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Post by west4thavenue on Apr 21, 2014 18:43:44 GMT -5
Hello. I'm new here and new to DS (4 weeks post op). Here's my little tale: I am a 57 yo female, married, 1 grown son. It took me ten years to finally have the DS. I have had three heart attacks, thyroid problems, osteoarthritis -- everything you are probably familiar with. My insurance company stonewalled me. Even my cardiologist wouldn't approve me for the surgery. My cardiac history and family history are bad. Dad died of heart disease at 68, my brother died suddenly of a heart attack in February of 2013 I took care of my mother until she died of cancer last June. She left me with a little money, and I decided to invest it in myself.
I went to a surgeon and told him what I believed. I said, "I don't have much more time." I took all the tests and went to a cardiologist the surgeon recommended. I passed the echocardiogram and the stress test (thought I was going to die) and was approved for the surgery with low to moderate risk.
On Friday, March 21, I had my DS. On Saturday, March 22, I had another heart attack. The nurse had gotten me up to get me walking. I was just passing the nurses station when it happened. It was my anterior coronary artery that was blocked -- the one they call "the widow maker", and probably the one that killed my brother. The surgery did not cause my heart attack. It would have happened anyway. The only reason I survived was that I just happened to be in a very, very good hospital and was being treated within 60 seconds.
There is a lot of good news and bad news here: The good news is I survived. The bad news is the heart attack did significant damage. I now have congestive heart failure. The good news is I had the heart attack AFTER the DS...nobody would do a surgery like this on me now. The good news is the weight loss will give me a better chance at a relatively healthy life. Progress is slow, but I am making progress.
Here is where I am asking for help from all of you: I am supposed to restrict salt intake, which complicates the DS diet. I have also discovered that I am now lactose intolerant. So no dairy. I am also unable to take Prilosec or similar meds because I am now taking blood thinners and other medications that are contraindicated. These are the dietary challenges in addition to the DS norm. I love salmon, tuna and avocados, but I am having trouble meeting my protein and fat goals. Obviously, progressing into the normal foods is moving very slowly. The nutritionist at the surgeon's office is not very forthcoming, telling me to eat a heart healthy diet per my cardiologist. To be honest, I think they are afraid to advise me because of the heart attack risk and the CHF.
I'm a tough old broad and I'm going to get through this. I'm still here. But I don't know everything. I know you all are much more savvy than I about these matters, having made many discoveries. Any suggestions or advice you can offer me is very much appreciated.
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Post by newyorkbitch on Apr 21, 2014 21:00:49 GMT -5
How about eggs ?
Also how about zantac instead of Prilosec?
Have you tried taking lactaid tablets when you eat dairy? How about lactaid products - there is lactaid milk, yogurt, cottage cheese, etc.
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flslim
New Member
Posts: 15
Surgery Type: DS
Surgery Date: Feb 2015
Surgeon: TBD
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Post by flslim on Apr 21, 2014 21:07:59 GMT -5
Hi West and welcome! WOW, you come a long way thru sheer determination and will. While I can only offer support at this point, I can say you have come to the right place. My dad passed at a very young age of CHF and that was one if the determining factors for me to have wls. While I do my pre-op testing, I soak up all the info I can from the vets and newbies alike. You have come this far, just hang in there, browse through the forum while you wait for some real help. Good luck in your journey. Julie
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Post by Taterweight on Apr 21, 2014 21:51:09 GMT -5
