RickM

It's more a matter of how quickly different things go thru it. Steak and most meats or otherwise dense Proteins can sit in there for quite some time while the stomach works on breaking it down to be passed on to the intestines, while other foods can just slide on through (the so-called "sliders") because they need minimal processing from the stomach. 3 oz of meat, give or take a bit depending on the type, is my comfortable capacity, but if I cut the meat back to 2 oz and throw it into a salad with some chopped spinach and a bunch of other salad veggies and a bit of dressing, that meal can be 6-7 oz. Some have reported that they can down an whole sleeve of saltine crackers in a sitting, and certainly things like ice cream or milkshakes can slip right through. If you choose your binges right, you can torpedo any of these procedures. Then there are individual variations - my wife could barely down her nominal stomach capacity in liquids for quite a while after her DS (same sleeved stomach, though a little larger, with intestial rerouting added) while I have had virtually no liquid restriction - I had a 6-8oz bowl of broth and a half cup of juice as a meal in the hospital with no particular distress (other than my own thoughts as to where is this restriction!)

That depends on what is included in your "soft food" stage - there are lots of variations. Mine included most seafood, rice & Beans, veggieburgers, eggs, etc.

It sounds like one of those "punish you because you're fat" ideas. In other words, she doesn't know either. I'm sorry that you have to put up with that.

That baffles me, too. I wish someone who has a doc who does this would ask them and post the answer. Ditto for the extensive post-op liquids - I can see a short time on liquids (tho some docs don't even do that,) but the stomach is muscle and while it does need some rest to heal, it also needs exercise to heal as well like the rest of our bodies. My suspicion is that this harkens back to RNY practice, where the structure and function of the remnant stomach is quite different.

If you're not familiar with them, look up the Merry Wives of Windsor. "The Swallow" should tickle your surgeon, if you don't mind a bit of laughter in the OR. Drunken Barmaid isn't bad, either.

I've played with these things for years, since my wife rejected them after her DS and I started mixing them into my instant breakfasts. At the moment I have settled on the EAS chocolate powder that's available at Target and many other places, as I find that is has a fairly delicate flavor (including any objectionable "protein" taste, at least to me) that can be boosted as desired with a little unsweetened cocoa or SF chocolate syrup depending upon level of sweetness desired. I use the unjury unflavored powder for non-chocolate use but that's an online order - I would give the EAS vanilla flavor a try based on how their chocolate works for me. I also use the powders to add to SF Jello pudding as a high Protein snack - sometimes I add greek yogurt instead for a little different flavor blend. I haven't used the powder with yogurt itself since adopting greek yogurt as my standard as that is plenty high in protein for my needs (about double standard yogurt, 20-22g/cup). The unflavored powders can be added to jello for use during whatever clear liquid phase you may have (mine was only a day pre-op, so I didn't use it much). Good luck and enjoy the journey, and particularly the destination.

I'm not quite as much of a lightweight as you at a 40ish BMI, but close; these have been my thoughts in going thru this as a relative lightweight. With the band you have less to worry about in the losing too much department, and may not lose enough; and there is the higher risk of complications down the road with erosion and slippage problems. The bypass presents you with a lot of long term lifestyle limitations (malabsorbing minerals, inability to use NSAIDS for pain relief, dumping prospects, dietary restrictions for the pouch to name a few) that probably are not worth the trouble for the amount of weight you have to lose. Some people report losing beyond goal with the VSG, but not specifying what those goals were and if they actually wound up losing "too much". Most people find that there are enough "sliders" (foods that just slide on through) that they worry about eating too much despite the restriction, but I don't think that it is that much of a problem if you can adjust to having a sane diet (and some exercise with it) long term - a lot of fruits and veg are sliders as well as twinkies and chips, so it's largely up to you how you balance things out once in maintenance mode. You can also discuss this with your surgeon (or prospective surgeons if you haven't settled on one yet) as there is still some controversy within the VSG world as to how big to make the sleeve - too small and it is thought that there is excessive reflux problems while too big and it is thought that weight loss and regain resistance may be inadequate (but they really don't know as they are all waiting on more longer term - 5+ years - data to confirm their assumptions). If possible, find a surgeon who has as much VSG experience as possible - 500+ procedures is best - as he will have a better feel for how different patients fare with the sleeve and how best to tailor the sleeve for the individual. Good luck on the decisions,

I can certainly understand the rationale for a pre-op diet in reducing calories, improving liver condition and getting used to the post-op hi protein routine, (though my doc never used one,) though the logic of the extensive liquid pre-op diet still escapes me. I can see more negatives to it than positives.

