RickM

From what I have seen, you may or may not be off of insulin and meds immediately - I think your surgeon is just being optimistic and won't actually discharge you without verifying your status. My wife was diabetic, just short of being insulin dependent and under treatment for it for around twenty years, and it took her the better part of a year to be fully off all of diabetic meds. The surgeon explained that generally, the longer one has been under treatment, the longer it takes to get off of the meds, though there are some long term diabetics who leave the hospital free of all meds, even with just a sleeve or RNY rather than the stronger DS. Her diabetes is still in remission 15-16 years later, despite some subsequent regain and losses. A few years ago, we talked to a woman in our support group who had an RNY some twenty years prior, and now her diabetes was coming out of remission with only some moderate regain, so she was in line to get that revised into a DS to knock it out for good. So, it is still very much worth getting the surgery even if you don't immediately go into remission. Note that I am referring to the "traditional" BPD/DS, which is known to have a 98-99% success rate with T2 diabetes, rather than the simplified SIPS/SADI/"Loop DS", which is not as well established.

Our program didn't have an RD at the time, so I was mostly winging it by reading and using common sense *what we know we should be doing, dietwise.) I did consult a couple of times with a fitness oriented RD that was associated with our PCP who did give some useful advice, combining my needs, her experience and the surgeon's program guides. One of the good reads that I found were some books by Dr. Michael Colgan, who is a sports nutritionist. Particularly useful is his Sports Nutrition Guide (All New! - as of twenty years ago, but nutrition science hasn't changed that much over time, only "diet science" changes with the fads.) A nice part of it is that he has a chapter 3-4 pages typically) dedicated to each micronutrient, what it does, where do we get it from, and what are the appropriate levels we need, often with comments about how specific activities may require more of this or that nutrient than average. These are quite distinct from the RDAs that we normally see published which are typically oriented toward avoiding deficiency disease rather than optimum function. He may have a newer edition (mine is published in 2002) or a follow on title - he doesn't seem to be afraid to change his views as newer validated science comes along. Check Amazon to see what's newer.) He also has a short booklet on "The Right Protein for Muscle and Strength" that is also useful, and may be a good counterpoint to some of the more promotional sources found in magazines pushing supplements.. Sorry, I don't have any particular online sources, but there are a couple of other guys on here who are more into that who may chime in on this. there is a popular notion that we see that it is impossible to build muscle mass while in the deficit required for weight loss. I don't like like words like "never" and "impossible" but I do find that it is very unlikely to do so - minimizing muscle loss during the loss phase is usually the best that can be hoped for, and then rebuilding. We did have a retired NFL guy in our doc's group who may have done that - if anyone can he would as he already knew on a professional level how to do that kind of workout (he just hated it and was glad he didn't have to do it anymore once he retired - that's why he ballooned to 500 lb and realized it was still part of his job! Got himself down to a 4% BF before letting himself go, and crept up to 6!) He also had the time to dedicate to doing as much work as he needed to, which most of us can't do. Good luck - it sounds like you are well on your way to good success. It may not be a direct route to where you want to go, but you can get there,

IIRC, I had some the day after getting out of the hospital as it was one of the things in the hotel breakfast bar to try that fit our plan. I'm not big on that type of thing but it was OK. I would expect that it would be on most any plan by this time, unless they are seriously carbophobic, but you can check with your team if in doubt, and it wasn't covered in your post op guidelines.

It likely depends upon where the hernia is. As noted, if it's a hiatal hernia, where the stomach is being pulled up through the abdominal wall, that will be repaired along with your WLS as they pretty much can't do one without the other. If it's elsewhere on the abdominal wall, then it may depend upon where it is and whether it's in the way of the WLS procedure; something like an umbilical hernia they will usually fix at the same time as they often cut through that area to do the WLS. If it's elsewhere on the abdominal wall that's not directly in their way, then they may or may not fix it; from what I have seen, they will usually fix it even if it's not directly in their way to avoid putting you through the stress of another anesthesia event and recovery. I would certainly prefer to get both done at the same time, but there may be extenuating circumstances as to why that isn't appropriate in your case, or it may just be your surgeon's preference (does he get paid more by doing two procedures?) If you have the opportunity in your health system, I would get a second opinion on it from a different surgeon - maybe he agrees with the first (ideally) or maybe he has a better idea, or doesn't have a problem doing both at once.

