Peggy D

Yes, mine certainly has been slow. I had a revision of the sleeve & conversion to a single-anastomosis duodenal switch on December 29, 2015. I had gained about 15 pounds from my low weight after the sleeve & did lose 11 pounds before the revision surgery. I am down about 13-14 pounds since day of surgery, most of that in the first two weeks or so. Since then my weight has fluctuated a couple of pounds. At one point I had gained about 4 pounds but that has now come off by doing just protein shakes for 3 days.

My starting weight was 303 on my scale. I had the gastric sleeve done on 8-22-2013. My weight the day before surgery was 259, a loss of 44 pounds in 4 months pre-op. Over the next 5 months or so I lost about 33 pounds & then I stalled. Nothing would break the stall. I did lose another 5 pounds over the next 10 months. On 12-8-2014 I had a panniculectomy where my surgeon removed 15 pounds (!) of excess skin & fat. This was covered by insurance since I had documentation of recurring severe rashes under the "apron." I did hit a low of 201 pounds about two months after the panniculectomy but that was very briefly & I have gradually regained to a weight of 218. My BMI was still just over 35 & I still have the co-morbidities, although markedly improved, that I did when I started. I can’t say the sleeve didn’t work. After all, I was down 84 pounds from my starting weight & 95 pounds from my highest weight. When they say patients lose an average of 65% of their excess weight, there are many on both sides of that average. I’m just one of the lower percentage people. So, after much consideration I decided to have the duodenal switch as my surgeon originally suggested. The major malabsorption of the classic duodenal switch still scares me so I had decided to ask Dr Srikanth if he would do a longer common channel when I learned of the single anastomosis duodenal switch, AKA loop DS or SIPS, which has an even longer common channel. He & I agreed on a 300 cm common channel which I am comfortable with. I got insurance approval one week after I completed the pre-op testing. On December 29, 2015, I had a revision of the sleeve, the loop DS & an hiatal hernia repair. Recovery has been a bit rocky. A week & a half ago I spent the afternoon & early evening in the ER getting IV fluids & a CT scan because I was having difficulty getting my fluids & Protein in & was vomiting quite a bit - four times just that morning. Two days later I had a repeat upper endoscopy & my surgeon dilated two strictures in my sleeve. There was still a lot of edema in the stomach but I'm doing much better now. I do wish there was a way to speed up resolution of the edema. I still feel a lot more restriction, especially in the afternoon & evening, than I ever did with the initial sleeve.

Update on my revision from VSG to SA-DS/SIPS/loop DS (pick your choice of names - I like loop DS), three weeks post-op Recovery has been rocky to say the least. I spent the afternoon & evening in the ER on Saturday getting IV fluids & a CT scan (to check my new stomach staple line). Yesterday I had an endoscopy & had two strictures in my stomach dilated with a balloon. The strictures were causing a functional obstruction. It wasn't a complete obstruction but certainly more than enough to make it extremely difficult to drink all of my fluids & get my Protein shakes down. It also led to increasing vomiting. Today, I am much better & have been able to get fluids & protein down & they stay down.

