Daydra
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So we were sitting around the office after hours talking about crapping our pants (sadly, this was weeks before this particular event)... I'm not kidding, the sewage-garbage duo is the crux of our professional lives. You probably don't want to know what else environmental health inspectors find acceptable workplace conversation topics...
Anyway, the general consensus was that if you say you have never had an oopsie in your droopsie, you're a total liar! So we are in good company!
GypsyQueen reacted to this -
To be blunt and to not waste anyones time.. Asking a surgeon for a detailed response about the effects of bariatric surgery on an individuals metabolic rate (particularly as we're all different) is like asking a baker to fix a rare sports car. In short, you need an endocrinologist.
As for the impeded weight loss. You sadly had a bit of a rough trot of it immediately after your surgery - so this would definitely have short-circuited the system - giving much credence to the points made by our learned friends on this site, that you may have to wait it out and see how your body normalises.
As far as references for current academic research go, please see below. As you'll know, academic research is normally very narrow in its focus, so you'll have to go through quite a few of them in order to assimilate a potential 'ground truth' for yourself. However, there are some articles which offer the generic information you seek which might at least allay your current fears. Naturally, this comes with the caveat that without full knowledge of the endless subtleties and nuances the endocrine system plays on our bodies, it might appear attractive to propose one hypothesis for your current predicament, for it to then be incorrect because of a previously unidentified and unevaluated interaction.
Consequently, if you want your rare sports car fixed? Go see a specialist mechanic
Hope this helps. Any questions or queries, please do not hesitate to ask. Best of luck, Daydra x
Bariatric surgery in obesity: Changes of glucose and lipid metabolism correlate with changes of fat mass Original Research Article
Nutrition, Metabolism and Cardiovascular Diseases, Volume 19, Issue 3, March 2009, Pages 198-204
F. Frige', M. Laneri, A. Veronelli, F. Folli, M. Paganelli, P. Vedani, M. Marchi, D. Noe', P. Ventura, E. Opocher, A.E. Pontiroli
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2 Effect of bariatric surgery on liver glucose metabolism in morbidly obese diabetic and non-diabetic patients Original Research Article
Journal of Hepatology, In Press, Accepted Manuscript, Available online 20 September 2013
Heidi Immonen, Jarna C. Hannukainen, Patricia Iozzo, Minna Soinio, Paulina Salminen, Virva Lepomäki, Ronald Borra, Riitta Parkkola, Andrea Mari, Terho Lehtimäki, Tam Pham, Jukka Laine, Vesa Kärjä, Jussi Pihlajamäki, Lassi Nelimarkka, Pirjo Nuutila
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3 Dramatic Reversal of Derangements in Muscle Metabolism and Left Ventricular Function After Bariatric Surgery Original Research Article
The American Journal of Medicine, Volume 121, Issue 11, November 2008, Pages 966-973
Joshua G. Leichman, Erik B. Wilson, Terry Scarborough, David Aguilar, Charles C. Miller III, Sherman Yu, Mohamed F. Algahim, Manuel Reyes, Frank G. Moody, Heinrich Taegtmeyer
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4 Bariatric surgery and its impact on sleep architecture, sleep-disordered breathing, and metabolism Review Article
Best Practice & Research Clinical Endocrinology & Metabolism, Volume 24, Issue 5, October 2010, Pages 745-761
Silvana Pannain, Babak Mokhlesi
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5 Progressive Regression of Left Ventricular Hypertrophy Two Years after Bariatric Surgery Original Research Article
The American Journal of Medicine, Volume 123, Issue 6, June 2010, Pages 549-555
Mohamed F. Algahim, Thomas R. Lux, Joshua G. Leichman, Anthony F. Boyer, Charles C. Miller III, Susan T. Laing, Erik B. Wilson, Terry Scarborough, Sherman Yu, Brad Snyder, Carol Wolin-Riklin, Ursula G. Kyle, Heinrich Taegtmeyer
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6 ESR1 gene and insulin resistance remission are associated with serum uric acid decline for severely obese patients undergoing bariatric surgery Original Research Article
Surgery for Obesity and Related Diseases, In Press, Corrected Proof, Available online 14 November 2012
Weu Wang, Tsan-Hon Liou, Wei-Jei Lee, Chung-Tan Hsu, Ming-Fen Lee, Hsin-Hung Chen
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Surgery for Obesity and Related Diseases, Volume 4, Issue 5, Supplement, September–October 2008, Pages S109-S184
Jeffrey I. Mechanick, Robert F. Kushner, Harvey J. Sugerman, J. Michael Gonzalez-Campoy, Maria L. Collazo-Clavell, Safak Guven, Adam F. Spitz, Caroline M. Apovian, Edward H. Livingston, Robert Brolin, David B. Sarwer, Wendy A. Anderson, John Dixon
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Surgery for Obesity and Related Diseases, Volume 9, Issue 2, March–April 2013, Pages 159-191
Jeffrey I. Mechanick, Adrienne Youdim, Daniel B. Jones, W. Timothy Garvey, Daniel L. Hurley, M. Molly McMahon, Leslie J. Heinberg, Robert Kushner, Ted D. Adams, Scott Shikora, John B. Dixon, Stacy Brethauer
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9 Bariatric surgery and the gut-brain communication—The state of the art three years later Review Article
Nutrition, Volume 26, Issue 10, October 2010, Pages 925-931
Maria de Fátima Haueisen S. Diniz, Valéria M. Azeredo Passos, Marco Túlio C. Diniz
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10 Postoperative Metabolic and Nutritional Complications of Bariatric Surgery Review Article
Gastroenterology Clinics of North America, Volume 39, Issue 1, March 2010, Pages 109-124
Timothy R. Koch, Frederick C. Finelli
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425]Bariatric surgeryhas become an increasingly important method for management of medically complicated obesity. In patients who have undergonebariatric surgery, up to 87% with type 2 diabetes mellitus develop improvement or resolution of their disease postoperatively.Bariatric surgerycan reduce the number of absorbed calories through performance of either a restrictive or a malabsorptive procedure. Patients who have undergonebariatric surgeryrequire indefinite, regular follow-up care by physicians who need to follow laboratory parameters of macronutrient as well as micronutrient malnutrition. Physicians who care for patients afterbariatric surgeryneed to be familiar with common postoperative syndromes that result from specific nutrient deficiencies.11 Update: Metabolic and Cardiovascular Consequences of Bariatric Surgery Review Article
Endocrinology and Metabolism Clinics of North America, Volume 40, Issue 1, March 2011, Pages 81-96
Donald W. Richardson, Mary Elizabeth Mason, Aaron I. Vinik
