RickM

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.

There are a couple of issues that need careful consideration and research as relates to diabetes and WLS. The intestinal rerouting procedures, the RNY and DS, have long showed very good type 2 diabetes resolution, on the order of 95-98% for the DS, somewhat less for the RNY. It is thought that there is something about the metabolic changes that come from the intestinal work is the reason, but the exact mechanism is not fully understood, though at the time of my wife's WLS a few years ago it was thought to be improved inflammatory response stemming from the metabolic changes from the intestinal work. The VSG is also showing very good results as well, though I haven't seen comparative numbers. This is why a lot of surgeons recommend the RNY (and\or the DS if they are qualified on it) for their diabetic patients. The other consideration is that there is often a connection between how severe the diabetes is (how long since initial diagnosis and/or amount of intervention required to control it) and how long it takes after surgery to resolve itself. My wife was type 2 diabetic who had been treated for about 20 years when she had her DS a few years ago, and she was just short of needing insulin injections - medication cocktails were near the end of their effectiveness in controlling it in her and it took 6-8 months to resolve in her case; we know of others who were on insulin and meds where it took around a year to fully resolve and be off of all meds with the DS. The impression that I am getting from these forums is that the more recent or less severe cases are being successfully resolved with the VSG, but I haven't seen how successfully the more severe cases such as yours are being resolved. I would certainly want to see good concrete evidence that these more severe cases are being successfully treated with this procedure before committing to it - maybe you have found some that points in that direction (that was not a focus of my research leading to my VSG as it is not an issue with me,) and that should provide reinforcement for your decision. Hopefully we will get some more people chiming in here that have experiences close to yours that can help. The good news here (or at least semi-good news) is that should the VSG not work for you, it is fairly straightforward to revise it to a DS (as the DS starts with a VSG in the first place) which has shown a very good success rate in this area. None of us here are keen on the intestinal changes involved (or we wouldn't be here on a VSG board) but that may be what is necessary to solve your problem. Hopefully your case can be resolved with the simpler step of the VSG, but it would be well to giving some thought to where you want to go if it is not. Good luck in your journey,

At 5'10, I was 292lb for surgery in early May and am 210 today heading to a goal of about 190 (15% body fat or lean side of normal for men,) and could probably do a "normal" BMI weight of 160-170ish if I wanted to be unhealthily skinny. Definitely a do-able do.

I had plantar fasciitis a number of years ago, and the orthopod I saw was one who firmly believed in pursuing simple and cheap solutions before getting into more expensive and invasive procedures. I was on basic anti-inflammatories, icing and exercise as the primary therapy, Before getting into custom orthotics he sent me down the street to a running gear store, which is primarily shoes (not your local WalMart or mall Footlocker!) These guys, being runners and into foot pain (!) they knew the ins and outs of living with these types of injures and finding shoes that fit correctly. They could look at how I walked and how my shoes were wearing along with the shape of my arches to fit me up with off the shelf shoes that worked. They were well worth paying full retail for their advice versus going to the discount store where you shop by brand name and color. I can't help you much on the steroid front, but since it's only for a couple of weeks, I can't see that it would put you too far behind your weight loss curve, particularly if you can stay fairly close to your normal calorie targets. Good luck with it - I can feel (or at least have felt,) your pain!

It does happen sometimes, though it doesn't seem to be as common with the sleeve as with the intestinal rerouting procedures. It often resolves itself over time or may only partially resolve itself. My wife ran into that problem after her DS a few years ago, and it is better than it was initially, but the sensitivity is still there. Lactaid milk works fine for her. Others may use some of the other milk alternatives like almond or soy milk. On the Protein supplement front, whey isolate is lactose free - it is more expensive than standard whey Protein drinks so check the ingredients label - the more whey isolate the better. Some are 100% isolate (and they will usually brag about it on the front label, and usually also say that they are lactose free; others may state that they contain whey isolate, but only as part of their mix. Some of the blends that are mostly isolate with other whey mixed in may suit you fine depending upon how sensitive you are - my wife can tolerate small amounts of lactose, like when using standard milk in cooking if it's not the primary ingredient, so that's something to experiment with. Also, yogurt usually doesn't have lactose in it (or not very much) so is usually well tolerated. Good luck, and may it be temporary,

