RickM

Odd things like this are not uncommon for a while - it can be diarrhea or constipation, or some of both like I had (once it got past the blockage, it was runny...) Liquid in - liquid out is a common cause for diarrhea, which resolves as the diet gets more solid; constipation can be holdover from narcotic pain relievers, and later on from being on a low carb, low fiber diet. Add into this the simple dietary changes that you are going through, which is often incompatible with your gut flora - all those nice bacteria in your gut that helps digest your food, may now be the wrong ones for your new diet and need to adapt - probiotics can help with that transition. It does get better, good luck and hoping that it is a quick transition for you

The patches seem to work well for some, and not at all for others. All one can do it try them and see how your labs come out. In the spirit of minimizing variables during a time of major changes after surgery< I would be inclined to stick with normal oral supplements until establishing how much of what is needed in your particular case, and then trying the patch to see how they work for you in comparison. But that's just me and my test geek brain.

This is a good heads up, thanks. This can sometimes even apply to our supplements. A few years ago, our surgeons practice was seeing a few patients with B6 toxicity. It urns out that the Costco branded calcium citrate has B6 in it along with a few other things beyond the normal D3 and sometimes mag. Taken as a normal person once a day, that's no big deal, but along with B6 in a multivitamin (often at multiples of RDA) and taken in bariatric quantities of 2 or 3 doses per day, it was going over the toxic levels. Some may also occasionally run into acetaminophen toxicity, with the inability to use NSAIDs with some procedures they can overdose the Tylenol since it is OTC and therefore "safe". Funny things can happen!

No, there unfortunately there is no single one a day vitamin that fits all our needs. Depending upon what procedure you are getting, you will need to do more or less of the vitamin game. The VSG is the most benign with the fewest requirements, with the RNY being fussier, and the DS fussier still. The main driver for most of this is that Calcium and Iron compete for the same sites to be absorbed in the intestine, so they need to be spaced out, typically at least two hours apart. Further, Calcium is limited to absorbing only around 600mg at a time, so if you need to supplement with 1500mg, that's three different doses spaced out. Plus iron at a different time (though that can be taken with your multivitamin if that doesn't contain calcium, or you can take a calcium dose with the multi if it does. At thee beginning, we all need to be taking vitamins at different times through the day as we aren't getting much nutrition from food - protein is the emphasis for a while as there is no pill for that. Over time, as we can eat more, we usually can simplify the supplement regimen as we get more nutrition from our food, assuming one is eating nutritionally. For my VSG, I take pills twice a day, mostly drugs. i take a multivitamin, mostly to fill in any gaps in obscure vitamins that I may be a bit short on in diet - I have cut that back to every other day with out ill effect on my labs, but the labs don't cover everything, so I just go with one a day for convenience as other pills are already being taken. I target 2000mg a day for calcium, for which I only need one supplement dose per day to attain. Iron is a twice a week thing, and maybe less (see how levels are this month and maybe drop it entirely.) An RNY malabsorbs minerals as part of its character, so they usually need to do more with the iron and calcium supplement, and some also take two multivitamins a day; B12 is usually needed as they don't absorb that well, either, In either case, the RNY or VSG, longer term it comes down to what your labs tell you that you need, and people will vary on that - even without WLS, people vary on their needs (my wife is chronically low on potassium, which has nothing to do with her WLS, it's just her.) The DS has a similar level of supplement fussiness, though it is somewhat different in what is needed. In short, get used to it, at least for a while. And if complying with these needs is going to be a problem for you (you know your personality best,) consider that in which procedure you choose. I know one gal in our support group who had to have her DS revised back to a VSG because she was just incapable of keeping up with its' nutritional demands and was suffering as a result. Good luck,

The DS is certainly the preferred solution for bile reflux problems - it's about a sure a fix as you can find. assuming that you have a surgeon who knows how to do it. Looking at the anatomy, and you see that bile has to go many feet down the inactive (non food) channel before it gets to the common channel where it and the pancreatic enzymes, mix with the food, and it would have to move many feet back upstream against the food flow to reflux into the stomach. The bypass is a less certain fix as the pyloric valve has been removed and the pouch moved just downstream of the bile ducts, but it usually isn't a problem if they make the roux limb long enough (sometimes in non-WLS variants of the procedure where they make the limbs shorter to minimize weight loss, bile reflux is a real problem.) As the DS uses the same sleeve that you started with, or maybe a resleeved version, it doesn't usually help with acid reflux, unless the original sleeve was poorly made (it happens, though not too often with a DS surgeon who knows how to make their sleeves.) Virgin DS's tend to be somewhat better on this than the VSG as they usually use a larger sleeve that is less prone to reflux problems. In short, you got the best procedure available for your bile problem - be happy.

