Escape_Pod

Yep, and most of us were obese as pre-ops because we failed to follow the "simple" guidelines of eat less / move more. And society judged us for failing to have a little self-discipline and lose the weight without surgery. Or, we went on a restrictive diet, became exercise fanatics, and lost a ton of weight, all the while committed to a permanent lifestyle change and then failed to "simply" stick with it and regained. Any of this sound familiar? How is it different to judge post-ops for failing to follow the plan?
I just don't think assigning blame is useful in this discussion, regardless of which way the finger is pointing, even if you're pointing it at yourself.

I'll admit up front, if regain of 22 pounds is the failure line, then I'm a failure. Or, I should say, I was. I'm working to get it back off again, and am well below that line again. But I definitely slipped back into old habits, and found myself slipping rapidly down the frightening slope back to obesity.
I don't find it useful to assign blame, either to the patient, or to the procedure, mostly because I think most of us were blamed for our obesity as pre-ops for a failure to "just stop" eating junk and get more exercise. Some of us struggle just as much to change what and how much we eat as post-ops (long-term).
I think it matters less whose failure that is, and more that we figure out how better to support patients, before and after surgery, in making whatever changes are needed for the individual to sustain long-term weight loss. There's so much at play here - long-ingrained habits, emotional and psychological elements, hormonal and biochemical elements, physical limitations, societal expectations... it's complicated.
I'm glad to see some honest reporting, though, on "failure" rates. For many (most?) of us, keeping those XX pounds off "forever" is going to require huge changes in many areas of our lives, not simply eating what we always have in smaller portions.

Abstract
Long-term weight regain is a fearedcomplicationof restrictive bariatric operation. The Sleeve Gastrectomy (SG)
is still in its early stages as a primary bariatric surgery and long-term data about its efficacy remains limited. From the
long term studies available it seems that approximately one-fifth of SG patients might be at risk for long-term weight
regain and about 5-10% of total SG patients will require surgical management forit. The possible mechanism behind
this weight regain is slowly being addressed. Patient noncompliance with dietary and lifestyle regimens is the most
practical factor that needs to be considered and can be prevented with a multidisciplinary team. Long-term gastric
pouch dilatation and gut hormone modulation are other theories that have been proposed to explain this weight regain.
Successful management strategies to combat weight recidivism include revisional bariatric surgery, performing a resleeve
gastrectomy or the addition of an adjustable band in the primary banded sleeve gastrectomy. However, the
safety of revisional bariatric surgery is a concern and should be performed only by an experienced bariatric surgeon.
It remains that as the SG continues to grow as a popular choice for the management of morbid obesity, more concrete
long term information will become available to address the how and why weight regain occurs.
http://omicsonline.org/open-access/the-sleeve-gastrectomy-and-how-and-why-it-can-fail-2161-1076-4-180.pdf

Abstract
Long-term weight regain is a fearedcomplicationof restrictive bariatric operation. The Sleeve Gastrectomy (SG)
is still in its early stages as a primary bariatric surgery and long-term data about its efficacy remains limited. From the
long term studies available it seems that approximately one-fifth of SG patients might be at risk for long-term weight
regain and about 5-10% of total SG patients will require surgical management forit. The possible mechanism behind
this weight regain is slowly being addressed. Patient noncompliance with dietary and lifestyle regimens is the most
practical factor that needs to be considered and can be prevented with a multidisciplinary team. Long-term gastric
pouch dilatation and gut hormone modulation are other theories that have been proposed to explain this weight regain.
Successful management strategies to combat weight recidivism include revisional bariatric surgery, performing a resleeve
gastrectomy or the addition of an adjustable band in the primary banded sleeve gastrectomy. However, the
safety of revisional bariatric surgery is a concern and should be performed only by an experienced bariatric surgeon.
It remains that as the SG continues to grow as a popular choice for the management of morbid obesity, more concrete
long term information will become available to address the how and why weight regain occurs.
http://omicsonline.org/open-access/the-sleeve-gastrectomy-and-how-and-why-it-can-fail-2161-1076-4-180.pdf