There is your key right there - whenever you see very rapid weight change, there is going to be a lot of water weight involved. Indeed, most of our initial loss is concentrated on water weight (it is associated with the glycogen/carbohydrate that we burn off initially,) and then we tend to pause to let things catch up before changing gears to start burning our fat reserves. We may just have a stall and not lose anything for a few days, or week or two, and we may even gain a bit as things stabilize. But they will stabilize and you will start losing again, albeit at a somewhat lower rate than before - expect that - as then you will be primarily burning your fat stores, which burn more slowly (on the order of 3500 calories per pound, versus around 2000 calories per pound when we are in that initial glycogen depleting state.)

Let the surgeon's office handle it, as it was their judgement that you needed to be there an additional day. That happens all the time - there are minor complications, or the patient isn't quite ready to be discharged so they are kept an additional day. I was only scheduled to be there one day but it turned into two; my wife had an outpatient orthopedic surgery but was kept overnight as she wasn't ready to be discharged on the original schedule. The insurance works it out with the doctors.

Things like veggie burgers, tuna and some other seafood items (usually start out with tuna salad or other mushified or lubed up version,) refried beans, etc. were on our first month diet, so it's not that far out of line - dietary progressions do seem to be accelerating some over time as different programs learn what people can actually tolerate - it's a lot more art and experience than science. Doc was adding more veg into my diet at day 10 as my protein intake was more than adequate. It's a big YMMV thing, which is why we see some programs that may still have their patients on liquids while others have theirs on steak. A bit of surgeon's personal philosophy in there as well, I suspect, as some may treat everyone cookie cutter style, forcing all to work to the lowest common denominator (one patient had problems with soiidish food at four weeks, so all must avoid that until everyone can progress together) while others are content and confident enough to allow more individuality, recognizing that patients' tolerances can vary widely. So, if you are working within your program's boundaries, all is good as long as your are tolerating things well. A couple ounces of the softish meats that are permitted at this point is not unreasonable - some may not be able to have that much yet, and others will have no problems. Likewise the veg, half a cup may or may not be too much depending upon what it is and how an individual gets along with that. Some things are more slider-ish than others, and go through with little problem, I suspect that what is considered to be "soft" even if we perceive them to be fairly solid, like a veggie burger, has more to do with how it is processed in the stomach (or not needing much processing) than how "solid" it may seem before we eat it. Most of the things in this 'soft" phase are things that usually go through fairly easily; this also means that we may be able to eat a bit more of them than we would "real" solid food like a tougher steak or pork that has to sit in the stomach for a while being processed before it is let through.

There are a lot of magical properties ascribed to IF, but from a weight loss perspective, it is a convenient way to reduce the amount of calories that you consume in a day, if you don't overcompensate by loading all of your normally consumed calories into that reduced time slot. It's much the same with any of the other popular diets over the years - cut out fats, that's a lot of calories; cut out carbohydrates, that's a lot of calories. It all comes to an end when you learn to adapt and start consuming as many calories as you were before when you were gaining.

Many don't do a pre-op diet (ours didn't) as they don't feel it provides them, or the patient, any benefit. It only seems here, online, that they are a standard practice as they are so objectionable (particularly the all liquid ones that some docs impose) that it's all people can talk about - those who don't have them have nothing to complain about so they don't post about it.

Another approach to weaning off of the PPIs (in addition to, or an alternate to the simple cutting the doses or spacing them out more is to substitute doses with an H2I class drug such as Pepcid or Zantac, or their OTC generic equivalents. They are considered a friendlier class of drug and preferred for longer term use if they do the job (they usually don't last as long.) Talk to your surgeon, but taking a Pepcid on the "off" days of Prilosec will probably remove the minor symptoms that you are feeling, then you can move on to completely substituting the Pepcid for the Prilosec, and if that works, try cutting that out, too. Just an common alternate approach that is a bit more conservative than simply cutting back the PPI dose by itself.

The third week stall that is so common signals a change in your weight loss character, from the initial loss which comes primarily from glycogen (short term reserves of stored carbohydrate) and the associated water weight to the longer term draw from our fat reserves once the glycogen has been depleted. This can take some time to shift gears (and sometimes very little.) I, too, never had a third week stall, but there was certainly a slow down in loss rate right at the three week mark (fat burns more slowly than glycogen/carbohydrate, on the order of the classic 3500 calories per pound vs. around 2000 calories per pound.) My only real stall (a week without loss, by my definition) was at about four months for a week, when I was travelling, so it was possibly a result of increased sodium intake from eating out more (I usually would gain 2-4 lb on those trips, which would dissipate within a week - classic water weight.) Why didn't we stall and others did? It might be random chance, or it might be that our metabolisms are still fairly robust, or maybe diet is not a low in carbohydrate as many maintain, so the glycogen reserves were able to more quickly return to a functional level. Whatever the cause, enjoy the ride!

