RickM

The best that we can do at our knowledge level is to consult with as many doctors as you can to get different, or hopefully, concurring opinions and then decide. In my situation, which was a very early stage cancer thing, I consulted at least four different doctors with relevant experience, and got four different approaches to the problem and then weighed all of the options. Ultimately in my case the most sensible was the simplest that also left the most options for future treatment if it ever became necessary (which was basically to do nothing except continue monitoring things.) In your case, it looks like there are more questions that need to be answered, so likely more tests will be needed to see what's going on inside you.

The fundoplication is used in the case of a hiatal hernia (where part of the stomach is pulled up through the opening in the abdominal wall, through which the esophagus passes) which can be the cause of acid reflux, and you are right in that in may or may not be appropriate depending upon whether there is enough fundus left to plicate. If your problem is more with the LES than with a hernia, there are other things that are sometimes done for that - there are implantable devices that replicate the function of the LES (LINX is one of them, there are probably others as well) and likely some purely surgical approaches to it (I am far from any expert on this!). Bile reflux is rarely a problem these days with the RNY, mostly because the surgeons have learned how to set up the limb lengths to avoid it in the most part; it is not uncommon in non-WLS versions of the procedure, such as the total or partial gastrectomies for cancer and the like, where they shorten the limbs to minimize malabsorption and weight loss in patients who can't afford to lose more weight. What can be done if bile is your problem is to move the pouch farther downstream on the intestine to move it farther away from the bile ducts. Revision to the Duodenal Switch WLS is the best response to it as it is virtually impossible for the bile to work its way back to the stomach and esophagus, but thats a very complex procedure that few surgeons in the world can do. The distal (or long limb) RNY is next best, but has similar nutritional consequences as the DS and by your figures, it doesn't look like you need to lose more weight. But there can be in between compromises on limb lengths that can do the job, if that indeed is your problem.

It can be done - it is called a total gastrectomy and is usually done for cancer, gastroparesis or other severe gastric problems - but it is something of a big deal to do. The long term functional difference to your RNY is small, but healing time is the big issue - the esophagus (eating tube) is only a two layer structure compared to your stomach pouch which is four or five layers (depending upon how you count things) so the direct attachment to the intestine is trickier than the stomach to intestine. This was an option I looked into some years ago on a cancer issue, and the partial gastrectomy (basically an RNY) had a normal RNY post op healing and eating progression. The total gastrectomy would have required several months on a feeding tube to let things heal before any food could be introduced. So, this is not something to go into lightly. (And, no, I never had either procedure done - second and third opinions indicated that they weren't necessary, at least for the time being.) Something else to look into - have they determined if the GERD is acid, or bile? That's a big difference in treatment, as if it is bile reflux, the basic RNY structure is already somewhat predisposed to that, and taking out the pouch will no help, and likely make it worse. A possible clue here is that the anti-acid meds aren't working, and they wouldn't if it was a bile problem. It sounds like your problem, or a good part of it, is a weak Lower Esophageal Sphincter (LES) which is the muscular valve between the stomach and the esophagus. That can be weakened by your obesity history (though that was a long time ago), by over eating - over stuffing your pouch can put pressure on it and weaken it, or by some other disease mechanism. There are procedures available specific to this problem that may solve things without having to go through the gastrectomy. Do some research on surgical treatment for GERD. You need to research and find a surgeon who is very experienced with bariatric problems and revisions to figure out what exactly is going on, and then what the proper solution would be. The RNY (or any procedure, for that matter,) does occasionally cause significant problems so you need someone experienced with that. Good luck in working this out! Note - there are some Facebook groups that cater specifically to people with total or partial gastrectomies, so that would be a good place to look to get a better idea of what living with that procedure is like.

I doubt that it was much more than a month or so for me, certainly no more than two months out (though we were on quicker progression than many, it was still based upon personal tolerances.) As others noted, people can have different tolerances for different things - steak, eggs and lettuce seem to be fairly common ones for some reason (but no problem at all for others.) My wife's surgeon, when she was complaining about tolerating ground beef, suggested that she try filet as that is often better tolerated than ground beef. He was right, and we still often fill that Rx! (it's on the menu tonight, for that matter.)