My Nutribase database lists 1/4 of a Domino's 12 inch thin crust cheese pizza as being 273 calories, 12g Protein, 31g carb, 4g sugar, 2g Fiber, 12g fat, 5g sat fat, 23mg cholesterol, 624IU Vit A, 225mg Calcium, 835mg sodium, 1mg Iron. That's about 28 sq inches compared to 16 for your 4x4 piece. Divide on thru for your homework assignment. Overall, not a terribly costly sometime treat.

As jinjin noted, if it's something that you're used to, that helps a lot, But this is certainly something to bring up with the surgeon's staff. As with many things involving the immediate postop period, there can be a wide variety of responses and outcomes. The best thing we can do is to hope for the best, but plan for the worst. Is there an alternate place with easier access where you can stay for a few days if things work out on the less rosy side - friends, relatives, hotel? It's always good to have a backup plan that you hopefully don't have to use.

For me the deli meats don't seem to be quite as solid as steak, chicken or pork but they are definitely restricted - more so than soft things like yogurt or more compressible things like fruits and veg. One slice of around 2 oz with a slice of cheese wrapped in it was filling enough early on while two are now quite filling. I don't use them so much anymore, five months out, as I usually have enough leftovers around to use for lunch and the odd breakfast when I'm not having turkey sausages or bacon, though I am starting to have open faced sandwiches sometimes, with some ham and cheese toasted on whole grain bread when I need a minor carb boost before a long workout (that's right, not all of the docs out there bow to the lo-carb god.) Like everything else, I'm balancing nutrition with calories on everything, though early on compromises are made to ensure enough protein gets in.

Sounds like a carbon copy of my experience at that time about 5 months ago - minimal pain, cutting back pain meds, good mobility considering, surg weight 292 with a initial goal of 200, since revised to 190 to accommodate body comp changes (currently about 212); though I gained about 5lb in the hospital from all the fluids - so you're ahead of my pace already! I hope it goes as smoothly for you as it has for me. Good luck.

I have used them on and off for a long time. The SF and regular varieties both have 5g protein in them (at least the two that I have on the shelf at the moment do,) so they really aren't a substitute for the protein powders, but I do mix them together to make a more palatable shake than just the protein powder itself (to me, at least). I don't need a real big protein boost. so substituting half a scoop of protein powder for half an envelope of IB is a reasonable compromise for me to get a little better nutritional profile that the blend provides. Half and half with a cup of skim milk still provides around 24g protein for when I need it. I've adopted the SF version since surgery - I'm not a carbophobe but the simple sugars should still be minimized and the 70 calorie difference can be put to better use - and for some reason, the SF version has more fiber than the regular (5g vs. 1g) which should be useful to most of us as it's hard to get enough fiber in with our limited intake.

That's right, 4+ 1/2 cup servings (or 4oz by weight by my measurements) - the extra scoops of protein powder adds a bit more volume than the basic package recipe, so you get a bonus half cup for the last serving. I've tried a couple of the eggface cake recipes and they work ok - texture isn't quite the same as real cake but they're a lot friendlier nutritionally. Certainly not a staple food but a nice treat (have a bit with the pudding!) and by my calculations around 70 cal and 4-5 g protein for a 1 oz piece (about a 1 inch cube). Not a big piece by pre-op standards, but a nice little munchie that can be tolerated in my daily calorie allotment.

