RickM

My doc doesn't focus on a specific number (just on protein and water,) but wants us to avoid the simple carbs and otherwise empty calories.

I am a week behind you, on May 9. I noticed when walking this morning (which I don't do routinely at home - too boring and hot at home in socal, but much more pleasant when I visit the central cal coast with beach and forests available) that I could barely get my pulse above 100 when walking as fast as one can walk without breaking into a jog/run (which my knees do not like.) Only a couple of months ago I could easily get my pulse up into the 120-130 range (my nominal 80% level) with a similar pace of walking. So, you may be seeing a lower level of exertion in your swimming and Zumba without realizing it. I swim routinely also, but haven't really been checking my heartrate lately while doing it - will try to remember to do that when I swim this afternoon. Changing exercise routine is another common suggestion for breaking stalls; you may have already gotten too comfortable with your current regimen.

I weigh everything, so I can get some consistency in what I prepare and find it easier to log the ingredients. For my salads, I typically have a couple ounces of leftover meat, usually marinated in 10-15g of BBQ sauce, 15g of chopped spinach (I could never figure out what a half cup of spinach or lettuce was...), 25g of grape tomatoes, 10-15g each of pepper, green onion, avo, shredded carrot, chopped snow peas, shredded cheese and dressing. That's a comfortable amount for me, though about 3oz of meat will stuff me.

It doesn't seem to be particularly harmful - your body will tell you if it objects. My doc has us on mushies from the hospital, moving into more real foods as tolerated, but avoiding the simple carbs and empty calories (and his practice has been doing sleeves for around 20 years, so I figure they know about the care and feeding of this type of altered stomach - I still can't quite understand the extensive liquids that some docs impose upon their patients - maybe it's a holdover from RNY practice?) I tried some restaurant chicken parmesan and soft tacos from Chipotle (less the tortilla) at around the two week mark and they did fine. I was told to start adding veg at my 10 day follow up since I was getting in more than the requisite Protein at the time. I was making small southwest style salads with a couple ounces of leftover meat in them in the 3-4 week range and was adding some raspberry and almonds to my greek yogurt Snacks at around the same time. I haven't tossed anything back up yet, though a couple things didn't quite feel right at the time. Your doc seems to have a fairly sane program. I can't quite fathom the ultra low carb mania that some docs are on - it's a useful thing temporarily for some conditions, but long term seems to be substituting whatever bad nutritional habits we may have had pre-op with another one post -op. Still, it works for some, (and some have a lot more weight to lose than we do, so need to lose at a faster rate to lose enough during the prime losing phase) though long term they're likely to have problems from nutritional deficiencies if they continue to be obsessive about it.. I'm not having as much fruit and veg as I was having pre-op, but am usually getting in a couple of servings of them a day. That will increase in time as I get into maintenance mode. I try to keep a lid of 1200 calories on my daily intake, and am usually in the 1000-1100 range (though I will probably break thru that today - we're going to Outback for dinner tonight and I'm sitting at about 750 this afternoon. I was 2/3 to goal weight at around the 3 month mark, so that seems to be working for me.

I never really discussed it with my surgeon, but I've had my own goals in mind and have known him for so long that it was probably a moot point. Most surgeons like to see a BMI of about 24 as a goal because that is where they set their point of normalcy for their "excess weight loss" calculations that they report on; that's good for them when reporting on a population, but of less value to individuals with all of our variations. I set my goal at getting down to a 15% fat mass, which is on the lean side of normal (or the "fitness" category on the Healthcheck site) for men, which would equate to about 22% for women. Initially that equated to about 200 lbs assuming that only fat was lost through all of this (a gross assumption, but a good starting point and one that could be adjusted as I get closer to goal.) As I got down around 2/3 to goal it looked like 190ish was more appropriate to meet my body composition goal - still quite doable as I'm only 3 1/2 months out. I may have to adjust it again as I get closer, but probably not my much, though I may try to drop somewhat below that goal if I can since there is often some snapback once one stops losing. That would still leave me "overweight" on a BMI basis (around 27-28) or on the"ideal" weight charts but to get down to those levels would mean either being unhealthily lean or losing excessive amounts of lean muscle - neither of which are acceptable to me irrespective what the insurance companies may "think"

