RickM

At least you have the dog to blame! A couple of things can be happening. One can be the consumption of sugar alcohols that are frequently used as a low calorie/carb sweetener in Protein shakes, bars and other calorie reduced products (look for ingredients ending in -ol, as in maltitol or xylitol). Since they are incompletely digested (the reason that they are lower calorie than regular sugar,) excessive use can cause problems with diarrhea or gas - some people experience these problems to varying degrees while others don't. Another possibility is simply that your digestive system getting used to its new diet after being cleaned out and much of its bacterial flora being wiped out by the antibiotics given after surgery. Probiotics can be useful in re-establishing the beneficial bacterial culture in your gut that promotes proper digestion. Even without surgery or antibiotics, some people can experience these problems with dietary changes that their systems aren't used to handling. Good luck, and hopefully your dog can escape any further blame!

I never netted out the calories - the exercise "calories" recorded by the gym machines or listed in various tables aren't all that accurate so it never made sense to me to try to compare one against the other; I generally cut the numbers in half when I did my mental calculations of what I was doing, and then just did a weekly tally to track exercise progress apart from dietary progress. I let my body tell me if I needed to make adjustments to the diet. That way I didn't fall into the trap of "gee, I worked off an extra 500 calories today, so I deserve a....."

When dealing with such technical questions, I suspect that the more important factor is the overall success and complication rates of the surgeon than the specific technique or products that he may use. There is usually so much overlap in outcomes that one is probably better off with a more skilled and experienced surgeon using a technically inferior technique than a less skilled surgeon using the latest and possibly superior techniques or product. There is usually enough debate and controversy about such details amongst the experts who do these things every day that it makes evaluation by us laymen very difficult.

We will all tend to see the most rapid weight loss at the beginning, no matter what our diet may be (assuming that it does have the requisite caloric deficit to trigger weight loss!) When we first go into a caloric deficit, as when we start a weight loss program, or get into a famine, that deficit is made up with our quick energy reserves of glycogen (basically carbs) which burn fairly rapidly at a rate of about 2000 calories per pound. When our body gets the idea that you are into something serious and the caloric deficit is not going away anytime soon, then it starts tapping into its long term energy stores of fat, which burns more slowly at about 3500 calories per pound. It typically takes 2-3 weeks to get to this point, which often coincides with a change in diet phase in post op WLS programs. This is also when many people experience their first stall - the dreaded third week stall - when the body has to take a rest and rebuild its glycogen reserves to more normal levels, which involves some hoarding of Water to keep it in solution. I was on mushies and soft Proteins from the outset, and also experienced my most rapid loss those first three weeks after which is slowed down as my body moved into fat burning mode. So, it really doesn't matter if one is on clear liquids, thick liquids, mushes or steak and potatoes those first couple of weeks, you will lose quickly assuming that the caloric deficit is there. On the original question, I typically ran in the 90-110 g Protein range (appropriate for the metabolism of a guy with relatively high lean body mass,) carbs were in the 80-120g range (workable and at times essential for a relatively high activity level,) simple carbs & sugars were minimized, though some fruits, berries mostly, worked their way in over time, and calories averaged around 1100 during my loss phase. The 50g protein level quoted by the OP is on the low side of typical recommendations (normally in the 60-80g range) but is in the ballpark if the OP is a relatively short and small framed woman (say, 120lb or less of "should be" or ideal weight.) Many find that 600-800 calories to be something of a sweetspot for weightloss with the sleeve, and at that level, if one is meeting the protein goals, there isn't a lot of room to go wrong on fat and carbs with the remaining calories.

The OP has a question for which I have yet to find a logical answer. The "liver shrinking" effect (for which there does seem to be some debate) for those docs who need that extra help, requires carb restriction but one doesn't need to do liquids for that; many docs who do these pre-op diets simply require a couple weeks of low carb diet - lean meats and veg primarily and sometimes a protein shake or two to get the patient used to them. Some docs don't do any pre-op diet other than the usual day or so pre-surgical liquid diet. The colon doesn't need two weeks to get cleared out, so that doesn't answer the question, either. The biggest negative that I can see for them is that along with the weeks of post-op liquids that some docs do, the stomach is left without any effective exercise (the stomach is a muscular organ,) for up to a couple of months on some plans, which can make the progression back to solid foods more difficult than it otherwise would be.

This article gives a good explanation of what is happening during a stall, and why you may gain a little during that time - http://www.dsfacts.com/weight-loss-stall-or-plateau.html Hydration and patience are your friends. Also, be prepared for your weight to drop a little more slowly once things start up again - that initial loss is mostly glycogen (carbs) which burn quickly while it will be mostly fat that gets used once you start losing again, and fat burns more slowly (it's that 4 cal per gram for carbs & Protein vs. 9 cal per gram for fats thing - it works in reverse, too.) The good news is that once you do start dropping again, it will be mostly fat that you are losing, which is what we are here for!