There are also lower volume preps available that don't require you to drink a gallon like some do. Talk to the doctor about it and your special needs as a WLS patient.

Quite possibly more than calories, is what those calories are (what is your average calorie count these days?) Since you are already taking B12, that's not likely it (B12 is more of an RNY thing than a VSG thing, but some can be intrinsically low it irrespective, or just diet is low in it for now, though most multivitamins have enough to do the job.) Overly low carbohydrates are frequently a cause of low energy in the absence of other anemia indicators, as that is where our quick energy comes from. It is what helps us chase down that antelope for dinner, or quickly climb a tree to avoid being a lion's dinner (hoping it's not a leopard chasing us!) We typically burn off our glycogen reserves (basically stored carb, held mostly in the muscle tissues) and the water that keeps it in solution first,, usually in the first couple of weeks or so, and then pause while we start to access our fat reserves to rebuild the glycogen back to a functional level - hence the typical rapid weight loss followed by the "three week stall". You may well still be trying to rebuild your glycogen stores to get you that everyday energy that you are expecting. I have seen some programs that specifically want their patients to do a bit of lightweight "carb loading" after surgery to counter this problem - things like oatmeal, cream of wheat, sloppy mashed potatoes, unsweetened apple sauce, watered down fruit juice, etc. I never had consistent energy problems as you describe, though I did run out of gas more quickly for a while - afternoon naps in the first 2-3 weeks were common and my bedtime shifted an hour or so earlier (my circadian rhythm has stayed shifted by an hour or so ever since - about an hour earlier to bed and hour earlier to get up,) but even within the first week I was outpacing my wife on our walks (granted, not a real high bar, but still....) I was back at the gym within the first 2-3 weeks, mostly to keep my wife in the habit, I basically just walked on the treadmill or did some gentle bike or elliptical work to explore range of motion, but moderate energy was there. I was up into the 900-1000 calorie range within the first couple of weeks, and the doc was adding more veg to the diet as my protein was satisfactory at 90+. I wasn't specifically carb loading, but neither was I avoiding them - just eating as healthy as possible within the limitations. Later, however, after about four months I was running into an energy wall after about an hour in the pool, and after consulting with the RD on it and added some complex carb ahead of my gym time, I found that a simple piece of toast made all the difference in breaking through that wall. So simple things can make a difference.

That is totally insane - I am really sorry that you have to put up with that. Note to lurkers and researchers - you don't have to put up with this type of treatment. Ask questions early in the process, like during the informational seminars, and decide then whether you want to go through with having surgery with that practice (they tend to spring these things on their patients late in the game, when it is too late to change surgeons.) Even the two week liquid thing is not standard, with most who do a pre-op diet doing some kind of hybrid low calorie or carb meals along with a couple of shakes a day; many don't do anything at all until the day before surgery. Most surgeons know how to do their job without putting this all on the patient. Good luck in getting through this!

Be skeptical of the BMR/TDEE, etc. calculators that you find online, particularly if they use scale or current weight in their calculation. Those work OK, for normal weight range people, but not for us fatties and former fatties since the critical weight factor for BMR is lean body or muscle mass; that extra fat that we carry or carried around does little to our actual BMR other than skew the results. For a better reading, use your goal or ideal weight for those calculators that don't use lean mass. The other problem that they have is that they tell you what your BMR should be rather than what it is. Our journey through obesity can compromise out metabolism such that we don't burn calories as well as we should - that's part of what keeps us fat - and that can carry over even after weight loss. A normal weight person who used to be morbidly obese will usually burn fewer calories on a treadmill doing the same work as a never-fat person of the same size, weight, sex, age, body composition, etc. So, take the calculators as a (very) rough guideline. From general observation of these forums over the years says that 12-1500 calories is high, even with guy metabolism. While 6-800 calories is often sited as being a good level to shoot for, that is probably overkill for you, and would be hard to attain once used to what you are currently doing. To the extent that we can compare individual experiences, as a comparison to my experience, I started out about 100lb lower than you (292) and at 4 months was down 72lb on an average of 1100 calories. I would expect to be losing a little slower simply by my lower starting weight and bit lower height (5'10). Prior to surgery, my total metabolism (BMR + activity) was 26-2800 calories based upon actual intake logging (weight was long term stable at that point - that's about as real world metabolism measurement as we can get.), So, call it around a 1500 calorie deficit. Total metabolism tends to decline as we lose (there's less weight that we are carrying around 24/7) so by the time I goaled out at 190, I was stable at around 21-2200 calories. My inclination for you would be to try to keep it around 1200 calories or below Another couple of factors to consider - 1 -stalls happen 2 - starting or radically changing up your exercise routine can cause a stall. Most stalls are water weight related (at least those not associated with eating too much!) and starting or changing up your routine can increase demands on hydration. As you do more lifting or strength training, those sore muscles you may be experiencing are associated with.....inflammation, which is more water weight. So, you are likely continuing to burn your stored fat, but aren't seeing that result on the scale because of the water weight changes, which will subside as the inflammation subsides, and you get better hydrated so your body doesn't have to hold on to every bit of water that it sees. Good luck, and have fun - you still have a ways to go, but are getting there!