Drinking seems to be one of those variables where there can be wide differences between people. I have had no problem drinking, and like you, was a bit concerned that I could put down a 6oz or so bowl of soup and half cup of juice in the hospital if fairly short order, while my wife, when she had her DS, couldn't drink more than her nominal stomach size (which was a real PITA for her since it meant that her protein shakes had to be so concentrated in order to get the requisite protein in that they were ghastly - big difference between a scoop of protein powder in a cup of milk or water and a scoop in a quarter cup!). So you, like me, should be able to be more flexible in what you drink but longer term means that you will probably have to be more careful in what you drink so that you don't drink excess calories.

It partly depends upon how your doctor's program is structured - some are very slow to move patients off of liquids and into real foods while others (like my doc's) start with soft foods in the hospital and progress into more solid foods as tolerated. I was lucky (I guess!) that I had little problem tolerating new foods as introduced, so in that second month I was eating fairly normally, though in small amounts, particularly the solid Proteins like meats. But I was having restaurant meals when they happened and ate chicken parmesan, chicken marsala, soft tacos from Chipotle (less the tortilla), steaks, mexican restaurant carnitas; all are good for 2-4 meals with a doggy bag. Chinese (not my forte, though) would be good, particularly if it's the type where you share a lot of dishes, so you can have some soup and sample small amounts of other things, too. For birthday celebrations, it is well to stay away from most cakes and other sugary things - I tried a small piece of cake that my wife made for a club meeting and it didn't settle well with me, as seems to be the case for most sugary things. We all tend to have our differences with what works and what doesn't for us. However, I have found that some of the cake recipes on theworldaccordingtoeggface lady's site make a good treat that's WLS friendly - you might have one of them made for celebretory purposes: http://theworldaccor...takes-cake.html

The other factor on the RNY/NSAID issue is the suture line between the pouch and the intestine - since the part of the intestine that is joined to the pouch is not used to being exposed to stomach acid like the duodenum (which gets bypassed along with the stomach) that joint is very susceptible to being irritated. It also tends to never fully heal as a result and continually weeps a bit of blood, compounding the Iron absorption issues of the RNY

A good part of the high book rates for these medical bills are courtesy of you favorite federal government. Nobody pays those rates (though they do try to charge them to uninsured emergency patients...) but Uncle does have some reimbursements worked into their system that will pay a small fraction of the "written off" discount back to the hospitals - the higher the "discount" (book rate) the higher the gov kickback they get. Aetna is real slow about paying the surgeons for some reason - I'm over three months out and they still haven't paid the surgeon's fee, though they have paid everyone else.

Aetna approved my sleeve fairly quickly - they seem to treat the sleeve the same as the other WLS and dont seem to put any special conditions on it like some companies do. I'm in SoCal too but went to San Francisco for my sleeve for a variety of reasons, primarily that we already had a working relationship with Dr Rabkin up there thru my wife's DS. He is certainly one to recommend, though you may not want to travel to have the job done. Good luck with your future sleeve,