The last time I lost a significant amount of weight was on the Adkin's diet when I was 23. I went from 201 down to 163, a loss of 38 pounds, & actually kept it off for a couple of years. Over the years I gradually gained until I hit my high of 314 after I quit smoking 4+ years ago. I gained about 10-11 pounds over 6 months & then lost that over the next 6 months without even trying. Then I was back to about 303-304 pounds where I had stabilized for several years. I had gone back on the Adkin's diet many times over the years. I had also tried the liquid "pre-digested protein" back in the early 1980s & Nutri-System in 1990-91. At the most I would lose 10 pounds & then stall. My surgeon did say he thought the duodenal switch would give me the best results for my type 2 diabetes but I said I didn’t want anything to do with malabsorption & he was fine with that. I did have the gastric sleeve done on 8-22-2013. My weight the day before surgery was 259, a loss of 44 pounds in 4 months pre-op. Over the next 5 months or so I lost about 33 pounds & then I stalled. Nothing would break the stall. I did lose another 5 pounds over the next 10 months. On 12-8-2014 I had a panniculectomy where my surgeon removed 15 pounds (!) of excess skin & fat. This was covered by insurance since I had documentation of recurring severe rashes under the "apron." I did hit a low of 201 pounds about two months after the panniculectomy but that was very briefly & I gradually regained to 219. My BMI was still just over 35 & I still have the co-morbidities, although markedly improved, that I did when I started. I can’t say the sleeve didn’t work. After all, I was down 84 pounds from my starting weight & 95 pounds from my highest weight. When they say patients lose an average of 65% of their excess weight, there are many on both sides of that average. I’m just one of the lower percentage people. My age & length of time I've had type 2 diabetes are probably the main reasons I hadn't lost as much weight as I had hoped. So, after much consideration I have decided to have the duodenal switch as my surgeon originally suggested. The major malabsorption of the classic duodenal switch still scares me so I had decided to ask Dr Srikanth if he would do a longer common channel when I learned of the single anastomosis duodenal switch which has an even longer common channel. He & I have agreed on a 300 cm common channel which is an amount of malabsorption I am comfortable with. The pre-op testing revealed that the upper portion of my sleeve has dilated so he re-sleeved that at the same time as the switch. I asked about the sleeve dilating &, apparently, that is normal. It's what our stomachs are made to do. It's the upper portion of the sleeve that will dilate. A gastric sleeve procedure removes a lot, maybe most, of that stretchable portion, but there is still some. It was a lot of work, getting all of the testing & an updated psych evaluation done, but I got them done in a week & got insurance approval a week after that. So I was able to get my surgery done before the end of the year, on December 29. I was even able to lose 10 pounds in the three weeks before surgery, most on the dreaded Clear liquids. I had a revision of the sleeve, the single-anastomosis duodenal switch & repair of a hiatal hernia. Recovery has not been as smooth as it was for the original sleeve but I'm making progress, probably faster than a lot of patients undergoing the same procedure. I think the hiatal hernia repair has cause the most discomfort. I had a lot of gas pains under my diaphragm & spasms of pain running across my diaphragm every time I swallowed. But that is better & I rarely take even acetaminophen for pain, just walking & drinking my liquids warm helps the most. Of course, I put on 10 pounds in the hospital & by six days after surgery I was back to "day of surgery" weight. My surgeon is very strict on the post-op diet & I was to start 5 Protein shakes a day on day 8. It has been a challenge, much more so than the first sleeve, to get all of my fluids in, but I have gotten the minimum 80 oz in every day, & over 100 oz the last two days. My shakes are supposed to be made with just 3-4 oz of Water. But trying to get even that much down is a struggle. I switched to unflavored Protein powder after my first sleeve because the flavored ones just "sat like a rock" in my stomach. Now I'm having the same reaction only more so to the unflavored. It does go best mixed with my homemade broth, but still it makes me gag. I’m now trying different brands I got from GNC & Super supplements. Instead of stressing over how much I’m getting in (& keeping down), I’m just doing my best. The huge number of Vitamin & mineral supplements as well as the regular prescription meds I take is very hard to do.

Yes, I'm still taking insulin. I've managed by checking my blood sugars at least 4 times a day & taking less insulin more often which is crucial when you make a dramatic change like the pre-op diet. I always have had a problem with high fasting blood sugars. Even back to when I only had gestational diabetes with both of my pregnancies that resolved after delivery. No matter how I adjusted my evening insulin that I took before dinner, it would be 170-180 or so in the morning, yet I would often have dramatic lows during the night. I started a low carb, high Protein diet (like Adkins or South Beach) the day I saw my surgeon for my first consult. My sugars were a bit better, but not by much, & probably more because I lost about 20 pounds in the first 6 weeks on that diet. Two months later I was so frustrated I went online & did a lot of research about the onset & peak timings of regular & NPH insulins. I had learned that in nursing school, but that was so many years ago & I didn't work with adults with diabetes to keep my knowledge fresh. I've never liked "micro-managing" my insulin but I had to do something. Because I am a nurse my PCP has always allowed me to manage my insulin with certain guidelines & I did check with his office about the changes I made. I started with checking my blood sugar 4-5 times a day & taking my NPH insulin 3 times a day, rather than twice - in the morning before Breakfast, at bedtime & halfway in between in the mid-afternoon - dividing the day total into 3. Then took regular insulin before each meal & snack. I was able to reduce the total insulin dramatically within a few days as my sugars were so much better. I used to take 20 units of regular before breakfast & before dinner & 35 of NPH before breakfast & 40 of NPH before dinner. Two months later, just before surgery, I was down to 20 units of NPH morning & mid-afternoon & 10 units before bed. I was taking 5-10 units of regular before eating, depending on my blood sugars. In the hospital my Hgb A1c was down to 5.9 from 7.3 that it was 3 months earlier.