I only had a day before diet along with a bowel prep (like for a colonoscopy) which is a bit of overkill for a VSG, but quite appropriate for a DS like my wife had with the same practice. Much rather have that than the multi-week liquid things that some practices impose.

The RNY and DS can have issues with extended release meds, depending upon the mechanism used, though crushing is rarely suggested to counter that problem (it can lead to too much of that med hitting too quickly) - rather doing as you are doing and going to smaller doses of the normal med taken more frequently. ER meds are not usually a problem with the sleeve, as the OP has. It's more likely that particular practice is a bit behind the times.

I never crushed them, either. Classically, that has been something of a bypass thing as they feared that pills could get stuck in the stoma, but as you can see from catwoman, that is far from a universal thing. Some practices really go overboard on their instructions on how long things need to be done or avoided, maybe to inspire their patients to go along with it rather than see it as just a short time thing that they can skip. Sometimes it may be a matter of ignorance, in that they say that something needs to be done for a year, and that works well, but they really don't really know from experience how long it needs to be done as they never experimented with it. For instance, I have seen a couple come through these forums that were surprised when their doc advanced them to the next eating stage earlier than their published guideline; when asked about it, the doc simply said that they had found patients cheating on the progression and not suffering from it, so they advanced it (they'll change it next time they print up more guidebooks.) You will find a lot of things like that in the bariatric world - some crush pills or use chewables while others never do; some are on a liquid diet at the same point that others are having steak, some have liquid pre op diets and some have none.... There is a lot more experience and habit than science in this game.

No, haven't had any ulcers from it (and neither has my wife who is pushing 16 years out on her DS - sleeve plus intestinal rerouting - and she is an occasional NSAID user.) I believe that ulcers can heal themselves given time and gentle diet, but they are usually helped along with medication, usually a PPI such as omeprazole and a coating med such as Carafate or Sucralfate, which are sorta industrial strength Pepto Bismol that coats the inside of the stomach between meals to protect it.

A couple of comments to fill things in here. It's not really a matter of steroids vs. non-steroids, but rather what a drug or class of drugs does to the stomach as a side effect, NSAIDs are merely the most common that are sited as being problematic for bypass patients. The issue is that the part of the intestine where where the stomach pouch is connected is not resistant to the stomach acid, so that anastomosis there is quite vulnerable to ulcers, so any med that can cause some stomach distress is generally to be avoided. Some of the osteoporosis drugs are avoided for this reason, too. This presumably applies to the MGB as well, as it uses a similar connection. The duodenum, the part of intestine immediately downstream of the stomach and is resistant to the acid, is bypassed along with the remnant stomach. These various meds can sometimes be used in limited times under certain circumstances under medical supervision, but it's a risk/reward trade off between doctor and patient. The sleeve based procedures are generally more tolerant as they don't have that marginal ulcer issue, but many docs still restrict them owing to their bypass experience, (and the sleeve is probably less tolerant than a normal person, while being more tolerant than a bypasser.) Your bypass can be reversed, (that is sometimes one of its "selling points" but it's not commonly done as it's a pretty complex job; not all surgeons will do it. It is usually reserved for times when there is no other option in treating some problem, rather than just buyers remorse. I have seen it done a couple of times in cases of intransigent ulcers, where no other treatment worked. It can also be revised to a duodenal switch, but that's even more complex than a reversal (they have to reverse it first, then sleeve it, and redo the intestinal rerouting. It is usually done when weight loss was inadequate or with excessive regain, or for other RNY complications such as the intransigent ulcers or bile reflux. You weren't offered the MGB as it doesn't fit the "standard of care" for WLS in the US - insurance doesn't normally cover it and the ASMBS hasn't approved it, though it has been further developed and used more commonly elsewhere. The next procedure that's likely to gain approval here is the SIPS/SADI/Loop DS

It varies - some walk out of the hospital free of insulin and meds, even with the VSG, while others it may take a few weeks or months. and occasionally not completely. Remission rates for the VSG and RNY are typically in the 80-85% range. Often the longer one has been in treatment for it correlates with a longer time after surgery for remission, but not always. For my wife, who had been on diabetes meds for around twenty years and just short of needing insulin, it took the batter part of a year to be free of all the meds, and that is with the more powerful DS that she had (which has remission rates in the 98-99% range.) So, it's a big YMMV thing. Best to continue monitoring things and stay a little ahead of the curve; much the same with blood pressure meds - it's often better to be a bit high for a while than be too low.