Yep, and most of us were obese as pre-ops because we failed to follow the "simple" guidelines of eat less / move more. And society judged us for failing to have a little self-discipline and lose the weight without surgery. Or, we went on a restrictive diet, became exercise fanatics, and lost a ton of weight, all the while committed to a permanent lifestyle change and then failed to "simply" stick with it and regained. Any of this sound familiar? How is it different to judge post-ops for failing to follow the plan?
I just don't think assigning blame is useful in this discussion, regardless of which way the finger is pointing, even if you're pointing it at yourself.

I'll admit up front, if regain of 22 pounds is the failure line, then I'm a failure. Or, I should say, I was. I'm working to get it back off again, and am well below that line again. But I definitely slipped back into old habits, and found myself slipping rapidly down the frightening slope back to obesity.
I don't find it useful to assign blame, either to the patient, or to the procedure, mostly because I think most of us were blamed for our obesity as pre-ops for a failure to "just stop" eating junk and get more exercise. Some of us struggle just as much to change what and how much we eat as post-ops (long-term).
I think it matters less whose failure that is, and more that we figure out how better to support patients, before and after surgery, in making whatever changes are needed for the individual to sustain long-term weight loss. There's so much at play here - long-ingrained habits, emotional and psychological elements, hormonal and biochemical elements, physical limitations, societal expectations... it's complicated.
I'm glad to see some honest reporting, though, on "failure" rates. For many (most?) of us, keeping those XX pounds off "forever" is going to require huge changes in many areas of our lives, not simply eating what we always have in smaller portions.

I'll admit up front, if regain of 22 pounds is the failure line, then I'm a failure. Or, I should say, I was. I'm working to get it back off again, and am well below that line again. But I definitely slipped back into old habits, and found myself slipping rapidly down the frightening slope back to obesity.
I don't find it useful to assign blame, either to the patient, or to the procedure, mostly because I think most of us were blamed for our obesity as pre-ops for a failure to "just stop" eating junk and get more exercise. Some of us struggle just as much to change what and how much we eat as post-ops (long-term).
I think it matters less whose failure that is, and more that we figure out how better to support patients, before and after surgery, in making whatever changes are needed for the individual to sustain long-term weight loss. There's so much at play here - long-ingrained habits, emotional and psychological elements, hormonal and biochemical elements, physical limitations, societal expectations... it's complicated.
I'm glad to see some honest reporting, though, on "failure" rates. For many (most?) of us, keeping those XX pounds off "forever" is going to require huge changes in many areas of our lives, not simply eating what we always have in smaller portions.

I'll admit up front, if regain of 22 pounds is the failure line, then I'm a failure. Or, I should say, I was. I'm working to get it back off again, and am well below that line again. But I definitely slipped back into old habits, and found myself slipping rapidly down the frightening slope back to obesity.
I don't find it useful to assign blame, either to the patient, or to the procedure, mostly because I think most of us were blamed for our obesity as pre-ops for a failure to "just stop" eating junk and get more exercise. Some of us struggle just as much to change what and how much we eat as post-ops (long-term).
I think it matters less whose failure that is, and more that we figure out how better to support patients, before and after surgery, in making whatever changes are needed for the individual to sustain long-term weight loss. There's so much at play here - long-ingrained habits, emotional and psychological elements, hormonal and biochemical elements, physical limitations, societal expectations... it's complicated.
I'm glad to see some honest reporting, though, on "failure" rates. For many (most?) of us, keeping those XX pounds off "forever" is going to require huge changes in many areas of our lives, not simply eating what we always have in smaller portions.

