RickM

We never had to do the weeks of liquids, but ground meats can be a problem for some. My wife had a problem tolerating ground beef for a long time, and our surgeon suggested ("prescribed" in our vernacular, now) filet as often being better tolerated than ground beef. After six years (for her, four months for me,) we still use the excuse of going to Outback as having to fill her "prescription." Likewise, the higher fat cuts are often better tolerated at first - dark meat chicken is moister than light meat, etc., though long term, of course, you want to stick to the leaner cuts as dictated by basic nutritional sanity.

I never had much problem with Protein, (they were telling me to add veg to my diet by day 10) though it does seem like you are having some overall eating problems. I understand the problem with tolerating the taste of Protein shakes, though there are many different kinds out there, and some taste better than others (and taste is such an individual thing.) - I find the EAS protein powders work for me as they have a relatively mild flavor that can be built on with additions (see below.) My wife had similar problems after her DS as she couldn't drink a lot either, so the protein powders had to be so concentrated that they were gagging. There are several possible things that you can do: Mix the powders with other things with stronger flavors - the Instant Breakfast suggested is a good start, but I boost the protein by mixing an envelope of Instant Breakfast with a scoop of Protein powder and 2 cups of milk for two servings - that significantly cuts the Protein shake taste; adding a little unsweetened cocoa to the mix deepens the chocolate taste with an insignificant calorie/carb addition. SF Hersheys syrup can be used for the same thing. Greek yogurt is a great protein source - 10-12g per half cup of plain, and can be sweetened to taste with your favorite sweetener, or even a bit of jam or SF syrup for flavor. I typically have it with some raspberries, granola, chopped almonds and wheat or oat bran to add flavor, texture, nutrition and Fiber. The SF instant puddings work well - I found that the classic hi-pro recipe of adding 2 scoops of protein powder to the 2 cups of milk and pudding mix still left a bit too strong protein powder flavor to it, so I substituted a cup of greek yogurt for 1 cup of milk and 1 scoop of the powder - that dropped the protein powder taste into the background, though added a bit of the yogurt tartness that some may not like. Peanut Butter is often suggested, and usually goes down well, though as with most plant based Proteins, it is an incomplete protein and should really be eaten with a complement like whole grain bread or crackers to complete the protein (which may not help you at this stage.) unjury makes a chicken soup flavored protein powder that you may tolerate, especially if you mix it with real chicken soup or maybe mashed potatoes. Good luck with it all - believe it or not, it does get better!

NSAID use is one of the classic reasons for getting a VSG or DS over an RNY. The main reason I have heard sited for RNY intolerance is that the portion of intestine that they join into the stomach pouch is not designed/evolved/created to be exposed to stomach acid, so that suture line never really heals fully so it doesn't like the added irritation of the NSAIDS.That's not an issue with the VSG, DS or bands.

My wife lost about 210 from her DS, and had another 14 removed with the lower body lift and didn't get a figur for the thigh lift.

Nexium was created as Prilosec was going off patent by slightly tweaking the molecule to make it different enough to patent (so it could be sold exclusively at elevated prices). It works in the same way as Prilosec and with rare exceptions, works as well as Prilosec/Omeprazole (except that it is the pretty purple pill...) If the cheaper, OTC Omeprazole works for you, Nexium provides no additional benefit.

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If you are not particularly a drinker or wine person, grape juice is supposed to provide the same health benefits, anti-oxidents, etc., as wine. Similar amounts (a 4-6oz glass) are fine for the same reason - limiting the excess sugars/calories while getting the proper amount of benefit and lessening the load on your liver during weight loss (some of us are on programs that avoid alcohol altogether during the weight loss period as our livers are already heavily taxed metabolizing the fat that we are losing - can you tell that my surgeon is also a liver specialist?) Addendum: any of the plant based foods with similar colors will have the same healful components - grapes, raspberries, blueberries, strawberries, etc.

