TStew

LAPAROSCOPIC GASTRIC SLEEVE DIET Joseph E. Chebli MD FACS Introduction The following information provides guidelines for you to follow before and after Gastric Sleeve Surgery and for the rest of your life. Gastric Sleeve Surgery is a weight loss tool. After surgery, you will be required to make lifelong changes in your eating habits and to exercise on a regular basis in order to achieve and maintain your weight loss goals. Gastric Sleeve Surgery reduces the size of the stomach which restricts the volume of food that you can consume at one time. This means that you will feel full after eating a small amount. The surgery also induces hormonal changes which help prevent you from feeling excessively hungry. You should avoid drinking liquids with meals. This is to prevent overfilling of the stomach. Frequent snacking or grazing must also be avoided as this contributes to excess calorie intake and can slow weight loss or cause you to gain weight. Exercise is an important component of weight loss success. Exercise is recommended before and after surgery in order to maximize the amount of weight that you lose and keep off. If you have not been an active exerciser, always consult with your physician for clearance and recommendations before beginning any exercise program. It is important to follow the lifetime Gastric Sleeve diet rules, supplement guidelines, and exercise recommendations in order to achieve and maintain optimum weight loss success. In order to begin preparing for surgery, start implementing the pre-surgery diet goals listed on the next page. Pre-Surgery Diet Practice Tips 1. Choose low-fat foods, and avoid fried foods. 2. Stop using sugar. Use healthy sugar substitutes. (T) 3. Decrease intake of Desserts and candy. 4. Stop drinking sugar-sweetened beverages such as regular soda and sweetened Kool-Aid. 5. Start weaning off of caffeine and carbonated beverages. 6. Start cutting back on fast food and eating out. Begin making healthy meal choices when eating out and at home. 7. Eat 3 meals a day. Do not skip Breakfast. 8. Start decreasing portion sizes. 9. Eat more fruits and vegetables. 10. Practice drinking Water and other fluids between meals, not with meals. 11. Drink 64 ounces water a day. 12. Practice sipping liquids. 13. Avoid alcohol. 14. Begin some form of exercise. 15. Review the following information on the gastric sleeve diet. 16. Practice chewing foods thoroughly, 20 - 40 times or to paste consistency. 17. Purchase your Protein drinks or supplements. 18. Purchase your Vitamin and mineral supplements. 19. Begin planning a schedule for mealtime, fluids and vitamin and mineral supplements. Post Gastric Sleeve Surgery Diet Important Diet Guidelines: 1. Eat 3 meals per day. Avoid snacking and grazing. 2. Eat small amounts. Initial portion size should be no more than 1 - 2 ounces - approximately 2 - 4 Tablespoons - of food per meal for the first month. At first you may not be able to tolerate this amount. Over time, you will slowly tolerate more volume at each meal. Long term, the stomach will eventually hold about 4 - 8 ounces (1/2 - 1 cup) of food per meal. 3. Eat protein foods first. 4. Do not try to eat food and drink liquid together. • Consume liquid 30 to 60 minutes before and/or 30 to 60 minutes after eating meals but not during meals. 5. You are required to take a multi-vitamin with minerals for the rest of your life. 6. Eat slowly! • Each meal should last 30minutes or longer. • Avoid gulping foods and drinks. • All foods must be well-chewed to a paste consistency. • Using a small fork or spoon (i.e. baby utensils) can help control portion sizes. • Have one place to eat (such as at the table) and avoid reading or watching TV while you eat. This helps you to enjoy your food, concentrate on eating slower and to realize when your stomach is full. 7. Drink plenty of calorie-free, non-carbonated, caffeine- free fluids between meals. • Drink slowly-sip fluids, never gulp. • Calorie-containing beverages should be limited to skim milk and Protein Drinks. • Limit juice to no more than 4oz. per day. • Consume zero-calorie beverages throughout the day. Diet Progression After Surgery The diet after gastric