Firstly, welcome to the board! Secondly, oh my gosh you've had a rough go of it, but as you said yourself, it's great you had the surgery before your latest heart attack. You can do this! If you haven't heard or read on this forum yet - strive for getting 30 grams of protein in your first 30 days, 60 grams by 60 days, and 90 by 90 days. Protein shakes are the easiest...but at your stage I was awfully sick of them. The ready to drink Premier Protein are the easiest for me to get down. I also had unflavoured Unjury that I used (and barely tolerated) until someone gave me the great idea to take one scoop and sprinkle it on everything I ate or drank during the day...not enough to change the flavour or texture of a thing, but with the goal to be finished with the scoop by bedtime. So tuna salad...one teaspoon of Unjury into the mix! Yogurt....a teaspoon....soup...a teaspoon...crystal light...a teaspoon, and so on until that scoop was empty. Now week 4 was a tough week for me....I'm on week 10 -- WORLD OF DIFFERENCE! It's like a switch is thrown around weeks 6-7 and you eat more and feel more human. Hang on, it's coming! Lactose intolerance, yup, here too...but try to suffer through with Greek yogurt if you can - for the protein and probiotic benefits. Like NYB mentioned, you can try the Lactaid tablets. I just suffered with mild bloat and diarrhea until that week 7 when alluvasudden I could eat more of the real stuff. Shrimp are easy to digest - so if you like them - I highly recommend them... With butter, of course! Shrimp scampi is super quick to make and easy to get down when you're in need of protein. I started on bacon around week 5...I realize you'd have to opt for low sodium - which takes some of the fun out, but it's still an option to bake up a package and keep in the fridge for a quick zap in the microwave. Have you tried eggs? 6 gr of protein for each one if you can work some into your day. I haven't been as successful with eggs yet, only egg salad works for me...but you can try it poached, scrambled, or fried if you have trouble with it a certain way. I'll cut it off here, but hopefully that gives you some ideas! I so wish you well on your recovery. Keep posting if there's anything else you need! -Resa
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Post by Leonie on Apr 22, 2014 2:15:59 GMT -5
Welcome! I hope we can help you smoothe the journey to full Wellness.
Regarding Sodium, ask them to give you a script to check the levels every month or so. I have been eating massive amounts and my levels are still low. I think fluid passes through so quickly, that you need more salt. Anyway, let your labs guide you.
I also became lactose intolerant, but could eat cheese, butter and cream. Much later I was able to add double cream Greek style yoghurt. Now I avoid milk just because of the carbs. I use a cup of heavy dessert cream every single day. Sheer goodness!
My protein levels have been excellent all the way. I have many meals. Think Hobbit style: first breakfast, second breakfast, tea, elevenses, lunch, tea, snack, dinner, bedtime snack, midnight snack. You are now working towards 60g of protein per day. If you have TEN mini meals of six grams you are sorted. Increase that to ten grams and you are getting there. Soon it will be easy to eat 120-150g protein per day in six or seven meals. This is doubly important for you because if you do not get enough protein, your body will burn muscle, and your heart is a muscle.
Note, do not mix a whole protein shake and sip on it all day. The protein starts losing integrity within twenty minutes. Rather mix small doses. You might even mix a third or half a scoop in a sherry glass and down it in a swallow or three.
How are you doing with the liquids? Dehydration increases nausea. Fluid still comes before food at this stage. Divide your 64oz into hourly goals. Drink first, then eat. That means you will have a cup in your hand ALL.THE.TIME. Of course liquid food counts toward your fluid goal.
Guess what? This passes. I no longer think about this stuff all the time. Staying here keep me mindful, but eating protein first has become a lifestyle. Now I am busy planning my next adventure.
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Post by MsVee on Apr 22, 2014 7:47:03 GMT -5
Welcome to the board. I am sorry to hear of your health issues but I am so glad you were in the hospital when you had the heart attack. I had a revision from RNY to the DS in 2012.