San Francisco has a cluster of some of the best bariatric surgeons in the world - Drs. Rabkin, Jossert and Cirangle - all in different practices (though Jossert did train with the Rabkins years ago,) and all with extensive experience and long lists of satisfied patients. Many people travel extensively to be worked on by one of these guys (I came up from LA to Dr. Rabkin - my wife's DS was a self pay several years ago, though my VSG was insured). Check into them all, as they each have somewhat different programs, one of which may make fit you better than the others, and their self pay rates will vary some as well. None will be as cheap as going to Mexico, but they all give pretty extensive post-op support and follow up as part of the service. It's hard to go wrong with any of them. Good Luck

Everybody is somewhat different in what they can tolerate when. My doc''s program is pretty liberal (mushy/puree from the hospital, no big liquid only phase) with the admonition to experiment with small amounts of new foods, one at a time. If something doesn't settle well, try again in a couple of weeks.

It's not that unusual for those who don't have insurance coverage for WLS (or cosmetics/reconstruction, either.) There are many good doctors around the world, and most countries don't have the legal cost drag on their systems; the trick is finding them, and this is where sites like this one or obesityhelp are useful as part of that research. Many people go to Costa Rica or Brazil for cosmetic/reconstruction surgery where there are a number of renowned surgeons in that field. When my wife was going thru her DS journey 6-7 years ago, Spain was the major non-US alternative for that, and Dr. Baltasar was (and still is) one of the top DS surgeons worldwide. Mexico wasn't really an option then - they were not as big in doing WLS procedures for US patients then, and I'm not sure if I would go to any of the docs there for a DS, though the simpler VSG seems to be fine. Ultimately we went to San Francisco and self paid with Dr. Rabkin for her DS - for us, the cost savings from going to Spain once all the travel and lodging costs were figured in wasn't worth the added risk and hassle of going overseas for a procedure such as hers. Mexico has lower travel costs and the stay requirements aren't usually as long as they were for the DS in Spain, so the case for a VSG is much more compelling now. Still, it pays to shop around as there is some comfort in staying domestic - from what I have seen, my doc's program (one of the best in the business, though we didn't self-pay this time as our insurance covered my VSG with him) in SF is only about 2/3 the cost of the Alabama program quoted here, but that's still a lot out of pocket, and you still have travel expenses, but it does show the variation in pricing.

If you dig through the Aetna website you can find their latest WLS policy bulletin on what is required - it's in reasonably plain English - or your surgeon's insurance coordinator may be able to lay their hands on one. When I went thru this earlier this year I needed either a 6 month Dr. supervised diet/exercise program or a 3 month program thru the surgeon (which my doc doesn't do.) I did the 6 month program with my PCP with a couple of visits with his associated nutritionist. I didn't get in monthly dr. visits as implied in the policy bulletin - scheduling issues made it more like 4 visits over the 6 months. I'm not sure about the 2 yr diet history (perhaps weight history is what they mean?), I didn't supply it specifically, but the data is in his records that were submitted. The pulmonary and cardiac clearances are requirements of your surgeon depending upon your medical history (I did neither); the support group meetings, pre-op classes and psych evaluation are likewise your surgeon's requirements, but are typical. Aetna is notoriously slow in approvals, but they shocked the insurance coordinator by approving within a week or so (though they are still dragging their feet on paying the surgeon's fees after 4 months) I didn't lose any notable weight during the 6 month period, but continued my long term stall (which is why I needed the surgery - hello!) I actually gained some in the time between approval and the surgery with the serial last suppers out while doing all the requisite pre-op med appointments.

Tiffykins has a good point by point response to this list. I would further break down the list to those issues that are VSG specific and those that are general to all WLS procedures, or rapid weight loss in general. The chronic GERD and possible twisting of the sleeved stomach are the only ones on the list that are really VSG specific. When you start looking at procedure-specific side effects, the sleeve starts to stand out from the others, and it's easy to see why it's gaining popularity. Issues that may be important to some is the general requirement by most WLS surgeons that patients stop smoking and drinking alcohol before surgery and for some variable period of time post-op, and that alcohol tolerance may be reduced long term. Another "issue", of sorts, to note is that all of the WLS procedures take some lifestyle changes and committment, which vary some by procedure, to be really effective long term - none of them are cures unto themselves.