sleeve surgery progresses through several stages. Your surgeon will let you know when it is okay to progress to the next stage. Day 1 - 2 after surgery: Clear liquid diet The clear liquid diet means fluids or foods that are liquid at body temperature and can almost be seen through. You will be on a clear liquid diet while you’re in the hospital. Examples of Clear Liquid Diet (No Added Sugar/ Sugar Free): • Clear (diluted) fruit juices without added sugar: apple, grape or white grape or diet cranberry • sugar-free Crystal Light drink mix or popsicles, Sugar-free Kool-Aid. (T - careful, usually sweetened w/Aspartame) • Herbal tea, caffeine-free tea • flat soda • Sugar-free Popsicles • Sugar-free Gelatin • Clear broth • Water �� It is best to dilute juices by 50% with water. �� Avoid citrus juices (orange/grapefruit) and tomato juice for the first three weeks. �� coffee and de-caffeinated coffee contain acids which are irritating to the stomach lining and should be avoided for the first few weeks for healing. Day 3 through Week 2: Full Liquid Diet The next stage is the full liquid diet which consists of sugar-free, low-fat milk products and the Clear Liquids listed above. You will need to supplement with protein (drinks or powder) after surgery. Remember to sip liquids, do not gulp. Examples of Full Liquid Diet (No Added Sugar/Sugar-Free, Low Fat): • Skim Milk or Lactaid milk • Soy Milk (non-fat) • Low fat, thin, strained cream Soup (smooth, no pieces of food) • Sugar-free instant breakfast • Protein drinks – Start daily when you get home from the hospital. (See section on protein and protein drinks) • Plain or “light” (no sugar added) yogurt with no fruit pieces • Sugar-free pudding or custard • Thinned cream of wheat or rice Cereal Week 3 through Week 8: pureed Diet You may now begin a pureed diet. This includes all items listed for clear and full liquids, and the items listed for the pureed (blenderized) diet. • Eat PROTEIN foods first • Make sure foods are well blended. • Start slowly. If you do not tolerate pureed foods go back to the liquid diet and try again in a few days. • Remember to drink liquids between meals, not with meals. • Continue protein drinks or protein supplements every day. Examples for the Pureed Diet (Sugar-Free/No Sugar Added, Low Fat): eggs cheese Pureed or blenderized scrambled eggs or egg substitute or cheese omelet; melted low-fat cheese, low-fat or non-fat cream cheese, ricotta cheese, very smooth/mashed soft cheese such as mozzarella, string cheese, low-fat or non-fat smooth or small curd cottage cheese meat, Fish, Poultry, Baby food meat or pureed meat or poultry moistened with broth or low-fat gravy Blenderized shrimp, scallops or fish Pureed tuna or salmon (canned in water) or pureed egg salad with low-fat or non-fat mayonnaise Potted meats thinned with broth; smooth deviled ham Starches Unsweetened instant oatmeal (strained), cream of wheat or rice cereal, mashed potatoes or sweet potatoes, smooth polenta, hummus, refried beans; low-fat or baked crackers or chips Vegetables Baby food vegetables or pureed cooked vegetables (no corn or peas) Mashed winter squash, tomato juice or sauce, pureed salsa, marinara Soup Strained, low-fat cream soup made with skim milk; fat-free broth Blenderized lentil or split pea soup or chili Fruit Baby food fruits (bananas, pears, applesauce, peaches, mango, etc) Unsweetened applesauce (smooth) Unsweetened canned fruit – blenderized Unsweetened fruit juice (diluted, no sugar added) Remember: IF YOU CAN CHEW IT, DON’T DO IT! Tips to Get Started Everything that you eat on the pureed diet should be sugar-free or no sugar added, low fat and blended to the consistency of baby food or smooth applesauce. • You will need a blender or food processor or you can purchase baby food. • Start with 1 ounce (2 Tablespoon) portions - no more than 4 Tablespoons at the most. Listen to your body and stop eating as soon as you feel full. • Eat protein foods first. Then if you are not too full, try vegetables or fruits. • Continue protein supplements (80 g protein per day from supplement). Helpful Hints for Blenderizing • Cut foods into small pieces before putting into the