MsVee
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Post by Girlrocker on Apr 22, 2014 10:40:51 GMT -5
Hi there, welcome and WOW! You are one tough broad indeed and I'm so glad you found us and are here! I'm Sharyl, I turn 53 this month, and I had my RNY to DS revision nearly 2.5 years ago, rest of my info is in my signature. You have been through a lot and you have an amazing approach to your health and how to deal with all of this - heart, DS - concurrently. As 4 weeks out, your options are going to be very limited anyway, the first 12 weeks (3 months) really are more about your insides healing from the major surgery you just had to your GI system. Think of your new plumbing (sleeve, switch) like that of infant, you progress gradually into more food variety, density, types as you get further out (from infant, to toddler, pre-school, etc) So, it's normal to rely more on protein shakes for your protein intake. And the 30/60/90 protein gram ratio parallel to each month out from surgery is a good guideline to follow. 50g carbs daily also a good guideline. I'm not as up on prilosec, stomach acid issues, but can help with food/nutrition. While there are definitely patterns and commonality in what we all eat, there are also lots of differences based on your own tolerances/preferences. You'll see us use the phrase YMMV often - it means, your mileage may vary. Many people become lactose intolerant after the DS. I'm actually the opposite, was semi-lactose intolerant after my RNY, tolerant now, though certain carbs like those found in milk/dairy products will send me to the bathroom I've always done fine with cheese and cottage cheese, it's dairy in pure liquid form that killed me. Not sure if there's that distinction for you? But Lactaid does make a whole line of products besides milk, and taste good. Almond milk is also a popular milk alternative, and there are a lot of soy based cheese products. Fats like mayo, butter, heavy cream might be a challenge if you are intolerant to those. There are also lots of mayo alternatives on the market, Smart Balance makes a good one, there's another one called Smart Beat, same for butter alternatives, if needed. Plain greek yogurt or regular plain yogurt is a great sour cream alternative for dressings/dips. Because our emphasis needs to be on protein, and animal protein is the best, just takes some time to work back up to while you're healing, having to watch your sodium won't be a stumbling block. Certain natural foods do have higher sodium content, but honestly, the biggest sodium overkill culprit is processed, prepared food. Plenty of ways to season/flavor regular food, and adding a few dashes of real salt doesn't increase the sodium intake so dramatically. You'll be able to cook with all kinds of flavored oils, avocado, olives also delicious fats/snacks. I literally lived on about 6 things for for the first 2 months. I doubled up the protein scoops in my protein drinks so when I drank one it was 60g; I did well with eggs in any form, hardboiled, egg salad, scrambled with cheese, peanutbutter, hummus, Boca chikn patties, tomato soup with tofu pureed into it - tomato was the only flavor soup I could stand for a long time and the tofu deflected the acid of the tomato, and I added parmesean cheese, cottage cheese, sugar free jello, sugar free pudding (with a scoop of protein powder), sugar free popsicles and fudgesicles, Pureeing tofu is another good trick for adding flavorless protein to food besides using unflavored protein to sprinkle in. In soups they become thick and creamy without the dairy. Check out Unjury.com they make a flavorless protein that is very popular for bariatric patients. Here's some protein info for you, links to threads here that will help educate, because our doctors, nutritionists seldom have any idea what we really should be eating And for us it's protein first, and we can have full fat, you just have to work up to full fat early in the recovery, take care of the healing insides. Protein Foodsweightlosssurgery.proboards.com/thread/2062/foods-high-proteinComplete Proteinweightlosssurgery.proboards.com/thread/8782/complete-proteinLast, I can't recommend this book enough, became my bible to learn about what was protein, what was a complex carb (good) vs. a simple carb (not so good, but not off limits forever by any means) It breaks food counts down into protein, carbs, fat, sodium, etc. and includes every type of food you can think of, brand names, fast food, the works. Any bookstore will have it or you can order it online from Amazon for under $10: Keep checking in, asking questions, venting for support!
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Post by west4thavenue on Apr 22, 2014 11:40:35 GMT -5
Thanks, everyone for all the great information! Zantac was not even mentioned to me as one of the meds I could use to protect my stomach. I never even heard of Lactaid pills before! I am going to implement all of your suggestions, as I am very anxious to meet the ultimate protein goals without having to drink the protein shakes. Thank you thank you thank you!