I think that what you may be seeing is a mix of comfort with a greater variety of foods along with the old discipline issue on the sweets front. At 75 lb down, you are in the 70-75% of excess weight lost range that is average for the sleeve, but at only a year out you still have some time left in the typical 18 month weight loss window - many people do beat the averages and lose all of their excess weight with the sleeve. Are you still fairly restricted if you have only meat at a meal - on the order of 3oz or so? That's my typical test for capacity and restriction - even though I can eat much more of other things, the so-called sliders, I try to make that an advantage rather than a problem by willingly having more veg and fruits to balance out the Protein rich meats, and avoiding the empty calorie sliders. I can readily (comfortably full rather than stuffed) have 6-7 oz of salad including a couple ounces of meat which is a nice balanced meal, but if I have only the dense meat my limit is still about 3 oz, give or take a fraction depending on the meat. Are you still tracking your intake (if you ever did)? I find that that still helps in keeping my mind on what I am eating, and can highlight how much damage the sweet cravings may be doing (be honest with yourself!) As is noted many times on these forums, the sleeve is still just a tool, and you have to learn how to use it, particularly in the long run; it can still be defeated by drinking calories or even letting them slip past in high calorie sliders. Also, while it's good to keep an eye on your carbs, despite your sweet tooth, how is your fat intake doing - that still counts despite low carb being the fashion of the day. At 9 calories per gram versus 4 cal per gram for carbs and protein, they can sneak up on you quickly, and the overriding factor in our weight control is still calories in versus calories out - it does no real good to limit carbs in the effort to burn fat sooner if we throw a bunch of fat back into our stores; we really need to watch all of it, even if we "only" have a particular weakness for one or the other. This gets back to the tracking discipline to help make sure things aren't slipping past us. Another issue that may be coming into play here is that the exercise that you have been doing all along may not be doing that much good anymore, at least on the caloric front - as you lose the weight, the exercise becomes easier and of less value, even if you feel that you are still working as hard as you ever were. It can really sneak up on you. I don't do a lot of walking since the first month or so (at least not as "purposeful exercise"), preferring the gym and swimming, but I noticed that sometime between the second and fourth months my heartrate when walking as fast as possible, just short of a jog, had dropped from 130ish (in the healthy cardio range of 80% of max heartrate for me) to barely 100 - it still seemed like I was working as hard as ever, but I really wasn't. I can still get that exertion level when swimming, but I have to work harder, and keep reminding myself to do so. On the diet pills front, I would check with your doctor on that - most of the infomercial pills are near worthless and can be outright dangerous while the more legit pharmaceuticals, prescription and OTC, have some value in certain cases, but I suspect that with the restriction that we already have with the sleeve, that their value would be limited; but it's worth a chat with a doc who knows you and how those drugs work. Good luck with it all, things can be jump started and you can get back on track,

I can't add any specifics about that kind of band, but with the current crop of bands it does seem to be fairly common for the revisions to be staged with the removal done in one procedure and then the sleeve done in another procedure some weeks or months later to allow the stomach to heal from any damage that may have been done by the band. I don't know how many are planned that way versus decided upon when the surgeon gets inside, but there is a band to sleeve forum here where you should be able to get some general insight on that issue. Good luck in making the change,

Neither my wife nor I had any major problems and recovered normally. I was outpacing her on the walks within the first week, though I was relatively fit and healthy pre-op. The second week had me down some with lower GI problems (body couldn't make up its mind whether it wanted to have diarrhea or be constipated.) I never had any particular issues with self care, though my wife had a harder time since she wasn't in as good a shape pre-op (she was a BMI 60-65 range, I was about a 42 and a semi-gymrat). She found a battery powered portable bidet unit that helped her quite a bit with toileting, given her size and post-op stiffness, I would expect that five days would normally be enough outside help, but that's another of those variables where some people may drag on longer. We do know people who have had some complications (going to the support group meetings for eight years, you do pick up on the occasional problems some people have,) and perusing these various forums you hear of the occasional person who was in the hospital 5-6 days or more with a leak or obstruction. Relatively rare events, but something to be prepared for in the unlikely event something like that does happen. We have no experience with drains after WLS as our docs normally didn't use them for their WLS procedures (I'm not sure what the differences between surgeons and techniques are where some use them while others don't,) though my wife did have several after her reconstruction surgeries where they are commonly used due to the large volume of incisions involved.

