RickM

They aren't the same thing, but have the same basic root cause of rapid stomach emptying from the missing pyloric valve (as with dumping, people with an intact stomach can also experience these things, though it is rare.) In addition to the symptoms that you have noted, RH is also associated with greater inter-meal hunger that can lead to regain, so that is another reason to keep it under control and learn what triggers it in you.

30 min after a meal, most certainly; 30 min before meals, maybe (depends on specific program instructions.) You don't want to drink after meals to keep the food in the stomach as long as possible; drinking too soon can help empty the stomach sooner leading to more inter-meal hunger and is associated with weight gain or poor loss. Drinking before meals can be a problem for some for a while immediately after surgery as with the potential for inflammation in the stomach, fluids may still be in the stomach at meal time, impeding getting the food in. As the inflammation resolves - a few days to a few weeks, the fluids move through the stomach easily and quickly and drain out in just a couple of minutes, so the pre-meal limitation is no longer needed. Some programs mention this last detail and open up pre-meal drinking at some point, but many don't bother and leave their patients hanging. (Similar problem as to how long does one need to sip, sip, sip their water before one can drink normally - many programs don't bother saying.)

Yes, it is. But are you expecting a better answer from us than from those with the expertise to know you and your condition best? Were you not in the hospital, the most appropriate answer for a question such as this, one which is giver quite frequently for situations such as this, is to either call your doctor and check, or to go to the ER and get it checked out. Blood coming out of any place after surgery is a concern, It may be a "we gotta get on top of this - now!" type of thing, or it may be a "let's keep an eye on this and see if it clears up on its own" situation, but that is something that needs professional medical judgement.

The industry standards are for coverage at BMI 40 without comorbidities such as hypertension, T2 diabetes, sleep apnea, etc. and 35 with comorbidities. The lap band industry got FDA approval for their devices down to a BMI of 30, and some insurance companies followed. My inclination would be to find another surgeon, as this guy doesn't seem to want your business - any surgeon worth a salt would send a patient such as yourself to get a sleep study to check for previously undiagnosed sleep apnea, which would qualify you for WLS. He would also verify your height to make sure that the calculation is correct.

It simply means that you no longer have any significant inflammation in your stomach, so fluids are flowing pretty freely, as they should. You won't really feel much fullness until you get into more solid foods that stay in your stomach longer.

If you are in the hospital, why not ask the experts who are there, rather than us online amateurs? Early diets and progressions vary all over the map, but your medical team will know what is within normal expectations for their practice.

As Fluffy said, differences for different programs - and also for different individual needs. I never worried about carb or fat counts as those don't bother me, just calorie count as that is what ultimately drives the weight loss. There is too much good nutrition associated with foods that are nominally carbohydrates for it to make sense to place arbitrary limits on them; on junk food (high calorie/low nutrition stuff) yes, but not solely on the basis of something being high carb or fat - the calories are an adequate limitation. With your bypass, however, and the prospect of dumping or reactive hypoglycemia, a reasonable carb restriction can be in order, particularly for simple carbs and/or sugars, at least until one figures out ones' individual tolerances.

Initial loss will be fairly quick, as there is a lot of water weight lost at first. The general trend will be declining after that, as it takes fewer calories to move 200 lb around 24/7 than it does 300, etc. My basic monthly numbers were (IIRC) 32, 15, 15, 10, 10, 10 and then I started ramping up the calories to slow things down as I was within about 10 of goal weight. YMMV

Some do OK on ground beef, while others have problems tolerating it; I would avoid trying anything new out in public. I would probably also be a bit more skeptical about a fast food burger vs. a home cooked one for starters - never quite know what is in those. My wife had some tolerance issues with ground beef, and our doc said that it was not an uncommon thing, and suggested that good quality steak, like filet, is often better tolerated - the best Rx we have ever gotten from an MD! Give it a try - what have you got to lose (other than your cookies....)

It seems like the only time one is really sucking air is at the end when trying to get the last out of the glass. I think that the general consensus on this, as with many things, is that if it bothers you, don't do it; if it doesn't bother you, you aren't doing any damage. Generally, it is best to humor them and follow their instructions as if you have any problems, related or not, you will be labelled a non-compliant patient and you will hear "see - it's those straws!"

Yes, if the rest of the day is fairly lean, you can afford to have something fatter for one meal. Likewise, if one wants to average, say 200 calories per meal, one can combine meals and have a 300 calorie meal followed by a 100 cal snack = just make the average work out for the day (or even the week, if one has an "off" day.)