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425]Obesity is a disease state with polygenic inheritance, the phenotypic penetrance of which has been greatly expanded by the attributes of modern civilization. More than two-thirds of obese persons have comorbidities, many of which are characteristic of cardiometabolic risk syndrome (CMRS) in addition to other life-quality–reducing complaints. The CMRS is associated with increased cardiovascular events and mortality. Individuals with a body mass index greater than 35 infrequently achieve or maintain weight loss adequate to resolve these metabolic and anatomic issues by lifestyle or pharmacologic strategies. Data suggest that some of these patients may be better served bybariatric surgery.12 Secretion and Function of Gastrointestinal Hormones after Bariatric Surgery: Their Role in Type 2 Diabetes Review Article
Canadian Journal of Diabetes, Volume 35, Issue 2, 2011, Pages 115-122
Alpana Shukla, Francesco Rubino
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13 Cirurgia bariátrica: como e por que suplementar Review Article
Revista da Associação Médica Brasileira, Volume 57, Issue 1, January–February 2011, Pages 113-120
Livia Azevedo Bordalo, Tatiana Fiche Sales Teixeira, Josefina Bressan, Denise Machado Mourão
I love this! Why bother to ask experienced people when you can do research until you find what you WANT to hear. I have been a part of these boards for 2+years and I have been sleeved for the same amount of time. I do know MUCH about the sleeve. My sister, niece, best friend and husband are ALL sleeved, so its not just my experience I am basing my comments off of, its that of my entire family! I really think that 1100 calories would be damn near impossible to take in if you are newly sleeved AND its from a good Protein source- besides shakes that is.. I'm talking solid food. All I can advise is to follow the Protein first rule and you will be successful, and be patient. Trying to cram in more calories just doesn't make sense to me, I don't care how insane it sounds to only be eating 500 or so. Its not insane for a sleever! Our tummies are tiny! No need to go trying to stretch what you paid good money to make smaller! but,, I digress.
Okay... 2 things.
1 - I hope you are not implying that by looking for information from professionals and published resources, I am somehow searching for the answer I "want" to hear, because I feel that it would be foolish to blindly accept advice on my health decisions from someone on a forum that I have never met or particularly noticed the quality or tone of their posts, just because they say they know what they're talking about. Perhaps that part of your response wasn't directed toward me...
2 - You seem to indicate here that you believe I must be gorging or stuffing myself when I eat. You stated in your previous post that you often were so full you felt sick after you would eat. I admit to having made some mistakes on tolerable volumes and the appropriate speed which I can eat without discomfort during the learning process, but I currently rarely feel ill or any discomfort when I eat and am especially careful when eating any dense protein because I am still adjusting to that. Perhaps you assume I am doing the same thing you did?
Okay, maybe 3 things... I actually do take offense to the implication that I am somehow trying to "cram" in calories. I am eating under my nutritionists guidelines. If you think it's silly to follow that recommendation, so be it. I would recommend that you don't follow it. Let me be very clear here. I understand that you believe you are right. And since you have been very successful, you clearly are right for you. However, I've never me you. To me, you are "a random". I'm unlikely to take your advice over someone I know to have a degree in nutrition, and that I found to be reasonable after lengthy discussion.
Just my two cents worth, and it's only my opinion, but the lower the calories the better. I couldn't get in 700 until almost 6 months out. I reached my doctor's goal in 5 and mine in 6.
The PhD doctor that speaks at a support group I attend said that unless we are in a POW camp, we aren't going into starvation mode and low calories will not alter our metabolism. You can take that for what it's worth, but I went from who knows how many calories a day to starting out post op at 300, and never more than 800 when I was losing.
I was very cautious about what I ate, that whole honeymoon period thing was forefront in my mind. This has worked for me, like this doctor told us, we had surgery to eat less. I've been maintaining for over 2.5 years. At 1300 I maintain, at 1400 I gain. If i drop back to 900 - 1050, I'll lose. It's a fine line, but I'm finding it easy to do, knock on wood.
Thanks! I appreciate the response. I linked an abstract in a previous response stating that there wasn't any clinical benefit to going below 800 cal. Not likely to be true for every single one of us, but it was true of their test subjects (obese women).
I have heard the "starvation mode is a myth" statement before. This 2013 article from Clinical Science states otherwise, well depending on how you define "starvation mode", but I think of it as the reduction in TEE as described in the paper. It's under Energy Expenditure in "Physiological Adaptations to Weight Loss" http://www.clinsci.org/cs/124/0231/1240231.pdf
Leibel, R. L., Rosenbaum, M. and Hirsch, J. (1995) Changes in energy expenditure resulting from altered body weight. N. Engl. J. Med. 332, 621–628
Sorry, that tiny font was the citation for the article that was used to support their claim. I tried to make it bigger, but the copy and paste just doesn't seem to want to play nice. Now I've got funky font size that seems resistant to change in my regular text, too!
Your statement of your calorie balance actually lends support to my belief that there should be no reason for me to drop any lower in calorie intake than where I am to lose weight. You weigh almost 100 pounds less than me, are 2 inches shorter than me, 18 years older than me, and I can all but guarantee you are built (what... finer than me? Smaller boned? Less stocky? None of that sounds good...) At any rate, I probably have a bigger bone structure, yet you lose at up to 1050. Yet, my doctor believes that I was telling her that I wasn't able to lose at 1100 (not exactly the impression she would have been left with had I been allowed to finish any of my attempts to explain my concern or answer her questions.) Her response was that I should eat less than 1100. I just can't buy that without some proof, because I don't believe that is the problem.
Mea Culpa.
Sorry, folks. I guess I came across too harshly. <insert guffaws here>. Sometimes I get carried away by my line of thinking and wind up not saying exactly what I meant. It reminds me of a saying by Robert McCloskey:
" I know you think you understand what you thought I said but I'm not sure you realize that what you heard is not what I meant."