blender or food processor. • Remove seeds, skins and fat. • Add liquid for ease of blending. Add enough liquid to cover the blades. Options include skim milk, broth, strained low-fat cream soup, low-fat gravy, low-fat or non-fat sour cream or fat-free half & half. • Blend the item to a smooth, applesauce consistency. • Make sure there are no particles, seeds or lumps remaining. If so put through a sieve or strainer. • If you have leftover blenderized foods, try freezing in single serving portions in ice cube trays and put the frozen cubes into plastic freezer bags. Meats – Very lean and dry meats puree better by adding a small amount of fat (margarine, oil, light mayonnaise, gravy, etc.) Fish also tends to be dry. Improve the texture by adding small amount of lemon juice, light mayonnaise or strained low-fat tartar sauce. Starches – Try pureed peas, canned Beans, sweet potatoes. Starches puree better when hot. Rice and potatoes tend to puree into a gummy paste and are not recommended. Substitute cream of rice cereal prepared with a flavorful broth and seasoned with margarine. Pasta or noodles are not recommended as they are not well-tolerated. Vegetables – Cook vegetables until soft. If using canned vegetables, drain first. Add melted margarine and puree. Add a small amount of liquid until it reaches the smooth applesauce consistency. Fruit – If using canned fruit, drain first. Add a few drops of lemon juice to help prevent them from discoloring. Begin to take advantage of your favorite leftovers before surgery. Process these foods, and freeze them in an ice cube tray. (Each cube is approximately 1/2 to 1 ounce). When frozen, pop out into Zip-lock bag; label and date, and freeze cubes until needed. Meal Guidelines for the Pureed Diet (See Sample Pureed Meals listed in the Appendix) Once you begin to eat pureed foods (which are considered solids) you will want to start differentiating between liquids and solids – meals should include pureed foods, and so liquids (including protein drinks) should be taken separately from your meals. • You should eat 3 meals a day with protein drinks between meals. • Protein drinks containing at least 20 grams of protein per serving should be consumed as needed to meet 80 g/day goal. • Start with a portion size of 1 to 2 tablespoons of pureed food for the first month. At first you may not be able to tolerate this amount. Eat your protein source first, and then if you have room a small amount of fruit, vegetables or other foods may be consumed. Hints for Measuring Foods: Liquids or soft/pureed foods are best measured in measuring cups or spoons; they can be measured in ounces, Tablespoons or mls. 1 cup 8 Fluid ounces 240 ml 16 tablespoons 3/4 cup 6 fluid ounces 180 ml 12 tablespoons 1/2 cup 4 fluid ounces 120 ml 8 tablespoons 1/4 cup 2 fluid ounces 60 ml 4 tablespoons 1/8 cup 1 fluid ounce 30 ml 2 tablespoons 1 Tablespoon = 3 teaspoons 1/2 Tablespoon = 1-1/2 teaspoons Week 9-12 After Surgery: Soft solid food Diet If you have been tolerating pureed foods, you may now begin a soft diet. This includes all items listed for clear and full liquids and pureed diets plus items listed for the soft diet. Try 1 to 2 new foods a day. This will help you to learn what foods you tolerate. • Remember your stomach pouch empties more slowly with more solid or dense foods than with liquids, so you will be able to tolerate a smaller quantity of food than you could with liquids. • Go slowly. If you do not tolerate the trial of soft foods, resume pureed foods and try again in a week. • Eat protein foods first • Avoid foods high in sugar and fat. • Space meals 4-5 hours apart • Continue your protein drinks between meals • Drink other fluids constantly between meals Examples of Soft Diet (No Added Sugar/Sugar-Free, Low Fat): • Baked fish (no bones) • Imitation crab meat, baby shrimp • Bananas • Canned peaches or pears in water or juice • Well-cooked vegetables without seeds or skin (no corn or peas) • Scrambled, poached or hard boiled eggs • Tuna or egg salad (no onions, celery, pimientos, etc.) • Finely shaved deli meat • Baked, grilled or rotisserie chicken o Moist foods will be better tolerated. Moisten meats