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...

1. 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.
2. 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.
3. 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.
4. 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?

On 2/12/2024 at 1:39 PM, newbegining2024 said:

My nutritionist advice for each meal now is 3oz of Protein, 1 oz of vegetables and 1 oz of starch. Always try to eat the protein first. My daily calorie intake is between 600-800 including the Protein Shakes. I am drinking 1 1/2 bottle of shakes. I fell 2 shakes to be too much for me, and 1 1/2 is just right. Protein intake is about 85-100grams. I will ask on my next visit to find out if I really need that much of protein since they told me my daily goal should be 65-75 grams initially.

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'm finally getting around to selling a few items that I felt that I should sell instead of donate because they were expensive, and I barely or never wore them. I have the following listed on eBay right now:

Size 1X Spanx "Slim Cognito" thigh-length body shaper (http://www.ebay.com/itm/SPANX-Slim-Cognito-Bodysuit-Mid-Thigh-Body-Shaper-in-Beige-Nude-Plus-Size-1X-/272318545469?hash=item3f67733e3d:g:B-YAAOSwTZ1XlQt-)

Size 14 purple silk-wool Albert Nipon skirt suit (http://www.ebay.com/itm/Albert-Nipon-Plum-Purple-Silk-Wool-Skirt-Suit-Size-14-NWT-/272318479876?hash=item3f67723e04:g:-w8AAOSwbsBXlPqK)

Size 14/16 (but runs large) Igigi Marisol lace dress (http://www.ebay.com/itm/Igigi-Marisol-Plus-Size-Lace-Semi-Formal-Dress-Size-14-16-/272318507952?hash=item3f6772abb0:g:7u4AAOSwbsBXlQHT)

And the size 7.5WW shoes I bought to go with the dress (http://www.ebay.com/itm/Annie-Cameron-Silver-Mesh-Lace-Heels-Size-7-5-E-WW-Extra-Wide-2-5-Heel-/272318532913?hash=item3f67730d31:g:qEEAAOSwIgNXlQgs)

Oh, I guess I didn't really mention what kinds and amounts of exercise I'm doing--usually I do 1-2 yoga/Pilates classes per week, 1-2 Zumba classes per week, and walk my dogs for about 30 min. most days. I also will count working in the garden, heavy-duty cleaning, and other activity that's out of my "norm" towards my exercise. I have a Garmin fitness tracker that counts my steps, and it syncs with MyFitnessPal to estimate my calories burned. So, I'm not doing intense working out or training that burns an insane number of calories.

I'm over 10 months out, and I have only thrown up on three occasions since surgery. Once was the day I came home from the hospital and stupidly took my whole antidepressant for the first time in a few days on an empty stomach (I started cutting it in half and taking it in two doses spaced out, with food, and was fine). Once was a couple months later and was just a weird combination of factors and seems to have been just one of those random things. And then a couple months ago I had a nasty stomach flu, which is completely unrelated to my surgery.

As far as acid reflux, I take prescription Pepcid twice a day as a preventive measure and have no problems. In fact, I haven't touched a Tums since surgery, where before I was popping them all the time.

Everyone is different, some people have these issues, but for me the benefits outweighed the possibility of the side effects. Don't panic and cancel surgery.

I have been theoretically in maintenance since before Christmas, but have lost another 20 lbs since then. My weight right now is lower than when I was a ballet dancer in high school (still trying to wrap my mind around that one). And I'm averaging about 1400 net calories per day, so I'm actually eating somewhere in the range of 1500-1800 calories per day depending on how much I burn with exercise. I'm still trying to find the sweet spot to maintain, as I am still losing in little dribs and drabs (.25 lb here, .5 lb there). If I were limited to 1200 calories worth of food per day, I can't imagine where I'd be!

Also, I average about 70-80 grams of fat per day... I was also told to keep to 30 grams or less, but I don't know how it's possible. That was also based on a 1000 calorie-per-day plan, which obviously is not where I'm at now. I'm already getting well over 100 grams of Protein per day, ditto carbs, so my macros would have to change drastically to make that happen. I have MyFitnessPal set for 1400 cals, with 35% Protein (122 g), 35% fat (55 g), and 30% carbs (104 g). Those amounts go up when I eat more total calories to compensate for activity. Obviously, I don't do real low-carb as it is (though I don't really eat bread, Pasta, rice, Cereal anymore), and I don't want to damage my kidneys with even more protein, so unless my NUT gives me hell at my next appt, I am going to keep fats where they are.