Stringbender, You are more of a pioneer than even us VSGers - good luck with it. All of these procedures start that way with little history and a good concept, with some enduring and becoming mainstream and others never being adopted widely and ultimately being dropped. My wife had a duodenal switch a few years ago, when it was reasonably accepted within the WLS community but still generally considered to be "investigational" by the insurance industry so we self paid for that one. Mexico didn't have the WLS factories that they have now, so the primary budget option at the time was Spain, but the delta cost wasn't worth the hassle over going to San Francisco. I was not overly concerned with leaks as my docs have been doing these VSGs for around 20 years as part of the DS and they are very anal (so to speak) about leakage and testing for them; I would be more concerned about leaks with some of the practices that do the VSGs outpatient where any leaks happen at home rather than in the hospital. Further, there is a small percentage of us out there whose bodies are particularly ornery and will react negatively to any procedure - that's just life. After being around the WLS community for a number of years now, I take a somewhat jaded view of "reversible" claims considering, as your surgeon notes, the body's propensity to adapt - things can often be reversed if there is some sort of adverse reaction early on, but less successfully as time proceeds. The bands are widely promoted as being "reversible", but more accurately they are "removable" while the damage that they can cause, sometimes in a matter of months, is far from reversible.

Unfortunately this turns out to be a false impression for most people - that the RNY allows them to eat as they did before, and is not much different than those who get the idea that the bands will be better because the procedure is simpler and quicker with no GI tract cutting, until they find out the problems that can be caused by that band longer term.. The net longer term result is that the RNY will malabsorb minerals but an insignificant amount of calories. This is why we see so many bypass patients totally failing and regaining all of their lost weight. The DS will usually maintain significant caloric malabsorption for the long term (10+ years) and is not as bad at mineral malabsorption as the RNY (due to the only partial bypass of the duodenum, where the bulk of the mineral absorption occurs), though the DS does malabsorb the fat soluble Vitamins (A,E,D & K) so those usually need to be supplemented with a Water soluble form. Overall, the RNY is no better at tolarating us drinking our calories thru sodas and milkshakes as the VSG. RNY dietary requirements for weight maintenance are pretty much the same as for the VSG, though the RNY has more restrictions on medications and greater need to supplement those minerals.

That is pretty much my fallback position if I need it - a revision to a DS, even if it means an open procedure for the second go-around. One word of caution on this plan, however, is that in my surgeon's experience, such revisions work best before any substantial weight regain has been realized - you typically don't get the same level of loss if one waits to return to their old weight than if they do it promptly after they start to regain and realize that they don't have control over it. Not the easiest decision to make at that point, and generally not covered by insurance until the first WLS is a total failure and one gets back to the35/40 BMI level again. For me, with my history, that was worth the risk of doing just the VSG.

I can't comment on the plication surgery, but I would expect that your goal is reachable with it - most of the common procedures offer enough restriction that 100 lb loss is quite reasonable during the 12-18 month prime loss period (the bands seem to be the least reliable in this area.) I am also looking to lose around 100 lb with the sleeve and am down about 65 lb after 3 months. The big differences between the different procedures for those of us in this "moderate" weight range is the durability of the loss along with the rate and severity of potential complications. The sleeve, with its relative simplicity seems to have a relatively low complication rate and its weight loss durabiliity seems to be similar to the other restrictive procedures like the RNY, while the bands seem to suffer from both poor loss durability and high longer term complication rates. I can't comment on the plication as it is even newer than the sleeve with less of a long term track record, but I would expect its basic near term loss to be similar but with a somewhat higher complication rate due to its band and folded type stomach restriction. As with the sleeve and RNY, I would expect that long term durability of the loss will be highly dependent upon your ability to stick to the lifestyle changes required to maintain a stable weight once the pounds come off. On the protein drinks, I find the EAS brand powders to be pretty good (or at least the least objectionable) with their chocolate having a fairly delicate flavor that can be enhanced with a little cocoa powder if desired. I use the Unjury unflavored powder as a mix in to other foods to enhance their protein component. Taste is such an individual thing that it's hard to give a solid recommendation other than just to experiment with the different brands. Good luck in your ventures,