It's great that you are going on this journey together, considering the difficulty some couples can have when only one is going through it (whether the other spouse needs it or not!) My wife and I started on it together as well, though our paths diverged along the way to our destination (we wound up being six years apart, but that's another story.) My general philosophy on this, and one we discussed when starting out, is to plan for the best, but be prepared for the worst - what happens if one has a particularly difficult time, either with the surgery and possible complications, the immediate recovery in the hospital or shorter term post op issues at home (first couple of weeks or so.) Our thoughts when contemplating this issue was to schedule things maybe a month apart. That way the later spouse can help the first one out of bed, our of chairs, toileting, etc. as may be needed (usually shouldn't be a big deal, but people differ in how they respond to the surgery and how quickly they bounce back.) The recovering spouse may not be too eager to be cooking (such as it is, post-op) or preparing meals, going to the store, driving to the doctor if needed (or the ER - hopefully not.) etc. After a month's time, the first spouse should be recovered enough to take over those chores, and if not, the second spouse's surgery can delayed if needed. Good luck on your collective journeys - it's a great thing for a couple to do (even if not at the same time!)

I haven't had my sleep apnea formally tested, but it's still there to a much lower degree based upon the wife test and how I feel. It's much better than when I checked it a couple months ago.

It all depends on what your doc's program specifies and defines as mushy or soft protein; there are so many variations between programs that it's hard to generalize. I didn't have a "stage 1, stage 2, stage 3, etc." type program but a farily simple first month (puree and soft proteins) and then second month and beyond (everything else) with some overlap as tolerated. My plan didn't specify ground beef the first month but tuna and other fish and veggieburgers were on plan - fish are generally flakey enough that the stomach doesn't have a lot to do to process them so they are often considered to be "soft proteins" like eggs and yogurt. Ground beef makes some sense from the same perspective, though some people can't tolerate ground beef for a while (when my wife was having problems with ground beef after her DS, the surgeon suggested filet as being better tolerated, though this was well beyond her first month at the time.)

That depends upon whether your doc has you on one of those low carb diets or not. The most important factor is the caloric deficit (calories burned minus calories consumed) while the composition of those calories is a minor point (beyond the minimum protein levels.) Your drinks and vitamins are less than 50g carbs per day which is still low, though not as low as the dedicated low carbers like to see. But protein is by far the most important thing and all through this weight loss phase we are making compromises in our diets to accomodate our weight loss goals, particularly early on when we are so very limited on what we can eat. Not getting in the requisite protein and Water will screw up your weight loss and health big time, while a few extra carbs will not do much of anything.

It is very common to have no pre-op diet, just as it is common to have one - it depends upon the surgeons' preferences.. I don't know of any survey as to how many docs do a pre-op diet versus those who do not, but both are common practices. I didn't have a pre-op diet and have done just fine - I'll be hitting goal weight around month 6-7. Some docs insist that patients lose X amount of weight pre-op or they won't operated, while others who use a pre-op diet just want patients to be low cal and/or carb and hopefully lose something as they feel that it helps with the patients' liver condition (since the surgery is going on in close proximity to the liver.) My doc is a liver specialist aside from his bariatrics and doesn't do a pre-op diet - I guess that he works with livers in much worse condition on the other side of his practice. Some docs use a liquid only pre-op diet (though I could never understand why,) while others just go restricted calorie or carb and hi Protein. It's just one of the program variations that we see, and is one more factor that can be considered when choosing a surgeon (though a bit late for you now,) - some people may not feel that it's worthwhile while others may find it helpful. Another variation that you will find as you progress is the wide variety of post-op diets from extensive liquids for weeks to puree/soft Proteins from the start progressing to firmer foods as tolerated. Some docs are high on the low-carb forever fad while others go for the basic hi-protein but otherwise balanced nutrition philosophy. The two common factors that they all have is protein first, protein first, protein first and sip,sip,sip your Water most anytime that you aren't eating or sleeping. Goodl luck with your adventure,

