RickM

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.

My goal weight is based on body composition, aiming to get to 15% body fat, which is on the lean side of normal for men (or middle of the "fitness" range on some charts) but still short of the athletic range. For me, that currently works out to about 190 (22 more to go!) which would still make me "overweight" on the BMI scale at 27, but as noted, BMI is fairly meaningless on an individual basis.

As noted, check with your doctors - surgeon and/or PCP and any med concerns. Were you given any post-op instructions by the surgeon or the hospital? That said, Prilosec/omeprazole otc twice a day is what I am on; I periodically drop one of them for a couple days to check progress.

I was starting to play with small southwest style salads (leftover meat w BBQ sauce tossed into chopped spinach, grape tomato, avo, pepper, green onion, carrot & cheese) around the end of the third week, and I still have them for lunch frequently. Tolerances and progression varies with us all, but it's worth a try; I was cleared to add veg at the 10 day mark since I was getting in more than the requisite Protein, so I could tolerate dropping the meat content of the meal in exchange for the veg. If you're still having problems with protein, that should still be your priority, but adding some variety to the protein may be a help. My program's general advice is to experiment with one new food at a time to test tolerance and if something doesn't feel right, try again in a couple weeks. Good luck with it all, and have fun (hopefully) exploring these new things.

Are you allowed the SF puddings at this point? I cant take the plain unsweetened yogurts either, but do make them mildly sweetened by mixing sweetened and unsweetened with some vanilla, but that would seem to be off your doc's menu as well. On the pudding front, if that is allowed, I mix some of the plain greek yogurt into it in place of one of the cups of milk. Add in a scoop of Protein powder and I get about 11g protein in a 4 oz serving, no obvious Protein Powder taste and only a mild tarting up from the yogurt. But, yes, it does sound like a death sentence - I can understand the no added fruit at an early stage if they're worried about seeds or skins going thru, but they must be anally no-carb to sacrifice your protein intake for the sake of a few grams of sugar at such an early stage; it makes no sense from a structural perspective. Good luck, and I hope you make it off death row soon!

I would certainly look for a surgeon experienced with the procedure that best fits you - don't fit yourself around the surgeon's desires or experience. I'm not sure about the numbers of surgeons experienced at what level, or where the numbers come from (ObesityHelp has some of that data, though I don't know how accurate or up to date it is.) Widening the field a bit is the fact that the DS has been around for quite a while and that is a VSG plus intestinal re-routing, so I would count DS experience in favor of a surgeon. My doc is listed on OH as having done about 90 VSGs but well over 1000 DSs, so he is well up the learning curve on it.

I would second that - the fat shrinks along with everywhere else, but there is still some skin sag (along with other places), so the locker room appearance may not have changed a lot, but there is more practical "reach" there now, just as there was when my wife lost her pubic pad after her surgery a few years ago. I expect that I will need to have a bit of tightening done when this is all over and that would get picked up along with the ab region.