deletedsally

If I am remembering correctly, you were sleeved in TJ by Dr. A and you said that you have minimal opportunities for follow up care. If you aren't better by the time you get this reply, you need to go to the ER. None of us have the ability to tell you how eating a protein bar might have affected your sleeve--particularly given the fact that it's been less than a month since your surgery.

Hi Rob, I didn't track everything for the first month. I bought a 22 oz tumbler and morning, noon, and night I mixed about 8 oz water with 3 oz fruit juice and 1 scoop of Unjury unflavored protein powder, then filled the glass to the top with ice. By dividing the day into 3 segments and making sure to get at least 20 grams of protein in each third, I didn't have to worry about inadequate protein. When I started tracking more carefully, was when I was eating more solid foods because I wanted to know when I was getting enough protein to begin using less of the Unjury. Also, after about 4 weeks, I was able to eat more and I wanted to monitor my carbs and proteins to get a good idea what I was eating. Now I monitor only sporadically because I use 1 scoop of Unjury daily with my food, and I know that I'm getting enough protein. I felt very tired, weak and sometimes a little dizzy for the first month. When I started eating mushies and getting in a few more calories, I started to feel much better. I had a "full liquid" diet for 4 weeks, and then "mushies" for another 4 weeks. I wasn't starting regular foods until 8 weeks out. It sounds like what you are experiencing is pretty normal for the first month. I think you will start to feel better very soon!

I'm just going to copy and paste my reply to Gatormom on the same subject: Hi Gator...I'm only 10 weeks out from surgery, so I'm still pretty new at the sleeve--but I'm not new to dieting/weight loss. Let me offer a guess at what I think is happening that may help you feel encouraged...Looking at your ticker, I see that you lost 25 pounds pretty quickly. When we restrict carbohydrates and/or cut calories drastically, we will almost always see an initial rapid weight loss followed by a brief "stall". Here's an explanation of why this may happen: "When we restrict energy intake too much too soon in order to lose weight quickly the body is forced to use up stores of carbohydrates and breakdown Protein in the muscles. As both carbohydrates and protein hold Water in the cells a loss of these macronutrients also results in a net loss of water. As a result rapid weight loss can often be made up of 75% water loss. After the energy systems stabilize water is regained because some of the protein and carbohydrate stores initially lost are replenished. The water is drawn back into the cells thus gaining back a little weight. It can be very confusing when one week you lose 4 pounds, the next week nothing. However remember that gaining protein in muscles increases lean body weight. More lean body weight increases our metabolism and helps burn fat faster!" Take a deep breath and keep doing the right things. Even though you are frustrated because you aren't seeing the scale move, I feel pretty certain that if you are eating 800 calories a day, your body is still burning fat as it replenishes some of the initial water loss from the beginning. Start adding some exercise to what you are already doing, and I think you will begin to see a more steady loss real soon. __________________

Hi Gator...I'm only 10 weeks out from surgery, so I'm still pretty new at the sleeve--but I'm not new to dieting/weight loss. Let me offer a guess at what I think is happening that may help you feel encouraged...Looking at your ticker, I see that you lost 25 pounds pretty quickly. When we restrict carbohydrates and/or cut calories drastically, we will almost always see an initial rapid weight loss followed by a brief "stall". Here's an explanation of why this may happen: "When we restrict energy intake too much too soon in order to lose weight quickly the body is forced to use up stores of carbohydrates and breakdown Protein in the muscles. As both carbohydrates and protein hold Water in the cells a loss of these macronutrients also results in a net loss of water. As a result rapid weight loss can often be made up of 75% water loss. After the energy systems stabilize water is regained because some of the protein and carbohydrate stores initially lost are replenished. The water is drawn back into the cells thus gaining back a little weight. It can be very confusing when one week you lose 4 pounds, the next week nothing. However remember that gaining protein in muscles increases lean body weight. More lean body weight increases our metabolism and help burn fat faster!" Take a deep breath and keep doing the right things. Even though you are frustrated because you aren't seeing the scale move, I feel pretty certain that if you are eating 800 calories a day, your body is still burning fat as it replenishes some of the initial water loss from the beginning. Start adding some exercise to what you are already doing, and I think you will begin to see a more steady loss real soon.

Super weight loss! Congratulations on the smaller body to ride the bigger bike!

Glad to hear that you are home safe and sound! I was so glad to be able to snuggle in and sleep in my own bed without all the beeping and banging around of the hospital. Hope you get great rest and update us soon!

I glad to hear about your decision...but I wish you didn't have to wait until September. I wish you the best in fighting off the hunger and maintaining your losses until September!