I'll admit up front, if regain of 22 pounds is the failure line, then I'm a failure. Or, I should say, I was. I'm working to get it back off again, and am well below that line again. But I definitely slipped back into old habits, and found myself slipping rapidly down the frightening slope back to obesity.
I don't find it useful to assign blame, either to the patient, or to the procedure, mostly because I think most of us were blamed for our obesity as pre-ops for a failure to "just stop" eating junk and get more exercise. Some of us struggle just as much to change what and how much we eat as post-ops (long-term).
I think it matters less whose failure that is, and more that we figure out how better to support patients, before and after surgery, in making whatever changes are needed for the individual to sustain long-term weight loss. There's so much at play here - long-ingrained habits, emotional and psychological elements, hormonal and biochemical elements, physical limitations, societal expectations... it's complicated.
I'm glad to see some honest reporting, though, on "failure" rates. For many (most?) of us, keeping those XX pounds off "forever" is going to require huge changes in many areas of our lives, not simply eating what we always have in smaller portions.

Yep, and most of us were obese as pre-ops because we failed to follow the "simple" guidelines of eat less / move more. And society judged us for failing to have a little self-discipline and lose the weight without surgery. Or, we went on a restrictive diet, became exercise fanatics, and lost a ton of weight, all the while committed to a permanent lifestyle change and then failed to "simply" stick with it and regained. Any of this sound familiar? How is it different to judge post-ops for failing to follow the plan?
I just don't think assigning blame is useful in this discussion, regardless of which way the finger is pointing, even if you're pointing it at yourself.

I'll admit up front, if regain of 22 pounds is the failure line, then I'm a failure. Or, I should say, I was. I'm working to get it back off again, and am well below that line again. But I definitely slipped back into old habits, and found myself slipping rapidly down the frightening slope back to obesity.
I don't find it useful to assign blame, either to the patient, or to the procedure, mostly because I think most of us were blamed for our obesity as pre-ops for a failure to "just stop" eating junk and get more exercise. Some of us struggle just as much to change what and how much we eat as post-ops (long-term).
I think it matters less whose failure that is, and more that we figure out how better to support patients, before and after surgery, in making whatever changes are needed for the individual to sustain long-term weight loss. There's so much at play here - long-ingrained habits, emotional and psychological elements, hormonal and biochemical elements, physical limitations, societal expectations... it's complicated.
I'm glad to see some honest reporting, though, on "failure" rates. For many (most?) of us, keeping those XX pounds off "forever" is going to require huge changes in many areas of our lives, not simply eating what we always have in smaller portions.

Congratulations, and thank you for sticking around to share your experience!

Well, I'd like not to be on a PPI long-term, but short of a miracle cure, I don't see getting off it any time soon. And having lost my mother to esophageal cancer a few years ago, I think I'd prefer to deal with nutritional deficiencies than the dangers of untreated / insufficiently managed GERD.

I worry about folks who think that healthy eating and having VSG rather than RNY will protect them from deficiencies. I consider my intake to be very healthy, AND I take good quality bariatric Vitamins, and still ended up with deficiencies. Maybe it's just marketing hoo-ha, but I'm willing to believe it matters which brand of Vitamins you take, because the source of the nutrients differs, and some are more readily absorbed than others. We were all told to take Calcium CITRATE, not CARBONATE, right? So it makes sense to me that other nutrients in a multi-Vitamin may also differ. I'm willing to pay more to take a Multivitamin that's formulated for post-ops. And while it's true that we don't have the same risks of deficiencies as RNY post-ops, we still have smaller stomachs, and many of us are on PPIs long-term, impacting absorption of nutrients that require an acidic environment. I'm vigilant, but I still ended up extremely low in thiamine and Iron. I keep up with my tests, and I focus particularly on Calcium, since I can't check that with a blood test. I had a bone density scan done along with a DEXA scan a couple of years ago, but since most women in their early 40s don't have bone density scans done, my PCP tells me there's not good data to compare my results to. I'll test again in a couple of years so I can compare to my prior results.

