RickM

After a couple of weeks for things like tuna or dark chicken. It's a big YMMV thing for us all. Dark meat poultry usually works better than white meat - the extra fat helps it go down easier. High quality steak like filet often works better than ground beef, which is usually cheaper tougher cuts ground up. Seafood is usually considered easier than beef or poultry and is often considered a 'soft food', though it's not really my thing. Having it in soup or a sauce (aka, 'meat lube') usually makes it go down easier. Good luck, and it does get better, even if one is on the slower side of progress.

You need to look at what your company's policy bulletin specifically says - it should be posted somewhere on their website or you can call them (and hope the rep tells you the right thing!) The policy bulletin is the legal requirement that you and they have to follow. Your surgeon's insurance coordinator may be able to help as they know the lingo and how to read the policies. Typically, these insurance diets are to be medically supervised, which can mean your surgeon, PCP or an RD (dietician), and sometimes a structured program like Weight Watchers is acceptable - you need to see what the policy bulletin states. I used my PCP for my diet and that went through fine.

IIRC, Viactiv is based upon calcium carbonate, which is not as well absorbed as the preferred calcium citrate. Citracal used to have a citrate chew but dropped the product, though I think it got picked up by one of the bariatric vitamin companies (possibly Bariatric Advantage) I think that they also make a chewable tablet as well - I bought too big of a bucket of them and was using them long after I could use the regular horse pill calcium tablet. Some vitamin makers (Celebrate is one, IIRC) produce a petite calcium citrate tablet that's half the dose and size of a normal tablet that works well for many.

Most important thing - can you tolerate them, or preferably, like them? These things don't do any good if they just sit in your garage unused after you choke on the first one. see if you can buy one to try somewhere first (I never got along with any of the RTD drinks; just learned how to make the powdered ones the way I like them.

That is something that they liked to emphasize in our program, that it often works best to offset the lower quantity that we consume with better quality. My wife's doc even gave her a "prescription" for filet when she complained to him that ground beef wasn't settling too well. We still fill that Rx often, even after 13 years, And, it's almost a wash between a half pound of decent ground beef and a quarter pound of filet (almost).

I would want to coordinate between all three - including your bariatric surgeon to get his input. The rheumetologist may know of some other therapies that may help, but the bariatric guy will have the most experience regarding your stomach. Brief rundown on the history of NSAIDs and bariatrics: NSAIDs are a big NO-NO for the RNY as that procedure is predisposed to marginal ulcers and doesn't need any help from any other stomach irritants. Sleeve based procedures are more tolerant than the RNY but still probably somewhat more sensitive than the general population. Surgeons' opinions on this vary widely depending upon their experiences - many are very gunshy about NSAIDs given their experience with the bypass and relatively lesser experience (typically) with the sleeve, so they tend to lump all procedures together with a general "no" recommendation until they get more feedback on the sleeve. Some surgeons who were early adopters of the sleeve (primarily from the DS camp) are much more liberal in their allowance for NSAID use (our doc recommends them as soon post-op as narcotic pain relievers are no longer appropriate; others are somewhere in between.) Most docs are amenable to their use in limited cases, particularly with the sleeve, though I have seen some bypass docs suggest them in some specific cases, so you should get him in the loop on this. From what I have seen, as a none-MD, occasional use is usually OK, but for consistent use as in arthritis or other chronic orthopedic cases, something else is probably preferred. Even for non-WLS peeps, these are serious drugs (even if they are available OTC) and consistent use should be monitored by a physician.

Fullness sensations differ, and my not really be there, for a while after surgery as some nerves have been cut, stomach can be swollen and the normal bit of stretch that is normally detected to start signalling fullness may not be there. And, you often don't really feel "full" on liquidy things as they usually aren't staying in the stomach that long. Things return to semi-normal after a while but in the mean time, it is best to measure what you eat so that you don't overfill things. Your stomach is probably around 2 oz in nominal capacity, so stick with that for more solid foods; liquids and semi-liquids slide on through more easily so more can be consumed, but you have to experiment with it (I was able to sip through a bowl of broth, prob 6-8 oz - and a box of juice in a meal sitting in the hospital, while my wife could barely go through her nominal stomach size of 4 oz - both within normal expectations. Our overall program rule was to try new foods one at a time to test them for tolerance, and if they didn't settle well, then go back to what you know and try that food again in a week or two, then try another new food at the next meal, if desired.