Assuming that you are not anemic - iron and B12 levels OK - then another thing to consider is your basic diet and compatibility with your activities. When I was about four months out, I was routinely hitting a wall after about an hour in the pool. Working with my RD, we rejiggered my diet to provide a meal/snack ahead of the workout that was relatively high in complex carbohydrates, moderate in protein and low to moderate in fats (this is a fairly common pre-exercise suggestion.) For me, that worked out to be a small meat and cheese sandwich on whole grain bread. That made all the difference, and I never had a problem with that again. My diet before was not specifically low carb (was never into the fad diet game,) but with the small amount that we are eating during this phase, we will by default be low carb and low fat. But timing the intake appropriately, concentrating on what the body needs when, can make a difference when our activity levels are variable through the day. Check with your surgeon or dietician for other possible suggestions.

It really has nothing at all to do with what phase you are in - liquids, mushes, solids, etc., as the same general timing of loss progression happens even for those of us who never had a liquid phase. Do a search for the "three (or third) week stall" and you will see that most everyone has this problem at around this time. The majority of the weight that we are losing initially is water weight as that is associated with the glycogen (basically carbohydrate stores) that we are burning at first. Once that is depleted, there is usually a pause, and often a pound or two of water weight moves around as your body attempts to restore some of its glycogen reserves as it moves into burning you fat reserves in the longer term. There may also be some hormonal effects that play into this as well, but this is completely normal. The important thing is your loss trend week to week and month to month (which will be declining overall, but usually at a decreasing rate over time.) Day to day, it's anyone's guess and often completely random as to what you might see on the scale, so don't sweat that.

Did I try blended foods a bit early? Yes, and no. Yes, in that I did work with blended foods - strained, and not so strained, soups, and lumpier things, in that time frame, but no, as in it was not early - it was part of our normal progression to try those things from the first week out, if we could tolerate them (scrambled eggs, yogurt, pureed anything in the hospital, for that matter.) The key rule was to try new things one at a time to test for tolerance, as one may or may not be ready for it. Things like tuna salad were on our menu for the entire first month as part of the transition to all other "real" foods in the second month. And one mushy or pureed item may go down better than another, so one "failure" doesn't necessarily doom an entire class of foods. If something doesn't work, go back to familiar things and try it again in a week or two. Go easy on it, but don't fret about having damaged something if you aren't feeling anything off.

Our weight loss tends to be "front loaded" with a chunk of water weight loss when we first start a major weight loss effort (figure 10-15 lb) Most people who have a pre-op diet will see that big drop when they start it; those who don't have pre-op diet will see that big drop soon after surgery; those, while those who lost it during a pre-op diet are often disappointed that they don't see a bigger loss immediately post-op. If you are doing an earlier diet than the week or two diet that many surgeons impose, then you will likely see that big drop when you start that, but less, if any, when you start the formal pre-op diet a week or two before surgery. And, you are right, that if if were easy for you to lose, you wouldn't need the surgery, yet some, but certainly not all or even most, surgeons have this type of requirement lose X lb or % before surgery, or at least threaten to do so (guess they think that it is in incentive for you to "try your best". Good luck,

The main thing that I can think of would be improvement in diabetes issues, as eyesight is one of the things influenced by diabetes. If you were diabetic pre-op, whether you knew it or not, better blood sugar control improves your eyesight. When my wife was first diagnosed and got under medication for it, she had just had new glasses made and they were near useless afterward. I never experienced any notable vision changes after surgery, though I was specifically not diabetic before or after, nor was I under any vision care, so that was subjective observation rather than objective measurement.