My program is also a mushy/soft Protein for the first month (tho we don't have ground beef on the list, just veggieburgers - I'm jealous!) Beyond what you listed, I have oatmeal and cream of wheat on the list in addition to grits, wheat germ can be sprinkled onto lots of foods for extra protein, yogurt (greek yogurt by preference as it has more protein,) Healthy Choice soups, tofu, soybeans, tempeh, rice and Beans, egg or soy noodles, Peanut Butter, liverwurst, pate, hummus. I extrapolated from that list and had some homemade chicken noodle Soup (dark meat chicken is on our second month, but I tried a bit of it first and it went down well) and french onion soup (broth, cheese and I figured that the bread/croutons are so soaked with broth that there's minimal expansion risk.) I added Protein powder to the SF puddings to boost the protein, and later substituted some of the milk and powder for greek yogurt for a taste and texture change. Good luck with it all, and yes, it does get boring (but not as bad as for those on liquids for another month!) I haven't had any of the soups since that first month - gee, did I get tired of them?

You might be ready to progress, but it really depends upon what your doctor's program states - those are your default instructions. My program was puree and soft Proteins (and liquids as needed, of course) from the outset, so things like rice and Beans were on the menu the first month as tolerated; other programs call for liquids only for an extended time. It isn't particularly clear why there is such disparity between programs, whether some docs are more cautious due to inexperience with the sleeve and draw from their RNY experience on post op diet requirements, or if there is a difference in the surgical techniques used to make our sleeves that allow some patients to progress more rapidly than others. My doc's practice has been doing sleeves for about twenty years, so I have confidence that they know what is required for the care and feeding of a new sleeve (or at least their sleeves.) Maybe your docs don't have the confidence in their sleeves yet to allow more rapid progression, or possibly they have had some negative experiences with more rapid progression - I would not contradict their opinion on their work as they know what they have done to your insides. If you are on one of these liquid intensive post op programs and feel that you are ready to go further, discuss it with your doc or their staff. People progress at different rates and their program should reflect that. If their practice is fairly new to the sleeve, they need the feedback to learn how to tailor their program to the needs of sleeve patients (my doc's guidebook has a section in it on "what we have learned from our patients".) Good luck with it all - I know how tiring Soups and the like can get in a short time.

The thing that helped me on the drinking front, and my wife when she went thru this a few years ago, was to get some small 1 oz cups - sometimes they're sold as condiment cups and maybe dixiecups makes something that small, or the small cups they use in the hospital for dispensing pills (or a shot glass would probably work, too) and think in terms of sipping one of those every five minutes (or at whatever rate your doc gave you). Even if you goof and down the whole thing it's not going to hurt (too much.) After a couple of months you'll be back to drinking fairly normally (unless normal for you is a chugging contest!) It does take a while to get used to the small sizes of things (clothes too, in time....) but small plates and bowls, weigh the portions upon serving and when you see how small your meal really is you tend to shrink your bites to make it last. Some people go with baby spoons to help, though I never went that far. 18lb down was about what I was a week out, too (actually the 10 day mark when I officially weighed in with the doc - so you have me beat by a bit on time.) You're making good progress, keep it up.

Sounds like a variant of the body comp scales that use electrical impedance to derive the composition figures. That might take care of one of the weaknesses of the scales - namely that they mostly measure lower body composition since it measures between your feet. That means that apple shaped people (mostly men) who keep their weight high around their bellies tend to have understated fat % on the scales while those who are pear shaped (mostly women), holding their fat around their butts and thighs, tend to be overstated. That may be part of the correction that my Tanita does (or attempts to do) when it considers gender in its calculations. In any event, it's going down, and that's the important part. I'm down from about 42% to 24-25% by its measure now.