Certainly mention it to him so that he is prepared for it, but it is typically something that they do automatically as pare of the WLS (they probably can't do the WLS without correcting the hernia.) Many don't know that they had one when they went in for surgery and the surgeon just mentions that he fixed it while he did the sleeve.

That is curious, and beyond my limited experience! I suppose that is can be strictly an esophageal problem, though as I noted, I have only seen such things as they related to other root causes. No, I haven't had such a revision, though it was suggested at one time for another issue, but I have avoided having to go that route (with the help of some second opinions that basically said to leave well enough alone for now.) I do have minor GERD, which is readily treated with low level OTC meds, so there is nothing worth fixing at this point on that account. The sleeve is predisposed to GERD by virtue that the stomach volume is reduced a lot more than its acid producing potential, but the body usually adapts to that over a few months, and most surgeons prescribe a PPI for the initial few months and then wean off of them. (Similarlly, the RNY is predisposed to dumping, reactive hypoglycemia and marginal ulcers, so there is no free lunch in that regard, no matter what procedure one goes with - there is always some risk there.) I would prefer to keep the sleeve as long as it cooperates, as the RNY is a little bit fussier to live with, but it's not the end of the world, either, and certainly preferable to what you are going through; my wife has a DS which is a bit fussier still, so I'm familiar with all that entails if I need to go there. The surgeon who has adopted our local support group does quite a few oddball and esoteric revisions (like the complex RNY to DS), people come from across the country to see him, and he sometimes pulls up scans on his laptop of one of the wonky sleeves that has come his way, so we get some feel of what can be done, that other surgeons pass on. That's why I brought up the stricture idea (beyond your regurgitation sounding like that might be it,) because that is something that many surgeons prefer to revise away rather than correct. I does seem like you are heavily restricted, much more so than normal for a normal sleeve, or RNY. 500 calories isn't so bad - it's not that unusual for people with any of these WLS to still be down there, though more commonly somewhat higher in the 6-800 calorie range; it's the water intake that I would be concerned with as dehydration will get one thrown into the hospital a lot faster than low protein or other nutrients in the short to intermediate term. The vast majority of people go through this, an RNY, or VSG, or a DS, with little or no complications, but sometimes they crop up; hopefully, you have had your share of them now and that's it. In some respects, the RNY is a more familiar procedure for the surgeons,, even if they don't do as many of them as sleeves, as it has been around in bariatrics for 40-50 years, so most started out with them; the basic procedure upon which it is based has been around for some 140 years in treating gastric cancer and other GI maladies, so it is familiar territory for most; the VSG on the other hand, had more limited application until it was created/adopted for WLS as part of the original BPD/DS, so it was not as widely used until the DS guys started using it some by itself (usually as part of a two stage DS) and saw that it offered good weight loss all on its own, so I wouldn't worry too much about your surgeon's experience with it, as that was the default WLS in Canada until fairly recently.

It sounds like you may have a stricture in your sleeve (makes it hour glass shaped) - did he mention anything like that, as that would show in the barium swallow test? The drugs that you are taking wouldn't help that as they are just to treat the acid overproduction (the pantoprazole and Dexilant) and the resulting insult to the tissue (the sucrafate). From what I have seen over the years (not an MD, just an interested bystander) the problems with the esophagus are likely a result of the stomach problem (assuming that it is a stricture - I have seen such things sited as a result of lap band damage resulting in such symptoms) Strictures of such severity (if indeed that is what it is) were more common several years ago when the sleeve was new and most US bariatric surgeons were just learning how to do them. The stomach, when sleeved, tends to like to bend or twist in the middle if you don't do it just right - it takes practice. These days, I see it discussed more commonly in countries, like Canada and Australia, that were slower to adopt the sleeve, so as a result, their surgeons, as a group, are at about the same place in the learning curve as the US surgeons were 6-10 years ago. Usually, it is treated by a bypass revision as the surgeon won't know how to repair it (if it can be done.) Often, it can be repaired, or resleeved, to correct the problem, But that needs a surgeon who is much more experienced with the sleeve, so if it is possible in your system to get a second opinion on it (particularly from someone more sleeve savvy) that would be the way to go, if for no other reason than to get concurrence with your surgeon's solution (or hopefully, an alternative approach.) Ideally, you would like to find someone who is experienced with the duodenal switch WLS, as that uses the sleeve as its' basis and those surgeons tend to be much more experienced with them than the average bariatric surgeon, but they tend to be few and far between. The only one that I know of in CA is Michel Gagner, who IIRC works out of Montreal. Likely, the RNY revision is the standard of care within the Canadian system (and much of the US as well,) for this type of problem/ Good luck,