Here is a good reference that I like to use - You don't need to follow his dietary guidelines, but I do find that his progression on meal volume over time is consistent with my experience. In short, some increase in volume capacity is to be expected and is normal. Call it stretching, adaptive growth (the body will adapt to the changes that surgery has imposed upon it, like it or not) or a more varied diet that includes more slippery foods that move through rather than stay in the stomach, or more likely, a combination of all three. On the volume vs. weight issue - a basic physics lesson to start with. When measuring water, an ounce of volume weighs an ounce - that is a definition and is the basis of our measurement system (similarly, a ml or cc of water weighs a gram in the metric/SI system. Most of our food is mostly water (as indeed, we are,) so on average, an ounce of food by volume will weigh about an ounce, give or take maybe 20%, and over the different components of a meal meat, fruit, veg, starch, etc. - should about average out to about one for one. Another consideration is that the important thing to your stomach is what the volume is when it hits your stomach, not when you put it into your mouth before you chew it and soak it in saliva. Once that is done, you have a blob (bolus) hitting your stomach that will be about, wait for it..... and ounce of volume that weighs about an ounce. This really saves you from agonizing over how to measure a cup of spinach - how big a leaf, chopped or whole leaf, how finely chopped, how densely packed into the cup...? Dr Weiner in the video above notes that we ultimately, on average, will be able to consume in a meal about half of what we could before surgery which is consistent with my experience ten years out, and in looking at others whom we dine with in our support group (pre Covid) who are all in the 10-20 year out range, and most every one is taking something home or leaving it on their plate, so some increased volume is normal. The tricky part is keeping your caloric intake steady as this volume increases over time - you still need to keep it at 1200,1500, 2000 calories - whatever level keeps your weight stable.

You can worry about it, but it won't do any good - you will or won't get it to whatever degree that you will. On the positive side, you are young, so elasticity should still be good and things haven't been stretched out for as long as with most of us. You are also "only moderately" morbidly obese, so things haven't likely stretched out as far as someone who was a BMI 50-60 or more. So, there is good hope that things will not be bad in that regard, though you will probably not be left with a perfect bikini bod without some work.

Odd things like this are not uncommon for a while - it can be diarrhea or constipation, or some of both like I had (once it got past the blockage, it was runny...) Liquid in - liquid out is a common cause for diarrhea, which resolves as the diet gets more solid; constipation can be holdover from narcotic pain relievers, and later on from being on a low carb, low fiber diet. Add into this the simple dietary changes that you are going through, which is often incompatible with your gut flora - all those nice bacteria in your gut that helps digest your food, may now be the wrong ones for your new diet and need to adapt - probiotics can help with that transition. It does get better, good luck and hoping that it is a quick transition for you

The patches seem to work well for some, and not at all for others. All one can do it try them and see how your labs come out. In the spirit of minimizing variables during a time of major changes after surgery< I would be inclined to stick with normal oral supplements until establishing how much of what is needed in your particular case, and then trying the patch to see how they work for you in comparison. But that's just me and my test geek brain.

This is a good heads up, thanks. This can sometimes even apply to our supplements. A few years ago, our surgeons practice was seeing a few patients with B6 toxicity. It urns out that the Costco branded calcium citrate has B6 in it along with a few other things beyond the normal D3 and sometimes mag. Taken as a normal person once a day, that's no big deal, but along with B6 in a multivitamin (often at multiples of RDA) and taken in bariatric quantities of 2 or 3 doses per day, it was going over the toxic levels. Some may also occasionally run into acetaminophen toxicity, with the inability to use NSAIDs with some procedures they can overdose the Tylenol since it is OTC and therefore "safe". Funny things can happen!

No, there unfortunately there is no single one a day vitamin that fits all our needs. Depending upon what procedure you are getting, you will need to do more or less of the vitamin game. The VSG is the most benign with the fewest requirements, with the RNY being fussier, and the DS fussier still. The main driver for most of this is that Calcium and Iron compete for the same sites to be absorbed in the intestine, so they need to be spaced out, typically at least two hours apart. Further, Calcium is limited to absorbing only around 600mg at a time, so if you need to supplement with 1500mg, that's three different doses spaced out. Plus iron at a different time (though that can be taken with your multivitamin if that doesn't contain calcium, or you can take a calcium dose with the multi if it does. At thee beginning, we all need to be taking vitamins at different times through the day as we aren't getting much nutrition from food - protein is the emphasis for a while as there is no pill for that. Over time, as we can eat more, we usually can simplify the supplement regimen as we get more nutrition from our food, assuming one is eating nutritionally. For my VSG, I take pills twice a day, mostly drugs. i take a multivitamin, mostly to fill in any gaps in obscure vitamins that I may be a bit short on in diet - I have cut that back to every other day with out ill effect on my labs, but the labs don't cover everything, so I just go with one a day for convenience as other pills are already being taken. I target 2000mg a day for calcium, for which I only need one supplement dose per day to attain. Iron is a twice a week thing, and maybe less (see how levels are this month and maybe drop it entirely.) An RNY malabsorbs minerals as part of its character, so they usually need to do more with the iron and calcium supplement, and some also take two multivitamins a day; B12 is usually needed as they don't absorb that well, either, In either case, the RNY or VSG, longer term it comes down to what your labs tell you that you need, and people will vary on that - even without WLS, people vary on their needs (my wife is chronically low on potassium, which has nothing to do with her WLS, it's just her.) The DS has a similar level of supplement fussiness, though it is somewhat different in what is needed. In short, get used to it, at least for a while. And if complying with these needs is going to be a problem for you (you know your personality best,) consider that in which procedure you choose. I know one gal in our support group who had to have her DS revised back to a VSG because she was just incapable of keeping up with its' nutritional demands and was suffering as a result. Good luck,