Many docs feel the same way, in part because they are most familiar with the bypass, and in part because it is the most sophisticated procedure that they offer (unless they do the DS, in which case that is what they would usually recommend for their high BMI patients). Some docs feel that the threat of dumping from the bypass will help as a behavior modifier for their patients (yeah - fat people need to be punished for being fat...) There is not a lot of long term data yet on the VSG regarding weight regain, but what is there suggests that it is no worse than the bypass, which isn't all that impressive to start with, and some docs feel that there is reason to believe that it will be somewhat better due to its functional pyloris. There are quite a few on these boards (and on obesity help, too,) who started in the 60+ range and have good success so far. Probably the best procedure for the high BMI people is the DS which offers statistically better loss and better long term maintenance, however, it is a more technically challenging procedure so many of the docs don't do it, though to the patient the downsides are generally less than that of the bypass. Many prospective patients don't like the idea of the added intestinal rerouting that goes along with the DS and bypass and that is a fair perspective, though with many that is the price of long term success - only you can decide for yourself what is best for you. Bias disclaimer - my wife was a 60+ BMI when she had a DS a little over six years ago and is still maintaining a weight of around 135, while I opted for a VSG since I was a 40+ BMI and had already lost and maintained a reasonable amount of weight on my own through the requisite diet/exercise/lifestyle changes, but couldn't get the rest of the way due to volume issues. I never considered the bypass as, overall, it has all of the downsides of the DS (often more severe,) without the DS's better weight loss and maintenance performance, or looking at it from another angle, the bypass offers similar loss/maintenance performance to the VSG at a much greater cost in side effects and lifestyle restrictions.

Depending on what your doctor's program requires (some people are still transitioning from mushies at two months!) you may still be restricted, but your body will probably be accepting most foods by then - I was on mushies in the hospital, transitioning to more real food over the first month. Restaurant meals should be no problem by then, but you will be getting lots of leftovers to take back to your room (try to get a room with a fridge!) Your current clothes will probably be falling off within the first month - there is usually a big drop the first couple of weeks before you get a stall and then resume loss at a more moderate pace - I was down about 30lb the first month and another 20 the second (more than half way to goal then!) Some will lose quicker than others, but something is wrong if you don't see a substantial drop in the first couple of months.

As noted by others, stomach healing and irritation is an issue at your early stage, and the alcohol is just empty calories that impede your weight loss. The third major issue is indeed your liver - even though it hasn't been physically touched by the surgery (or maybe it was, but not cut...) the liver is usually not in the best of shape in obese patients to begin with, and the rapid weight loss further taxes the liver by virtue of its' role in metabolising the fat that we're losing so it doesn't need any extra aggravation from alcohol during the period of rapid weight loss. My doc is one of those who is out on the farther end of the scale on booze consumption - none during the 12-18 months of prime weight loss - and for good reason : his other specialty beyond bariatrics is liver tramsplants, and he doesn't want to see any of his bariatric patients coming back to him for a transplant. Take it for what you will.

Your doctor may be disappointed, but you shouldn't be. If you are eating the right things, that's the majority of the battle - I had been eating the right things, too - I had evolved into a good healthy diet over the years before surgery, but couldn't get the volume down enough to lose any more, which is why I needed the surgery. It's good to start the good postop habits early and experiment with new compliant foods - what Protein drinks do you like best, etc. Some docs claim that they use the preop diet to shrink or prepare the liver for the procedure. My doc is a liver specialist outside of his bariatrics and he doesn't have a specific preop diet, so that should say something about the validity of that claim. I gained a bit in the month before surgery from the serial last suppers (we won't be able to eat here for a while, and as long as we're out for this preop medical appointment, why not...) and it hasn't effected my weight loss postop - I'm 2/3 to goal weight in three months. Don't add any more stress to your life at an already stressful time (and hopefully your doctor won't, either) Good luck with it all,