Losing 10 lb in two weeks is a tall order, particularly if you have already been losing some in the months before. Those who report losing that much are either doing so during a longer pre-op diet/exercise program that many docs and insurance companies require, or they had no significant prior weight loss effort so that their 2 week program loss was their initial loss. It is not unusual to have a fairly large initial drop the first couple weeks of any kind of weight loss program. What happens is that most of the initial loss is from your limited stores of carbs and Protein, which lose at a rate of around 2000 calories per pound. After those first couple of weeks you will often experience a stall when your body realizes that something serious is going on starvationwise and works to adjust things before tapping your fat reserves, which then burn at a rate of around 3500 calories per pound, so your rate of loss slows some, but you are then burning mostly fat, which is the whole idea. You have likely already gotten into this fat burning mode from your efforts since June, so there really is nothing to worry about - things are going as they should. Also, don't be surprised to see some weight gain when you get home from the hospital - they are going to keep you well hydrated with that nice IV bag feeding your arm. I think I gained about five pounds during that time, but it comes off quickly in a couple of days as you literally pee the weight away! Good luck with it all - you already have a great start.

I start with the milk and mix in the Protein powder and any other flavorings (maybe a little vanilla extract to boost the vanilla a bit, or peppermint in the chocolate version). If I use greek yogurt in it, then I only use one cup of milk and one scoop of Protein Powder, otherwise it's two of each for the small box. Then the pudding mix goes in and mix for a couple minutes until it thickens. I normally do it all with a wire whisk, but a mixer should be workable too (it's just too much of a PITA for me to pull the mixer out, set it up and then clean it.) I find that the unjury powder doesn't like to mix quite as well as some other powders. When I first started playing with these things early post-op, I usually frapped the milk and powder in a blender first and then transferred it to a bowl to mix in the pudding mix. I got out of the habit of doing it that way (got lazy, I guess...) and just accepted that the texture of the Unjury puddings wasn't quite as good as some of the other versions, so that's something to consider if you have any problems getting them mixed well enough. And, I think that adding the yogurt helped on that texture front, too.

There is not a lot that one can do (outside of infomercials,) to target fat loss - it pretty much comes off in the same way it got put on. Walking, while still good for your circulaton, is probably not doing much for you anymore calorically; some docs don't count it as exercise after 2-3 months. I don't walk much anymore (at least as "exercise") simply because it has been too hot and boring around home. I still do when I travel to the central Cal coast where there are nice places to walk and hike, but I noticed somewhere in month 3-4 that when walking as fast as I could without breaking into a jog/run (which the knees still don't like) that I could barely get my heartrate over 100 while a couple months before a brisk walk would easily get it up into the 130 range where it should be for me for good cardio exercise (that typical 80% of max heartrate range.) This is something that can easily sneak up on you - it didn't "feel" like it was that much easier, but my cardio system could sure tell the difference! Swimming will still give me a good workout, but I do have to work harder at it than I used to. Weight/strength training should certainly be part of the program. Cardio exercise will burn fat while you're doing it, while increasing muscle mass burns fat all the time by way of increased metabolic rate. Strength training typically requires a day of rest between workouts, so I usually alternate days of strength and cardio, though one can also do strength work on your upper body one day and lower body the next - so a shorter session along with some cardio each day is workable too, and may be less boring. I typically swim for about an hour (or hike, up hill, both ways!) on those days that I do cardio and work the weights for an hour to an hour and a half, mostly concentrating on toning/endurance routines rather than outright muscle building as I already mostly have enough muscle but want to preserve what I have and build endurance to improve specific functions and activities. There may not be a lot you can do about the flabbiness that comes from the rapid weight loss - building some muscle underneath can help, but in most places there was a lot more fat than there will ever be muscle (particularly since muscle is denser than fat.) I don't think it is possible to build up one's abs enough to replace all the fat that was there! Unfortunately, a nip and tuck is what is usually called for to fix that problem for most of us. On the other end of the equation, how is your diet holding up - sticking close to original weight loss levels or has it been creeping up? Our metabolism and calorie burning ability slows as we lose weight, particularly if we lose a lot of muscle mass with the fat, at the same time as the exercise gets easier and burns less and our intake tends to increase as eating gets easier and we get more comfortable with things - sometimes we can lose that calorie deficit that drives the weight loss (which you realize may have been what happened to you in August - or it may have just been a stall.) Good luck with it - simply realizing that you have the problem is a big part of getting around it and continuing to your goal.