What I meant was see if this topic has been previously covered by someone else on this site or another site. I was suggesting just research. The main reason I wrote this is that it seemed (from my perspective) that some people were being harsh and negative. (Something that I clearly cannot relate to. ROFL
The other reason I wrote this ... and I'm sure you can all understand and sympathize ... is that it was Day One of my pre-op diet. Enough said?
Pre op was rough! Thanks for the support.
Truly, though, my post wasn't intended to ask for advice, though I am always willing to considering something offered in good spirit. I was primarily just throwing my bad experience with my surgeon out into the universe to vent, but I always hope that whatever I share might in some way benefit someone else (if only in that misery loves company...) I have been doing a ton of reading. I actually bought the books my surgeon suggested. The one I didn't list was "Why We Get Fat" (I forgot about it until I went back over my notes from my appointment). Turns out, this one seems like I may find it valuable. However, I found it hilarious that the first couple chapters seem to be dedicated solely to how doctors have been blaming patients for their obesity for decades when there is a significant amount of research that directly contradicts "calories in/calories out" and that most research indicates that neither calorie restriction, nor increased exercise actually works to keep weight off, except rarely. Yet there she was, adamant that I must be doing something wrong if my body wasn't responding the way we expected. I don't know... maybe she was sick the day she read those chapters... Just like I was sick that day in Kindergarten when we learned sharing...
I feel just like you. I am always doing battle with doctors. Yes, they are the professionals but they are not in my skin, or yours.
Absolutely! We always have to decide how much to trust, which advice we're going to take, what recommendations we can live with, the list goes on and on. At the very base, we have to be willing to learn enough and be confident enough to be our own advocates when we feel like something is off. We should never be made to feel that there is a question we shouldn't ask or a concern that we shouldn't voice.
Thanks!
Everyone here is different but the commonality is that we are sleeved. I averaged 400-500 calories a day for the first 6 months or so. Its all I could eat. I never worried about it. I had good success and it did slow down after the first three months. My surgeon didnt worry about it either and they never pushed me to eat more calories. It gradually increased as I could hold more food. I was 100% successful in my weight loss and hit my goal at 13 months post op. The moral is.. do not make it your GOAL to eat a prescribed amount of calories. Shoot for as much Protein as possible 70-100 grams and that's it. No need to push it. You will not be as successful as you could be if you do that. I am shocked you can hold 1100 calories right now unless its high calorie Protein shakes. I have a friend who is also sleeved and her doctor harps on her about not eating enough. I think its all BS. I think you should eat Protein first and not worry about calories. Lets face it, If you are eating lean meat, cheese, etc.. good protein sources, there is no room in there for carby foods and junk or anything else really. You cannot really compare how you eat now to how you used to eat presleeved. Its totally different and your body is now totally different. If you get enough protein and hydration, you will not feel weak even if it seems impossible to live on that few of calories. I didnt purposefully eat so few. I ate protein and I could not hold much. I was so full I was nearly sick each time I ate. I only snacked on protein as well. I ate no bread or Pasta or rice because it filled me up with one or two bites and made me uncomfortable. Good luck to you and I think that you should try to stick to mostly protein and always eat the protein first. Dont worry about calories, only protein. The weight will come off as long as you are following that simple rule. Good luck to you! You can do this!
Thank you! I appreciate your well wishes and sharing your experience. Excellent example of how everyone and every program is different! I would like to respectfully point something out in your response. As I read it, it seemed like because of your specific experience or paradigm, your statements allude to the exact kind of judgement I received from my surgeon that infuriated me so, though I'm sure you didn't mean for it to come off that way. You state that you can't imagine how I can make it to 1100 without eating high calorie Protein Shakes and remind me (more than once) that I should eat protein first. You state that if I were doing that, there wouldn't be any room for any of that carby foods and junk. You can't know what I have room for, because you can't know the exact size of my sleeve, and you can't know what and how I eat, because I haven't told you other than the number of calories and macronutrient ratios over the week previous to my appointment. I'm not offended, I just wanted to point it out, because my recent interaction made me particularly aware of this. I also know that I have unintentionally made judgements based on my own paradigms and am going to have to work at identifying and stopping it whenever I can in the future.
Intake not even as low as yours didn't work out for me too well. I was managing to get my protein minimums in most of the time (though, admittedly, my tracking was beginning to get a bit dicey. It seemed hardly worth doing when my intake was so low.), and my lab results showed that dehydration wasn't the issue, so that pretty much leaves me with calories as the culprit, as my doctor also believed.
I do make use of a protein supplement most days to make sure I get it all, but no, they are not particularly high cal. If I make something higher calorie like a smoothie, it balances out because it replaces a midmorning snack and takes me until afternoon to finish it. Some solid protein sources still feel a bit like rocks, so I'm still relying somewhat on plain greek yogurt, kefir, cheese, and milk. Not ideal, but it gets the job done. My nutritionists plan provides some servings of carbohydrates, and some carbs come with protein-rich foods as well (dairy, beans). Also, your surgeon may have made your sleeve smaller than mine. I discussed sleeve size with my surgeon before the procedure, and she stated that she feels that going slightly larger reduces risk of stricture. A goal I can enthusiastically get behind, and since I would prefer to lose slower rather than faster, that was a-ok with me. I believe I read an article that stated that ultimately, the capacity of any one person's sleeve is someone affected by their height, basically due to the slightly longer length of the stomach in taller people (I may be off on that statement because it seems like it was one of the early things I read when I was researching, so if someone recalls a paper that said something different, I apologize.) I also recall reading an article that stated that the size of the sleeve doesn't indicate patient success. This paper states that there is "no clinical advantage" to reducing caloric intake below 800 cal. in a VLCD http://ajcn.nutrition.org/content/55/4/811.short
My original post really wasn't about my diet or intake, so I'll just stop here, except to say that I'm not comparing the way I used to eat to the way I can eat now. It would have been extremely foolish to think that I would eat the same after surgery. My calorie comparison from before surgery was simply to illustrate the idea that the surgeon seemed to be under the impression that my body virtually instantly took a nearly 60% crash in it's caloric expenditure (if we take the possibility of me lying off the table). If that were truly the case, it would warrant more investigation that simply being told to eat less.