with broth, low fat mayonnaise, or low-fat gravy or sauce. o Fish and seafood Proteins are softer and easier to break down than poultry or red meat proteins. o Reheating foods tends to make them dry out and hard to tolerate. Common Problem Foods (Avoid for 3 months after surgery) • Red meat such as steak, roast beef, pork. Red meat is high in muscle Fiber, which is difficult to separate even with a great deal of chewing. Avoid hamburger for one month after surgery. • Un-toasted bread; rolls, biscuits. (Toasted bread may be better-tolerated.) • Pasta • Rice • Membrane of citrus fruits • Dried fruits, nuts, popcorn, coconut • Salads, fresh fruits (except banana) and fresh uncooked vegetables, potato skins. Month 4 After Surgery: Regular Diet • Problem foods as listed above can now be tried. • Rice, pasta and doughy bread may not be tolerated for 6 months or more. • Try fresh fruits without the skin first. If tolerated, the skin can be tried the next time. Salads are generally well-tolerated if chewed well. • Go slowly. Try a small amount to see how you feel. • Avoid high sugar and high fat foods to avoid a high calorie intake. Foods to Avoid: Hard/crunchy foods may always be poorly tolerated. Nuts and seeds are difficult to break down. Fried foods/greasy foods are hard to digest and are very high in calories. • Corn chips, potato chips, tortilla chips, hard taco shells • Nuts and seeds • Fried foods and greasy foods Points to Remember: • Solid foods will fill your stomach pouch more than liquids so you will be eating smaller quantities of foods versus liquids. • If you don’t tolerate a food the first time, wait a week and try again. • You may find that you tolerate a certain food one day and not the next. It is normal for this to happen. • If you don’t tolerate certain foods or notice nausea, vomiting or diarrhea during or after eating, ask yourself the following questions: o Did I chew to a paste consistency? o Did I eat too fast? o Did I eat too much volume? o Did I drink fluid with my real meal or too close to my meal? o Did I eat something high in sugar or fat? o Was the food moist or was it too dry? Steps for adding solid foods: • Try only 1 small bite of the new food and chew well. Wait awhile and if there are no problems, take another bite. • If at any time you feel too full, nauseated or vomit, stop eating and rest. Take only clear liquids at the next meal and add blended foods and liquids at the following meal. Try one solid food again the next day. PROTEIN Protein is the most important nutrient to concentrate on when resuming your diet. Because the volume of your meals will be limited, you should aim for a minimum of 80 grams of protein per day – this needs to come from your protein supplement. Why is protein important? • Wound healing • Sparing loss of muscle • Minimizing hair loss • Preventing protein malnutrition Remember to eat protein foods first at each meal, followed by vegetables and fruit. These are some good sources of protein: Protein Sources Serving size Protein (g) Skim or 1% milk 1 cup 8 Evaporated skim milk (canned) 1 cup 19 Soy milk beverage 1 cup (8 ounces) 7 Non fat dry milk powder 1/3 cup powder 8 Nonfat, sugar free yogurt 1 cup (8 ounces) 8 Nonfat or low fat cottage cheese ½ cup (4 ounces) 14 Nonfat or low fat cheese slices String cheese *1 ounce/ 1 slice 6 LEAN meats – skinless chicken or turkey breast, fish, beef, ham, Deli meats *1 ounce 7 Egg or Egg substitute 1 egg or ¼ cup subst. 7 Peanut Butter (creamy) 1 Tablespoon 5 Tofu ¼ cup 5 Legumes; dried beans peas or lentils Chili, bean soup ½ cup cooked ½ cup 7-9 6-7 Soy/vegetable patty (like Gardenburger) 1 patty 8 - 10 Hummus ½ cup 6 Measuring Hints: *1 ounce of meat is equal to about 3 – 4 Tablespoons of chopped or ground meat. 1 ounce of grated or cottage cheese, tuna or egg salad is ~ 1/4th cup (4 Tablespoons). A 3-ounce portion size of chicken or meat is about the size of a deck of cards. High Protein Ideas Chicken or Turkey Pureed – Use baby food or make your own. Try mixing it into strained low-fat cream soup. Breast – baked or grilled Thin-sliced/shaved deli slices Ground – meatballs, meatloaf Canned – works great for chicken salad