This would really be a question for your RD or surgeon about this specific product, but at this point, I doubt that you have any real need for a special pre workout meal or snack - it is unlikely that you would be working hard enough yet to need anything special this early, and it is probably inappropriate to be working that hard yet (work back up to it.) At around four months, I needed something because I was hitting a wall after about an hour in the pool. After consulting with the RD who suggested the classic pre workout snack of fairly high complex carbohydrate, moderate protein and low to moderate fat, I settled on a small meat and cheese sandwich and hour or so before and that did the trick. No special commercial potions were required. My suggestion would be to start working out again slowly, within your doctor's guidelines, ramping things up over time as you build strength and energy, and see how things go. Then address any issues you have as you come across them rather than "pre-medicating" with something that you don't need yet. Good luck,

That sounds fairly normal - we can usually eat more volume as time progresses. This doc gives a fairly common progression from his experience, and it is consistent with mine: I think that one of the key factors over this time - the later months of our loss phase - it's not what we can eat, but what we should eat. I could probably eaten more, but I continued to weigh and measure what I was eating, and maintaining consistency on that until I needed to increase my intake to slow things down and go into maintenance. It looks like you know where your weaknesses are, and that is what you need to work on in the long term, or they can take over again. This doc has some good ideas for the long term (though I don't buy everything he says - still not sure about his green smoothies!) but my takeaway from it is to fill that additional capacity that you are finding with bulkier, high nutrition, lower calorie veg as a means to keeping your calories under control as your capacity increases. Once you get to goal, you can shift things some towards lower nutritional density foods to increase calories to stabilize things. I continue to do that, with a menu that has a spectrum of foods with varying nutritional densities, I can make adjustments as needed to increase or decrease my calorie intake to keep things stable. Note that lower nutritional density does not necessarily mean junkier food, but ones that still have good nutritional value, but just higher in calories - think either higher fat content foods or some of the starches or whole grains - still good useful food, but less dense nutritionally than say, green veg or lean meats.

As noted, it can be very individual, but my gut feel from being around these places for years is that it high for the majority of people. I was probably touching that sometimes at that point, but I was losing 10 lb per month consistently and within 10 lb of my goal weight, so I was trying to ramp up my consumption to slow my loss and ease into maintenance (and I have a guy's metabolism, which tends to let us get away with more.) How is your weight loss going? How close to goal are you? Do you have any idea how much you were consuming before surgery when your weight was stable (i.e. what was your total metabolism)? For many people, 1500 calories, give or take a bit, will be their maintenance level. In short, your current loss rate and how far you are to goal should be the major determining factors. Also, be aware that typically, our loss rate tends to decrease over time as our total metabolism tends to decline as we lose weight (it simply takes fewer calories to move 200 lb around than 200, and fewer still to move 150 lb, etc., so it is usually best to avoid increasing our intake over time until we are ready to stop losing. Good luck,

IIRC, my surgery was scheduled a month or two out, but that can vary from practice to practice depending upon how busy they are, and now we have Covid getting in the way, and if you were cancelled due to weather, that's another complicating matter - so it's really anybody's guess in your case. Pre-op diets also vary markedly - we didn't have any other than the day before surgery - but most typical is a week or two for those that have them. Those that do them can also waive or modify the requirement if scheduling dictates, and depending upon the patient's situation (have you already been dieting for insurance purposes, is your weight on the "moderate" side, have you had a clear liver ultrasound, etc.) If your surgery was just cancelled, then I would expect that you already would have known about whatever preop diet requirements that they have, and they would remain the same.

