Daydra

You would think, after a lifetime of experiences that incontrovertibly show that no good ever comes from me being impatient and ramming through whatever decision I make, I would learn to STOP! Nope. I'm just not that smart... So... I paid about $20k out of pocket for my surgery, when I could have been covered by EITHER of my TWO insurance companies. Allow me to elaborate... Tricare (my secondary coverage) guidelines I was able to find showed that Tricare would cover either bypass or band, not VSG. My clinic confirmed this information. My primary coverage also only covers bypass or band. My primary also requires a 6 month medically supervised diet before they will even approve a consult with a surgeon. So, basically I said "Eff you guys, I've got a health reimbursement arrangement, I'll just pay for it myself instead of screwing around with all your rules just to have to choose a surgery I don't want, to get coverage." So, I had my surgery less than 60 days from my initial consult. I subsequently found out that I could have gotten my surgery done at the Army hospital in my area (completely free to me, of course...). That's what I get for relying on what I had found in the coverage literature and not actually seeing an on-post doc for a referral to find out what the MTF could offer that Tricare claims not to cover. Fortunately, this wasn't all that upsetting to me because I've had some bad experiences within the military medical system, and I would have been a lot more anxious about my surgery. Sometimes, peace of mind is worth a lot of cash... The second blow came today when we were presented with information on our 2014 benefits at work. The insurance plan I have has decided to begin covering vsg starting next year with a recommendation from the facility performing the procedure. Had I done the 6 month diet (perhaps with the thought that I might decide I was willing to go with one of the other procedures since they would be covered... but no, once presented with the information, I generally make a virtually immediate decision with little or no waffling. One of the few situations where being decisive is a hindrance instead of a help!), I would have been ready to schedule at the beginning of the year. My insurance coverage is very, very good. I would have had probably less than $2000 (likely way less, because my secondary picks up a lot of what would be my out of pocket costs) in out of pocket costs had I known and waited. Grrr... That's really all I can say. Grrr! Well, I suppose I just got a really expensive 6 month head start... Thanks for providing a space for me to type out my annoyance.

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!

No, definitely don't delete your post. I've always valued your opinion.

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!

Alternate title: How I Shat Myself Sooo, you know that little statement on sugar free candy that says something to the effect of "excessive consumption may have a laxative effect"? I implore you to take it seriously, people. I never really ate much sugar free candy pre surgery, but I'm absolutely certain that I've had more than a single serving at any one time in the past, just by the nature of some of my historic eating habits. I've recently developed a penchant for the Jelly Belly Sours. They come in a little bag that is labeled as 2 servings (80 cal per). Yesterday, I was a bit low on my calorie count for the day and was just craving the dang things, so I didn't see any significant reason not to indulge. I ate both servings over the course of an hour or two. Big, big mistake. After the undeniable realization that the rumbling in my tumbly was most definitely NOT just gas (no saving those underoos!), I spent the better part of 3 hours making panicked runs back and forth to the bathroom. Not even a little bit fun. However, it does appear that I've found a solution for the next time constipation raises it's ugly head... I can't tell you how thankful I am that I was at home, close to bedtime, and didn't have anything (else) pressing that I had to attend to. Good luck! And watch the sugar free candy! 2 servings was all it took!

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 Show preview | PDF (216 K) | Recommended articles | Related reference work articles 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 Show preview | PDF (808 K) | Recommended articles | Related reference work articles 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 Show preview | Purchase PDF | Recommended articles | Related reference work articles For purchase 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 Show preview | PDF (355 K) | Recommended articles | Related reference work articles 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 Show preview | Purchase PDF | Recommended articles | Related reference work articles For purchase 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 Show preview | Purchase PDF | Recommended articles | Related reference work articles For purchase 7 American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery Medical Guidelines for Clinical Practice for the Perioperative Nutritional, Metabolic, and Nonsurgical Support of the Bariatric Surgery Patient Review Article 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 Show preview | PDF (1294 K) | Recommended articles | Related reference work articles 8 Clinical Practice Guidelines for the Perioperative Nutritional, Metabolic, and Nonsurgical Support of the Bariatric Surgery Patient—2013 Update: Cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery Review Article 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 Show preview | Purchase PDF | Recommended articles | Related reference work articles For purchase 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 Show preview | PDF (156 K) | Recommended articles | Related reference work articles 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 Show preview | Purchase PDF | Recommended articles | Related reference work articles For purchase 425] Bariatric surgery has become an increasingly important method for management of medically complicated obesity. In patients who have undergone bariatric surgery, up to 87% with type 2 diabetes mellitus develop improvement or resolution of their disease postoperatively. Bariatric surgery can reduce the number of absorbed calories through performance of either a restrictive or a malabsorptive procedure. Patients who have undergone bariatric surgery require 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 after bariatric surgery need 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 Show preview | Purchase PDF | Recommended articles | Related reference work articles For purchase 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 by bariatric 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 Show preview | PDF (1234 K) | Recommended articles | Related reference work articles 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

Thank you, I agree that the dietician would likely give me better insight than the surgeon, however, she's already given me her recommendations, so I'm sticking with them. I think I indicated in my post (if not, I did in one of these responses) that I didn't believe that I actually need a change in diet. I believe it's some combination of increased hydration and my body's reaction to the calorie normalization. But, at any rate, the post was about the interaction with the surgeon, not any "failure" to lose weight. The entire issue was that I was angry at being marginalized. I saw a therapist for a few months before surgery, but we determined that there wasn't really a need for me to continue seeing her unless I ran into something I felt I needed to work out. All of my closest friends are therapists and social workers. I talk to them about everything. It will be pretty easy for me to identify when/if I need to see a therapist. So far, I haven't had the emotional sh*tstorm I expected. No tears, no increase in depression, no sense of loss or grief. Short tempered at times, but that's pretty much my baseline. I used the clinic therapist for my psych eval. I would not consider seeing her for therapy. She was very nice, but her idea of a psych eval was a 25 minute telephone conversation. Thank you very much, $275, please! I didn't know that was what I was in for until she didn't make it to the scheduled appointment and rescheduled me for a phone "interview". I would have used my regular therapist, but she couldn't do it, so I just used the one at the clinic because I figured it would be less hassle. That part was definitely true... All of that is neither here nor there. At any rate, a therapist isn't going to tell me all the deep dark secrets of how the metabolism works, and I'm not stressing over weight loss. I'm just angry about my interaction with my surgeon during this appointment.

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.

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.

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...

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!

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.

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!

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... :-)

Thank you so much! Good advice and I intend to take it!

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.

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!!!)

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... :-)

Thank you. Agreed!