I would just use the serving size of Protein powder and a little bit less liquid than it called for and I would use water because the egg would thicken it up a bit. Never tried it with a shaker -always a blender. It does sound gross but I use to look forward to that Breakfast because it was the only time of the day I felt good! Because its raw it needs little digestion and you feel great almost immediately. It's not gross at all though - it just makes it creamier! Once in a while I would taste a little yolk because I only blended for a few seconds but I love yolk so it didn't gross me out or anything. Please buy organic / free range eggs though. I don't know how much a difference it makes but these eggs are coming from much healthier chickens and I just feel much safer!

lol - I love that!!

Hello, I just commented on a post about what kinds of things you can do in the hospital during recovery. I mentioned the Health Journeys CDs because that's what I did when I had my last surgery (uterine fibroid) and it helped me relax and pass the time in a constructive way. I did not have the surgery CD at the time, I was listening to general wellness and pain CDs (more for the deep breathing and relaxation - I've grown very fond of Bellaruth's voice). It did help me and I've already ordered the CD for surgery (they have one for everything). Check it out at http://www.healthjourneys.com/Product_Detail.aspx?on=1&id=29&mcid=10&catid=, great reviews and there are some audio samples as well. No, I don't sell these and have nothing to do with the website. To be honest, I didn't like her voice or the weird things she says on the CDs when I first heard them but it was part of the pain mgmt program I was lucky enough to be a part of I did it along with everyone else. It didn't take long to realize that there was no denying how relaxed and good I felt later that night (after doing a tape) and even the next day. I had to buy some of my own. Unfortunately, they're just collecting dust at the moment. I'm going to do the surgery one every day (scheduling with Dr. Aceves mid December) and hope for the best. I feel better already as I've been quite anxious lately and worried about my decisions.

A woman wrote about this but I'm not familiar enough with the site to be able to go find her post.... She also had her surgery with Dr. Aceves and she said the first day she slept a lot and little interest in anything else. However, after day one it was a different story and she was quite bored. She said that they have wireless internet so if you have a laptop - bring it! She also mentioned that the TV only has Spanish stations so that did not hold her attention. I'm thinking of buying a portable DVD player and my sister has a little Nintendo game player and I'll try to borrow that and her iPod as well (since I don't have a laptop). She said that magazines are way better than a book because it's hard to concentrate when you're being given pain meds. Someone also mentioned crafts (knitting, etc.) to pass the time. I just had a uterine fibroid removed and was in the hospital for two days. I felt like crap and on the second day I tried doing deep breathing exercises and healing mediations (visualization) and I brought a portable DVD player with some guided imagery CDs that I bought from www.healthjourneys.com It's a good way to pass the time and help your body get in the healing mode. Health Journeys has CD's for EVERYTHING. The ones I have are for Fibromyalgia pain and general well being and stress but they have one specifically for surgery and I ordered it the other day ($20+shipping). Before anyone jumps to conclusions, NO, I'm not selling it and I don't work for Health Journeys. I learned about Bellaruth Naprosek when I took pain mgmt classes at the hospital. They had us listen to these and at first I thought it was a joke but I felt so relaxed afterward that I bought some for myself. Here is the surgery tape: http://www.healthjou...9&mcid=10= (great reviews!!) Good luck! I'm thinking about 12/17 but still haven't scheduled.

I know, I'm pretty lazy too (especially in the morning). I haven't done the brushing in a while but I'm starting (tomorrow - hahaha) because of this surgery. I'm going to hang the brush right outside my shower so I always see it before getting in. I always think about the brushing after I'm already in the shower and it's too late at that point.

Thanks for your helpful comments! I think I'm going to use the patch and ask for something more just to be sure!

Toxins are stored in fat cells. Hopefully it will eventually clear up.... I'm sure I will have the same problem

What about seeing another surgeon to get a second oppinion?

I had laproscopic surgery in August (fibroid tumor) and the surgeon gave me something that would stop me from getting nauseous after surgery. Believe it or not, I forgot to use it (you have to put it on the night before) but luckily I didn't have any problems. It's a patch that you put behind your ear the night before surgery and just leave it there. The information from the box: TRANSDERM SCOP PATCH SCOPOLAMINE HYDROBROMADE 1.5 mg Each patch is programmed to deliver in vivo approximately 1.0 mg over 3 days. This is a medication for motion sickness / traveling but my surgeon said that it works well for surgery patients. After reading about the nausea issues I'm definitely going to email Nina and ask if I can use it because the throught of throwing up after that kind of stomach surgery scares the crap out of me!

I'm not uncomfortable with the culture but I don't speak a lick of Spanish or even Spanglish. I've lived here for less than 10 yrs. I so wish I could move the date and have someone there because I'm going to do it alone! However, I have an office party to plan and my office is closed between Christmas and New Years and I'm forced to use vacation time that week. Otherwise, I would change the date in a second.

