Daydra

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!

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!

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.

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.

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.

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!

And fiber! They have fiber! See, they should be considered a supplement! (yeah, that's the ticket...)

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.