The RNY and partial gastrectomy are fundamentally the same thing, differing mostly in preferred limb lengths and whether or not a remnant stomach is left behind, so it really shouldn't be any different than a normal RNY recovery. I assume that it is a gastric tumor, and that they are removing the entire remaining stomach beyond the pouch they form. I have seen a couple of others over the years in these forums who had no remnant stomach and they didn't seem to be markedly different than any other RNY veteran. The one question that I haven't seen addressed before (I never really asked, either) is whether there are any particular consequences or risks with not having that remnant stomach there (other than removing the technical reversibility of the procedure)? The only thing that I can think of is maybe increased risk of bile reflux from not having the stomach acid there to neutralize the bile, but that's just speculation on my part. Good luck in everything coming out well...

You've already had some post op labs? That's good, as I don't think that our first ones were until three months. Assuming that all is good - iron complex and B12 would be the most relevant, then the next simple thing to try is on the diet front. Our early diets are often low in carbohydrates, even if one isn't trying to do that, but that is our first line of energy. Some programs specifically have things like oatmeal, cream of wheat, unsweetened applesauce and the like in their early diets to combat fatigue problems. That might be worth a shot, within your program's guidelines.

That looks just fine. Your protein might be a touch low for a guy, but in the ballpark overall (programs often have numbers like 60-80g for women and 80-100g for men, but generally men need a bit more owing to our typically greater lean mass/musculature.) I was aiming for 100-105 for the lean mass that I had and was trying to maintain, but my program was fine when I was at 90+, wanting me to add more veg at that point (which was only a couple of weeks out.) Things aren't all that precise in the nutrition world, so ballpark is usually fine! Actually, the "low carb, low fat" part is rather redundant, as any of our post op diets are by default low carb and low fat if we keep to our typical protein goals and keep the calories in a sensible range for weight loss (usually 1000 calories or less). People often get caught up in some of the magical macro limits or ratios promoted by some of the popular fad diets, but those just don't make any sense in our bariatric world. They might make sense (but usually don't) against a typical American/Western diet of 3-4000 calories, 300+g carbohydrates and 150+g fats, but our WLS and early post op restriction takes care of that. Tracking your intake is great, as that gives you a reference point of what you are doing and how that relates to what you may do in the future, and can help point out some of those "WTF - that's so not worth the calories" moments. I basically controlled to my protein and calorie goals, and worked to get as balanced and healthy a diet within the non-protein side, which in retrospect turned out to be a rough caloric split between fats and carbohydrates, though that wasn't a specific goal. As a side note, I found the tracking data to be particularly useful in finding my maintenance point after getting to goal weight, as it told me how many calories I was consuming in those final months, and relating that to my loss rate during that time, gave me a ballpark figure on where I should be to keep my weight stable - much better than any of those online calculators as this was based on real world data on...me! Good luck on your continued progress.