Hi Rob, Same boat.... I was considering the band and went to a required seminar and found out two things that I didn't know. 1. You had to keep it for life. 2. You had some pretty serious follow up to contend with. After I got online and started researching, I quickly realized that I'm not willing to deal with that nightmare. I'm in San Diego and I also have Blue Cross PPO (Anthem) and after pulling teeth to finally talk to somene who could confirm that the sleeve was indeed covered, I found out that Blue Cross considers it 'investigational' and does not cover at all. They will cover the bypass or the band but not the sleeve. Also, I would have to have any bariatric surgery at a COE for it to be covered and that severely limits your choice in doctors unless you're willing to travel far and wide. I was very disappointed and I went to the appt with my surgeon and talked to him about it. He explained that this surgery was a life changing decision and I should not even consider going with something or someone I'm not comfortable with and he ensured me that they would probably cover the sleeve in the next few years. He also told me that the cash price here would be in the tens of thousands (hospital alone would be nearly $20k). I started reading about Mexico surgeons and kept coming across Dr. Aceves name. I know that people are hired to get his name out there and say good things to bring in pateints but I find so much and so many people who claim he was their surgeon and he is awesome. I think it's a sign that he is only 2 hrs away from me and will actually pick me up at home (I live near airport) and bring me back home. I'm considering mid December but I haven't made my final decision about it yet. I can't afford it but I'm so ready and if I need to go further into debt to get it so be it....

Candidosis? I'm pretty sure there isn't anyone who thinks that you can make a loaf of bread with Candida overgrowth but then again, yeast is yeast. It's a fungal overgrowth and it can range from a superficial vaginal problem to a life threatening condition. I'm really not that interested in knowing if I can make bread with it but Candida overgrowth in the gut is no joke. It's likely caused by years of poor diet and I wouldn't be one bit surprised if most of us on this site have it to some degree. Most of us live(d) on sugar and processed foods. Most people with this condition have a ton of health problems and the doctors can't find anything wrong. They go undiagnosed for years and then many learn about Candida on the internet and learn to follow a strict diet and take supplements and cure themselves. I know someone who had it and struggled for two years with the diet and is now a happy and healthy person after over a decade of being sick. I'm not at all surprised that an article about Candidosis would mention dry skin brushing. And the Candida diet is very similar to Atkins or the WLS diets but pure and natural - no chemical additives, all organic, low carb, no sugar, etc...

OMG - am I going to be accused of selling natural bristle brushes? I don't know what 'author' you stumbled across but there is info all over the web about dry skin brushing. I first learned about it on a cancer survivors site. Again, it's all over the internet and it's not a big secret. Many people practice it. How can this possibly be a SCAM? Are you kidding? Why would anyone bother? That doesn't make any sense at all. Who is trying to scam who? The brush makers? And even if you're right about the lymph system being too deep for skin brushing to affect and all the practioners who recommend it and all the people who practice it are wrong - I think that most people on this site would be most interested in what it can do for the skin. I'm also a bit of skeptic but if any part of these benefits are true then it's worth it. It's worth the 3 minutes before each shower and it's worth the $3.99 for a long handled natural bristle brush.