I use the weight I was at my first visit to my surgeon. It's what I'd been for a few years aside from the 10 pounds I had gained then lost again after I quit smoking. I definitely count the 44 pounds I lost from that first visit to the day before surgery. After all, I'd been on the high protein, low carb diet since that day. I've only lost 20 pounds since then in the 2+ months since surgery.

Check out the threads in the Sixties forum. There are a lot of us there.

Ask your surgeon if he/she has a requirement for your Hgb A1c. I always have had a problem with high fasting blood sugars. Even back to when I only had gestational diabetes with both of my pregnancies that resolved after delivery. No matter how I adjusted my evening insulin that I took before dinner, it would be 170-180 or so in the morning, yet I would often have dramatic lows during the night. I started a low carb, high Protein diet (like Adkins or South Beach) the day I saw my surgeon for my first consult. My sugars were a bit better, but not by much, & probably more because I lost about 20 pounds in the first 6 weeks on that diet. Two months later I was so frustrated I went online & did a lot of research about the onset & peak timings of regular & NPH insulins. I had learned that in nursing school, but that was so many years ago & I didn't work with adults with diabetes to keep my knowledge fresh. I've never liked "micro-managing" my insulin but I had to do something. Because I am a nurse my PCP has always allowed me to manage my insulin with certain guidelines & I did check with his office about the changes I made. I started with checking my blood sugar 4-5 times a day & taking my NPH insulin 3 times a day, rather than twice - in the morning before Breakfast, at bedtime & halfway in between in the mid-afternoon - dividing the day total into 3. Then took regular insulin before each meal & snack. I was able to reduce the total insulin dramatically within a few days as my sugars were so much better. I used to take 20 units of regular before breakfast & before dinner & 35 of NPH before breakfast & 40 of NPH before dinner. Two months later, just before surgery, I was down to 20 units of NPH morning & mid-afternoon & 10 units before bed. I was taking 5-10 units of regular before eating, depending on my blood sugars. In the hospital my Hgb A1c was down to 5.9 from 7.3 that it was 3 months earlier.

I had my gall bladder out at the same time as my sleeve.

I do have the video of my surgery. They did stop the recording before they finished, though. I would have liked to have seen my humongous gall bladder laying out.

Insurance criteria has changed a lot since I started doing medical necessity review 13 years ago. Although each company is somewhat different, generalizations can be made. Back then criteria required a BMI of 40 or more and at least one uncontrolled comorbidity such as diabetes with a Hgb A1c greater than 10 or high blood pressure uncontrolled on three medications or poorly controlled sleep apnea. By the time I retired 6 years ago the criteria had changed several times & then required a BMI of 50 or more, or 40 or more at the presence of one comorbidity, or 35 or more & two or more poorly controlled comorbidities. Now criteria commonly requires a BMI of 40 or more or a BMI of 35 or more with the presence of one comorbidity. With the classification of obesity as a disease by the AMA & the increasing evidence of the effectiveness of WLS on type 2 diabetes, I would not be surprised to see criteria relax even more. I also think it will be more & more common for policies to cover WLS as insurers & employers see the financial benefits of covering WLS.

Do you make your shakes with milk? Maybe you're lactose intolerant. Try some lactaid & use water, soy milk, almond milk, etc.