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Post by bboop on Apr 22, 2014 13:17:51 GMT -5
There's also protonic which is a script for indigestion. I don't know a thing about indigestion and heart disease, but I'm sure your doc can help out in that department. I take one of those per day. One thing as you progress in the DS life is your cholesterol, both the good and bad will drop like a rock. I can't wait for that to happen and see your doctor's face when he sees the labs. Obviously I won't see his face but you can. Keep drinking...anything you can tolerate. You must stay hydrated. We have a saying here sip, walk, sip, walk. If you don't stay hydrated, you will become nauseous and then with then dehydration, more nausea. Makes it so much fun. There are numerous kinds of salt substitutes out there and I understand they are good...Mrs. Dash comes to mind. I suspect you already know about those. Many lactose intolerant people aren't bothered by Greek yogurt ( I put SF preserves in mine), cottage cheese, and regular cheese. Something in the processing eliminates the lactose intolerance. As already said, there are lactose pills out there and they do work. Later you may not even need them...I have no idea why but many who are lactose intolerant at the beginning aren't later on. Now for me, eggs were jut plain old hell and I love eggs. So if this happens to you...wait and then later you can eat them again. I love eggs again now and they are a great source of protein. Don't eliminate a food just because at the beginning it sticks or comes back up...it won't later on. Most of the DS foods are high fat and high protein. Once you have progressed to the point of eating just about anything..except carbs you will love the DS and it will love you. I had a resleeve and can now just barely eat beef...don't know why but chicken which bothers everybody is my go to food now. That's one of those YMMV kind of things. Ask your doc as your progress if you can eat salt...remember you malabsorb food now and I'm thinking, of course I could be very wrong, but that stuff won't be sticking to your artery walls anymore. But please ask before you jump in. The high liquid amount you consume will also wash away a lot of salt, too. Unjuy is a life saver and I recommend that. You have to buy it on line so I would order it now. How are you doing with your vitamins? If you haven't started taking any you may want to try. Remember any oil based vitamins are worthless to a DSer. You must take dry vitamins. Vitalady is a great source for vitamins. I buy most of my dry vitamins from her and get the rest at a pharmacy. Welcome to the forum...we are glad you found us and please come back often for more questions. We love questions. BTW, I had my DS when I was 63 and I'm 68 now so it's nice to meet another tough old broad.
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Post by west4thavenue on Apr 22, 2014 18:54:03 GMT -5
Thanks, bboop. I asked my surgeon, Dr. Ayyola, if there is any literature regarding the absorption of salt following DS. He did a little digging, then emailed me this extremely erudite paper: www.ncbi.nlm.nih.gov/pmc/articles/PMC297237/pdf/jcinvest00239-0230.pdf Fortunately, he included this conclusion in his email: "Essentially, it determines that your ileum (which I left largely intact) is capable of absorbing sodium just as well as the rest of the intestine. How much sodium you ultimately absorb would be related to how much you eat. You aren't going to malabsorb sodium like you do protein or fat but you certainly will have less intestine to absorb it with."
A low sodium diet is helpful in treating hypertension. However, I believe that they are recommending low sodium for me in order to alleviate the CHF symptoms. I am supposed to weigh myself every day in order to ensure I am not gaining fluid around my heart. I take all kinds of meds to prevent it. Of course, there is no such thing as a sodium-free diet, especially not when relying on animal proteins and fats. All I can do is make the best choices possible and watch it.
I was having trouble with eggs, but I may try them again now that I have stocked up on Zantac. I also got Lactaid tablets and some gas-X! I am searching for Unjury on the internet. I live in a pretty small town, so I have to order a lot of things online.
Thank you again to everyone!
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Post by newyorkbitch on Apr 22, 2014 19:13:18 GMT -5
As a precaution, you should check with you doctor to make sure Zantac is okay for you to take.
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Post by willowrayne on Apr 22, 2014 20:30:50 GMT -5
It seems like everyone had covered it all as I can't think of anything to add. So I just want to send my kudos to you for being tough. Glad you are here.
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Post by Mariposa(Heather) on Apr 22, 2014 20:42:04 GMT -5
I just wanted to say welcome!
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Post by bboop on Apr 23, 2014 0:26:21 GMT -5
Just curious why did you leave your ileum more intact than regular DSers? Well, it sounds like you have it covered. Do check with your doc about the Zantac and make sure that PPI is ok to take. As I said before I take Protonix and really like it...but it is a script and it may be contraindicated. Unjury is online...I like the chicken broth with lots of protein...I drank a lot of that at the beginning. Keep coming here for more suggestions and good for you for trying so hard. If anything is going to help you, I think the DS will definitely do it. Your weight loss will amaze you and I guarantee that you will feel so much more energetic once some of the weight comes off. I know I sure do and I was surprised. Now all I have to do is make myself go to the gym...I'm so lazy.