Sliders aren't necessarily high calories/fat/carbs, but are simply foods that go through our stomachs easily and with little restriction. Many of the junk foods that we should avoid fall into that category - ice cream, chips, twinkies, crackers and the like. But many low calorie/high nutrition foods can also be sliders - peppers, onions, spinach, avocado (ok, not so low cal, but good nutrition when you can afford it), tomatoes and the like tend to go through me fairly easily (can you tell that I just made a salad?) and when added to some meat can increase the volume consumed with little caloric impact but a good addition to the daily nutrition. I would often have mixed meat and veg meals - stews, stir fries, salads, chili and the like once my Protein intake was fairly reliable and I could back away a bit from the "protein first" rule. "Slider" is a bit like color - it is neither good nor bad, it just is. Green leafy vegetables are generally good, while green fuzzy meat is not. The same with sliders, and that can be used to your advantage as you progress through this process - benefit from the good sliders while avoiding the crap sliders. The greek yogurt that is often recommended is a great slider for getting in additional protein when meats and other firm Proteins are too restricted.

Loss rates will be all over the map since there are so many variables involved, not least of which is amount of weight that needs to be lost (bigger, heavier people at the start will tend to lose more pounds per month even if the percent of excess weight lost is lower.) I lost about 60lb of the 100-ish that I had to lose in the first three months; others will lose slower and some will lose faster. YMMV. I have guy metabolism on my side (guys tend to lose more quickly than women) as well as established patterns of fairly high activity levels. I did a 5k walk at about 3 1/2 months (running is a no-go on my knees), but I had been doing them periodically for several years pre-op. What is probably more important for you is your condition at three months rather than any particular weight loss - any loss will be a big help, but you will be feeling so much better by that time that it won't matter that much if you are down 60lb or 30. It was around the three month mark that I noticed that fast walking was no longer providing me with the exercise intensity that it once did - a fast walk pace, about as quick as I could walk without breaking into a jog, somewhere a little above a 3mph pace, would previously get me into that peak cardio target zone of 80% max heart rate (130-140bpm for me) but after about 3 months I could barely break 100bpm at that pace. I really needed to get into the hills and do some climbing to get my heartrate up to that previous level. These days, at 17 months out, it takes some serious work in the pool to get it over 120. For the record, I lost about 30lb the first month, 15lb each of the next two months and 10 lb per month thereafter; your numbers will likely be different, but the profile of loss will should be similar, with your biggest loss in the first month tapering off after that. In the meantime, do your walk, walk, walking preop and postop as your doc instructs, and ramp it up as you feel up to it.

I suspect that a lot have cheated on it. The most important part of those pre-op diets (for those whose docs require them - many don't) is that they be low carb to help improve the physical condition of the liver when they are working around it doing your sleeve; your liver doesn't care whether you have been sucking liquids or eating meat and veg. I have yet to find a satisfactory rationale for liquid over solid diets pre-op.

This is very common - my doc's plan has early meats be things like tuna or chicken salad - soft and squishy blended into sauce. Early meats by themselves would be dark meat poultry (fatter & moister than light meat) and fatter, moister cuts of beef when getting to that point. Chicken breast and the like can be some of the more difficult meats early on.

The NSAID ban is mostly an RNY thing, carried over by RNY docs when they move into doing sleeves. NSAID use has long been one of the advantages of the DS (which uses a sleeved stomach as its basis) and now the stand alone sleeve over the RNY. There are specific structural issues with the RNY that contraindicates the use of NSAIDs and other stomach irritating medications that doesn't apply to the sleeve which is structured quite differently. This factor has been used many times in the successful appeal of insurance decisions favoring the RNY over the DS or sleeve. There are some systemic issues with the use of NSAIDs for the population in general that may be exacerbated by our smaller stomachs but those are generally mitigated by use of PPIs if the NSAIDs are going to be used routinely, but caution should be applied to this class of drugs for anyone needing to use them long term. Some sleeve docs will not recommend their use for some period of time after surgery out of healing concerns while others will recommend their use shortly after surgery for pain relief after the narcotic pain relievers are no longer appropriate. So we have yet another topic where there is little consensus amongst surgeons, though from my observation, the surgeons with the most specific sleeve experience have little problem with NSAID use for their sleeve/DS patients. YMMV