Take heart, I've felt like I could eat a lot too, since pretty early on. The most important thing to remember is that just because you can does not mean you should. I think the amount you can consume is different for everyone. And whether you can eat 3 ounces or 6 ounces, it's still up to you what you do with it. Both of those scenarios will allow you to gain weight if you eat high calorie foods and graze.
It's a good idea to measure food and try to keep it to whatever your plan calls for at the stage you're at. It was one half cup for me at that stage. I also count(ed) calories.Now, at 15 months out, I can eat more like 6-12 ounces at a time, depending on what it is. I keep my calories around 900-1000/day to lose, and try to follow the Protein first rule.
I don't know if you can stretch your sleeve or not. I have tried very hard not to, but I can certainly eat way more now than I could at 5 months, or at one year, but I don't think I did anything to cause that. I'm hoping it levels off, and I think it will. I think it's normal to have an increase in capacity as times goes on in the first couple of years.
The important take away is that even with a capacity that seems larger than others, you can still be successful at losing weight. You made a comment that you are starting to choose the wrong foods. You used the word choose, which is key, because it really is ALL about our choices. It's up to us how we handle this gift of the sleeve. Good luck!

I noticed it post-op, but things eventually returned more to normal for me. Of course, long-term, simply changing what you eat will cause your taste-buds to gradually adjust as well, so some things I use to enjoy are still too sweet, but I chalk that up to a change of eating habits. I'm rather certain if I went back to eating Reeses PB cups I go back to loving them in no time. Not going there...

Abstract
Long-term weight regain is a fearedcomplicationof restrictive bariatric operation. The Sleeve Gastrectomy (SG)
is still in its early stages as a primary bariatric surgery and long-term data about its efficacy remains limited. From the
long term studies available it seems that approximately one-fifth of SG patients might be at risk for long-term weight
regain and about 5-10% of total SG patients will require surgical management forit. The possible mechanism behind
this weight regain is slowly being addressed. Patient noncompliance with dietary and lifestyle regimens is the most
practical factor that needs to be considered and can be prevented with a multidisciplinary team. Long-term gastric
pouch dilatation and gut hormone modulation are other theories that have been proposed to explain this weight regain.
Successful management strategies to combat weight recidivism include revisional bariatric surgery, performing a resleeve
gastrectomy or the addition of an adjustable band in the primary banded sleeve gastrectomy. However, the
safety of revisional bariatric surgery is a concern and should be performed only by an experienced bariatric surgeon.
It remains that as the SG continues to grow as a popular choice for the management of morbid obesity, more concrete
long term information will become available to address the how and why weight regain occurs.
http://omicsonline.org/open-access/the-sleeve-gastrectomy-and-how-and-why-it-can-fail-2161-1076-4-180.pdf

Yep, and most of us were obese as pre-ops because we failed to follow the "simple" guidelines of eat less / move more. And society judged us for failing to have a little self-discipline and lose the weight without surgery. Or, we went on a restrictive diet, became exercise fanatics, and lost a ton of weight, all the while committed to a permanent lifestyle change and then failed to "simply" stick with it and regained. Any of this sound familiar? How is it different to judge post-ops for failing to follow the plan?
I just don't think assigning blame is useful in this discussion, regardless of which way the finger is pointing, even if you're pointing it at yourself.

Meaning someone else already had this rant a year ago. You mean you didn't do an exhaustive search to find it, before posting on it again? Tsk tsk
Sorry couldn't resist. :-) ????????

Awesome! Congratulations!!
I don't think you look dorky, I think you look strong and skinny, and very, very happy.

Lisa,
I'm sorry for everything you're suffering with right now. I know your focus and energy need to be spent on your husband at the moment, but I thought I'd mention one possibility for your esophageal spasms. When I was investigating sleeve surgery, I spoke with a local surgeon who handles some of the more challenging bariatric cases. He was concerned about VSG in my case because of my history with GERD, and in that context mentioned a patient he was treating who had developed very severe GERD post-sleeve surgery. I remember he indicated she was receiving regular botox injections (esophageal, presumably) to manage symptoms. He made it clear this was treating symptoms, not the cause, and was not a workable long-term solution. But, I thought it was worth mentioning as a possibility for treating your symptoms short-term.