You're telling my story, too, including being a nurse. I first looked into WLS nearly 40 years ago when the only option was intestinal bypass. I'm certainly glad I did not have that. The majority of people who did have it died within 5-10 years, usually less. I've know about gastric bypass for many years but am not at all comfortable with the malabsorption issues. I had never heard of VSG until a year ago & when I did I, too, knew it was the right procedure for me. I do wish the VSG had been around 30-40 years ago, but we cannot change what was & can only go forward from here. Had I still been working, I probably would have learned about it sooner. My one regret is that I didn't hear about VSG 4 years ago when my current insurance started covering it. My surgeon did tell me at my first consult that he thought the duodenal switch would give me better weight loss & increase the chance of my diabetes resolving. But I told him I don't want anything to do with malabsorption & he said "that's all I need to hear."

I was not allowed to start purees until week 5 post-op. You'll find that every program is very different. Just follow your surgeon's plan. My favorite is refried Beans with melted cheddar cheese. I did puree it for the two weeks I was on purees. Another new favorite is Kroger greek cream cheese & greek yogurt spread. Carbmaster yogurt is good & has more Protein & less carbs than regular or "lite" yogurts. I did try plain greek yogurt & added sugar-free Torani, DaVinci or Walden Farms syrups but it was too watery. I checked the flavored ones but they have too many carbs.

We were warned in our pre-op class that gaining 10 pounds in the hospital was average. I only gained 6 pounds, but it did take a week to lose that.

Love those ears!

I have always had a very large "apron" & it's not shrinking much, but it's also not hanging down any further, yet any way. It is flatter. I don't really know what size pants I wore or wear now as I've made my own for years, but they are definitely looser & I've had to take 7 or so inches of elastic out of the waist recently to keep them from falling down.

Mine follow who ever has the best smelling food. I tell them they all get to eat more than I do, but I still get the pitiful looks. We finally got a picture of all five of them at the same time. These are my girls. My boys are human.

My surgeon's ARNP suggested Quinoa to add to my soft food diet. She said it is a complete protein. I had never heard of it before. Where do you buy it?

We were told that the protein starts to break down after 30 minutes or so of mixing so you wouldn't get all of the benefits.

Well I did gain but only 0.1 pounds, nothing really. Time will tell. I don't think I should have to go back to clear liquids & protein shakes every week or two just to lose some weight. I'm eating about 800-900 calories a day & walking 30-45 minutes a day (as much as my knees & sacroiliac will allow). It just seems that every pound is a struggle. I could understand that if I were close to goal, but I'm not even half way there.

My surgeon doesn't allow pre-made shakes, only the powders & that has to be 30 grams of Protein in 2 scoops or less. As I've said many times, I used the Body Fortress chocolate Peanut Butter pre-op but they did make a change to it, going from 27 grams protein to 30 grams in a scoop & the flavor changed. Post-op I got to the point where any flavored protein did not sit well at all. I ended up getting Now Sports unflavored whey isolate & it is working very well for me. I can add it to all kinds of things or make it with Water & add Torani, DaVinci or Walden Farms sugar-free syrups.

I'm only down 18.9 pounds since surgery & I'm 8 weeks out.

Weight loss has never been easy for me. The most I ever lost on any diet was 38 pounds on Adkins 40 years ago. I don't remember how long that took. I was sleeved on 8/22/13, eight weeks tomorrow, & as of this morning I am down a "grand total" of 18.9 pounds since the day before surgery. The last two days I went back to clear liquids & 4 protein shakes a day just to try to "kick start" losing again. Tomorrow I see if I gain back any of the 5 pounds I lost in the last two days.

I'm 64 & was diagnosed with type 2 diabetes over 20 years ago. I had had gestational diabetes with both of my pregnancies 28 & 30 years ago. I've had to take increasing amounts of insulin to keep my Hgb A1c "reasonable." A year ago my Hgb A1c was 7.5. In May, one month in on my 3-month supervised high Protein, low carb diet it was 7.3. I remember being told that it was checked while I was in the hospital & it was 5.9 but no one can find the result. I just had it done today for my annual check up & it is 6.0. I haven't taken Metformin since 10 days before surgery & I'm now taking dramatically less insulin. As for the skin, I have especially noticed my weight loss in my face but not any excess skin. My "turkey neck" is less than it was a month or so ago. Abdominal skin is another story. I have always had a huge "apron" & it's now flatter, but not shrunken at all. I've known all along that I will be needing a panniculectomy when I get to goal.