Thanks again for your thoughtful response.
Wow..I read your post and all the replies......Well some Doctors are in it for money others are in it because it is their baby and they want to really help people who struggle with the disease. I found one that is very emotional about the whole thing and watches his patients like a worried father...That said..If you are not getting the support you need, go elsewhere!
Stop weighing yourself so much....I know you are an athlete but you still need to nurture your body. I worry about metabolism slowing down with less caloric intake....Being active is amazing and your a full fledged exerciser....Keep your mind on what you feel like...How your clothes fit and the fact that you are moving forward whether fast or slow. You are moving!
All the technical jabber is fine..But you know your body and are learning more and more about it every day....
I was at a surgeons office the other day and he said sorry..I don't know what WLS is.. I have never heard of it...dah!!! That is a man that would never understand anything related to the struggles we go through.....Right now you are struggling within yourself....
Remember that this is a lifetime journey and there will be gains and loses and stalls and what ever else the body can throw at us....
I weigh myself very seldom..Have not experienced a stall or gain yet...I have missed them all because I go by how I feel and the clothes sizes dropping...Our minds are set on numbers... Numbers mean nothing! How you feel, how you look. What are you able to accomplish...How your health is...Those are the priorities....
Over thinking is just that sometimes...Over thinking! Hope some of this makes sense! Always willing to hear your thoughts
Thank you, I appreciate it! I definitely do overthink... everything!!! I am constantly recalculating plans and responses in my head at every turn for whatever I'm dealing with, weight loss included. It has served me well in most cases, but I'm sure I could have benefitted from not trying to control things so much, and I'm sure when action was required, I would still have made good decisions.
Unbelievable that a surgeon (not just a general practitioner, but a surgeon) wouldn't have kept up at least on bariatric surgery in general... Good grief!
Hey there,
For whatever it's worth, I have two thoughts:
1) Give yourself a bit more time to have everything stabilize - you've really been through the mill lately, and it may just take a little longer to get back on track.
2) It sounds as though your surgeon isn't going to be a good partner for figuring out the ins and outs of whatever is going on; now that the surgery is finished, could you maybe just meet with the NUT and only see the surgeon for whatever post-ops are absolutely required? Personally, if I had had that interaction, I'd be shopping for a new doc.
Hang in there - things will get better!!
Thank you! This is exactly where I'm at! Really, none of the post ops are "required". Lots of patients never come back once they're sure they're fine. I've had just enough go wrong that I hadn't felt it appropriate to lose touch with them, but I had no idea that I was going to have this kind of interaction with my surgeon. Fortunately, the weirdness seems to be petering out, and I can always see the nurse or do my post ops by phone unless something else goes wrong (Nothing to see here, Murphy, no jinx to be had here!), so it's no big deal at this point. I just know who I won't go to for certain questions... I haven't decided whether or not there would be any benefit to providing some feedback to her on that interaction. I can't imagine what that would have been like for someone that is more sensitive to conflict than I am. I can just picture someone bursting into tears after that. It really was a mess. I don't even talk to people that way when they're trying to argue their way out of me writing them a ticket, and I'm doing code enforcement work, not a medical provider for people that have had to live a lifetime of discrimination, dismissal, and being stereotyped. Ugh... still angry. I'd better wait a little longer on deciding on that feedback... :-)
Hang in there, Daydra! Definitely get your BMR tested and maybe even a full blood work up to see what's going on. I hope your PCP is patient, kind, and interested so that you can get some peace of mind during this frustrating time. Good luck!
Thank you so much! Good advice and I intend to take it!
It's my thought that you are working yourself up into a frustrated fury and while it's understandable emotionally, it's a tad premature.
You lost a ton of weight pre-op and that's going to slow your weight loss after. You are also approaching that three month stall period. I "only" lost 20 pounds pre-op and I hit my three month stall at about 2.5 months. It lasted 28 days and in that time I fluctuated up and down by about 5 pounds. In that month, I lost 3 pounds but my body size continued to shrink. I ran a few 5ks, hiked a LOT, got in ton of kickboxing and martial arts classes and added calories, decreased calories, starved, gorged... My body did what it wanted WHEN it wanted.
Like you, I tallied everything; calories consumed, estimated calories burned, carbs, fat, miles, steps. There was no reason that I was in a stall other than that I was.
As much as I love science and math (I was a math/sci teacher!), it's not always that cut and dry. Stress will cause you to gain weight or hold on to what you have. I suggest you just keep doing what you are doing, exercise comfortably, eat what is healthy and makes you feel "right" and tough it out. The scale will move in it's own time. You've accomplished GREAT things so far, you will get to where you want to be, I have no doubt.
Thank you! And I agree with everything you said, except, it's not the weight or loss or gain that's got me worked up, it's the interaction with the doctor. Also, I set my start weight in my profile as my high weight in 2009 because I wan't to see all of my hard work indicated there. So it was waaay pre-op. My bmi at surgery was right at 40, and I knew that because I didn't have quite so far to go "only" 100 pounds-ish, I would be unlikely to post huge numbers in tiny amounts of time. That was actually what I wanted, though, because I wanted to be as gentle to my system as I could. Toward the end of my post, the "throwing everything I had" at a problem talk is easily interpreted as me indicating that I was very upset about the weight part, but actually, it's kind of me throwing a bit of a temper tantrum in response to my doc (I'll show you! I'll fix it myself!), and actually has little to do with the actual "problem". I do intend to get my bmr tested, though, because I really want to know. I'd really like to compare it to what I'm getting from my monitor. (that'll be an expensive calibration test...) :-) Not too proud of the tantrum, but I'll own it...
Thank you so much! Hope you have a good day! (one of these hours, I'll actually go to bed...)
Oh! and I'm totally okay with eating less calories than before. That was obviously expected. I'm just not okay with 800 cal/day, particularly when I still weigh 240. Extra particularly if I'm gearing up to start training to race again. I was burning nearly 5000 calories on brick or long ride training days. After my previous experience, I just don't see that working out very well... Even at a reduced rate of burn due to lower weight and the associated disproportionate decrease in total expended energy from low cal diets. Although, I will be logging longer distances now that I'm lighter. There will be some trade-off there, but it won't be equal.