Not to overrule your dietician or doc, by my inclination in this situation would be to "borrow" against other meals of the day; I never worried much about macro counts (other than protein) but just concentrated on calories for the day and getting the best nutrition that I reasonably could within that budget. I would inquire with them as to whether that would be acceptable (I suspect that it would be). These limits per meal are usually just a tool to get you thinking about how to balance out a meal and not go overboard on the fats or sugar, but there are compromises in real life and sometimes there are things that are very nutritious that are a little higher in those undesirable elements than we would like, so we make trade offs. I suspect that since you are talking about real food with real nutrition (as opposed to bulletproof coffee, fat bombs or soda pop) that can be worked into your daily budget, and is a desirable food to have on your long term menu, that it should fly.

Probably nothing wrong - our loss is usually greatest at the beginning, but at 50+ lb down, you have already been at this for a while so probably have already had that big initial drop (which is primarily water weight from burning off your glycogen.) Those who didn't do any pre-op dieting and are having surgery at their high weight will show that big loss right after surgery, so it only seems like that big loss is surgery related, while is actually overall loss program related.

The best explanation of the difference between the two that I have seen is on poster's surgeon's advice was that if you call me up in five year's time complaining of nausea and vomiting and you have a band, I would tell you to go the the ER ASAP; if you had a VSG, I would tell you that you just ate some bad fish. While the bands are simple to install and have a low initial complication rate, that complication rate increases over time, and while it is a removable device and the procedure can be reversed, often times the damage that it does to your stomach can't be reversed, so you wind up getting revised to a sleeve, bypass or DS.

From what I have seen, (just from others, never had the band myself,) if you were able to successfully maintain a good weight with the band, but the band failed mechanically, then you should be able to do similarly with the sleeve. Those who have trouble with this revision are those who were never able to make the band work in the first place - they figured out how to "eat around" their WLS, and if one is intent on eating around one WLS, they will likely work out how to eat around another WLS.

The general answer to this is probably yes, though I would couch it more in terms that the DS has better regain resistance for those who may need it. Also, I don't know about both being similar in ultimate weight loss - for those who are "moderate" in their morbid obesity (say, BMI in the 40's) both would do well, but for those in the higher BMI region, particularly 60 and above, the DS would be the choice. While we do see some in the higher ranks lose well with the sleeve, the long term weight control is the question - the DS is a stronger metabolic tool that seems to better address the problems of those in the higher BMI range. It is not unusual for those coming down from a high BMI to maintain in the 1000-1200 calorie range with the sleeve (or no WLS) which some can adapt to but many can't; the long term caloric malabsorption of the DS allows for a more normal (or natural) diet that is easier to maintain. I have little problem controlling my weight now in the 2000-2200 calorie range, but I still have something of a "guy's" metabolism and was only moderately obese in the mid 40's so the sleeve works well for me; contrast my wife who was in the mid 60's BMI would struggle to maintain with a sleeve, but does reasonably well with her DS (not perfect, but much better than if she had a VSG or RNY) after 13-14 years.

Certainly, there are no end of idiosyncratic dietary quirks that we can, as individuals, have - my wife is chronically low on potassium, which has nothing to do with her WLS (it's just her.) My thoughts on the thiamin issue is that is seems like they may be trying to pinpoint a surgical cause, whereas they may well be chasing a dietary/social issue.

I suspect that at least of part of this is from the popularity of low carb dieting, as grains are one of the major sources of B1, and even for those who aren't big into Atkins, keto, etc., grain products tend to be but on the back burner for quite a while in favor of protein (a necessity) and green vegetables.

Zantac (or other H2 blockers like Pepcid) are good and aren't supposed to have any of the potential long term side effects of the PPI class of drugs, but they are also somewhat less effective and don't last as long - so you may need to take them twice a day where a PPI may only require one per day. H2 blockers are also used as a step down therapu when moving off of PPIs. But if they work, and you don't need anything stronger, that's great. If they don't, then there are the PPIs to try. Of course, don't go over the label instructions for dosage or frequency without checking with your doctor.

Typically, the iron and calcium in multis are only a partial dose, so there isn't quite the conflict that there is if you try to take full doses of calcium along with full doses of iron (a multi may have only 200mg of calcium vs. 600-650mg as a normal maximum absorbed dose by itself. Likewise, a lot of the foods that we eat (or will eat again once we are through this.....) are rich in both calcium and iron, but the conflict is usually avoided by virtue that, again, there isn't a full supplement dose involved, and the time delay from digestion. I generally ignore the iron or calcium in multivits as they are usually the cheapest and least absorbed forms (typically calcium carbonate vs. the preferred calcium citrate) so I only count that which comes form my food and from the specific supplements. If you find a multi without the iron and calcium in it, then you can take an iron supplement (if needed) along with it, and the vit C in the multi will help with the iron absorption, and that is one less pilling session for the day - you don't need to space out an iron supplement from the multi. This is less of a deal for us sleevers who usually don't need to take as much mineral supplements as the RNY guys so we don't usually have as many pillings during the day, but we still need to take some while we are losing and not eating well.

