fill because they are gaining weight, but that just leads to eating more soft carbs and less protein.

You get the picture. If you have a Lap Band and you can’t tolerate protein you will not lose weight.

The answer to getting the scale moving in the right direction is not a fill, but an unfill. Eat your protein first, take a few bites of mashed potatos, exercise regularly, and lead a long and healthy life!

Dr. Trace Curry

The Backyard BBQ Diet

by jenrul 15 Comments

Memorial Day weekend is the kickoff to cookout season!

American backyard BBQ favorites will be staring you in the face. Holiday eating after weight loss surgery can be tricky! Before you decide to bail on the festivities to avoid wrecking your diet, read on for tips to help you get through it.

Burger vs. Hot Dog: Either one will work out, but skip the bun to save calories. Feel free to pile on the lettuce, tomato, onion, sauerkraut, pickles, ketchup, mustard, salsa or relish, but skip the mayo or cheese. Other meat options that are equally as good as or even better than a plain burger or hot dog include chicken (skin and breading removed), seafood, lean steak, or veggie burgers. Skip the ribs, sausage, or brats.

Salads & Side Items: The best options are lettuce or spinach salad, cucumber salad, or tomato salads. Avoid the mayonnaise-based potato and macaroni salads. German potato salad with vinaigrette dressing and coleslaw are great options. Only have ½ cup serving of either.

Eat the corn! Soak up the butter with a napkin. Squeeze some lime juice on for added flavor! Baked beans are a nice choice because they are packed with fiber and protein, but watch the calories and portions. Stick to 1/2 cup. Avoid chips, pretzels, crackers, and dips. They are very tempting, but they are a waste of calories.

Desserts: Skip it if you can! If they’re just calling your name, limit yourself to what lis the most appealing, take the smallest piece, walk away and savor it.

Drinks: Water, water, water! The colder the better. Unsweetened tea with fresh lemon is also a good option. If you do choose alcohol, light beer or wine spritzers are best (with plenty of water as well) but limit to 1-2 drinks. Avoid any sweet, fruity, or frozen concoctions as these will throw your calories for the entire day.
Happy Memorial Day! Enjoy your day and be thankful for all you have. loseweightcincy.com

Stage 1: Clear Liquid Diet

by DrCurry Leave a Comment

Click to download details about the post op clear liquid diet.

Perioperative Stage 1 (Clear Liquid Diet)

Vitamin Supplementation for Gastric Bypass and Sleeve Gastrectomy

by DrCurry 1 Comment

For the first 3 months after surgery you will be on a chewable vitamin. You’ll want to be taking a high quality vitamin, due to the fact

you are at high risk for vitamin deficiency.

The following are required to be taken after your surgery:

Multivitamin
Iron (26 mg/d)
Calcium Citrate (10001500 mg/d)
Sublingual B12 (1000 mcg/week) OR Monthly B12 injection
At 1 week out you will begin taking 1,000 mcg daily until your 1 month visit.
Starting at 1 month postop you will decrease to 1,000 mcg/week.
Vitamin D3 (15,000 IU/weekly)

The following brands are recommended chewable vitamin supplements:

Bariatric Advantage (sold at Fast Track or in the estore at www.thebanddoctor.com)
Optisource Vitamins (sold at Walgreens or at www.walgreens.com)
Celebrate Bariatric Vitamins (found at www.celebratevitamins.com)
GNC Vitamins (liquid/chewable/powered are available)

The above vitamin brands will provide you with all products you are required and are rated very highly for purity and quality.

After 3 months you may begin taking capsule supplements based on your tolerance. B12 will remain sublingual long term.

The following are recommended vitamin supplements:

Nature’s Way (found at most health food stores and Whole Foods Market)
Solaray Vitamin’s (found at most health food stores)
GNC vitamin products (found at GNC locations or at www.gnc.com)
Nature’s Life (found at most health food stores and Whole Foods Market)
Prothera Vitamins (found at www.protherainc.com)

There are various wholesale vitamin sites online that you may also be able to find these products.

Vitamin Tips and Information:

The form of Iron that you need to take is either Ferrous Fumarate or Ferrous Gluconate.

Ferrous Sulfate is the most commonly prescribed form of iron but it not well absorbed after your surgery.

If you are ever required to take Vitamin D, the preferred form is Vitamin D3.

The preferred form of Calcium Citrate, this is due to the lack of stomach acid being produced by your new pouch.

Calcium carbonate is the most common form found OTC but, is not absorbed well because it does require a larger amount of stomach

acid to be absorbed.

Calcium and Iron need to be spaced 2 hours between each other. They actually compete for the same absorption sites and

can interfere with absorption.

Products to Avoid:

Centrum
OneADay
Flintstones Generic store brands
“Gummy” type vitamins

Vitamin Supplementation for Adjustable Gastric Band Patients

by DrCurry Leave a Comment

For the first 3 months after surgery you will be on a chewable vitamin. You’ll want to be taking a high quality vitamin, due to
the fact your are at an increased risk for vitamin deficiency.

The following are required to be taken after your surgery:

Multivitamin with Iron (18 mg/d)
Calcium (1000 mg/d)
Vitamin D3 (15,000 IU/week)

The following brands are recommended chewable vitamin supplements:

Bariatric Advantage (sold at Fast Track or in the estore at www.thebanddoctor.com)
Optisource Vitamins (sold at Walgreens or at www.walgreens.com)
Celebrate Bariatric Vitamins (found at www.celebratevitamins.com)
GNC Vitamins (liquid/chewable/powered are available)
The above brands will provide you will all products you are required and are rated very highly for purity and quality.
After 3 months you may begin taking capsule supplements based on your tolerance.

The following are recommended vitamin supplements:

Nature’s Way (found at most health food stores and Whole Foods Market)
Solaray Vitamin’s (found at most health food stores)
GNC vitamin products (found at GNC locations or at www.gnc.com)
Nature’s Life (found at most health food stores and Whole Foods Market)
Prothera Vitamins (found at www.protherainc.com)

There are various wholesale vitamin sites online that you may also be able to find these products as well.
Vitamin Tips and Information:

The form of Iron that you need to take is either Ferrous Fumarate or Ferrous Gluconate. Ferrous Sulfate is the most
commonly prescribed form of iron but it not well absorbed after your surgery.
If you are ever required to take Vitamin D, the form you’d want to take would be Vitamin D3.
Calcium and Iron need to be spaced 2 hours between each dose.
They actually compete for the same absorption sites and can cancel each other out,

Products to Avoid:

Centrum
OneADay
Flintstones
Generic store brands “Gummy” type vitamins