Pre WLS but I thought I would share this with all of you because it's known to help skin elasticity and it releases toxins and I'm sure that losing weight dumps a TON of toxins into your body. Fat cells are where most toxins are stored. I don't know if it will be safe right after surgery but I'm sure that it would be extremely beneficial after healing. Did a quick Google search just to see how much is out there on this topic and this was listed the first page: Benefits of Dry Skin Brushing: 1. Removes cellulite 2. Cleanses the lymphatic system 3. Removes dead skin layers 4. Strengthens the immune system 5. Stimulates the hormone and oil-producing glands 6. Tightens the skin preventing premature aging 7. Tones the muscles 8. Stimulates circulation 9. Improves the function of the nervous system 10. Helps digestion 11. AND it’s easy, inexpensive and invigorating! Dry Skin Brushing The skin plays a vital role in ridding the body of toxins and impurities. Dry skin brushing is one of the best techniques to open up the pores of the skin, and to stimulate and detoxify the lymphatic system.The skin is the largest organ in the body, and is responsible for one-fourth of the body's detoxification each day. It also makes it one of the most important elimination organs! For this reason the skin is also known as the "3rd" kidney, with the lungs being known as the 2nd kidney.Our circulatory system has its own pump (our heart) to move blood through our bodies but our lymphatic system does not. It primarily relies on our movement to assist it. Typically, the more active we are physically the better condition our lymphatics will be.Skin brushing helps move lymph Fluid and gives us a jump-start on health. When the pores are not clogged with dead cells and the lymphatic system is cleansed, the body is able to carry out its important function of eliminating toxins and waste material. Under normal circumstances the skin eliminates more than one pound of waste products every day. If the skin becomes inactive with its pores clogged with millions of dead cells and other debris, toxins will remain in the body. This puts undue stress on the other eliminative organs, mainly the kidneys and liver, making them increase their activity. Eventually they become overworked.Skin brushing helps exfoliate and invigorate our skin too. It increases our blood supply to the area bringing with it nourishment and oxygen. Dry skin brushing will not only help increase circulation and elimination of toxins, but will also make a huge difference to the quality of your skin and it will look and feel healthier.Dry skin brushing improves the surface circulation of the skin and keep the pores of the skin open, encouraging your body to discharge metabolic wastes. Dry skin-brushing - dry meaning not in the bath - will change the health of your whole body by helping it get rid of toxins. Benefits of dry skin brushingstimulates the lymphatic systemcleans toxins from the lymphatic systemhelps digestionstimulates circulationincreases cell renewalstrengthens the immune systemtightens the skinremoves dead skin layers and other debris collected in its pores Use the right kind of brush The brush used should be a long-handled, bath-type brush. It is essential that it contain natural bristles and not synthetic ones. Synthetic bristles will scratch the surface of the skin and are harsh and irritating. The brush should be kept dry and not used for bathing.For hygienic reasons it is wise to have a separate brush for each member of the family.Thoroughly wash the brush with soap and Water every couple of weeks. Always allow the brush to dry out when not in use. How to do skin brushing The body should be dry, and the brush should pass once over every part of the body except the face.The best time to do skin brushing is before showering or bathing at least once a day, and twice, if possible.Do not wet the skin since it will not have the same effect because this stretches the skin. The skin should not become red. If it does, you are probably brushing too hard.There should be no back and forth motion, circular motion, scrubbing, or massaging - one clean sweep does it. Use long gentle, but firm, stokes.The direction of the brushing should generally be towards the lower abdomen. To brush the skin, use long gentle, but firm, strokes Start at the feet and legs brushing upwards to your groin.Then do your hands and go up your arms to the armpits.Then brush upwards on your buttocks.Brush down the neck, chest and trunk.Brush your lower abdomen towards the center.It is permissible to brush across the top of the shoulders and upper back as the best contact with the skin is made that way.Don't brush your face.Brush the breasts very lightly avoiding the nipples. Additional information If you haven’t done skin brushing before it is wise to start with only one pass over the skin’s surface. Over time you can gradually increase the number of strokes done during each skin brushing session. The reason is that too much stimulation can be too hard on the body. And always use long gentle, but firm, strokes. Remember that your skin should not turn red, which means the pressure on your strokes is too heavy. The idea is to stimulate and not to irritate the skin.Many people may find large amounts of lymph mucoid in their stools a day or two after beginning skin brushing. This is the emptying out of the backlog of mucoid from the lymphatic system and is the effect of detoxifying the lymph system.

Thanks for putting this together! A few things I've read about that I probably wouldn't have thought of: An eye mask and ear plugs (wish I would have had them a few months ago during my hospital stay!!) Slippers or slip on shoes to walk the hallway A camera Lotion, shampoo, soap, deodorant, etc Reading glasses Phone charger I'm getting the surgery in Mexico and I plan to bring some Water and food items with me for the night before. I don't want to have to worry about going out to get something to eat (I'll be by myself).

What a great idea!! I just had a uterine fibroid removed (laproscopic) and I could really have used one of these!! I tried to explain to the nurses that my swollen stomach needed support but they didn't get it. I asked if they had some sort of elastic girdle thing but they told me they couldn't give me anything like that.... I was miserable.

* Stevia - Very healthy! Can also be used for baking. Comes in a powder or a liquid (I like the liquid better but it's easy to put too much). It's an herb so the taste (and aftertaste take a little getting used to). A company called Stevia Leaf (I think) makes liquid flavored Stevia sweeteners in all sorts of flavors. * Lo Han or Liu Han (inulin) Feeds good bacteria in intestines (very expensive!) * Yacon – Peruvian Tuber (FOS) Syrup - Amazing therapeutic properties. The body is not able to break it down as sugar and it passes through and then promotes the good bacteria in the intestines. Tastes like a cross between honey and molasses – a good, inexpensive brand is Amazon Therapeutic (brown glass jar and red label) sells for $16 for 16 oz jar. I use this in my oatmeal and I LOVE IT! * Xylitol – Has antibacterial properties. You should always carry mints (look for Spry mints) or gum sweetened with this if you can’t brush after a meal. It’s being used more and more in foods and toothpastes and such! Very healthy and affordable! * Arithratol (sp) is also antibacterial.