I wasn't on any special pre-op diet other than the typical day before thing, but I think that it is a good idea to start getting used to your long term diet since so much of the long term success of WLS are the lifestyle changes made along the way - the WLS helps you get the weight off, but it's largely up to you to keep it off. From what you are saying, it seems that the doc wants you on real food, but portion and carb limited and high Protein, is that right? That isn't a bad thing to do (I still can't understand the docs who put their patients on extensive liquids for weeks pre-op) and is something that I was doing for a long time pre-op (before any decisions had even been made) as I was working to adapt my tastes to more and more nutritionally dense foods. I have largely succeeded on that front, though could never get the meal sizes required for satiety down - hence the VSG for me. Certainly you can have a 4 oz piece of meat, or a couple of slices of deli meat for lunches. Add some veg on the side to taste - I often have a couple ounces each of carrot sticks and grape tomato. Some salads to go along with that, or with the meat mixed in a la chicken caesar or southwest style salads. 2-3 oz of meat at a sitting will be your typical post-op capacity. Post-op I frequently have small southwest style salads with a couple ounces of leftover meat flavored with BBQ sauce mixed into some chopped spinach, green onions, peppers, tomatos, avo, etc.., some grated cheese and a little dressing, while dinner is usually some 3ish oz of freshly cooked meat with a token amount of veg on the side or mixed in (like a stir fry or meat heavy stew.) You should certainly experiment with different Protein shakes, pre-made and/or powders depending upon your lifestyle needs, to find the ones that you like - the highest protein/lowest carb drink that your surgeon may recommend is useless if you can't stand drinking it. I have played with the powders for years mixing and matching them to my taste and as different products go on and off the market. I find the EAS powders my choice at the moment, sometimes with some leftover Muscle Milk mixed in, as it has a fairly delicate flavor (at least the chocolate variety does) and minimal "protein drink" taste, that can be enhanced with unsweetened cocoa powder or SF chocolate syrup to taste. You should also try out yogurts (preferrably greek yogurt, as that has about double the protein as regular yogurt) and find one, or a blend, that you like/can tolerate. I don't like the plain yogurts, but find that a blend of plain with some sweetened vanilla yogurt (I'm running a 3-1 ratio now) with a little vanilla extract and maybe a bit of Splenda added in suits me fine now - enough sweetness for my taste without being overly sweet, and not noticably artificial in flavor. A little bit of jam mixed into plain yogurt works well too, and is a lot less costly on the calorie/carb front than the commercially sweetened yogurts. SF instant pudding mixes can be protein enhanced by adding Protein Powder to the mix, and I usually replace a cup of the milk in the mix with a cup of greek yogurt to the mix instead for added protein and better texture. Good luck with it all, it is worth the trip!

There's lots of hope in your case - the ultra low carb diet that many surgeons use in their VSG programs is the same thing that is often prescribed as the first line of defense against pre-diabetes/metabolic syndrome/insulin resistance. My brother in law was diagnosed with pre-diabetes a few years ago and that was his doc's prescription (he has been somewhat overweight, but not obese.) He was restricted to 30g carb per day for several months (had to give up his favorite wines for that time) until his numbers corrected, and was then allowed to increase his intake into the 100ish g range to maintain things. He was able to add back his beloved wine, but otherwise he sticks to mostly meats and veg with lesser amounts of fruits and whole grains and that is working well. For much of this year he had to give that up to adopt a "Wonder Bread" diet where he had to avoid the whole grains and fiberous veg and fruits for another health issue and he felt like total crap. He's glad to be back to his normal healthy carb diet now, and looking forward to losing the 20lb he gained on the white food diet. With your family history, there certainly is cause for concern, but also good hope if you can maintain a healthy diet appropriate to the problem along with the VSG weight loss. The good news is that if you can maintain that good anti-diabetes diet, that should also help to maintain your weight in the long term, and that is probably the biggest challenge to most restrictive WLS patients in the long term.