Last New Years, I flew out from Philly to Indianapolis to visit my parents. My dad's younger sister had died two months prior due to complications of diabetes. I was at my heaviest, was depressed, and having back and other health problems. My mom brought up the idea of WLS to me while I was there, and I reacted poorly and defensively. My flight back to Philly was on a slightly smaller plane than the one I flew in on, and I couldn't lower my tray table because of my stomach, and I spent the flight home trying to keep my fat from spilling over into my neighbor's seat and thinking about what my mom had said. I started researching WLS the moment I got home.

I also take Effexor XR and thought I would have an issue with it as well but thankfully did not. And argh I know all about the brain zaps. So far it seems to be doing okay with me, I am 7 days post-op. Do you feel the drug works better for you than before overall since WLS or the same?

I feel like it's about the same, except that if I miss a dose I feel it much more quickly than before--and not just brain zaps, but I start to get anxiety/mood swings. I take the regular version, though, not the extended release.

I'm currently wearing my wedding band on my middle finger (not sure what message that sends, haha). I haven't been able to wear my engagement ring for months. Right now I'm waiting for hot weather to have them sized, because my fingers always swell in the summer, and I don't want them to be sized too small.

What the others said-- get rid of them, except for one or two things to keep as the "before"--like I did to compare my size 20W shorts with my new size 2 shorts.

I donated my stuff in one of the bins as the local elementary school where the proceeds go back to the school. Most of my clothes were cheap things from Target, so they were not worth selling.

Sorry for the suspense. He eats 3 raw eggs a day, a full can of clam chowder, 2 cans of potted meat, whole Beans and salsa. Some other stuff, both large portions, solids, spicy stuff.

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Yikes. I have to say, with the exception of the Beans and salsa, the rest of that would make me barf even 9.5 months out... but raw eggs, clam chowder, and potted meat would have made me queasy before surgery, too.

Weight and BMI are ultimately pretty meaningless numbers. There are SO MANY more important numbers. BP, A1C, cholesterol, triglycerides, body fat percentage. THOSE are the numbers you should be focusing on for health and longevity!

True. Don't forget clothing sizes--they are probably the most meaningless because they are so arbitrary, especially for women (see my post above!). I want to get my body fat measured to see where I'm at in that regard--I know I could stand to build some more muscle at this point.

My goal is 165 which is my teenage weight and I was healthy there. To get out of the overweight category I will have to be 158. It's hard to imagine either... With my weight only 260 right now, it's possible I could be smaller. But at 165 I was a size 12. I can live with that!

I don't know how long ago it was for you that you were at 165, but don't be surprised if you get there and find that you can wear smaller than a 12! I was about 120-125 in high school (mid- to late-1990s), but I never wore below a 7/8. At the same weight in 2016 clothes, I wear a 2 or a 4. Vanity sizing is insane! I often wonder how the ~really~ skinny girls find clothes... like, are there secret stores for uber-thin people that carry things in triple- and quadruple-zeros?

My shoulders seem very narrow and I don't think I can stand to lose much more in my upper body but I have always been lower body heavy and definitely need to lose more in my thighs (though of course, we cannot spot reduce fat). I am more focusing on clothing sizes. I am still in a size 14 pant (16s some places) and XL or XXL shirt (again depending on place). So to me, that says, I still need to lose a little more.

I've found that my weight is distributed differently now that it was when I was around my current weight as a teenager, 20 years ago (shocking, I know). My upper body seems a lot bonier than it did then--my collarbones and sternum stick out more than I remember.

For me, I actually feel like I have a burp stuck and it hurts. As soon as that happens I have to be done or I will be sorry. That also happens if I don't chew properly or if I eat too fast.

It doesn't happen often but when it does I know to stop right there and spit out anything I may have in my mouth.

Same here. I get a sharp pain beneath my sternum. It only lasts for a few minutes, but it's not very pleasant.

My insides make crazy whale sounds when I eat a meal that is higher in starches and fat than normal--like Thanksgiving dinner.

I had a lot of issues with orthostatic hypotension (getting dizzy/feeling like I might black out when I stand up, especially from a crouched or bent over position) for a few months. My NUT suggested upping my sodium intake a bit, and drinking something with electrolytes when I exercise. That helped, and as my weight loss has slowed down, and I'm taking in more calories, it doesn't happen nearly as often.

Yes, I'm intrigued to hear what he was eating, also...