Okay, thanks for the otter babies (WAY too cute and my daughter loves them so I will share with her.)
Yep, your metabolism has been altered by having surgery and while I don't pretend to understand the science behind it, I realize that I will be eating lower calories for probably the rest of my life unless I want to gain weight. I have experimented with calories from the very beginning and my surgeon is like "why are you counting calories...just count Protein grams, that is all I care about" which I understand and appreciate. BUT most of his patients are coming from a lifetime of frustration when it comes to the word CALORIE. So they are fed up with counting calories and I think he tries to provide an easy system to help them keep track but not obsess over calories.
I think part of your frustration is the way you were treated by your dr. I think that would irritate me too. Don't talk to me like I'm a 2 year old who needs a time out. BUT, on the other hand, I sense that another piece of your frustration is the fact that you aren't shedding pounds. I'm not exactly clear about why you were taken to the ER, usually as Butter said, low calorie doesn't equal a trip to the ER, your body just happily burns your excess stored fat. So you thought it was dehydration but wasn't? Usually the dehydration DOES equal a trip to the ER. Anyway, sorry if I didn't catch exactly what happened there. But after the ER you gained +10lbs and have slowly chipped away at that which brings you to the present where you are net -2lbs after the ER +10 GAIN?
Mentally we ALL KNOW that we aren't going to lose weight overnight, but in all honesty who here DOESN'T want the extra pounds gone immediately? I knew going into this that it would be a journey, I knew all my extra weight wouldn't immediately disappear but that didn't stop me from wanting it too. Please give yourself time and take a breather. Your body is still in healing mode. You are not quite 3 months out from major surgery, sounds like you had a hiccup (ER complication) and now you just need to mentally and physically hit the RESET button and work from where you ARE to where you want to BE.
Hang in there!
Thank you! I'm glad I added that little otter payoff :-)
Yes, the extreme frustration and the reason for the post was the treatment by my surgeon. There is going to be some part of me that is always going to "wish" I lost a little more this week/month/whatever, but that part of the equation is so minor, I never would have posted about that. (I save that kind of frustration for my status :-) Also, I'm very realistic about it and actually don't want to lose too fast, because my biggest fear is slowing down my metabolism more than absolutely necessary. Though I know I can't actually control that, slow, steady, and cautious is my goal here (as it is with most things).
"Net" referred to only being 1/2 a pound down from the morning I went to the ER on the day I had my run-in with the surgeon. So the gain of the approximate 10 pounds after treatment was essentially erased. If I counted the ten pounds as lost weight, it would be just about dead on with my calculated caloric deficit over the 4 weeks. So what it would have been nice to be able to get answers to during my appointment is why the gain and does it count? Frustrating that I had to go through the gain and then loss, sure, but gaining after a Fluid infusion was familiar to me (came home from surgery 10 pounds heavier than I went in, took a week to get that off, gained several pounds when I got 4 liters at the clinic (2 liters, 2 days in a row) when we discovered I had a kink in my staple line and we did an endoscopy to straighten it out), so I wasn't concerned so much about the gain itself, just that it didn't come back off within a week -10 days like the previous times I received fluids was making me a bit nervous that something wasn't quite right. (still, none of my testing revealed clinical dehydration, pretty much they gave me fluids to make me "feel" better)
I think I answered the rest of your questions in other replies, but let me know if I missed something.
Thanks again for reading and understanding! I hoped your daughter liked the pictures! (I really gotta find me one of them baby otters!!!)
You are basing your research on the fact that you have gained weight as a consequence of increasing caloric intake. This makes perfect sense, however we all know that our VSG journey is by no means a journey without obstacles, stalls and hiccups along the way. It could be possible that your body is just holding on to some extra calories as a consequence of your calories being too low or it could be some type of stall that has coincided with change in diet. I have been struggling with stalls each time I increase exercise. Unfortunately this journey is different for everyone and even the most prudent surgeons struggle to provide individualized advice. I am 5"1 and my doc has suggested that I shouldn't eat more than 900 cals per day (from now to eternity). Had I consumed the same calories without surgery I dare say that I would have been bordering on an eating disorder. As the others have mentioned - this surgery changes everything. Just be patient, maybe you just need to tweak a few things here and there. My best advice would be to follow your program - stop when you are full and don't eat outside designated Snacks and meals. I hope that helps and I really understand your frustration.
Thank you, I appreciate it. You are absolutely right, I could be having multiple little things going on right now. A stall is certainly possible, as is my body reacting to the "famine" it experienced, as well as the increased ability to hydrate. Could be one, all, or none of these things. I find the diet recommendations between programs to vary so much that it is nearly impossible to implicitly trust any of them. My nutritionist advised me to NEVER eat less than 900 cal. once I made it out of the recovery phase. Eating disorder... Exactly! I did not enjoy my time as an unwilling anorexic and I do not plan to put myself in that situation again. It was not a good time. Yeesh! I would have liked to have told my surgeon that, but she didn't take well to being challenged by questions, I'm pretty sure snarky comments would have gotten me nowhere... :-)
unrelated to your weight and weightloss. Consider working with a more supportive team. I know I do better when I see my struggle as a poartnership with the professionals, and I would not feel so with this one...
Thank you. Agreed!
Jeez I read that whole thing.
Whatever else you do, get your BMR tested. That's the one thing you mentioned that makes sense. With that information you do not have to guess any longer. Your BMR test results will tell you exactly how many calories you're burning.
The problem with the fit bit/body bug devices is they estimate your calorie burn based in non sleever information. Everything changed the day you got sleeved. It has been well documented the metabolic "reset" that VSG causes....and they are still not 100% sure how and why. But such things as diabetics being able to go off meds immediately even before they lose the weight...these instances happen frequently.
Point is what worked before sleeve doesn't necessarily work the same way now. Also, curious about your hospitalization. Was it lack of calories or lack of hydration? Cause most people suffer from dehydration immediately after surgery, but lack of calories does not usually cause problems. Our bodies will happily burn fat at that point. But even drinking the 64 oz of Water maynot be enough for someone like you with a large athletic frame. It's not for me. I drink double that. It's always a shock to people how much of our daily Water needs are obtained through food prior to surgery. After surgery, that's no longer the case which is why they push us to drink so much.
