lauraellen80

I had VSG (2015) to RNY revision on January 18th due to GERD. I also had regained almost 70 pounds from my VSG post-op low weight. I've so far lost about 20 pounds since the pre-op diet & surgery. I need to lose another 20 pounds (for normal BMI) to 50 pounds (for calculated ideal body weight). I'm now on unrestricted food textures, and per my program's dietician, I'm supposed to be on my "maintenance" diet now. However, they refuse to discuss any calorie goals or macros other than protein. I'm someone who needs very clear goals and guidelines (thanks, long-undiagnosed ADHD), and I'm feeling very lost about what my diet should look like moving forward. The lifelong guidelines for my program, as I understand them: 60-80g protein per day Up to 4 oz. (1/2 cup) per meal, consisting of: Up to 3 oz. protein per meal Up to 1 oz. (total) veg, fruit, or starch per meal 3 meals per day 1 snack per day (the program guide I was given says 1-2, but per my surgeon I'm only allowed to have 1 snack per day and it has to be between lunch and dinner) - I have no guidelines for the amount I'm allowed for the snack. I assume it's not supposed to be as much food as the meals, but I don't know. Protein shakes/powders are frowned upon The only sample menu provided in my program guide is as follows: Breakfast: Egg omelet with sautéed peppers & onions Snack: Protein shake OR Greek yogurt with berries [removed per my surgeon's instructions] Lunch: Lettuce wrap with turkey and avocado/cheese [it is not clear to me if the / means avocado OR cheese, or avocado AND cheese, but I assume the former] Snack: Apple slices with 2 tablespoons nut butter OR carrots with hummus Dinner: Pesto chicken with spaghetti squash, sautéed spinach, and cherry tomatoes I plugged this menu into the Baritastic app to try and get a sense of what the calories and macros are supposed to look like. The sample menu gave no amounts other than the nut butter, so I used the 3 oz. protein + 1 oz. veg/fruit/starch rule. With the carrots & hummus snack option, here are the macros for the day: 593 calories 62g protein 32g fat 17g carbs (13g net carbs) 4g sugar 4g fiber And here are the apple & nut butter (I used natural peanut butter) macros for the day: 739 calories 67g protein 43g fat 21g carbs (16g net carbs) 8g sugar 5g fiber So from that, I'm extrapolating that I should be aiming for the following daily: 600-750 calories 60-80g protein 30-40g fat less than 25g carbs less than 10g sugar I have a few concerns... I have already been going well over those amounts at just over a month post-op. I've typically getting around 800-900 calories per day. It seems like a real struggle to get to the upper range of protein daily while sticking to the allowed amounts and without using any shakes or protein supplements. Even then, 80g seems low for a protein goal. I have never been a big meat eater (I was vegetarian through most of my teens and 20s), and I absolutely cannot stand any fish or seafood. I do eat a lot of dairy, eggs, and beans, but it seems like that's not going to do it. The standard daily fiber goal I've always heard is 25g per day. I've been getting about 12-15g per day right now, but knowing that I'm overeating and already having too many carbs means even that's not sustainable. I've struggled with post-op constipation... I have gotten to a much better place recently, but if I need to cut back to 4-5g of fiber per day to be within my other limits, I'm afraid of going backwards. That I'm limited to 1/2 cup of food per meal for the rest of my life came as a shock to me, as a revision patient. I knew that my pouch would be smaller than my sleeve, and like with my original surgery, the amount I'd be able to eat at one time would be very small initially. But with my sleeve (which was done by a different surgeon in a different program), there was definitely not the expectation that the amount I could/should eat at 1 month post-op would be the same as what I could/should be eating at 6 months or 1 year out. My bypass surgeon also told me that she left my pouch a little larger than normal so that I wouldn't lose too much additional weight, so my pouch is already larger than a regular bypass patient's. Do these amounts seem in line with other people's experiences? Or am I way off-base?

Well, apparently part of my problem was that the nutrition guide I was given at my final pre-op appointment was not the same one that the dietician is currently working from. ? Just got sent the correct one, and it's way different, especially in regards to protein shakes. So that's fun. Makes it kinda hard to trust my program when they can't get their **** together enough to give patients the correct materials.

Thanks for sharing your experience. I'm just over a month post-op from VSG to RNY revision and feeling kinda lost. Do you track calories and/or macros? If so, what are your daily goals? Is your pouch normal-sized for a bypass, or did your surgeon leave it larger like mine did? How much food per meal are you eating at this point?

That's interesting... I had revision surgery the day before you, so we should be on the same stage, but even over a week after you posted this, I'm only allowed 3oz protein and 1oz veg, fruit, OR starch. 4 oz. total, with no indication that these amounts will ever change moving forward. And I'm being told that I should not be using protein shakes anymore if at all possible. I'm struggling with how to consistently get 20g of protein per meal when I can only have 3oz. at a time. If I could just eat plain chicken breast for every meal, sure. But I'm not cleared for unrestricted textures yet, and canned chicken breast is only 15g protein for 3oz. The dietician also REFUSES to give me any guidance on how many calories I should be aiming for per day and says that I shouldn't be "restricting," because I'm in my "maintenance phase" now. Which I am extremely confused by, because according to their plan, I'm still on "soft foods" until Monday, 2/25. And I have 25-50lbs to lose, still at the high end of the "overweight" BMI range.