If you are self pat, you really should have some kind of contract that spells out the costs and obligations on both sides - the insurance companies do that in their network contracts and it is reasonable to do so as a self pay patient. We self paid for my wife's DS and that was under an all inclusive contract that the surgeon had worked out with the hospital - all hospital and surgical fees including anesthesia and incidentals (no lingering bills for $10 Q-Tips, etc. and it seems that everyone down to, seemingly, the floor sweepers are independent contractors wanting to send you a separate bill.) Our contract also included a cost cap in the event of complications, covering additional surgeries and hospital days, if needed. As a self pay, you have the choice of dealing with any surgeon and hospital in the world; the surgeons are often more sensitive to this than hospital administrators, though I would expect in a city like Huntsville they would be more sensitive to competition than an a rural county with only one hospital. Talk to your surgeon about this. They are often on staff at multiple hospitals, and some hospitals are more accommodating than others. Good luck, and hope all works out...

I would go with what your research and feelings tells you is the best for you in the long term. The surgeries have different "personalities" that make them a better fit for some than others; get the wrong one for you and you can wind up dissatisfied with the results and headed for a revision. If you feel that you need the extra strength and regain resistance of the DS, then the RNY is not a substitute, and revising that to a DS is no simple matter (there are only a handful of surgeons around with the skills and experience to perform those. I have seen a couple of band to RNY to DS patients come through our support group and they obviously wished that they had done the DS in the first place (but didn't really know about it, or were persuaded by their surgeon to do the bypass since they didn't perform the DS. Since you are well aware of the DS and have the option available, you are in a good position to make a well informed choice as to what is likely best for your needs. Note that my wife has a DS (13+ years post op) so I know well it's ups and downs, and it was the right move for her. I went with the VSG as that better fit my needs, so it is an individual situation. If you have already decided on the DS, think about whether your long term needs would be overly compromised by going with what is more convenient in the short term.

Taste is a subjective thing, so one person's favorite may well gag you, and vice versa. If you know of something that you like, and can choke down the cost for a few weeks that you need it, that my be the best approach rather than trying and tossing ones that you don't like. 100% whey isolate is generally the preferred protein as it is the best absorbed, but also the most expensive; many brands use a whey blend or concentrate that is only partially isolate because it is cheaper; but if that is a brand that you like, it is better than the ideal that you won't use. At the moment, my wife and I use, when needed, the Optimum Nutrition (ON) Isolate, usually from Costco. It runs about $50 for 4lb, though sometimes on sale for $30-40 (like this month). Whether it meets your taste needs is up to you. I have never gotten along with any of the RTD drinks.

The bands by themselves on a normal stomach don't work well and tend to be complications in escrow - they go in easily and with minimal complications, but the complications (typically slippage and/or erosion) pile up over time. I haven't seen much about such complications with the BOB (band over bypass) but the overall success rate is fairly poor; likewise with the various stoma tightening procedures. Here is one bariatric surgeon's perspective on the value of various revisions: Check some of this other doc's videos on addressing regain problems - his solution may or may not be something that works for you, but it is something to think about and see if you can craft another approach that is to your liking. Your hunger is not likely to be much affected by the band, as there are no hormonal changes being made to address that issue. There may be some dietary tricks that can be done to reduce hunger (going back to the classic "protein first" bariatric diet is a start.) Have you seen an RD (registered dietician) to see what can be done on that front? That should be a first step before going into a revision. Another surgeon's perspective is that with a BOB, you are taking a failed surgery (your original RNY) and applying a high failure rate device (the band) and expecting great results - disappointment is the most likely result. Sorry.

Some heartburn or reflux is common for a while after the VSG, common enough that many/most surgeons prescribe a PPI such is Prilosec for a while after surgery. As you have seen, Tums only goes so far. An H2 inhibitor such as Zantac or Pepcid is better and works fine for us, and if that does the job for you, it is preferable to the PPIs as they seem to have a more benign history of longer term side effects. If Zantac/Pepcid up to twice a day doesn't do the job, then talk to your doc about a PPI.