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Post by west4thavenue on Apr 23, 2014 10:43:13 GMT -5
Leaving the ileum intact was the surgeon's choice and news to me post-surgery. I have to be honest with you, I don't know what the advantages/disadvantages are. I am only just now learning from these boards that not all DS surgeries are alike.
I asked the surgeon very directly on the initial consultation if achieving a normal BMI was a realistic goal, and he assured me in no uncertain terms that it was. From reading the real world posts in this forum, I am getting a very different picture. However, I have to tell you that I would be most grateful for that average 75% loss or somewhere in there, provided that I can maintain it. I went for the biggest gun in WLS to give me the best chance at some quality of life.
Again, thank you for all your advice!
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Post by Melinda on Apr 23, 2014 14:10:09 GMT -5
I'm just so glad you're here. Not just "here" on these boards but HERE on this earth, still
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Post by goodkel on Apr 24, 2014 5:06:27 GMT -5
Welcome! You've received some excellent advice here. I'm glad you found us. Please stick around. I'm looking forward to watching your health improve.
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Post by west4thavenue on Apr 24, 2014 9:34:14 GMT -5
Everyone,
I can't tell you how much better I am feeling -- and eating -- thanks to your advice. I even got out and walked a little yesterday, which I have been too weak to do. Thank you so very much!
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PeteA
Full Member
Posts: 221
Surgery Date: 4/15/13
Surgeon: Dr. Phillip Schauer
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Post by PeteA on Apr 25, 2014 10:35:01 GMT -5
Welcome. All good advice. I was never much for salt so I cook a lot with Mrs. Dash and find that sufficient for my tastes. When you are eating more solid foods I would see about cooking your meat without salt, you might not care. It does make me more sensitive to salt when I eat take out or at a restaurant.
I also second the use of protein shakes to help your protein totals. It will be hard otherwise. I never liked the pre-mixed shakes. You might want to get some of the sample packs of powders fromn vitalady.com to see what works best for you if you go the powder route.
I understand protein drinks can degrade but I'm not sure about the 20 minutes. Early on if you finish up within an hour or so I think that will be fine. We usually have that discussion for people that want to take their protein already mixed to work or mix it the night before.
I'm glad you made it through all that. Keep asking questions you can never tell what will help other people too.
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Post by maggiesara on Apr 25, 2014 12:48:10 GMT -5
West 4th, I'm going to make a suggestion I NEVER thought I would make: Think about consulting a good nutritionist. Folks here, the vets in particular, tend to be very good at helping to create a diet that is DS-friendly, but you have multiple issues that your diet needs to address, and I suspect the range of concerns puts you beyond the ad hoc help you can get here. The key, of course, is a GOOD nutritionist, and that can be hard to find. Their coursework tends to be rather wildely behind the times even for "normies," meaning that they tend to be terrified of fats, and saturated fats (like, uh, the kind you find in animal proteins) in particular. So with a garden-variety NUT, you're going to be told to eat as close to a vegan diet as you can -- right? Avoid all them animal fats -- which will not do your new DS-ified plumbing any favors. If you know anyone who can give you a really good recommendation, hurray. If not, you might be best off dealing with a NUT attached to a low-carb-oriented practice. Talk to them, see if you can find one with a brain. And once you do, then wheel in the DS and CHF stuff. Let it be a challenge for them You might well have to deal with a NUT who is not local -- i.e., working via email and phone -- but that may not be such a terrible thing. I think it's a lot more important to find the right person than it is to look that person in the eye. Besides, there's always Skype. In your position, I would find it much easier to get a very, very clear recommendation from your cardiologist: I.e., HOW MANY GRAMS OF SODIUM can I consume on a daily basis? Then go to something like Fitday.com or….eh, one of the other food-tracking programs that folks use, and plug in your food until you get the numbers that work. As Sharyl noted above, once you do your own cooking and rely less and less on processed foods, your sodium