Absolutely. I wasn't going to lose the weight in any other sustainable manner. I got part way there with the typically advised lifestyle adjustments (have been a semi-gym rat for about eight years now, combined with maintaining a sane balanced diet) but couldn't get over the volume requirements my body was making, despite eating primarily high nutritional density foods. The only change I would possibly make is to take the VSG as part of a DS if I find that I can't maintain the weight loss, but that is something that I won't know for several years. Many of the most common "issues" people have with the sleeve, such as constipation, diarhea, and gas, are as much a function of the dietary changes imposed upon us as they are a result of the sleeve itself - our bodies get used to what we were eating (all those little buggers in our gut that promote digestion,) and major changes to our habits often result in such symptoms until our bodies adjust. Other issues are common to all WLS, and different individuals have varying responses to the trauma that their stomachs have experienced - whether that trauma is the result of being sleeved, pouched or banded. Surgical complications such as leaks can occur with any of the common procedures; less so with the bands, but they have a much higher rate of other problems down the road due to slippage, erosion, etc. The only real issue that seems to be more common in the sleeve than in other procedures is reflux; the other procedures all have a longer list of issues, many of them more severe than what is typically seen with the sleeve. Yes, I would do it again.

Walking from the day of surgery, of course - as is the recommendation of most surgeons. Started back into mild strength training, avoiding ab/core work, after the third week - used the machines to better isolate muscle groups and dropped weight to about half the pre-op level; got back into ab/core work after twelve weeks. Resumed swimming after about five weeks (had a tempermental incision that continued weeping a bit for a while.)

The companies that make the lap bands (Johnson & Johnson and Allergan) lobbied the FDA to get the BMI lowered to 30 for their band products; whether or when the insurance companies will follow that recommendation is anybody's guess. As far as I know, the standard 35/40 BMI standards still generally rule amongst the insurance companies for general bariatric surgery approval, with some companies demanding higher BMIs for some procedures (including the VSG, strangely enough.).

The white meat has a litle more protein than the dark meat, (around 15% more,) along with about half the fat (4 vs 8g in 100g roasted) and about 15% less calories. Overall, not that much of a difference, particularly at the amounts that we can eat. Dark meat is often better tolerated by our sleeves early on due to it being moister, but I haven't noticed much difference between them in my tolerance.

I am in somewhat the same boat as your husband - if I get down into their recommended weight range for a large frame (by some measures I am a medium frame, others would say large,) and my 5'10" height, I would have to lose an excessive amount of muscle mass and/or get into the seriously athletic body comp - which wouldn't be all that sustainable long term. I use an impedance scale (a Tanita) for everyday body comp measurements, and will get dunked again when I get into my goal region (about another 30lb to go for that). I was dunked a few years ago after I had lost some of my problem thru classic diet/exercise efforts and it correlated well with the Tanita. But my wife, who had lost around 200lb with a DS and had lots of excess skin hanging around (lost another 10-15lb when she had reconstruction surgery later) had readings that didn't make much sense. She was reading about the same 34% fat mass that I was at the time, and well above the average Tanita readings, but there is no way she had that much fat on her (even though women are supposed to be carrying more). There just isn't/wasn't that much fat on her, even in the places women normally carry it!

It is certainly something to discuss with your surgeon (and maybe the psych, too,) and get their views on the pros and cons of it. Sleeves are not made the same size- there is some controversy amongst the surgeons as to how big to make the sleeves - too big and weight loss may be insufficient and regain may be more problematic, while too small and reflux can be a bigger issue. They're waiting for more 5 year data to provide more guidance. As is often the case in this world, this may not be a simple case of more (restriction) is better. You may not actually need the smallest sleeve, which may be more appropriate for someone in the 50-60 or more BMI range; a somewhat larger sleeve will probably allow you to lose all that you need to lose if you eat reasonably well with it, and a smaller sleeve may not help you if you don't. Also, the sleeve may not be the right procedure for you. The duodenal switch, for instance, often provides better loss (which you don't really need at your moderate condition) and also better resistance to regain. It tends to allow one to eat more normally and somewhat larger quantities (it uses a larger version of the sleeve as its basis) while still keeping the weight off. As always, there are tradeoffs to consider carefully. Of course your surgeon may not make such a suggestion if he doesn't do them. I chose the sleeve because I have not had major regain or yo-yo issues and had already made substantial lifestyle changes which helped keep my weight fairly stable, but volume was still an issue keeping me from losing more than I was able to "the old fashioned way". YMMV The major "cure" that comes from any of these surgeries comes from the lifestyle changes that you make, which the surgery helps you make. At your moderate size, most any size sleeve will likely provide enough restriction for you to be successful - even the smallest sleeves can be defeated if you drink your calories. The RNY typically leaves a smaller stomach and more nominal restriction, but regain is still a problem with many RNYers. It can be a tough decision deciding which procedure is right for you, as none of them are a silver bullet that will cure all. They all take commitment and a willingness to make changes, though these are somewhat different for each procedure.