Thanks, and yeah, bmr testing is definitely in my plan, even though I believe that this isn't truly the issue (I wrote my working hypothesis in my previous post, I'm sure everyone will appreciate if I don't type it again...)
I could have been way more clear on the hospital visit. I had nausea. No vomiting. I was only getting around 20 oz most days in addition to very low calorie/nutrition. I was reaching the point where I was having near misses with passing out, fatigue, little strength, didn't feel like I could do much other than sleep, frequently light-headed. My biggest fear was that I was dangerously dehydrated and thought that was what was causing the nausea and everything else. My surgeons biggest concern was that I had an abscess or something causing the nausea. Turns out, not clinically dehydrated and after surgeon got test results she stated that she felt that the nausea was due to residual swelling and everything else was because I wasn't getting enough calories. I was forcing enough Protein by sheer force of will with Protein supplements and what I could manage to get down. So, technically, the reason for the trip to the er was the nausea/fear of dehydration, but had it gone on much longer, I would eventually have passed out and ended up there anyway.
Still not getting enough water, but doing much better than I was, and you are right. If you go by the 1 oz for every 2 pounds of body weight, I should be getting in 120 oz. I'm nowhere close to that, but considering at about 20 oz a day I still wasn't clinically dehydrated, so I don't worry about it and just get what I can for now.
As far as the body monitors go, I agree that the devices are powered by algorithms based on averages. However, the bodybugg/bodymedia devices factor a lot more into the calculations than the simpler devices like the fit bit and others that only measure movement. The bodymedia devices are not only triple axis accelerometers, but they also measure skin temperature, heat dissipation, and conductivity, so it "knows" when you are sweating. Also, it's worn on the upper arm instead of the wrist, so it gets a more accurate picture of movement.
For the metabolic changes after surgery, there are tons of papers on improvements in the function of several metabolic hormones (insulin, PYY, GLP-1, etc.), but I haven't run across anything about a dramatic shift in overall calorie burn immediately after surgery, other than the reduction in Total Expended Energy that comes with every calorie restricted "diet". If you have a source for a paper on that, I would really appreciate it if you could send me a link or something. This would be exactly the kind of thing I would like to read. At this point, I just simply haven't come across anything that would lead me to believe that it would be appropriate to expect that still being at 240, I would only be able to lose weight if I ate 40% or less of what I could eat to maintain only 90 days ago.
Thanks again for taking the time to read and respond. I have always thought you give valuable and considered input.
I read the beginning of your post and then skimmed the rest since it's long and I'm tired.
Back in high school, I was an avid Water faster. I have gone 14+ days on Water alone. I am not justifying what your surgeon said at all, but just know that it is possible to not eat anything and not end up in the ER. Also, if you jumped right back up from under 700 calories to 1100, your body will gain. Had you taken a more gradual increase of say 100 cals per day, it would not have come back so quickly.
I'm sure that everything will level off for you and you will be okay. You seem to be on track other than this small bump, and you will fall back in place quickly.
Thanks, and no worries on skimming. I totally can't blame you!
I totally agree that you can go for quite some time without food. I believe in general its up to 3 days without water and 21 days without food. However, in my case, I had been eating below what my nutritionist had given me as a caloric floor for around 9 weeks. (pre-op diet, then recovery, then nausea) At any rate, the result was near-passing out and fatigue to such a degree that I could not function. I was managing to make it to and from work at least some days each week, but I couldn't manage to get out into the field to do inspections, so I was stuck in the office with my fieldwork backing up. I'd pass out the instant I got home and would sleep between 14 and 20 hours a day on the weekends, which dropped my intake even further. Both times I had to go into the clinic or the ER, were Mondays after a weekend like that.
Thank you, I know it will stabilize. I feel much better physically, and I am collecting lots of info and have a plan, so it's going to be all good. My current working hypothesis on what's going on is that while I was not clinically dehydrated (Lab tests at the ER show the specific gravity of my urine to be just this side of clinical dehydration. No freaking way is anyone going to get me to believe that not needing to pee when you wake up in the morning and literally never feeling like you need to pee during the day is okay.), the 2 liters of Fluid I received coupled with being better able to hydrate myself after getting better anti-nausea meds and the ability to eat again actually popped me up to the weight I "should" have been, had everything gone more smoothly. I only had a "net" loss of about 1/2 a pound from the morning before I got fluids and meds, but if I count from the weight I topped at a few days later, I think it's about 10 pounds (well, 10 pounds from my appointment on Thursday, now it's more like 12). Unfortunately, my doctor never let me get that far, she just went straight into the non-compliant patient routine. Regardless, I'm still down 45 pounds since July 15. I'm not at all dissatisfied with my overall loss. I only wanted to discuss the concern and bounce my thoughts off her. I'm totally floored that something that should have been so simple turned into such a debacle.
Hi Daydra, I totally "feel" you. I agree with your assessment as you described, and have had some similar issues due to yo yo dieting/binging for years and my age slowing down weight loss. One thing I wanted to mention is that surgeons become surgeons because they like to go for the quick fix. I don't think many surgeons are interested in exploring other options as to why a body isn't functioning optimally. It sounds to me that you are your best resource. An endocrinologist is helpful to order and interpret hormonal tests, but again I don't see them giving you the answers and guidance you are looking for. I did see a kinesiologist who was also a holistic practitioner and he really knew his stuff. Over the years I have used both western and eastern type practitioners, and have found the eastern type to be much more whole body oriented. Western medicine has become more specialty oriented, to the great detriment of the patient in my opinion. Good luck to you, and keep posting how your Quest is going. I am very interested in hearing how you do and what you find out.
Thank you for the support. Yeah, I really don't expect to get a "complete" answer from any one source. I think each discipline has a piece of the puzzle. I just need to collect those pieces and put them together. What I'm really looking for at this point is to understand exactly what is happening at this time, whether normal or slightly off. That's not really something I can get from a research paper or a diet book, so I'll continue to read to get some background, but if I still need to find out what's happening with me, particularly, I'll need testing. You are so right. We have a long way to go to get to a place where the majority of medical professionals in this country consider the patient as a whole and not a list of discrete ailments that have to fit in 15 minute chunks of time...