Generally not - your initial loss these first 2=3 weeks is mostly water weight caused by burning up your short term energy stores of glycogen (basically stored carbohydrate in your muscles) which need water to stay in solution. Once that has been depleted, your body needs to restore the glycogen reserves to some functional degree by converting whatever it can that you eat, or from your fat stores, to rebuild it - which means that it also needs to hoard some water to get that back into solution. So you will hold on to some water weight, or possibly gain a bit, while this happens. Once things stabilize again, your scale weight will start to drop only now your body will be drawing from its longer term fat stores rather than glycogen - which is what you want! Note also that as this happens your loss rate will probably drop some, as the fat takes more calories to burn than the glycogen, (on the order of 3500 calories per lb vs. 2000 calories per lb) but you are doing what you came here to do now.

Actually, I find a home impedance scale to be better than the ones at the doctor's office. The reason here is that they are sensitive to your hydration, so you can easily see a difference of maybe five points on the body fat reading between first thing in the morning when you are typically dehydrated from sleeping, and late afternoon when you are usually fully hydrated (the late afternoon reading is generally taken to be the more accurate one.) If you use one at home, at the same time each day, you may see some variation day to day due to hydration fluctuations, but if you average it out over a week, it is pretty good; if you just do a measurement at the doctor's office, it is just a snapshot and you don't really know if the reading is on the high or low side, or just about right. When I was losing, I basically took a mental moving average of the readings. Typically, my BF% may be, say, in the 33-34% range and it would fluctuate around there but I didn't put any great significance in the individual readings. In a couple of weeks, I would start seeing readings in the 32's, and then no more in the 34's - so that I took as a good indication of progress - I went from 33-34 down to 32-33, so call it down a point in those couple weeks; a reading of 32.5 one day and 33.5 the next doesn't carry any real significance. One can calibrate these readings by comparing them to a water dunking or DEXA scan test, which isn't a bad idea every six months or so while things are moving, or at least as you get closer to goal weight (though those tests can have their own errors, though generally smaller) and for me, at least, they correlated fairly well to my moving average readings. The BMR readings on the scales will be somewhat better than the online calculators as they are taking body composition into account, but I wouldn't depend on them too much in figuring out how much you should be consuming to lose that last 10 lb.

I never counted carbs (they were "accounted for" by way of being recorded along with everything else, but I ignored them as far as controlling them) as our program never jumped onto that bandwagon when it came into fashion a few years ago. They do want to minimize simple carbohydrates and sugars, but no specified level. Overall, if you maintain your protein minimums and an appropriate caloric deficit for weight loss, your diet will by default be low carb and low fat by any reasonable standards, so there is little value to worrying about either. I simply concentrated on getting the best overall nutritional value I reasonably could within the non-protein portion of my diet (same as now, it's just a larger part of the diet today) which in retrospect came out to be a rough split calorically between carbohydrates and fats, though that wasn't a specific goal.

Yes, I kinda went with the reverse of that when working into maintenance, taking my average loss of 10lb per month in the prior 2-3 months and extrapolated that out to being a caloric deficit of around 1000 calories per day, which worked out fairly close as I had been consuming 1100 calories per day on average, and wound up maintaining in the 2000-2200 range. BMR is stated to be in the 17-1900 range depending upon what formula is used, and activity burn is the really big variable - no one has a decent handle on that one for us fatties/former fatties. Using the typical lifestyle or activity intensity factors would give me numbers several hundred calories higher than what my real world metabolism produces.

The thing to watch for with the various online BMR calculators is that they are intended for normal people, not significantly overweight people. BMR most closely correlates to lean body, or muscle, mass rather than overall scale weight - all that extra fat that we carry, or did carry, does little to influence BMR, but can give a false sense of hope by implying that we can lose weight at, say, 2000 calories when we really need to be at 1000 to get the weight off. For my numbers, there is a difference of close to 1000 calories on that calculator between the fat me and the normal weight me, and while scale weight can make some difference when discussing active or moving metabolism, as it takes energy to move that extra fat around, the difference to resting metabolism (BMR) is insignificant. When using these calculators, it is best to use your "ideal" or goal weight to get a better idea of what your BMR really is. The other problem is that these calculators seek to tell you what your BMR should be rather than what it actually is, and with the metabolic problems that can accompany severe obesity, that can be a significant difference. Individual testing such as a VOX test is better, but costs more than a free calculator, but can still have some errors as they are still algorithmically based upon normal people. but they are closer. As for using BMR after WLS, the best way to use it is to simply say "that's interesting" and then ignore it. Keep your calories as moderately low as you can, say 800-1000 calories per day for most, and don't worry about BMR until you get close to your goal weight and need to increase your consumption to stabilize your weight (weight loss history is a better measure of your real world metabolism anyway) or if your weight loss is too slow and you need to adjust your intake downward. In short, BMR is an interesting number, but not overly useful for us in the form that we usually find it.