I noticed it post-op, but things eventually returned more to normal for me. Of course, long-term, simply changing what you eat will cause your taste-buds to gradually adjust as well, so some things I use to enjoy are still too sweet, but I chalk that up to a change of eating habits. I'm rather certain if I went back to eating Reeses PB cups I go back to loving them in no time. Not going there...

WE can develop due to thiamine deficiency. I'm particularly interested in this topic because my 1-year labs came back showing very low thiamine levels, despite faithful Multivitamin supplementation, so I've added a B complex to my routine. I know others on the boards have also seen this development. Unfortunately, the full text of the study requires a subscription or article purchase, but you may be able to obtain through a local library. Just for the record, I did not experience persistent vomiting (or, actually, any vomiting at all) - noted as a major determinant here.
Wernicke Encephalopathy in Subjects Undergoing Restrictive Weight Loss Surgery: A Systematic Review of Literature Data AbstractThe use of weight loss surgery is progressively increasing, and in recent years, restrictive bariatric surgery procedures have been more often used. Although thought to be associated with a lower incidence of post-operative side effects than malabsorpitive surgery, some cases of micronutrients deficiency have been reported because of an acquired thiamine deficiency; in this clinical setting, some cases of Wernicke encephalopathy (WE) have been described. Major determinants and predictors of this major neurological complication are currently unknown. The aim of this systematic review was to analyse literature data in order to address this issue. The main result of our systematic review was that persistent vomiting is the major determinant of WE in patients undergoing restrictive weight loss surgery. In addition, early thiamine supplementation can rapidly improve the clinical conditions, avoiding permanent deficiencies. On the other hand, given the wide variability of clinical and demographic characteristics, definite prognostic factors of WE occurrence and of clinical outcome cannot be identified. In conclusion, although our results are suggestive, further ad hoc prospective studies evaluating changes in micronutrients levels according to different types of surgery are needed. Copyright © 2014 John Wiley & Sons, Ltd and Eating Disorders Association.

Lisa,
I'm sorry for everything you're suffering with right now. I know your focus and energy need to be spent on your husband at the moment, but I thought I'd mention one possibility for your esophageal spasms. When I was investigating sleeve surgery, I spoke with a local surgeon who handles some of the more challenging bariatric cases. He was concerned about VSG in my case because of my history with GERD, and in that context mentioned a patient he was treating who had developed very severe GERD post-sleeve surgery. I remember he indicated she was receiving regular botox injections (esophageal, presumably) to manage symptoms. He made it clear this was treating symptoms, not the cause, and was not a workable long-term solution. But, I thought it was worth mentioning as a possibility for treating your symptoms short-term.

I'll admit up front, if regain of 22 pounds is the failure line, then I'm a failure. Or, I should say, I was. I'm working to get it back off again, and am well below that line again. But I definitely slipped back into old habits, and found myself slipping rapidly down the frightening slope back to obesity.
I don't find it useful to assign blame, either to the patient, or to the procedure, mostly because I think most of us were blamed for our obesity as pre-ops for a failure to "just stop" eating junk and get more exercise. Some of us struggle just as much to change what and how much we eat as post-ops (long-term).
I think it matters less whose failure that is, and more that we figure out how better to support patients, before and after surgery, in making whatever changes are needed for the individual to sustain long-term weight loss. There's so much at play here - long-ingrained habits, emotional and psychological elements, hormonal and biochemical elements, physical limitations, societal expectations... it's complicated.
I'm glad to see some honest reporting, though, on "failure" rates. For many (most?) of us, keeping those XX pounds off "forever" is going to require huge changes in many areas of our lives, not simply eating what we always have in smaller portions.