Stevia is an herb so the taste is going to take some getting used to but you do eventually get used to it. I remember how disgusted I was with Diet Coke and the aftertaste but ended up loving it until I found out what Aspartame does to you body and brain.... There are other healthy sweeteners that taste great: * Stevia - Very healthy! Can also be used for baking. * Lo Han or Liu Han (inulin) Feeds good bacteria in intestines (very expensive!) * Yacon – Peruvian Tuber (FOS) Syrup - Amazing therapeutic properties. The body is not able to break it down as sugar and it passes through and then promotes the good bacteria in the intestines. Tastes like a cross between honey and molasses – a good, inexpensive brand is Amazon Therapeutic (brown glass jar and red label) sells for $16 for 16 oz jar. * Xylitol – Has antibacterial properties. You should always carry mints (look for Spry mints) or gum sweetened with this if you can’t brush after a meal. It’s being used more and more in foods and toothpastes and such! Very healthy and affordable! * Arithratol (sp) is also antibacterial.

I haven't had the surgery yet but I'm guessing any Atkins or low carb cook book would be good.

I have Fibroymyalgia so I'm very concerned about how much I will be able to exercise after surgery. However, I do have many tools and hopefully I have the drive and will power. I was part of a 'pain management group' at a local hospital last year and they taught us how to manage pain without meds. A huge part of that was exercise. I bought a few DVD's that I was really impressed with and had fun doing with the group. Unfortunately, they've been gathering dust for many months but I'm counting on them to get me started on a more active lifestyle. (Why haven't I started already?!? lol) By the way, these DVDs were available in the hospital library and you could check them out for an unlimited time for FREE! Check with your hospital to see if they have a library because it's an incredible resource for books and CDs. Here are the ones I loved and bought: Rainbow Sun Qigong (It's for seniors and when I see these older women doing these moves I feel that my 41 yr old butt has NO EXCUSE not to) 4 Minute Fitness with Dr. Keith Jeffery (he's cheesy as hell but I did feel good doing these exercises and gained strength quickly) Yoga in Bed (Very gentle moves and the only Yoga I can do!) These are GREAT if you have a lot of pain and tend to use that as an excuse not to exercise (like me!!).

I have Fibroymyalgia so I'm very concerned about how much I will be able to exercise after surgery. However, I do have many tools and hopefully I have the drive and will power. I was part of a 'pain management group' at a local hospital last year and they taught us how to manage pain without meds. A huge part of that was exercise. I bought a few DVD's that I was really impressed with and had fun doing with the group. Unfortunately, they've been gathering dust for many months but I'm counting on them to get me started on a more active lifestyle. (Why haven't I started already?!? lol) Here are the ones I loved and bought: Rainbow Sun Qigong (It's for seniors and when I see these older women doing these moves I feel that my 41 yr old butt has NO EXCUSE not to) 4 Minute Fitness with Dr. Keith Jeffery (he's cheesy as hell but I did feel good doing these exercises) Yoga in Bed (Very gentle moves and the only Yoga I can do!)

I used to hate it too but there are so many different kinds (brands / curd size) and I tried one once that had very small curds and I loved it!

Thanks for posting this! I'm pre WLS and I'm trying hard to find some good quality powders without any dangerous chemicals. I'll print this out so I can check out ingredients and Protein amounts. I've been reading a lot about unjury and I just looked it up and I don't like what I see in the ingredients list at all: UNJURY chocolate whey protein supplement is specifically-designed by a clinical dietitian to deliver Medical Quality Protein. Ingredients: Whey protein isolate fructose (the most pro-diabetic sweetener we can consume. Do they really need this AND artificial chemical sweeteners?) natural and artificial flavors (This could mean ANYTHING and it almost always means MSG or other dangerous additives.) cocoa powder soy lecithin xanthan gum aspartame (a dangerous chemical sweetener that is an excitotoxin that causes brain cancer / tumors and MS symptoms.) acesulfame (ANOTHER dangerous chemical sweetener??) I love the one that I use currently but when I posted about it on the obesityhelp web site I got accused of being a spammer and some girl said that this shake was no good for WLS patients at all. The more I learn, the more I think she was full of crap. Thie shake I like has 14g of protein at 100 calories but I could add another 14g by adding two raw eggs to bring it to 250 calories and 28g of protien. That's a great meal post WLS, isn't it??

This is probably a dumb question but is 'smoothie King' a store or a brand name of a shake?