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!!!)