You are likely to be losing some of your lean body mass simply because some of your musculature will no longer be needed to support your weight. Ideally, we can redistribute that muscle mass, but I suspect that would be a tall order. Someone in one of these forums mentioned that their nut said that the rule of thumb that they use is that we will lose 1 lb of muscle mass per 9 lb of fat. I don't know the validity of that figure, but it seems like a reasonable starting point, and is consistent with my experience. My goal has been to get down to the 15% body fat level - starting at about 42% at 292lb. My first estimate was that I should get to 200 even to meet that goal, making the gross assumption that only fat mass was lost and I would readjust the weight goal as I got closer. Re-evaluating things as I got into the 2/3 loss region indicated that 190 would be a better weight goal - so I have lost about 10 lb of lean body mass despite swimming or strength training for about an hour a day five days a week - not an unexpected readjustment. For myself, as I have been working out these past few years as part of my attempt at getting down to semi-normal weight the "old fashioned way" I never really wanted to get muscular enough to be lean and still in the mid 200's - I figure that ultimately that "excess" muscle mass will turn to fat as I age further and/or get injured - it takes a lot of work to maintain that level of musculature. At 5'10", my goal of 190 would still be "overweight" on a BMI basis, albeit a healthy overweight, but it would probably still ultimately be "fat in escrow", but I can live with that amount. The body comp is not something I agonize over, but is more of a reference point - if I get into that 15% region, I will be happy with the result. The body comp readings aren't all that accurate for us "losers" no matter how it is done (impedance, calipers, dunking, etc.) since they're based upon population averages and their norms don't quite know how to deal with the excess skin that we typically have after substantial rapid weight loss - it seems to treat it more as fat than lean mass - but it's as good of a indication of our overall condition as we have.

5'10, was 292 at surgery, (highest was 335 several years ago,) down 32 after one month, down 72 now at four months and about 30 more to go to meet my body comp goals (15% fat mass).

Medicare approval of a procedure is a major milestone toward general acceptance - when Medicare started covering the DS a few years ago, that created a cascade of policy revisions on the part of the insurance companies, as they could no longer claim that a procedure covered by Medicare was "investigational" or "experimental". Currently with the VSG, more insurance companies seem to be covering it so that should be a tweak toward Medicare covering it - eventually. How long that could be is anybody's guess, given the pace of government action on such things.

The other aspect, beyond the basic sleeve healing and caloric intake issues, is liver health. Being obese, our livers usually aren't in the best of shape to begin with, and the rapid weight loss further taxes it by it's role in metabolizing all the fat that we're losing, so it doesn't need any more work by having to metabolize the alcohol. My doc is a liver specialist outside of his bariatrics practice, so you better believe that we are on the no alcohol program for the 12-18 months of rapid weight loss - he doesn't like seeing his WLS patients coming back as transplant patients!

I'm in SoCal (in the Valley,) but went with Dr. Rabkin in San Francisco. While not based down here, he does have a presence in Ventura where there are support group meetings (tomorrow evening, for that matter) and an office where they do some pre-op and follow-up appointments, so most of the work beyond the actual surgery itself can be done locally. His CV over on ObesityHelp lists that he has done about 90 VSGs and 1500 DSs (which include a VSG as part of the procedure,) so he's one of the more experienced VSG guys out there.

The RNY was never on the table for me (or vice versa, I guess!) since it really doesn't offer any upside to the VSG to go with all of its limitations. The DS was the only alternative considered as it does at least offer some performance upsides in exchange for its trade offs. I will only know if that would have been a better choice for me in a few years time if I experience any marked regain - an area where the DS offers a clear statistical advantage over the other WLS procedures.