intake will drop like a rock. At any rate, I would find that much more useful than a blanket "don't eat too much salt" recommendation, which would leave me constantly worried about what is "too much" and have I crossed that line? If you've got hard numbers, and you can force yourself to do the data-entry (it's really not that much of a PITA, in my experience), you will remove that source of anxiety. FWIW, Mediterranean cuisines are going to make your cardiologist the happiest -- relatively low saturated fat, relatively little added salt or processed foods. Lose the starches and pulses, for the most part, and be careful with tomatoes (which can irritate newly DS-ified insides), and you will have a menu of delicious food that will address the bulk of your health concerns, I think. Lots of garlic, lots of olive oil, lots of fishies and some lean meat, with some veg on the side. It ain't bad
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Post by west4thavenue on Apr 26, 2014 10:30:23 GMT -5
That is a really excellent suggestion, maggiesara. Finding a NUT in my small town would be impossible, so long distance would be the way to go. The sodium goal is a max of 1500 g of sodium daily, and so far that has not been too difficult. I'm already doing my own cooking (of necessity!). I'm tracking everything in fitday, which is very helpful. Just taking the Zantac has made a huge difference.
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Post by goodkel on Apr 27, 2014 5:03:53 GMT -5
You've received great advice here. There's just a few things I'd like to add.
I was in treatment for atrial fibrillation for 4 months and, while I was on Coumadin/Warfarin, I had a prescription for Protonix for my heartburn. You should ask your cardiologist about it. It worked great.
Your best bet for avoiding sodium is to avoid processed foods. When you can't avoid them, read the nutritional labels carefully. Some items might surprise you. For example, Lightly Salted Saltines have less sodium than Saltines without salt on top. Don't trust the packaging.
Getting all your protein in with food is something you should be able to do. Remember the rules: 30 grams by 30 days, 60 grams by 60 days, and 90 grams by 90 days. Don't try to push it more than that.
Heart healthy diets are very low in fat. Your DS makes everything low fat for you. Your cardiologist will be very pleased with the results of your 3 month labs.
In summary: 1. Ask your cardiologist to call in a Protonix rx for you 2.You should be at 30 grams of protein a day now, gradually increasing it during the next month. 3. Keep an eye on the edema and sodium. 4. Don't worry about fat.
I am so happy you had your DS before the heart attack. It is going to go a long way in helping your heart: less weight means less strain on your heart, everything you eat is automatically low fat protecting your arteries, and your blood pressure will go down, too.
I believe that yours is going to be one triumphant journey. I'm looking forward it.
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Post by newyorkbitch on Apr 27, 2014 7:15:17 GMT -5
I think she has been told she cannot take PPIs, so she can't take Prilosec, Protonix, etc. It may be because of an interaction with other medications she's taking. That's why I suggested Zantac - it's not a PPI.
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Post by Girlrocker on Apr 27, 2014 10:28:43 GMT -5
Hi there, I just wanted to also reiterate, that the sodium culprit really is in processed/prepared foods, and you'll become a label reader. And this book really helped dispel what I 'thought' and what was actual. It's also paper-back size and easy to tote around in a purse. For additional support, we have a weekly weigh in thread here on the Main Board, and it's for weight numbers, non-scale victories, food challenges and anything else we face during the week. I'm glad too, again, you had your DS before your heart attack, and greatly admire your spirit and courage!
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Post by teachermomolp on Apr 27, 2014 10:31:17 GMT -5
I bought this book on your suggestion- it's an eye-opener! Get it. It's cheap too.
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Post by goodkel on Apr 27, 2014 10:54:18 GMT -5
I think she has been told she cannot take PPIs, so she can't take Prilosec, Protonix, etc. It may be because of an interaction with other medications she's taking. That's why I suggested Zantac - it's not a PPI. She said it was because of the blood thinner she is on. I took Protonix while on blood thinners, so there may be something different about its formulation. But, as long as the Zantac is working for her that's great.
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