Wow! You are really rockin! Congratulations!

LOL...That ought to keep you too busy to think about much of anything else. Sounds like your daughter had a good idea!

Hi Jenn, It sounds like you are feeling pretty overwhelmed with the responsibilities of taking care of children and having a busy lifestyle. It's almost always hard to find the time to take good care of yourself when you are busy taking care of everyone else in the family--and it becomes even more complicated when your partner is sabotaging your success by bringing unhealthy foods into the home. My children are older, but I babysit for my grandchildren (2 & 4), and it seems like the things that I need to do for myself always get put aside on the days that I have them...Maybe I don't have time to take a shower until bedtime...or there's no time to exercise...or I forget to drink my fluids because I'm so busy chasing them and cleaning up messes...I definitely can't take the time to record my food... My experience is that everything that you can do to simplify your life will help. You can't change your husband...but sometimes talking to a counselor can help when our spouse are unsupportive. It might not change your circumstances, but it might help you get to the root causes of feeling unhappy, and begin to make changes that you would feel good about! Hope you start feeling better soon!

Maddie...I hope that when you read this you are already feeling much better and on the road to a rapid recovery! Please keep us posted on how you are doing...I will be looking forward to hearing that you are home and doing well.

Wonderful news! Never heard of the condition, but I'm glad it won't stop you from moving forward!

Mini, I've been scared too. I didn't read the stories--but truthfully I didn't need to read about someone else's WL failure to to experience the fear of my own ability to self-destruct with food. I don't worry so much about getting to the point where I could eat really large meals again--but I tend to be a grazer, and now that I am 10 weeks out and a little more comfortable with eating, I can see very easily how I could stop losing and/or gain weight even right now. I'm drinking almost calorie free liquids, I'm not drinking with meals, I'm eating healthy Proteins, and I'm not eating lots of carbs or high fat junk--but these are choices that I don't have to make. It's requiring some determination and effort on my part, just like every other time I have dieted. The sleeve is helping me because it reduces the amount that I can eat at one time, and it has significantly reduced my hunger. Unfortunately, even now, the sleeve can't force me to make good choices, or prevent me from snacking all day. I'm hoping that the reduction in ghrelin production, and the smaller size of my stomach will give me a little edge that will help me to be more successful at losing/maintaining, but what I'm most afraid of is me...I am still perfectly capable of packing in the calories without eating huge quantities of food. Here's a perfect example: I was running errands with my grandson the other morning and I pulled into the drive through at Hardee's and got us each our favorite "breakfast" junk--a sausage biscuit. I was able to eat almost the entire biscuit--and that's only 2 months after surgery. That was a whopping 530 calories (340 from fat) and 36 carbs for one meal--so when Tiff says that she can now eat about twice what she could eat at 2-3 months out, I can do the math, and the numbers are not good. The fact is, I can make lousy choices right now, and in another year, I could do even more damage. Definitely no magic solution in the sleeve...Ultimately, the solution still rests with me.

This isn't new information...but for all of us who are concerned about not losing quickly enough, I've been running the numbers: The average woman needs around 2000 calories a day to maintain. (Of course this varies according to how much muscle you have, how active you are, etc...) But if we just take the average and go from there: Eating 1000 calories a day should create a deficit of 7000 calories a week, which should equal a 2 lb. weight loss each week. In our heads, eyes, and on our plates, the difference between a 500 calorie daily intake and 1000 calorie daily intake is huge...and we think that the weight loss difference should be huge. In reality it adds up to a 3500 calorie difference over the course of a week, which is only the equivalent of one pound (an extra 4 pounds a month)--and that's assuming that your metabolic rate didn't slow down to compensate for the low caloric intake. If our weight loss is slower than that, it may be related to hormonal factors, slow metabolism from years of yo-you dieting, little muscle mass, or a variety of other factors...But the bottom line is that if we want faster weight loss, eating less may not be a reasonable solution. What does seem reasonable is to move more. My weight loss isn't bad, but it isn't as fast as some others. I'm not blaming the luck of the draw, or thinking that my sleeve isn't working. I'm thinking that I'm not going to the gym, and I'm not walking. I'm trying to swim--but if I want a bigger or more consistent loss, I am going to have to find ways to burn more calories.

I can sure understand your discouragement. Your weight loss isn't bad--every pound we lose is a good thing--but when we are eating very small amounts of food, we think our weight loss should be rapid. It's even harder when we compare our loss to other people who may be losing faster. I think that there are a lot of factors that can affect our weight loss, and calorie intake is only part of the equation. I do think you will loose if you continue to make healthy food choices and exercise regularly. For myself, I can already see very clearly that the sleeve is a tool that makes it easier for me to eat small portions, but I also see that I could make food choices that would stall my weight loss completely. Maybe your doctor would have some ideas that would help you feel reassured.