First, we are not on a high Protein diet, rather we are having enough protein to maintain ourselves, which is an amount that doesn't change much from what we should be doing pre-op, post-op, maintenance, surgery or no surgery. The 60-80 gm per day (sometimes up to 100gm for men) that we commonly see as the recommended amount is consistent with the govt. RDAs of 60 gm for basic maintenance of our lean body mass for the "average" person. Our tissues - muscles, skin, organs, etc. are continually regenerating themselves, and need protein to do it, and that's where these basic recommendations come from. The amount needed is roughly proportional to our lean body mass, so a lighter framed woman who may be 120 lb in "normal" or "ideal" weight may need around 60gm while a larger framed man of 180 lb normal weight may need 90-100gm. Men normally tend to be leaner than women, so a normal man would need a little more protein for maintenance than normal woman of the same weight ("normal" body fat % for men is in the mid teens, while for women it's in the mid twenties.) My lean mass in the mid 150lb range needs around 100-105gm of protein to maintain; if I were interested in seriously adding muscle mass, that could easily require 140-150gm. Like Pdx, I never really did low carb during the loss phase (I'm 17 months out, maintaining for the past 10,) as it didn't make sense for my activity levels, though I added some complex carb part way through the process to better fuel some workouts as they got longer. My overall philosophy was to work to keep as reasonable a balance as possible with the remaining calories beyond my basic protein intake. Also like Pdx, I am on injured reserve status (shoulder surgery for me) so exercise intensity is down, though overall activity levels are up some (new puppy helps...), so I am keeping stable on the same 2000 calories that I was using before I got into this rehab mode. Off to the pool, now, for some restricted workout....

I started working with small salads with some leftover meat around the end of the first month. I mostly use chopped spinach instead of lettuce to boost the nutrition a bit, and some misc. salad veg. Doc told me to add veg to my diet at day ten as my protein intake was more than adequate at that time (so make sure you are still getting in your protein when you add salad to the mix!)

Before subjecting myself to a bypass, if that is the recommended fix, I would consult with a surgeon who is more experienced with the sleeve and duodenal switch (DS simply by virtue that it has been done for a long time and uses the sleeve as its basis, so any surgeon who has been doing DSs for a while has also been doing sleeves for that time.) There are a lot of surgeons around who are comfortable with the bypass and just getting into the sleeve, so if they have any problems with the sleeve, their first instinct is to return to their comfort zone and do a bypass rather than fixing the sleeve as a more experienced sleeve surgeon would do. So, when one gets into complications such as this may be, it is doubly important to get second opinions to see what your options really are. http://www.dsfacts.c...h-surgeons.html The above is a list of well qualified DS surgeons around the world that may be handy if you need a second opinion from a doc who knows their way around a sleeve (and a few of them are also well qualified in revising RNYs to DSs, so if they can re-fabricate a sleeve out of an RNY pouch and the old remnant stomach that was set aside, they would likely have no problem un-twisting a sleeve - assuming that the twist didn't cut off the blood supply and kill off the tissue.) Good luck, complications of any description are never a fun thing,

I started with six meal/snacks a day and dropped it to five after a month or so when I could get enough protein and other nutrition in on just five, and there wasn't that much time between breakfast and lunch to make the extra snack worthwhile. Now, in maintenance, I have added that sixth feeding back in to get enough calories in for the day.

Cirangle's program fee isn't too patient friendly, particularly considering that it covers a lot of things that would be covered by insurance if they were billed separately. His program is a bit one-size-fits-all which is great if you fit his profile but a bit of a waste of his high program fee if you don't. Some docs charge a program fee, but it is usually a nominal few hundred dollars to cover thier support groups and the like. By all feedback from the online patient population he is a well qualified surgeon though I can't say what his reputation amongst his peers is (which can be quite different.) I went with Dr. Rabkin in SF who is another long experienced sleeve and DS guy (came up from SoCal for him,) He doesn't have any program fees, but he also isn't in network for any of the major insurance companies (I think that he buries the costs of what would be the "program fee" in the ordinary surgical fee, so doesn't have room for the forced discount for the insurance networks - you pay one way or another - though since I had already hit my max out of pocket limit for the year, the insurance paid his fee 100%.) The other SF doc that I would consider is Dr. Jossart who used to partner with Cirangle and did his early training with the Rabkins. A little further out in CA is Dr. Keshisian who operates out of the central valley and Glendale and is another of the top drawer DS/sleeve surgeons around. If you happen to have any liver issues along with your obesity problems, Rabkin is your go-to guy as he is also an experienced biliopancreatic transplant surgeon.

It really depends upon how your doc phases things in - I never had a liquid-only phase so I progressed quicker than those on slower progressing programs. Protein shake a day, protein loaded puddings and jello, unstrained soups, tuna in cream sauce, mashed potatoes, softer cheeses, boiled eggs etc. were my norms then. It all depends on what your doc's program allows and what you can tolerate at that point - I was getting sick of soups and jello by then and haven't had much of either since, a year and a half later, so I know where you are coming from!.

