RickM

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

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.

I think evolution of thought is the right term for this, just as other practices in the medical world have evolved. I equate this situation with the general evolution of how surgical patients in general have been treated in recovery. The stomach is a muscular organ, which actively compresses and manipulates the food as it processes it for transfer to the intestines. After a major injury, it does deserve some rest and recovery, but also some physical therapy and exercise. One may recall that in the 'good old days' patients required days or weeks of bedrest after surgery, while today the normal practice is to get us up and moving as soon as possible because that promotes healing. I suspect that there is an analogous situation locally with our stomachs, that they do better with some moderate early exercise than if they are prescribed weeks of 'bedrest' first. It seems that the docs who have been working with this stomach configuration for a while - those with longer term VSG and DS experience - would lean more toward this philosophy than the docs whose main experience has been the RNY which eliminates much of these basic stomach functions and replaces it with a more static pouch that mostly just gets stuffed and stretched. What still doesn't make a lot of sense to me is the extensive liquid pre-op diets some docs impose - I can understand the interest some have in pre-op weight loss and its effect on liver condition, but allowing an organ to effectively rest for so long before surgery is counter to the normal practice of wanting patients to be in the best physical shape they can be in prior to the knife. Again, maybe that harkens back to RNY practice where they are basically throwing the organ away after surgery and don't care about its' recovery?

That's one of those things that seems to vary with the individual. The generic OTC prilosec/omeprazole works fine for me but may not for others, I tried the generic Zantac and it didn't do anything for me, so it was back to the prilosec. It what you are using or were initially prescribed/recommended isn't working well, try another one.

Deli meats and cheeses are a classic early soft/solid staple. I still sometimes take a slice of turkey or ham and roll it up with a piece of cheese inside for a quick protein fix.. All of these things tend to be a bit high on the sodium front, but that usually isn't big issue with as little as we are eating during this phase. Enjoy the noshing!

There's no reason to be disappointed, and if you were on a pre-op diet losing some, that just moves the goalposts back since you started your weight loss early. What's happening is that the initial weight loss comes from your ready stores of carbs and protein; once those are depleted the body usually stalls until it starts tapping your fat reserves, which is what you want. Our bodies have all sorts of mechanisms in them to preserve weight when it senses starvation, but it can only do that for so long before it throws in the towel and lets some of that weight go. That's why most "diets" are fairly easy for a week or two when the initial weight comes off fairly easily but then the stall before the fat starts burning creates the frustration that causes many such efforts to be abandoned early. With the surgery and its' forced limited intake, we have no choice but to stick with it thru the stall, but it will happen. And, it will happen again, maybe several times during the loss period as our bodies resist giving up that weight. When your loss resumes, don't be surprised if you lose at a somewhat slower rate than before - that initial loss from your ready stores comes out at a rate of around 2000 calories per pound, while after getting into the fat burning mode the rate is around 3500 calories per pound, but now it will be mostly fat. That's worth celebrating (but not too calorically!)

Yeah, that's right. The findings, IIRC, are that the fake sugars trigger the same insulin response as the real stuff, so they may cut some of the calories, but they aren't necessarily an effective substitute for diabetic issues. They're one of those things that I use selectively - they work in some things that aren't overly dependent on added sweetness, or I blend them with the real thing where appropriate. The whole grain waffles I used to make (off the menu since surgery, but will probably be back on once in maintenance mode since they do have a useful nutritional contribution) used agave nectar because it worked well in the recipe that I had evolved and the caloric impact was negligible with the amount used. And, indeed, you have to look at the labels and any other info you can - some of the "lighter" fare has some positive impact on the caloric count while some aren't worth the trouble. I usually use the lower fat cheeses because they often have an extra gram of Protein in them along with the moderatly reduced fat/calorie count; however cooking with them doesn't work as well so I tend to use regular versions for those applications. On the milk front, I evolved into using skim milk years ago, but will use the higher fat milks sometimes if they're appropriate for the use. The fuller milks do have a bit more protein in them, but not enough to make up for thier higher fat/calories on a nutritional basis - I can add a couple extra ounces to the cup of skim milk to even out the protein if needed (which it rarely is in my case,) and still be down 30 calories vs. the 2% variety, but that's just me (sorry, my brain has been in optimization mode for too long!)

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I guess that, other than dairy, I would say that I don't use much of them, but then I don't use a lot of products that have SF or low fat alternatives. My basic essentials are skim milk and nonfat greek yogurt. I avoid things that are intensely artificially sweetened since they tend to have too much of the fake sugar quality about them. I don't drink much tea anymore since we're not drinking with meals, but when I did, I usually used the Equal or Splenda provided; if only saccarin was available then I used regular sugar, but I was never sweetening to the extent of most of the pre-packaged sweetened teas. The yogurt use is a blend of real and fake sweetener - I'm not fond of plain yogurt, but most of the commercially flavored yogurts are too sweet for my taste, and other than Trader Joes, the only nonfat flavored yogurts I find at the markets are all artificially sweetened, and too intensely fake sweetened at that. I make a blend of plain and (real) sweetened vanilla nonfat greek yogurts (3 to 1 ratio these days, down from 2 to 1) with some vanilla extract and Splenda or stevia added to taste, and that works well for me. I think that the mayo, or miracle whip or whatever we have is the light version, but I haven't used any of it since surgery. I do use the lower fat salad dressings generally, but don't agonize over it at restaurants - I generally get what I prefer rather than forcing myself into their token lowcal offering (unless that one is to my liking to start with) and get it served on the side since I prefer my salads on the drier side, at least relative to the places the glop on lots of dressing. The only other place where I use a marketed SF version is with the SF puddings - that knocks about 2/3 of the calories out of the mix, and leaves lots of room to boost the nutritional value of it by adding some Protein powder and greek yogurt to the mix. This brings the protein count up into the 11-12g per half cup serving with about 100 calories, which is a pretty good trade off, and has enough complexity to its flavor blend that the SF aspect of it isn't noticed, but the missing 70 calories is useful at the end of the day, either by keeping the daily caloric total in check or by adding some other essential nutrition to the daily score. In short, I seek high nutritional density while minimizing energy (caloric) density within the bounds of sane taste. I have been adapting/evolving my tastes and preferences for several years to this end, and the surgery has now helped drop the volume to the point where I can actually lose again. I want to continue to keep the fats (saturated fats in particular) and simple carbs under control for the long term and not get into the "I'm having so little that it doesn't matter" mindset as overall calories and good dietary (and exercise) habits are essential in the long run to keeping the weight off once it has been lost. As with the bands and RNY, weight regain is going to be the major long term challenge for many of us VSGers, even if most are still in the honeymoon phase and don't realize it yet.