Sadly, it happens - more frequently a few years ago (6-10) when most bariatric surgeons were still learning how to do sleeves than more recently, but I guess that there are always some who are still learning! The sleeve tends to want to bend in the middle, or form an hourglass shape, if it isn't done quite right, it may not yield a total blockage type of stricture, but it can leave the narrowing that can impede the flow and/or exacerbate reflux problems. While most surgeons in the US are now far enough up the learning curve to usually avoid this problem, knowing how to fix it can be beyond their experience, hence many prefer to go with a bypass instead. It may be possible to correct your sleeve, but you may need to find a surgeon who is very well experienced with the care and feeding of the sleeve construction. My suggestion, if you want to go for a second opinion (which I think anyone should do when considering a revision,) is to book a virtual consult with Dr. Ara Keshishian, who happens to be on the wrong coast for you, out in Pasadena, CA, but he has been doing virtual initial consults for years before Covid as he has patients all over the country. This will at least give you a reading as to whether this is a viable option in your case, or give you confidence that the RNY approach is the best. If a resleeve is an option, then you can decide whether to travel across the country, or seek out another surgeon closer to you who can do it. I would suggest looking for one who routinely does the duodenal switch (DS) procedure, as they tend to have the longest and most extensive experience with sleeves. I believe that there are at least a couple in FL, and several further north along the East Coast. If you do choose to proceed with the RNY route, do discuss things carefully with your surgeon, as there are tradeoffs in how he proceeds. Limb lengths, as suggested above, are a compromise as if they are too short to minimize malabsorption, you can be more prone to bile reflux. There are several Facebook groups that cater to total and partial gastrectomy patients (primarily for cancer or gastroparesis) and bile reflux is one of their common complaints. When I was considering such a thing a few years ago, the surgeon I was dealing with said that as long as he kept the limb over a certain dimension (80cm, IIRC) then they saw no problems with it. Hopefully, the surgeon that you are dealing with has enough experience on both the WLS and non-WLS side of it to know those tradeoffs. Bariatric programs that are associated with major cancer center hospitals readily "swing both ways" on that, but one that only specializes in bariatrics may not. I wouldn't worry too much about the malnutrition issue, as the RNY is very well understood; it is somewhat fussier than your sleeve in supplement needs but things are pretty straightforward on it if you keep up with labs and change things up as those dictate; it can be problematic for those who get overly casual about such things and let it slide - then you can get into trouble. If you fall into that camp, then I would try to do everything to preserve your sleeve and its greater flexibility; otherwise, the RNY is a good alternative. My personal preference, as I was faced with some similar decisions, is/was to stick with the sleeve if it is viable, as the RNY (or something different) is always an option for the future, but once one has an RNY, changing things gets more difficult, so options are fewer. Also on the option front, with the bypass, there remains a "blind" remnant stomach along with the duodenum and upper intestine which are unavailable for endoscopic evaluation or treatment (things much be done surgically.) As there are an increasing number of procedures that can be done endoscopically these days, and into the future, and I have already had one lifesaving endoscopy this is an option that I am keen to preserve, if at all possible. Short term, you may lose too much as you go through the high level of restriction that comes in those first few months after surgery. In that case, there are ways to "eat around" your pouch by basically doing all of the "wrong" things for your WLS - drinking calories, eating slider foods, higher calorie options particularly fats as tolerated. The tricky thing is to avoid making too much of a habit of it as the restriction does diminish over time and you can naturally eat more of conventional foods to maintain your nutrition

I, too, am much in the camp of working on your long term lifestyle rather than a short term weight goal. When I started having to do that six month insurance thing, I looked at what should my diet, and overall lifestyle, be in five or ten years - not six months from now. Basically what an RD would tell anyone they should do to live and feel better and longer - food pyramid, my plate, etc. all represent a basic healthy diet of leaner meats, more fruits and veg, whole grains instead of the overly refined/processed white flour stuff, minimize sugars and in particular - junk foods (high calorie, low nutrition) whether they be high carb or high fat - or frequently both. It was not perfect to any one particular standard, but it was what I could do, and thus, more sustainable than any "book" diet. It was also an evolution (and still is) as I worked to drive my preferences in the right direction. I also started with going to the gym (local Y) and got back into swimming, which I had always liked before, and found I liked playing with the weights. That was fifteen or so years ago, and I am still at it, though in a somewhat evolved form (particularly during Covid!). But the lesson here, much as with diet, is to make it something that you enjoy (or at least tolerate) and make it a habit. It can certainly evolve, as you say with starting out with just walking. Carve out the time to do something, and let the activity evolve with your ability, interests and circimstances. I had no particular weight goal in mind for this phase, but as I noted, it was an exercise in developing better habits for the long term. As it turned out, I dropped around 50 lb, or about a third of my excess, in that six months which caused a rethink on the surgery idea, at least for a while - but that is another story. I suspect that I would not have done as well if I had been aiming fora specific pre op weight goal.