The complete disregard was the worst. I felt crushed. This is the kind of crap I gave up $500/mo of Health Reimbursement Arrangement contributions to get health insurance at work so I didn't have to deal with this kind of discrimination in the military treatment facilities I had access to as a dependent. Of any medical specialty, this should have been the one place I didn't have to worry about this kind of thing. The good news is I can schedule further followups with the nurse or with one of the other surgeons if necessary, and now that I'm not experiencing nausea and major fatigue or other side effects, I can do many of my monthly followups over the phone.
I read your post and kind if wonder why you arent just working your program and getting healthy !!
Your body just went through major surgery, it takes time to heal, time to stabilize and you are basically ignoring the advice of a professional whom you chose, who hopefully has a proven track record of success, and has a lot more experience at this process than you?
You have been given a chance to restart your life again, at least in terms of nutrition and possibly body weight.
Sorry sent it before i was done.
Since you have this wonderful opportunity to restart, why are you basing your diet/nutrition on your old philosophies that really only assisted you enough to maintain a weight that you felt the need to have WLS?
Work the program, lose some weight, get healthier. You will have plenty of time to figure out your diet as you go,
This isnt meant to be a flame... I just think you are wasting a great opportunity to improve your health...
Thank you, I didn't take it as a flame, but I think we're kind of missing each other here.
I am, actually, following my prescribed calorie and Protein intake guidelines from my clinic's nutritionist. I'm right in the window of where I was advised to be. I'm only just starting to exercise again, the previous calorie far below what I was advised should be my minimum intake left me in an intolerably low-energy state. After nearly 5 weeks in the prescribed intake window, I can finally function mostly normally, but I still have a lot of muscle weakness and need to begin to rebuild strength.
My surgeon is an excellent surgeon. I would trust her to cut me again. She saved the life of one of my coworkers when she overrode a decision made by one of the other surgeons in the office. However, that doesn't necessarily mean that she and I can effectively work together. After this interaction, it is apparent that she is not someone that can partner with me to problem solve with some of the more nuanced aspects of the process. My post was an expression of my hurt, anger, and frustration at this interaction with her. I expressed a concern, and instead of discussing it with me, she immediately decided that I was merely non compliant and must be lying about my nutrition stats. She prevented me (by frequently cutting me off mid-sentence) from completely expressing my concern and my thoughts about it, or fully answering even a single one of her questions. I don't care how much experience she has. I can not have that as a "partner" in my healthcare decisions. There are other professionals out there that are just as experienced.
As far as my "old philosophies" go, using my philosophies and my measurements, I was able to lose 115 pounds between 2009 and 2011. I feel like I can confidently consider that success. I only began to gain weight again when the maintenance of those strategies began to require more effort than I was capable of. I only know that I could maintain at 2400 cal because of 4 years of monitoring. That is certainly no indication that my system didn't work, just that I couldn't maintain it forever. I decided to have the surgery because I was struggling to pull it back together again and was terrified I was going to see 349 again before I managed it. Not to mention being at significant risk for having to go through that all over again, perhaps multiple times throughout the rest of my life. That possibility was untenable. I felt that the surgery would be a significant factor in my equation for long-term success. My life never stopped, so there wasn't really any restart to consider. My health has always been reasonably good and I have 8 triathlon completion medals. As far as the health part of the equation goes, my biggest concern was my health as I age.
The last thing I'll say is that no one is an expert on me, but me. I can totally own when I'm wrong, but not to be considered to have any valuable input on decisions that concern my healthcare and to be expected to accept everything my doctor says without question is not something I will accept.
Thank you everyone for your time, thought, and responses. I do appreciate the input.
I will respond to each comment, but I think I may need to clarify the intent of my post, as I think that my post (or the intent) may have been misunderstood by some (easy, since it was horrifyingly long...), or perhaps I misunderstood the intent of some of the responses.
I posted this simply to put my experience out there. In doing so, I am hopeful that it might somehow be of use to someone out there. Maybe someone has had a painful experience with their doctor, but doesn't have the confidence (or whatever) to be upset on their own behalf and believe that he/she is the only expert on his/her body and experiences. We can never really guess how what we share might help someone else. At any rate, the two things I wasn't doing, was complaining about a perceived insufficient weight loss, or asking for help.
This is likely to be long... and more accurately a vent or a rant than anything else, probably.
I had my (about 3 month) followup with my surgeon today and I am spitting mad! About 5 weeks in I had some nausea, which resulted in me averaging less than 700 cal/day (don't have my charts on hand to give an exact #) for about 3 weeks. For me, that was too low and resulted in an extreme lack of energy, nearly passing out, I thought I was extremely dehydrated, and long story long... I ended up in the ER trying to figure out if something was really wrong. Turned out to be no big deal, and all I needed was stronger anti-nausea meds, fortunately. Unfortunately, as soon as I was able to eat at my prescribed calorie level, I gained 10 pounds within just a few days, and now, 4 1/2 weeks later, my net loss is only about 1/2 a pound.
I've done some reading on what happens when a person is subject to starvation or semi-starvation and then is able to re-feed. In the simplest terms, the body pretty much thinks it better hang onto every bit of energy it can in case there is another "famine" around the corner. One thing I read stated that in a fairly short period of some level of starvation, one can expect the body to take up to 3 weeks to stabilize. Now that I'm at about 4.5 weeks from beginning to eat more appropriately and feel like my body is still not normalizing, I'm looking for more information on exactly what's happening, so I can figure out what to expect and how best to support myself and my system while it adjusts. This is the same kind of thing I always do when I encounter a problem... A big part of my identity (and career, in fact) is in problem solving. Nearly everyone within my sphere of influence comes to me for answers and advice. I encounter a problem, work to understand it, decide what I think is the best course of action, and then implement it and see if or what adjustments need to be made. Not really any different from anyone else, but I work really hard to figure things out and come up with good solutions and I'm pretty well recognized and trusted among my friends (all well-educated professionals) as having a talent for it. So that's the background...