From the perspective that the surgery does not need to be done today and can be put off, it can be considered to be elective - hospitals faced with labor actions will put off elective procedures but will continue to do emergency procedures. That it is medically necessary for most of us here, there is little question - which is why insurance generally covers it (unless ones employer chooses to specifically exclude WLS coverage in general.) Just because there are alternatve treatments available, i.e. classic diet/exercise programs, drug treatments, etc. does not alter its medical necessity or its validity as a viable treatment. There are usually several medical treatments available for any particular ailment, and some treatments work better than others for different individuals. The medically supervised ultra low calorie diet programs do work - for maybe 5% of the cases. Bariatric surgery has the best record of success, but there are still lots of failures as it is still just a tool for the patient to use and sometimes the tool isn't used correctly, or the wrong tool was used (bands vs. RNY vs. VSG vs. DS, etc.) Don't get too upset over others' ignorance - you can try to educate them but it's not your job to educate the whole world. People who don't have a particular problem tend to be ignorant to its ramifications and solutions - If they had an orthopedic problem like a torn knee or shoulder, they could be ignorantly criticised for having surgery to repair it rather than just doing physical therapy (which can work on its own in some cases.)

Mashed potatoes were on my immediate postop mushie list; at home they could have some protein powder mixed in to help get in the daily protein allotment. I will occasionally have a some roasted potatoes (lots of potassium in them, despite the carbs for those on the highly carbophobic programs. I would certainly stay away from the fried potatoes as that doesn't add anything but empty calories which you don't need now or later - a habit that would be good to break. Long term, there is nothing particularly wrong with potatoes other than they are relatively low on the nutritional density scale, but they do have useful nutrients in them - you just don't want to make them a staple long term as that will make maintaining your weight loss more difficult.

I set my goal based on body composition, looking to get down to around the 15% fat mass level, which is on the lean side of normal for men. Using the gross assumption that only fat would be lost, that would put me in the 200lb area as the initial goal, with a re-evaluation as I get closer. Now that I'm about 2/3 to that goal, it looks like 190 or so is the appropriate weight, so I will adjust accordingly. That would still be "overweight" on a BMI basis, but I'm in this for my health, not some numbers on an insurance company chart.

I don't know if there is any validity to the whole pre-op diet/liver prep/cleanse idea or not, but my doc doesn't have any special pre-op diet and he's a liver specialist who does transplants when not doing bariatrics, so he tends to be rather anal about liver health (as in no alcohol period during the 12-18 month weight loss time, etc.) Or, maybe he's just more skilled in that area so that whatever minor differences such pre-op treatment makes is insignificant to him.

The Band was never a consideration for me due to its poor performance and high complication rate. The only other option considered was the DS which, unlike the RNY, offers a notable performance improvement for its added complexity and side effects, but in my situation I decided that I didn't need the bigger hammer to solve the problem.

I was on pills as soon as the IV was removed in the hospital. Granted that it was more of a PITA taking them one at a time with a sip or two of Water rather than the handfull with a gulp preop, and I use the chewables for the calcium rather than the horsepills they normall come in, but that's not much of an issue anymore. I use the chewables now because I have them but probably won't re-order them. No mention was ever made about liquid form or crushing pills,. Though I expect that it would be suggested for those who had problems taking their pills, it apparently wasn't enough of an issue for them since they didn't mention it in their patient manual. Has your surgeon done many VSG's? This sounds like a holdover from RNY practice that doesn't really seem to apply to the VSG. My doc doesn't even have this limitation on his DS patients, so this seems to be more of a concern about pills getting stuck in the little orifce that the RNY uses for restriction (another reason to keep your pyloris!)

I'm 11-12 weeks out now and my typical day, as it has been for the past couple of months, is: B: 3 turkey sausage links, strips of turkey bacon or leftover meat S: half cup greek yogurt w raspberries and slivered almonds or granola L: mini southwest salad w 2 oz leftover chicken or steak, chopped spinach, green onion, pepper, tomato, avo, carrot, snow peas, cheese S: Protein shake on workout days (most days) or more yogurt D:3 oz meat w some token veg or 2 oz meat in a more veg intense dish (fajitas, cacciatore, etc.) depending on protein load for the day S: hi pro sf pudding or hi pro sf cake typ 1000-1100 cal w 100-110 g protein and of course - water!