Typically, you stop eating after midnight before any gastric procedure (surgery, endoscopy, etc.) which allows plenty of time for the stomach to empty. For surgeries or procedures that work farther down in the intestines or colon, they will usually do a liquid diet the day before, sometimes with a laxative bowel prep, to clean out the rest of the GI tract if that is needed. So, if you continue your specified liquid diet, your cheat secret will be safe.

For treating a regain problem, I prefer the DS as it is stronger metabolically than either the VSG or RNY - the RNY is too close to the VSG in strength to reliably offer a significant improvement in weight loss, from what I have seen over the years. Figure maybe 20lb loss on average - about what one would expect from going through all the intense dieting associated with going through surgery again. (There are some who do significantly better, bit it seems to be more a function of their determination to "make this work" or "not screw it up again" than the actual surgery itself. Call it something like a surgical placebo, lol.) By your surgeons not finding the codes for the DS implies that they are talking about the newer SIPS/SADI/"loop DS" which is a single anastomosis adaptation of the traditional BPD/DS (biliopancreatic diversion) which has been routinely covered by US insurance and Medicare for the past 14-15 years, but is a more complex procedure that relatively few bariatric surgeons perform. Some practices that do the SIPS/SADI use the BPD/DS billing codes which is technically insurance fraud, but if they're comfortable doing it, that's their concern. Revising the VSG to a DS, of either flavor, is straightforward as each use the VSG as its basis (some don't even consider it a revision, more a "completion" of the ultimate configuration.) The strong point of the BPD/DS is its regain resistance - regain is possible as it is with any of these procedures, but it is harder. I know many with the DS who are 10-20 years out (my wife included) who are still maintaining a healthy weight; some are up a bit more and working on losing their "Covid 19" - just like "normal" people but major regains are relatively uncommon. The SIPS/SADI type of DS seems to fall somewhere in between the VSG/RNY and the BPD/DS - I have seen a few in the various forums who have had it and seem to be doing well with it, but it doesn't have as long a history. Any of these procedures - the RNY, DS or SIPS - will be somewhat fussier and less care-free than your VSG when it comes to supplements and follow up; the RNY is maybe a bit less so, but one can get into some serious trouble with any of them if one slacks off. If keeping up with supplements and annual labs is not an issue with you, then any of them should be fine.

Curious. I have seen a couple of sleevers over the years have that problem, but doe seem to be unusual, particularly compared to acid reflux (isn't it nice to be "special"?) but it doesn't seem to be any more prevalent with us than with the general population. It seems that most anyone can be subject to it on an occasional basis; it's the chronic condition that is problematic, so I guess that you continue to monitor things and see how it goes. There are tests that they can do to determine if this is a chronic thing and if something needs to be done, so keep on them about it if it continues to be a bother. There was one gal a few years ago whos surgeon revised her to an RNY to treat it, which seemed odd given its' predisposition toward it, but it seemed to work (at least initially - like most, she dropped off the forums after a few months) so presumably the surgeon did everything in the RNY toolkit to avoid it. The better approach if things are that bad is to revise it to a DS as that is as good of a cure as one can find (it puts the stomach and bile ducts at near opposite ends of the GI tract, so it's virtually impossible for the two to mix), but most bariatric surgeons don't know how to do that one. Hopefully, you don't need to go so far as a surgical solution. Good luck!

Over the years on these forums, it's not something that we see a lot of, though it does pop up occasionally (as it does in the non-WLS "normal" population.) What procedure did you have? It is something of a predisposition with the RNY pouch style of procedures, as the pyloric valve has been taken out of the main flow and the stomach access has been moved downstream of the bile ducts, but from what I have seen it is more common amongst patients who have had the procedure for non-WLS reasons (gastroperesis or gastric cancer typically) and the surgeons keep the limbs short to minimize weight loss; usually if the limbs are of typical weight loss length it doesn't present a problem. The mini bypass has historically been associated with bile reflux problems, though there are claims that they have developed techniques to minimize it for that as well.