That's a great non-threatening answer. Another could be "when I can see my feet!" (Of course guys can use another long lost feature..,)

Nexium and Prilosec are close kissing cousins - when Prilosec was going off patent a few years ago, Nexium was created from it by making minimal changes to the molecule in order to patent it as a new drug. For the vast majority of people, Prilosec works just fine. The generic name is omeprazole and it is available over the counter in 20mg tablets for about $15 per 42 tablets at costco and a little more at other stores. 40mg tablets are available by prescription for around $30 for 60. I use the OTC omeprazole twice a day, though if it were a longer term thing I would look into using the prescription version once a day as that would be a bit cheaper.

Yes, I use the unflavored Unjury for the non-chocolate puddings, though to my taste the chocolate versions work better, being closer to "real" with less of the artificial tastes in it than the other flavors I have tried. But that's just me. My wife loves the tartness of plain yogurt, which I still cant take by itself, doesn't like it added to the pudding which I find to be a good complement. Go figure - as if we're individuals or something!

This may be a nutritional issue, as post-op we live on limited volume with a Protein emphasis and it's hard to maintain a reasonable balance; some programs compound the problem with intentional imbalances by going ultra lo-carb in an attempt to ramp up the weight loss, a debatable approach at best though useful in some cases. I have similar concerns to yours when I go out playing with the racecars - I can't afford any kind of lethargy or brainfade either. I work to maintain as much nutritional balance as I can within the caloric and protein restrictions we have, and haven't noticed any kind of problems in this regard (nor has anyone else noted them in me,) beyond the expected issues the first week or so when working off the anesthesia and pain meds. As suggested by others, discuss these concerns with your doc, both your surgeon and your PCP (particularly if he has experience with others in similar critical fields like the pilots,) and maybe a consult with a dietician to work out how best to keep yourself sharp through all of this. Working with the docs to adjust meds appropriately as you lose is also essential, particularly when things can change so quickly at the beginning. The surgery and the entire process is not a sentence to any particular problem; we are all individuals who respond somewhat differently to the initial surgical trauma, anesthesia, inital weight loss and resulting chemical imbalances in our bodies, dietary and med changes and it's next to impossible to tell ahead of time who will have what reaction to which change, if any at all. Stick close to your docs and dietician (if you have one) and if anything seems questionable, then question them on it - this whole process is far from standardized as there is quite a bit of variation between programs and surgical techniques used. Good luck with it all - long term it's a good move and hopefully the short and mid terms are fairly uneventful as they are with most of us.

I use the Bariatric Advantage chewable (as opposed to gummy or chewy) calcium - chocolate sorta flavor and a couple others I think; they're a bit chalky that some may object to, buy they are zero cal/carb. The rest I take as normal pills, and will probably go back the the standard Citracal calcium tablets when I run out the the chewable calcium, but then pills haven't been a problem for a while.

Peanut Butter is a good start, and you should be having it with those crackers you mention (preferably whole grain) - as with most vegetable Protein sources, peanut butter isn't a complete protein and needs to be complemented by something like whole grain bread to make it complete, carb counts notwithstanding -it's real hard to do both low carb and vegetable protein at the same time. The lunch meats are a good choice as well. I used to roll them up with cheese for a quickie (cheese really is an option, you can always have a little more meat instead for the protein,) though now I usually melt the cheese over the meat on a slice of whole grain bread when I need the extra carbs. I often have some turkey Breakfast sausages (about 15g protein for 3 links) or turkey bacon at about 6g protein per strip (at least the uncured bacon at Trader Joes, if they are in your area, are that high.) I cook up the whole package of either at one time and can then warm up what I need when i need them. I sometimes make a protein loaded SF pudding with one scoop of Protein powder per cup of milk - 10-11g protein per half cup. Greek yogurt may be tolerable if you mix it into the pudding instead of one cup of the milk and scoop of powder. Protein loaded Jello is another possible, though I got tired of that early on from overloading on it in the token clear and soft protein stages I was on, but that may appeal to you. Any leftover meats can be used for quick snack by themselves, or added to any salads or Soups you may buy to boost the protein content.