While there will always be variations and exceptions, it is not unreasonable that much of the "outside" world has better food, at least from the perspective of being less processed and closer to the ground (as one of the docs on our network puts it, "eat dirt - that which grows in the dirt, or which eats what grows in the dirt, with as little detour through a factory as possible..." Certainly the reduction in white processed/refined flours will be much more agreeable to your DS. OTH, there are places like much of China where KFC and McD's are considered health food, as their supply chains are more reliable than most of the locally based stores where you really don't know what you may be eating. In the states, it is better than it used to be in that with the big natural/organic/local movement, a lot more better foods are available, and becoming more mainstream, but one does need to be choosy and know what you need to look for. Eating out is still a crap shoot, particularly with major chain restaurants which depend on a lot of processed and packaged goods. Our neighborhood Italian place is quite good in that respect, as we often see Vito down at opening of the local farmer's markets and he is out meeting the boats at the wharf for his fish; not everything will be fresh (those &^%&* seasonal foods!) but he tells you what's what - something you don't get at Olive Garden!

Note that when an article refers to "bariatric surgery" or "weight loss surgery" in the general sense - not specifying any particular procedure, they are typically referring to the RNY gastric bypass, as that is, or has been, the most common procedure over the past 20-30 years (and particularly in Canada and other countries that may have been slower to adopt newer procedures). If you have a different procedure, the article may or may not apply to you. The warning may still be valid - changes in diet after surgery may result in deficiencies even of the procedure that you have doesn't have any inherent relevant malabsorption - and the advice may still be sound - keep up with labs and maintain appropriate supplements, even if they may be different from what is anticipated in the article.

I have never thrown up in the seven years since surgery. I don't know what "slimies" or "foamies" are from any personal experience, only what others report.

I's so sorry that you have gone through all of that, but I'm really surprised that they had such a problem finding it, as that is the classic place for ulcers to form on an RNY, and that should be the first place they look. With the Prilosec, was that indeed a capsule, as opposed to the little oblong pills that they often provide (I have mostly used the OTC generic version, so that's what I'm mostly familiar with). I can understand a capsule may not dissolve properly within the pouch, but don't most regular pills work normally (other than possibly time release meds)? I would think that the medication form (pill, capsule, liquid, etc.) would be specified on the Rx if it were critical. (Note to all of us - get friendly with your pharmacist and ask questions!) Bit confused and concerned on the treatment you have been getting, but best of luck in getting everything resolved...

I've never heard the wet lettuce expanding thing before, that's a new one on me. Bread, toast and rice are often thought by some to have that effect, and likewise readily ignored by others to little effect. But this early out you should be taking things slowly and following your doc's advice. Some people do have a problem with lettuce for some reason, even many months out (and, as usual, many others have no problem at all - a big YMMV thing.) I generally use chopped raw spinach rather than lettuce due to its somewhat better nutritional profile, but haven't had any particular problem with lettuce when I have had restaurant salads (I just don't eat much of it since they use it as filler instead of the more expensive and nutritious vegetables and Proteins.)

I have found salad to be something of a slider for me, too - which isn't really a bad thing considering the high nutritional density of most salads (if you do them right and don't load them up with a lot of high calorie junk!) I found when starting with salads a month or so out that if I cut back my normal serving capacity of meat from 3 oz to 2, that I had comfortable room for another 3ish oz of salad veg (typically chopped spinach, avo, tomato, green onion and bell pepper, and/or whatever else I had around. I found it a convenient way to get in at least a token amount of veg, and make my eating a bit more "normal" than typical post-op fare, which made for less of a "being on a diet" feeling and reinforced what good sustainable eating habits that I already had. Such salads are still a staple of my diet five years later.