Most likely not, as the MGB has never been accepted by the ASMBS and few, if any, US insurance policies cover it as it usually still falls under the "Experimental/Investigational" label. The only ones routinely covered in the US (with Medicare as the primary guideline) are the RNY, DS, VSG and lapbands. For a long time the DS was classed as experimental, but once Medicare accepted it, the private insurance companies could no longer use that dodge to avoid coverage.

I set my initial weight goals based upon the gross assumption that all my loss would be fat, and needed to get to a healthy body composition, and then reworked that as I got closer and got better figures on what was actually happening (hey, we engineers do that all the time, making assumptions to get us in the ball park, and then circling around to get a closer solution as more information is gathered.) As it turned out, I lost about 10 lb of lean mass in the process and adjusted the scale weight goal accordingly; the body composition goals remained the same (for me, a mid-teens fat percentage, which is on the leaner side of normal for men, depending upon whose chart one uses.)

I settled in at around 1100 within the first month, which was comfortable and worked well with my guy metabolism - I had been stable before surgery at 2500+ so I had confidence about having a decent caloric deficit for continued weight loss and maintained that level throughout my loss phase. YMMV. I am somewhat suspicious of programs that ramp up calories on a schedule over time, as our natural inclination is for weight loss to decline over time as we get lighter - we naturally burn fewer calories as we have less weight we are moving around 24/7. I recognize that there are multiple hypotheses about metabolisms and weight loss, but there also seems to be little strong consensus on it, either. I have seen good overall good results from many on these forums over the years doing programs in the 6-800 calorie range, and there are many who seem to stall or go into maintenance early on 1200+ calorie programs. Yet we also see some success at higher levels, or reports of that breaking stalls. Take these under consideration while trying to understand how your body is working, but my inclination would be to keep things on the lower side. At my six month follow up with our RN program director, she was wanting me to cut back my exercise as she felt I was losing too fast (which I wasn't going to do as I was basically working at my semi-normal activity levels,) but by the end of that month (it was November,) I was within ten pounds of my goal weight, and losing a consistent ten pounds per month, so I started ramping up my calories to slow things down (I basically let the holidays happen...) which stretched those last ten over two months instead. I never controlled carbohydrates, net or otherwise, or fats, but sought to get the best overall nutrition from the non-protein side of my diet, but in those later months carbs typically ran in the 100-120 range; I had selectively increased my complex carb intake at around four months for energy management purposes (I was running out of gas in the pool after an hour) which did the trick without any effect on loss rate.

We had no specified limits or goals on macros other than protein. If you think about it, this makes sense as if you get in your requisite protein, and your calories are low enough to facilitate the desired weight loss, then it really doesn't matter what your fat or carb macros are (leave that for the fad dieters) as both will be quite low. As an example, if you are following the common 6-800 calorie post op diet (or even 1000,) with 60-80 g protein and totally ignore the other macros, you may be around 50-60g of carbs; does that make any functional difference to the magical 40g (or 30, or20) promoted by some of the popular fad diets? No. Against a typical Western/American diet that is often 300+ g of carbohydrates there numbers may make some sense (primarily that it represents a lot of calories...) but typically for us post op, it doesn't make any difference. Concentrate on learning to eat a healthy, sustainable diet that includes your typical fruits, veg, leaner meats, nuts, whole grains instead of the processed white flour junk, and in general bypass the junk foods (high calorie, low nutrition) and you will be miles ahead of those who agonize over macro counts and ratios (and most likely, a fair bit lighter in the long run. Good luck...

I sounds like you just aren't quite ready for those yet, even if they are on your plan. You may have more inflammation in your stomach than most, which restricts the thicker (or sometimes even the thinner) things more than others experience. I had yogurt (and purees, etc.) in the hospital without problem, but others on the same plan couldn't handle them. Our general rule was to try new foods one at a time to test for tolerance; if it worked, great, if not, try it again in a week or two.