Hi Holli, Your doctor can give you a prescription for an anti-nausea medication if nausea is interfering with you getting your fluids in. I used sublingual Zophran off and on for the first 4 weeks. As far as hydration and protein: We each seem to find our own solutions that fit our preferences, but it helps to get ideas from others. The solution that worked for me in the intial weeks was to have one 22oz glass of Fluid three times daily with 1 scoop (20g protein) of unflavored unjury stirred in. If I accomplished that, then any other food that I could eat was a bonus, but not a necessity. I didn't use any thick shakes or premixed Protein drinks because they filled me up more and made it harder to get in my fluids. Also, I didn't like the taste of anything sweet right after my surgery, I don't use artificial sweetners, and chocolate can exacerbate problems with reflux. What worked for me was to take about 10 oz Water, add the unflavored Protein powder, stir in about 3 oz fruit juice and then fill the glass to the top with ice. This way, I got my water and protein at one time, and because it was a watery beverage, it was easier get in the required amount because it doesn't sit in your stomach as long. The juice added flavor and some calories to the water without making it thicker and without adding artificial sweetners. Slowly sipping something with protein and a small amount of carbohydrate from the juice helped maintain energy in the first couple weeks. As my food intake increased, and I was getting in more calories from food, I stopped using the fruit juice and added some Crystal Light Pure Fitness to my water instead. Now, as my diet has advanced, I either add the Unjury to my water or leave it out depending on how much protein I have been getting in my meals. Some people seem to prefer warm liquids--but for me, I wanted ice and lots of it. I still have a hard time drinking anything at room temperature. It will get better soon. I am at almost 10 weeks, and I am able to enjoy having meals with my family. I can't eat very much--but that's why I had the surgery! It is going to be much easier for you in a few weeks!

I understand your concerns. I talked with my surgeon, because after reading lots of information, I had decided that I did not want the smaller bougie sizes. I was anxious about an increased risk of strictures, possible osteoporosis from overly rapid weight loss, GERD, and difficulty eating some foods. He laughed when I told him that I did not want a stomach the size of a Bic pen. (He had not seen the photos comparing bougie sizes to pens and markers until I brought them to my appointment.) Anyway, my surgeon said that he typically uses a 40f to reduce the risk of those problems (although he was willing to change that if I wanted him to)--but what he also explained to me in a diagram, is that the bougie is used to determine the size of the upper portion of the sleeve, but that you still have a small "pouch" type area at the bottom that is larger than the bougie size itself. He said that there is a lot of surgeon judgement that affects how this area at the bottom of the sleeve is measured/shaped, and the amount of food it will contain. So even though the bougie size is important and causes you to feel restriction when you eat, the bougie size alone is not the only thing that determines the stomach's capacity. Some surgeons use the smaller bougie sizes in hopes of improving weight loss/reducing the risk of regain. Those things are important to me and I would love to be thin, but at 54, I am equally concerned with overall quality of life issues. For me, a 40f was a reasonable choice that would reduce my anxiety about possible problems. It's possible that at some point, I could wish he had gone smaller, but at 10 weeks, I am satisfied that my surgeon did a good job. I am eating small, but satisfying amounts of food. I haven't had any problems with reflux/acid (and I'm not taking a PPI). I'm losing satisfactorily--and would lose more if I were exercising more. I advanced my diet slowly, and thankfully, I haven't found any foods that I can't eat comfortably. I don't think it is unreasonable to be concerned about aging issues. For me to get adequate Fluid intake, I have to pay attention/work diligently to drink 64 oz a day. Alzheimer's runs in my family--and watching my mother last week made me very much aware that she would not be able to "sip sip sip" all day. At this point, she's doing well to know when she needs to go to the bathroom. It may be that some aging people with gastrectomies do very well, but I don't think there is enough research for us to know how this may affect those of us who develop problems with dementia/Alzheimer's. I had to make a judgement call. Is it better for me to be slim and be able to enjoy the years immediately before me, while taking the real risk that it may complicate nutrition/hydration problems if I develop Alzheimer's as I age...or is it better for me to stay fat and miserable now, so that I can insure my ability to eat and drink at some point when I am older and may not even know my name? For me, it was an easy choice. Let me LIVE now, and if I have to be rehydrated with IV fluids when I'm older because I can't remember to drink fluids, then so be it.