First - you should avoid setting weight/time goals because you have little influence over them; lose 15 lb, that's great, but it might take a week, a month or two. Don't knock yourself out about it. OAGB has the right idea that you can only generate a certain level of caloric deficit to drive your loss, That said, there are variations, primarily based upon manipulating your body's water weight. When we first start a major loss effort, we often experience the "easy 10" which represents the typical amount of water weight that we lose early on by burning up our glycogen stores (some who start bigger with more muscle mass and fat may lose a bit more from this - maybe 15 or so). Take this freebie and run with it, but don't agonize over how much this "bonus" might be - it is what it is. Concentrate more on setting yourself up for long term success by learning how to eat a healthy, sustainable diet consistent with long term weight control vs. quickie loss. When I was doing the 6 month insurance program, I ignored weight loss and concentrated on establishing the healthy eating habits that would need five or ten years in the future. That turned out to be worth about fifty lb, or about a third of my excess weight without agonizing over the scale. Learn to eat healthy and let the surgery do its job for you. Good luck,

One common suggestion is to fill a 1 oz shot glass or medicine cup and sip one every five minutes; if you can do more than that, that's great. Yes, it does get better, quicker for some than for others. But you have to do it as dehydration will get you put back into the hospital quicker than just about anything else in this phase.

I wouldn't necessarily worry, but it is something that might happen; it is not associated with any particular procedure, but rather with the rapid weight loss that we get from it. It seems to happen to a small minority of patients - my guess based upon what I see on these various forums is maybe 10% - your surgeon can give a better guess as he is dealing with this every day. Some surgeons prescribe medication to help with this, though from what I have seen, most do not. My surgeon routinely removes the gallbladder when he does the DS as he doesn't want some other surgeon getting lost in that altered anatomy in that region - this isn't a problem with the VSG or RNY and he only removes the gallbladder in those procedures if he feels any stones in there while he is working. If you are concerned about it, ask your surgeon about whether it would be appropriate to medicate for it, and talk to your RD about things that you can do on the diet front to minimize the risk. I still have mine and never had any problem with it and didn't do anything special to avoid it. YMMV

I'm kinda with Greater Fool on this, in that almost anything will work at this point, and even for the next few months. 20-30 years ago, it was not uncommon for bariatric programs to tell their patients to "just eat like you always have, just less..." and they lost weight just fine eating the same way that got them fat in the first place. At least they did for the first few months to year and then they started gaining again because they never learned how to eat sustainably. It is not unusual to see people come into these forums after having failed at (insert favorite fad diet here - Keto, Paleo, IF, Atkins, Zone...) and they continue eating that way and gee, all of a sudden that's the only diet that will work with your WLS. I did much the same thing, too, adopting a basically balanced nutrition oriented diet that I could do forever - worked on evolving that for several years before surgery, then tailored that for the lower post op intake and continued with that as the intake naturally increased over time; still doing that ten years later. IF works like most of those diets - by forcing a reduction in caloric intake. Some cut out fats, some carbohydrates, IF cuts out time, but they all are a mechanism for reducing caloric intake, which you really don't need at this point as you can't eat much to begin with. As noted, stalls will come and go, and there are as many personal experiences and hypotheses as to how to "break a stall" as there are people. I really have no input on how to break a stall as I never really had much of one, even at the dreaded three week point. Chalk it up to better diet, stronger underlying metabolism, not worrying about them - who knows. As to your experience, consider that you have a data set of one - and it's real hard to establish a trend with a single data point. Just go with the flow! Good luck

I'm not a doctor or pharmacist, but generally, the sleeve doesn't promote any particular issues with medications. The malabsorbing procedures like the RNY or DS can have issues with extended release meds depending upon the XL mechanism used, and the RNY can have issues with some meds known to promote stomach upset. Check with your bariatric surgeon or a pharmacist to make sure. el

I don't think it's such a bad thing; the problem is more a matter of expectations - if you are expecting to log a loss every day with no gaps or minor gains (water weight is everywhere!) then you should stay off of it. However, if you can just look at it and say, "gee, I wonder why that is?" then it's fine. I weighed twice a day because I was using a body composition scale to monitor that progress in addition to scale weight, and those work best if you weigh twice - first thing in the morning when your scale weight is most "accurate" (assuming after first eliminations, if you're that regular and before any consumption) and then in late afternoon when you are usually fully hydrated and the body comp measures are most "accurate" (or at least repeatable). Those in particular worked best with daily readings applied through a moving average. The body comp was of greater interest to me than the scale weight. That said, I only "officially" recorded weight once a week to smooth out the day to day fluctuations.