The DS is certainly the preferred solution for bile reflux problems - it's about a sure a fix as you can find. assuming that you have a surgeon who knows how to do it. Looking at the anatomy, and you see that bile has to go many feet down the inactive (non food) channel before it gets to the common channel where it and the pancreatic enzymes, mix with the food, and it would have to move many feet back upstream against the food flow to reflux into the stomach. The bypass is a less certain fix as the pyloric valve has been removed and the pouch moved just downstream of the bile ducts, but it usually isn't a problem if they make the roux limb long enough (sometimes in non-WLS variants of the procedure where they make the limbs shorter to minimize weight loss, bile reflux is a real problem.) As the DS uses the same sleeve that you started with, or maybe a resleeved version, it doesn't usually help with acid reflux, unless the original sleeve was poorly made (it happens, though not too often with a DS surgeon who knows how to make their sleeves.) Virgin DS's tend to be somewhat better on this than the VSG as they usually use a larger sleeve that is less prone to reflux problems. In short, you got the best procedure available for your bile problem - be happy.

There are also lower volume preps available that don't require you to drink a gallon like some do. Talk to the doctor about it and your special needs as a WLS patient.

Quite possibly more than calories, is what those calories are (what is your average calorie count these days?) Since you are already taking B12, that's not likely it (B12 is more of an RNY thing than a VSG thing, but some can be intrinsically low it irrespective, or just diet is low in it for now, though most multivitamins have enough to do the job.) Overly low carbohydrates are frequently a cause of low energy in the absence of other anemia indicators, as that is where our quick energy comes from. It is what helps us chase down that antelope for dinner, or quickly climb a tree to avoid being a lion's dinner (hoping it's not a leopard chasing us!) We typically burn off our glycogen reserves (basically stored carb, held mostly in the muscle tissues) and the water that keeps it in solution first,, usually in the first couple of weeks or so, and then pause while we start to access our fat reserves to rebuild the glycogen back to a functional level - hence the typical rapid weight loss followed by the "three week stall". You may well still be trying to rebuild your glycogen stores to get you that everyday energy that you are expecting. I have seen some programs that specifically want their patients to do a bit of lightweight "carb loading" after surgery to counter this problem - things like oatmeal, cream of wheat, sloppy mashed potatoes, unsweetened apple sauce, watered down fruit juice, etc. I never had consistent energy problems as you describe, though I did run out of gas more quickly for a while - afternoon naps in the first 2-3 weeks were common and my bedtime shifted an hour or so earlier (my circadian rhythm has stayed shifted by an hour or so ever since - about an hour earlier to bed and hour earlier to get up,) but even within the first week I was outpacing my wife on our walks (granted, not a real high bar, but still....) I was back at the gym within the first 2-3 weeks, mostly to keep my wife in the habit, I basically just walked on the treadmill or did some gentle bike or elliptical work to explore range of motion, but moderate energy was there. I was up into the 900-1000 calorie range within the first couple of weeks, and the doc was adding more veg to the diet as my protein was satisfactory at 90+. I wasn't specifically carb loading, but neither was I avoiding them - just eating as healthy as possible within the limitations. Later, however, after about four months I was running into an energy wall after about an hour in the pool, and after consulting with the RD on it and added some complex carb ahead of my gym time, I found that a simple piece of toast made all the difference in breaking through that wall. So simple things can make a difference.