LOL...you know, it probably won't matter, because when we all get thin, it will just be raining men everywhere we go...

Congratulations on GREAT weight loss!! Muscle spasms and cramps can be caused by calcium and/or magnesium deficiencies. You might want to try increasing your supplements to see if it helps.

I agree with this, and some guidelines even say that you aren't supposed to drink fluids for an hour after eating.

Hi Jillian, The nutritional guidelines from my surgeon are not available online, but lots of others are. I printed out multiple guidelines that were online prior to my surgery. They were all fairly similar, but I got different ideas from each one that helped me. Try these links and see what you think. Also, I found that if I had some form of pureed Protein, I stayed full for hours. I used baby food meats sometimes for convenience, but I preferred the taste of fresh stewed chicken that I cooked with onion and carrots and fresh herbs--pureed it all in my food processor. I also cooked fresh steamed broccoli and pureed it in the food processor. I did really well with that. http://www.cornellweightlosssurgery.org/pdf/dietary_guidelines_sleeve_gastrectomy.pdf http://www.hopkinsbayview.org/bariatrics/docs/nutrition_sleeve.pdf http://www.bethesda.med.navy.mil/patient/health_care/surgery_services/bariatric_surgery/bariatric%20nutrition%20guide-sleeve%20gastrectomy.pdf http://www.iabsobesitysurgery.com/Media/Forms/SleeveDietGuide.pdf

Jillian, it's hard to know what to say at this point because I don't know anything about the dietary guidelines you were given by your doctor, and I don't know how your surgeon approached the construction of your sleeve given the small amount of weight you had to lose. With respect to your food choices: I can only tell you that I was instructed to stay on clear liquids for 4 days post op and on full liquids for 4 weeks before starting the mushies. On the full liquid stage I was able to have pureed and strained foods only. Cream soups--strained. Baby food meats mixed with soup. Protein shakes. The only foods on my list with any texture at all were cottage cheese and cream of rice cereal. For me, the mushies started 4 weeks plus four days after surgery. If you are having this much hunger, you may want to check with your doctor about how to approach this, so that you protect your sleeve.

100 pounds in 4 months??? That's absolutely incredible! Great job!

My surgeon writes all his patients a prescription for Reglan prior to surgery and asks them to take it for 6 weeks postop. It helps with motility in the digestive tract, helps keep food moving through your system, and can help reduce nausea. BUT there is a class action lawsuit that is being advertised right now because Reglan can cause irrreversible problems with tardive dyskinesia that may develop as late as 7 weeks after taking the medication. It now has an FDA black box warning. I talked with my MD and told him I was not comfortable taking Reglan and he said that the problems generally were only for people who had taken it longer than 6 weeks. Maybe... but I'd rather take my chances with a little short-term nausea than end up with permanent tardive dyskinesia.

I think most people have heard horror stories about people who have had serious problems with RNY and they assume that VSG will be similar. Many of my friends and family members were supportive of me, but not necessarily supportive of the surgery, because they were afraid I would have serious complications and come to regret the surgery. Then there are those people who have never had significant weight problems, who think that those of us who struggle with obesity are either uneducated about nutrition ("don't know how to eat"), or gluttonous, or lazy, or totally lacking in self-discipline. I can't tell you how many times I have heard, "Well I just ___________" (blah, blah, blah) Yeh...well I've heard all their self-assumed dieting expertise. It makes me want to barf. Come on...why does being at a normal weight give a sister who eats Lucky Charms for Breakfast and a big bag of M&M's every day for lunch the idea that she is entitled to give me dieting advice??? (I kid you not on that one.) As someone who has lost well over 500 pounds over the span of 30 years, I think that I know a little bit about how to diet. I also know that diets have had a horrible effect on my metabolism, fat storage hormones, and appetite regulating hormones--and actually sabotaged every reasonable effort that I have made to maintain any weight loss. I refuse to honor people's uninformed, presumptuous opinions about anything related to my weight or weight loss decisions. I've been valiently fighting a battle with obesity my entire life, and I think that this surgery is the best option that I have to improve the quality of the remaining years of my life. I don't expect anyone who hasn't fought the same battle to comprehend why I would voluntarily allow a surgeon to remove 80% of my stomach...how could they even begin to understand? You deserve whatever it takes to be healthy and have a better quality of life! Would anyone dream of telling someone with breast cancer not to have a mastectomy if they had previously elected to have a lumpectomy, but were still having problems? Hardly. Don't let other people make you feel guilty or ashamed. Do your research and trust yourself to make the best decision for you!