Thanks for all the replies, everyone. On the advice of my therapist and my surgeon's nurse practitioner, I stepped away from bariatric social media for a bit before my revision. The surgery went OK - it did take 6 hours, as my surgeon found a considerable amount of irregular tissue on my sleeved stomach that had to be removed and biopsied. Thankfully it turned out to be benign - probably was scar tissue from my sleeve surgery. I did have more pain and nausea immediately after surgery this time than the first time around and ended up staying a second night in the hospital until that was under control. It got much easier from there, and I only took 2 of the oxycodone they sent home with me (right before bedtime on the first two nights at home), and then minimal Tylenol for the next few days. I've been able to get all my fluids and protein in from the start. Pain is now minimal, my incisions are healing well. I'm starting to get my energy back albeit slowly. I'm now on soft foods and have tolerated each new food I've introduced without any problems, My biggest issue is constipation - I don't remember it being this bad after my sleeve. I'm using Colace, Benefiber, and Miralax. I wish I could drink coffee, that would help! ? My surgeon also left my pouch a little on the larger side, saying she doesn't want me to lose TOO much weight. I'm pretty disappointed about that, since I had 40-50 pounds to lose. I'm definitely already on the upper end of the amount I'm supposed to be eating at this point - 4oz. per meal (3oz. protein + 1oz. fruit/veg). I am down about 10lbs since surgery at 3 weeks post-op and just got back out of the OBSESE category. Hopefully I'll continue to lose at least something over the next few months.

Hello - I had gastric sleeve in June of 2015 and lost over half my body weight initially, getting down to well below my initial goal in the first year. Started having issues with acid reflux pretty early on, and it's gotten steadily worse, especially in the past 3 years. I'm currently on omeprazole and famotidine, plus Tums in addition. A 24-hour PH study showed that I had over 100 episodes of reflux in that period. So I was approved to revise to a gastric bypass. I also have regained over half of what I lost, mostly since my reflux has gotten worse, and am about 50 pounds heavier than my ideal weight. The reflux makes me feel hungry all the time, and I'm eating way more carbs than I should because they seem to tame the acid somewhat. I understand that it's pretty much a pipe dream that I'll be able to lose anything close to that with revision, but I guess any weight loss would be better than where I am right now. My new surgeon said she expected that I'd get back down to 110-120 after revision (my preferred weight personally is around 125), but based on all the posts I've read here and on reddit, she is definitely exaggerating to make me more willing to go through with the surgery. The best it sounds like I could hope for is to lose maybe 15-20 pounds over the course of a year or more? I am scheduled for surgery on Jan. 18th, but I'm having second thoughts after reading so many horror stories of unpredictable dumping episodes and ever-changing food intolerances. I guess maybe my reflux isn't as bad as others, since the reality of daily life with RNY seems unbearably miserable to me in comparison to my life currently. I'm afraid that I won't be able to do my job anymore (or even leave the house at all) if I am unable to eat or drink anything without the risk of vomiting/foamies (I have pelvic floor issues, so I pretty much always lose bladder control when I vomit or dry heave) or having uncontrollable diarrhea. After revision, do you have to wear an adult diaper all the time? Has anyone developed an eating disorder based on fear of getting sick after consuming anything? Do you have any "safe" foods, or is it always a (literal) crapshoot? I know that continued GERD can cause esophageal cancer down the line, but wouldn't the same be true of daily vomiting? Has anyone who is several years out from revision developed cancer or precancerous damage to their esophagus due to the constant vomiting? Likewise, have your teeth been ruined from it? For those who revised from VSG to RNY and are past the initial healing stages, would you do it again or has it made your life even worse?

I live in Montgomery County, and I had my surgery at Einstein in East Norriton with Dr. Dallal. Both the hospital and my surgeon have been great. They offer regular seminars on their bariatric surgery program, and they will give you lots of information to take home. I also have Keystone Health Plan East, and my surgery was covered... maybe it's the specific plan, but you may want to double check. I only had to meet the requirement of a BMI of 40 or above (or 35 with comorbidities) for coverage. The folks in the program at Einstein will look up your insurance stuff for you at the outset to determine if you are covered. Good luck! I'd be happy to answer any other questions you have!

I just caught the Skin Tight episode. I have to say, it actually made me feel better about my excess skin, which has been bothering me a lot. Comparatively, I have a minimal amount of loose skin--which I knew in my rational brain, but it seems a lot worse when it's just me staring at my bare stomach alone. But I completely relate to not wanting to be touched where there is loose skin and making intimacy difficult. I was so insecure of my body before I lost the weight, and it was a huge disappointment to feel just as disgusted with how my unclothed body looks now as I did before.

The pic on the left is from my brother-in-law's wedding last December. The pic on the right is from a friend's wedding over the weekend. Not quite at goal yet, but thought the difference was enough to share!

@@VSGAnn2014, this is where I get really confused, too. I'm not in maintenance yet, but I'm at 1000 calories a day now, as per my dietitian's instructions. She said I should still be keeping my carbs to 50 grams or fewer, and my Protein should be at least 60 grams, and another handout I have says to keep fat under 30 grams per day. That... doesn't add up. I have my macros in MyFitnessPal set to a goal of 50% protein, 25% fat, and 25% carbs, which for 1000 calories per day ends up being 125 g protein (!!!), 63 g carbs, and 28 g fat. I never make that protein goal (and it sounds like I shouldn't, according to @ElizabethAndersonRD), and I nearly always end up going over the fat allotment every day in trying to keep the carbs close to 50 g. The fat is mainly from cheese, olive oil, and nuts.

Good question--I wonder that, too. My understanding is that too much protein can cause kidney damage, but I don't have a sense of how much that is, and over what kind of time frame.

I'm one month post-op today. I'm trying to take "mugshot" pictures along the way, in the same outfit, in the same place, so that I can judge my progress more easily. These are definitely not glamour shots! The top row was taken the first day of my pre-op diet at 218.4 lbs. The bottom row was taken tonight, six weeks later at 190.4 lbs.