Certainly strained out should be no problem, and over time as you progress you can have more of it included. My doc's plan didn't have discrete clear and full liquids then mush then soft proteins but combined them all together in one step allowing progress as tolerated, so we made some homemade french onion soup and progressively added the more solid components. You should be able to do much the same thing as you keep to your doc's specified progression.

I would say that this is a definite yes - with qualifications. If you are one who will agonize over every little bump along the way - "I didn't lose anything yesterday" or, "I gained a pound yesterday but didn't eat anything..." then use it only weekly, or maybe even monthly. If, on the other hand, you can accept that it can be a bumpy set of stairs down the scale rather than a smooth slide, then a daily weighing can be useful, The next factor is getting into good habits for the long term, and in the long term once you have gotten to your goal weight and want to maintain it, it will become very important to weigh regularly - again weekly or monthly (more frequently when you are earlier on in maintenance and things are still settling out) - because you want to catch any regain quickly - typically within 5-10 lb where it's fairly easy to cut things back to basics and bring the weight back where you want it. Just as with "normal" people, the less one has to lose the easier it is to do so. Some may find it best to only weigh in during doctors' visits during the loss phase, but in maintenance you will probably want to do it a bit more frequently than that (particularly since doctors' visits should be less frequent then.) Another thing to consider is getting a body fat (or body composition) scale that reads your body fat % as well as your weight. These typically run $50-100 but are worthwhile in tracking what you are really interested in losing - the fat! They can help you better understand what is happening to you as you lose, and help to form better goals based upon your individual body composition rather than just scale weight and BMI My goals were based upon losing fat mass and getting to a healthy body composition rather than a simple weight on a BMI chart, and as a result, I am still a little "overweight" on the BMI chart but on the lean side from a body composition perspective because I still have a fairly significant lean muscle mass - driving myself to "normal" BMI would mean losing too much muscle mass which isn't healthy. (Conversly, one can be in the "normal" BMI range yet still be overly fat.) The body composition measurments are not as accurate as the basic weight measurments, but if measured regularly (daily works best for these measurements,) you get a good sense for the trend of your loss and whether you are losing too much muscle mass relative to fat. In short, get a scale at least for the long term monitoring benefit - keep that weight from coming back, and don't put the scale in the closet if you see a bit of regain!

My doc's plan allows for Peanut Butter immediately as a soft Protein (creamy style, of course - avoid the crunchy types for a while.) I didn't use it much after the initial 2-3 weeks when I could get in better protein rich foods as its' caloric content is a bit much to swallow in any quantity during the loss phase, I typically had some on a saltine cracker or two, as those are good at soaking up excess stomach acid and settling stomachs that are still getting used to their new life. It should be good whenever your plan gets you onto soft Proteins - soft cheeses, yogurts, etc., unless your doc's plan specifically says otherwise.

It's not a worry, as the anesthesiologist is there to keep you breathing and monitor everything while you are out - that's his job!

The whole wheat english muffin with PB is the best bet protein-wise, as the whole grain complements the Peanut Butter to make a complete protein; peanut butter by itself, as with most vegetable Proteins, is not a complete Protein, so whole grain bread or crackers are your best bet nutritionally. Like some others here, I never did the low carb thing, either, and never suffered on the weightloss front because of it. The other suggestions of bananas, carrots or celery are popular items that are also healthy, and even if they aren't protein complements, may be very good taste complements! If you are looking for good potassium sources, try the low sodium variety of V8 juice - an 11.5 oz can has around 1100mg of potassium in it, and is about as good a supplement that you can find without a prescription. (My wife also has potassium problems so we are always on the lookout for good sources.)

Not a worry there - you aren't going to hurt your sleeve (your body will tell you if you are doing too much.) There is a wide variation in how different people handle liquids and mushes which generally are not very restricted by the sleeve. I was able to drink remarkable amounts (sip, sip, sip) of broths and juices in the hospital while my wife at the early stage of her WLS could barely get in her nominal stomach capacity of liquids - the doc and program RN were not at all worried as these are just normal variations. I was getting in enough protein by my token shake per day, yogurt, protein loaded puddings and jello, and soft protein dishes that the doc was adding veg to the diet by day 10.

Yes, quite normal. They pump you full of fluids in the hospital and that shows up on the scale. I think I gained around 5 lb when I had my sleeve done last year, and it happened again this year when I had my shoulder repaired. It will come off in a couple of days and the weight will likely continue to come off until you hit the dreaded third week stall. Enjoy the ride, even if it gets a bit bumpy sometimes!

It really depends upon the specifics of the BCBS policy bulletins on WLS (and which BCBS you are covered by - there are dozens of them.) See if you can look up the bulletins on their website (they are usually there somewhere) or check with the insurance coordinator for your surgeon (if you are that far in choosing a surgeon) as they know how to translate insurance-ese.