You are probably doing fine, unless you have known kidney issues, in which case your nephrologist would give you overriding instructions.. Typically, bariatric programs have recommendations on the order of 60-80 g for women and 80-100 g for men, sometimes somewhat higher or lower depending.... The 40-55 type numbers I think originate from WHO and represent something of an RDA type of level - sufficient to prevent deficiency disease but not necessarily what is needed for optimum health under varied circumstances. It's great if you are having to figure out how much of what type of food to send to some remote area after a disaster; not so great on figuring what you need for your lifestyle. The other end of the spectrum would be the recommendations for 150,200,300 g that you may see in the men's health or body builder magazines that are intended to sell protein supplements. Generally what you need is proportional to your muscle or lean body mass (similar, but not quite the same), so ignore any calculators that deal strictly with overall body weight - the excess fat that you are carrying now doesn't need protein to maintain it. The best indicator that I have found is from a Dr. Michael Colgan who is a sports nutritionist that does (or did, may be retired by now) a lot of work trying to figure out just what the body needs for different circumstances, as opposed to basic RDAs. The basic formula he came up with takes the premise that the body is replacing all of the muscle mass every six months, and that works back to the amount of protein that is needed daily. So, for my 150 or so lb of muscle mass, it needs about 105 g daily. A short woman with half that muscle mass would need half that, or about 50g. So his figures are in the same ballpark as most of the rest that were derived from other means, so it passes my "smell test" - it's plausible. Being a guy of similar size, I would expect you to be similar. Further, this method tells me that if I wanted to add muscle mass, then I would have to add around 40g per day to add around 10 lb over six months - a reasonable goal with suitable work and training and without funny drugs (but it does take the work - it doesn't just get there by eating more!) Overall, it seems like you are on the right track for your size and previously stated fitness inclinations.

I don't do much fast food these days, or even before, but what I preferred when I needed to during my early days - loss phase and early maintenance - was a Chipotle order of soft tacos, whatever fillings you like but I biased it toward the basic meat, cheese and veg. Early on just ate the filling out of the tortilla, but later included that, too (I never was big on the low carb game - just give me nutrition.) One taco was enough, and I would save the other two for future meals. Generally when we ate out we went to regular restaurants, more often independents rather than chains, and just ordered the healthiest things that looked good on their menu - nothing really special as ?bariatric food" - and split things up to take home the leftovers. Even today, ten years out (call it 16 for my wife) it is disappointing not to get two or three meals out of a typical restaurant meal.

Some struggle for a while with a lot of inflammation and resultant high restriction, getting in only in the low hundreds per day for a while, and others have a more nominal recovery and can consume somewhat more (not that one shoule necessarily be eating as much as one can!) I was around 900 within a week or two and settled at 1100 for the rest of the loss phase - but that's with a decent guy's metabolism and it still provided a large caloric deficit to drive the loss to its conclusion. Others, particularly women but some heavier guys too, need to stay a little lower - 6-800 it often sited - to ensure adequate caloric deficit through to goal (loss rate tends to decline over time as our total metabolism declines some with declining weight, so it's good to leave some margin.) My general philosophy on it is that if you have a decent idea of what your metabolism was prior to surgery (ideally from tracking your intake over time, rather than those weight based calculators which tell you what it should be rather than what it actually is,) that can be a good guide as to how far you can permit yourself to go calorically over time My weight was stable in the 26-2800 calorie range prior to surgery, and dropped with my weight to where I am now, stable around 2000-2200, so I still had a healthy margin to play with keeping at 1100 to lose. Some whose metabolism started around 16-1800 has a lot less margin to work with and needs to stay somewhat lower, and would seriously struggle at 12-1400 as some programs advise. It's not a one-size-fits-all world.

Usually, such things are not a problem and are simply repaired as part of your WLS; sometimes people don't even know that they had a hernia until the surgeon told them about fixing it while he was doing the surgery. Give your surgeon a heads up on it so that he can allocate a bit more time for your surgery if it makes a difference to his scheduling (some surgeons really pack their schedules, assembly line style, while others don't.