My surgeon didn't give me a goal, he just said that the average loss would be about 60-70% of my excess weight. That would have put me still in the "obese" range, so I didn't pay a lot of attention to that. I initially set my personal goal at 145, which was still in the "overweight" category for my height, because it was the lowest weight I could realistically see myself at. But as the weight was coming off, I realized that I could revise my goal downward, so I picked 134.8 because it was just in the "normal" category and would put me right at 100 lbs lost. Then I hit that and decided that it'd be nice to have some "wiggle room" and went for 125-130. I'm now working on maintenance but am still losing a little and am at 114.4 at the moment. Even when I was a ballet dancer, I couldn't maintain under 120, so this is really bizarre for me. Since puberty, there has never been a time in my life where I wasn't trying (or hoping) to lose weight.

So, to some extent, your body will dictate where you'll end up. I think there are a lot of factors at play--how long you were overweight/obese, your age, your metabolism, genetics, etc.

Yeah I struggle with depression before surgery due to an assault and I've been working on that for a while now. I can't say things were great to begin with but they have gotten so much worse. After surgery my back pain escalated and my stomach is cramping so over all I feel miserable. The medication I was taking required a certain amount of calories that I can't get in one setting so now I have to find something different. I hoped it was just a food change that I had to deal with but I see it's my whole life.

How long ago was your surgery? It sounds like maybe you're not very far out. Most people feel pretty crappy for the first couple weeks (or more), but it does get better, I promise!

The first time I tried to take my Effexor post-op, it made me puke because it should be taken with food, and I didn't have enough in my sleeve to make it tolerable. I also found that I metabolized it differently and would get to feeling really weird (Effexor users call it "brain zaps") when it got too long in between doses. So what I did (with my psychiatrist's OK) was to cut my pills in half and take one in the morning and one in the evening. Later I was able to get a smaller dosage pill so that I can take one in the AM and one in the PM. My surgeon said that it was OK to take them right after I eat with a little sip of Water, so there is something in my stomach when I take it. I don't know what medication you were taking and if it can be cut, but that may be something to bring up to your doc if you were otherwise happy with the meds.

Yup, I've struggled with depression since I was a teenager and have a strong family history of it on my dad's side.

I've tried a variety of antidepressants and have settled into a decent place with a low dose of Effexor (BTW, if you take meds, you may have to adjust them post-op. I have to split my dosage and take it twice a day instead of once after being sleeved, or it makes me nauseated.).

I had been in therapy off and on over the years, but when I had my psych eval before surgery, they recommended that I find a therapist that I could work with through the whole process. So I started seeing someone a few months pre-op, and I am still doing biweekly sessions at 9.5 months out from surgery.

While I am much happier since surgery in a lot of ways, there is a lot of emotional baggage that comes along with massive weight loss. I knew from the start that having surgery and losing the weight wasn't going to magically "cure" my depression, but it's one step in getting to a happier place.

Best of luck!

-Quest bars, a dangerous obsession

-tracking my food, Water, steps, etc with MyFitnessPal and my Garmin Vivosmart

-collecting WWII British Army Auxiliary Territorial Service items (yes, very specific... and expensive)

-criticizing myself... I'm working on getting rid of this obsession

My surgery is next month probably and it seems sureal to me. I feel line there's no way I'll actually lose 100lbs even though I'm projected to lose more than that. I guess I feel like weight loss is simply impossible and it won't happen. After such a big weight loss, do you feel thin or do you still see yourself as fat?

Like you, I could not even begin to imagine losing 100 pounds. I originally set my goal weight at 145 because I simply could not conceptualize ever weighing less than that again. I still have days where I find it hard to wrap my mind around that fact that I've lost so much weight. I'm 9 months post-op, and I hit my goal of 135 around Christmas, so it's still really new to me. I started at about 235 and am at 116 now... I went from a size 20W to a size 2... I've lost over half my body weight!!! Physically, I feel SO MUCH BETTER. My feet don't hurt, my back pain has lessened, I'm not popping Tums constantly, my sugar is normal, etc.

I'll be honest, though--I'm not yet used to seeing myself as a thin person rather than a fat one. And as I've talked about in another thread, I'm still struggling with feeling ugly, not good enough, etc. I recommend finding a therapist that can help you through the mental and emotional aspects of this process, because it can be a roller coaster ride.

This is a very appropriate place to use affirmations. Especially when you look at yourself in the mirror.

Start with a simple: "I am beautiful."

I am on the run so will come back with more later. I am sure others have examples.

I've had therapists work with me on affirmations, and I struggle with it. I'm too cynical... the best thing I've been able to manage is "I'm not a total a-hole, I guess."