When my surgeon walked in and asked how I was doing, I admitted to being frustrated since getting the nausea worked out a month ago. I explained what had happened with my weight. I told her that I documented over the last 2 weeks (just the duration of the report I ran) that I had been running about a 1200 cal/day deficit and didn't really understand why my body wasn't responding. She stopped me and asked me what that meant (I think now because she didn't think I knew what that meant). I told her that I use a bodybugg (sophisticated body monitor that measures caloric output)... before I even had a chance to finish my first sentence, she cut me off and told me that I couldn't go by the information that a bodybugg gives me, and I can't use it to decide how many calories I should be eating. I tried to explain to her that was not how I use it. That I've been eating an average of 1100 cal/day over the last week (again, just the length of report I ran), which is still 200 cal below what the nutritionist in her office directed me to eat. I told her that I simply compare what I eat to what I burn to get an idea of what I should expect from my body. I explained that I have used this method to great success (115 pounds) within even the last 4 years and my experience with it has been that it was exceptionally accurate and reliable for me in the past (measurements proved to be accurate right up until surgery). So, sometime between right before surgery and now, I went from being able to eat about 2400 calories/day (without any significant exercise) without gaining weight to not being able to lose at less than 1/2 that. That tells me that there has been some significant change very recently and warrants some consideration and perhaps investigation, but did not trigger any reconsideration of her stance, no thought or discussion toward figuring out why my body isn't responding as expected. She got defensive and said "Well it's not working for you now, is it?" That was pretty much where I determined that I would be unlikely to take any further advice from her on this particular topic...(talented surgeon, but this is complete b.s.) She asked me if I was measuring my food. I replied I was. She then tested me, and asked me if I owned a food scale (So, what? I'm lying to her now? I told her I was measuring my food, of course I own a scale! 2, in fact! And GASP! I use them.). She then said that maybe 1100 calories was too much for me. (I'll note here that I'm about 5'9" and have a very large build for a female. I have had a weight loss doctor tell me that I had the largest bone structure any woman he had ever treated. I'm also naturally muscular and athletic. I have never had any trouble burning calories. I have always been successful in losing weight when I was able to maintain an intake lower than my expenditure. My issue seemed to be in the amount of effort it took to do that when I felt like I constantly needed to eat. At some point, I would get tired of it and give up.) She stated that I could drop down to 800 cal/day and still preserve my muscle mass, but I would have to exercise rigorously at the same time, and make sure that I "resisted the temptation to increase my calories with the increase in activity". (I'll note here that an average of under 700 calories with no exercise put me into a state of such low energy that I needed to go to the emergency room. I don't think a hundred or even 200 or 300 more than what put me in the ER would be healthy for me considering it would be combined with an extra burn of approximately 400-600 cal.) Thank you, I will pass. She then went on to say that I can't expect my body to fall in line with "normal people" because I'm a morbidly obese patient and "they" have different metabolisms than "normal people". I bet you're pissed now, too... That's all fine and good. She's right in that there is a lot of research and studies on the metabolic hormone differences in morbidly obese people in comparison to normal weight people. However, she's doing the exact same thing as lots of doctors do that is completely unfair... she's responding to me based on her stereotype of an "obese patient". There are many hormones that have been discovered that play critical roles in metabolic function. They interact with each other and their respective receptors to give the brain the "right" signals. There are about a million places where this system can have a glitch, a breakdown, or simply function sub-optimally so to imply that all obese patients are the same is just as much garbage as saying that all people are the same. That was the "easy" answer, and completely unhelpful.
At this point, I'm furious. I really couldn't go any further with her and just pretended I was accepting what she was telling me. I redirected her and told her that I really just wanted to understand exactly what was happening with my body right now, and asked her if she could recommend some resources and references for me to read. She suggested "Wheatbelly", and "Fat, Sugar, Salt". Seriously?!?! I ask for some educational information on the function of metabolism and my doctor suggests that I read a couple books on the evils of specific foods and additives in our diets? Sorry, doc. Not. Good. Enough. Pissed really doesn't even begin to explain how I was feeling. My concerns had been dismissed as something I must be at fault for, or lying about, because I must be a non-compliant patient, and when I asked for more information I was directed to dramatized crap, not educational sources. Angry. Hurt. Frustrated. Feeling like I'm still fighting the "Fat person" stereotype in a place where I should feel safe from that.
So... my next steps: Discuss this with my PCP on Monday during my appointment. I think I'm going to look into some metabolic testing to figure out what exactly is going on right now. I may discuss a referral to an endocrinologist to see if some information can be gained by digging a little deeper into my metabolic hormones. And, of course, keep reading articles and looking for books that can give me some understanding (I've got some stuff lined up I found with Google Scholar that I haven't worked my way through yet, and I have a couple college textbooks on metabolism and nutrition that I need to work my way through still). Ultimately, I may have to do what I've always done: figure it out for myself.
Full disclosure: I do recognize that it may be too early to worry. I very well may just still need to wait a little longer for stabilization. This doctor appointment just whipped up every instinct of determination to "solve" this that I have. Nothing like pissing me off to get me to throw everything I have at a problem... While I'm angry, I'm not panicking, nor am I feeling any despair. I know that I will get it figured out and all will be well once I do. I'm really not feeling overly emotional or depressed or anything over this, so fear not, caring VST circle of friends, I'm totally fine.
Thanks all for reading! I think if you made it all the way to the end, you deserve a medal!!! :-) Since I'm fresh out of medals, how about pictures of baby otters instead!
All together now... "AWWWWW..."
http://www.huffingtonpost.com/2012/03/08/painfully-adorable-baby-o_n_1332519.html
Hope you all are having a good night and I wish you all good luck and success!
lrs, IdahoGirl32 and DangerousD reacted to this
Although... if I can work out the right "dose" they're far more exciting than the 1/2 dose of Miralax I've been having to take every day to keep the Constipation at bay.
And fiber! They have fiber! See, they should be considered a supplement! (yeah, that's the ticket...)
It's maltitol! Always always always check sugar free food for this ingredient. It even have my dog the runs so I check all dog treats for it. Many sf products use maltitol. Acts like a laxative. Not good LOL
Although... if I can work out the right "dose" they're far more exciting than the 1/2 dose of Miralax I've been having to take every day to keep the Constipation at bay.
ChihuahuaMom and TanyaB reacted to this
I am furious with my surgeon at the moment... This is NOT my fault!
in Gastric Sleeve Surgery Forums
Posted
No, definitely don't delete your post. I've always valued your opinion.