My doc's perspective on the subject is that ideally alcohol should be a never again thing, but realistically, people being human, his real absolute is for none at all during the weight loss phase (something we sign up for during the psych evaluation). His biggest concern, beyond the long term transfer addiction issue that is the centerpiece of this article, is liver health. Or livers are usually in marginal, at best, condition from our obesity, and it is further taxed by its role in metabolizing all the fat that we are rapidly losing; it doesn't need any more stress from metabolizing alcohol (which beyond being a toxic as noted, is specifically a liver toxin. His perspective is somewhat colored by his background as a biliopancreactic (liver/pancreas) transplant surgeon before he got into bariatrics and continuing along side that practice. Addressing the obesity problem can significantly reduce the demand for transplants; alcoholism is another significant source of such demand. He does not want to see any of his bariatric patients coming back on his transplant table.

Approved by whom? FDA? ASMBS? wlsolutions? The manufacturer?

If anything, I may have dropped a bit on girth, (though that is not something I measured or tracked.) At least relative to my glans the shaft is now a bit skinnier - I was never much of a mushroom headed guy, but it is now to a greater degree. So, either the shaft shrank a bit or the glans is grew a bit.

It most certainly does - my wife lost around 200lb from her WLS several years ago and that made a substantial difference (not least of which was the joy of being able to get my arms and legs around her!) and now with the deletion of my fatpad as well, we have hit bottom. Ah, the trials of life!

My wife and I are in much the same boat with bottoming out. It is something that we continue to experiment with to find the right positioning to tickle both of us without the problem (just gotta keep doin that homework!) I hear you on the visibility aspect, as the common "enhancement" procedures only really improve the locker room image, but this really does improve the functional aspect of it too.

The body comp scales are measuring your body's impedance (electrical resistance) to derive the fat and lean mass percentages, and as a result, are very sensitive to hydration, which is going whacko these first couple of weeks (first they pump you full of fluids in the hospital, then that dissapates, then your body gets starved of its glycogen reserves from the initial caloric deficit, so then it needs to hold on to Water as it replenishes the reserves.... Right now, your body is confused, and so is your scale. http://www.dsfacts.com/weight-loss-stall-or-plateau.html This article gives a good explanation of what's happening these inital couple of weeks of weight loss and why we typically see a stall in these first 2-3 weeks. Once your body settles down into something more routine after the first month or so, the body comp readings start to make more sense. Your body fat readings will also vary during the day as your hydration changes during the day - you tend to be dehydrated first thing in the morning, which will read a somewhat higher body fat %, while the optimum time of day to read the body fat is usually late afternoon/early evening before dinner when you are typically as hydrated as you will be (you may see a 5% difference in your body fat % from early morning to late afternoon, and you may see a point or two difference from one day to the next depending upon day to day hydration differences; you may also see a change if medications change, particularly diuretics.) Of course, exercise routines and scheduling can impact your hydration and scale readings, so take that into accout as well (don't expect the best readings right after a workout!) The best way that I have found to use the scales is to follow a moving average of the body fat % and not get too wrapped up in day-to-day fluctuations. Your late afternoon readings may be measuring between say, 36 and 38 % at the extremes, so 36.7% one day and 37.1% the next (and 36.6 the next...) isn't particularly significant, but when you start seeing readings in the 35's and aren't seeing 37's anymore, that is a good sign of progress. The scales are a good tool for following longer term trends but are limited in value for snapshots - you may get whipsawed between despair and elation if you are looking for instant gratification from these scales! Used in this way, they seem to correlate fairly well with the "more accurate" body comp tools like hydrostatic testing or the bodpod. Good luck and have fun with this crazy journey!

As others have noted, this is a fairly common occurance, so I would read the OP's docs response as indicating that he may not be very comfortable with the sleeve procedure yet, so it would be worth getting a second opinion on this issue. This may not be very convenient at this late stage before your scheduled surgery, but the cost of the alternative - living with an RNY and all that goes with it for the rest of your life - is just too high to rush into it. Or, to keep the schedule, and if you really like your surgeon, perhaps he can have a more experienced sleeve doc assist so that he can better learn to handle this relatively common problem. Hopefully, if the sleeve doesn't work for you, then you would go ahead and have the DS completed rather than changing it to an RNY which would not likely work any better than the sleeve. Also, more than likely, once the sleeve is done, any future revisions would involve another round of insurance approvals unless the doc specifically had a two-stage DS approved.