My program does not specify a particular caloric goal, either, just the basic protein goals that all programs have (or should have.) Some programs state a blanket 6-800 calorie goal for everyone which is certainly a good minimum to provide something approaching tolerable nutrition during the weight loss phase, The protein is essential as you body has no other way of getting the basic amino acids (the building blocks of the proteins) while carbs/sugars it can convert from you fat stores (and protein/muscle if you are really active and demanding upon your body,) while there is almost no end to the fat that we have on board! Most of the essential vitamins and minerals we can get from supplements during this phase when we are malnourishing ourselves, tho long term we do need to get back to (or adopt if we weren't there before) a well balanced diet to maintain ourselves with a minimum of supplements as real food sources tend to be better than artificial ones in most cases. If you can be satisfied in the 6-800 calorie range, that seems to be a good range to live in for this time, though many do well at somewhat higher levels depending upon their weight loss goals (need for high caloric deficits,) activity/exercise levels and individual metabolic rates. Even early on I was running in the 900-1000 cal per day range as a comfortable level and I have allowed that to creep up to around 1100 as I have added more balanced nutrition to my diet, but I'm working on the last 20lb towards goal at five months out, so I have more margin to play with than someone who still has 100lb to go. Carb goals vary by program - some are dedicated low carb while others emphasize more balanced nutrition avoiding the simple sugars and otherwise empty calories (junk food). I don't control to either fat nor carb grams but to overall caloric intake as it is the basic caloric deficit (calories burned minus calories consumed) that drive the weight loss; other factors like the low carb/ketosis game that is popular these days are minor in comparison (though if one has diabetic issues, the low carb diet of 30ish g is often prescribed for that on a temporary basis, irrespective weight loss concerns.) If you keep the calories and protein in check, the rest will tend to work out reasonably well during this phase. I am typically running about 80-90g carbs (still low for the calories on a classic balanced nutrition basis, but the protein emphasis that we have skews things some,) with about 35g fat and 10g sat fats; most of the basic and essential nutrients are at satisfactory levels except for potassium which is hard to get enough in with our limited volume (and even harder if one is carb restricted) and near impossible to supplement without prescription but that's being monitored.

It's a big variable depending upon a lot of individual factors, including how heavy you are at the start, your caloric intake, your exercise levels and basic metabolic rates. Of course, you will lose more quickly at the beginning than later. You may even gain some when you are in the hospital from all the fluids they pump into you, but that comes off in a couple of days. Not including the 5lb of Fluid gain I got in the hospital, I lost a little over 8 lb per week the first three weeks (from a total of about 100 that I need to lose,) which then slowed to 4-5 lb per week, and is now down to around 2-3 per week at 20lb to goal. The first 2-3 weeks your loss typically comes from your ready store of reserve carbs and Protein, coming off at a rate of about 2000 calories per pound; after that (and maybe after the dreaded third week stall,) you start buring mostly fat, but at the lower rate of about 3500 calories per pound. I didn't have a significant third week stall as many do, but there was a definite slowing ot the loss rate at that point which correlates well with the physiology of weight loss progression.

I routinly use a body comp scale but will do a hydrostatic (dunking) or bodpod when I get into my goal range as a comparison. I would take any of these measurements with a few grains (or even kilos) of salt after massive weight loss, including the caliper measurements. The all take measurments and then compare them to some population norms to arrive at their composition figures, and that is fine if you are, say, 190 lb having gained some over time from an ideal weight of 160; however if you are that same person at 190 but who is down from 350, your body compostion is different than in the first case - you probably have some amount of excess skin hanging around that the population norms don't adequately account for. I did a dunking a few years ago after losing about 50 lb from my high weight over 2-3 years (but was still a BMI of maybe 36 or so.) The test came back as a BF% of about 34, which correlated well with our Tanita body comp scale. However, my wife had the same test done after losing around 200lb from her DS and she was also reading about a 34% BF from the dunking, versus a mid 20s BF% on the Tanita. There is no way that she had enough fat on her to be 34% (though women are normally higher BF% than men, she doesn't/didn't have much fat in the areas where normally healthy women carry their fat, so it is likely that the Tanita was a more accurate reading in her case. It seems that when taking the volume measurement (the Water, or air in the bodpod, displacement measurement) that the excess skin is treated more like fat than lean mass despite that skin being mostly lean tissue) I want to get her checked again now that she has had reconstruction and has lost most of that hanging excess to see how well the numbers correlate. This is certainly something to ask if you can find someone who is very knowledgeable and experienced with this testing that may have some insight into this - the techs that usually do the tests tend to know little more than how to operate the machine. A physical trainer who has good experience with rapid weight loss patients may have some insight into how to correct the caliper readings for our case that a typical gym PT wouldn't have. Is the engineer in me who is always suspicious of measurements showing through? (LOL) In any case, we are getting healthier, and it's good to get some different measures of how our bodies are improving, but shouldn't agonize over the numbers too much.