theantichick

I had seven kinds of hell in my pre-op diet, and I wasn't even on liquids only. I felt deprived and starving. I worried incessantly that I was going to be the ONE PERSON who didn't have the hunger drive killed off with the surgery.

I all but lost my hunger with the surgery. I don't know what the people are going through who are having the starving feelings. I'm not discounting them, I'm just saying that didn't happen for me.

I had a few days with some stomach pains that felt like true hunger pains when my sleeve would get completely empty, and I just took that as a sign I wasn't sipping often enough on my Protein shakes. That and the PPI for acid stopped that. After about 10 days I was desperate to just CHEW something... wasn't really hungry for anything, just tired of drinking everything. But I soldiered through. I did have a hankering for refried Beans and cheese, which is the first thing off the pureed list I had once cleared by my doc, but could only get down a couple spoons before I was FULL FULL FULL.

Really, I was weeks and weeks out before I had an old craving hit, and that was just a voice in my head trying to tell me that Little Debbies (an old nemesis) would count as "soft foods" but I thought about what it would actually taste like, and it didn't appeal. I wasn't hungry, and wasn't driven to eat junk. I was probably 6 weeks out before I really felt hungry for real. I had to set alarms on my phone to remind me to eat and drink because I'd get busy and forget for HOURS.

Now, I have days and days where it doesn't occur to me to eat, I have to remind myself that yes I need to stop and eat something. And then I'll have a couple of days where it catches up to me and it's like I'm hungry ALL DAY LONG but not binge eating, just I'll eat and then a couple of hours later I'll find myself hungry again, so I'll actually eat 6 small meals that day where I'm normally fighting to get 4 in (I'm supposed to eat 5-6 small meals a day). I'm just now at almost 4.5 months out starting to want to eat stuff I shouldn't in quantities more than a bite or two, and am dealing with that but it's still not overwhelming, just thoughts of "oh, wouldn't a huge bowl of ice cream be great?".

So at least for some of us, the hunger really isn't an issue after the surgery.

Premier is pre-mixed. After surgery, it was the only thing I could stand. Do you tolerate milk OK? My paperwork suggested something called "double milk" which is powdered nonfat milk mixed into regular skim milk with a blender. Also, Fairlife milk has more Protein than regular milk which can help. Also, try mixing the powders with more water/milk than it calls for. Or, alternatively, mixing it with less to make a pudding consistency that you might find different enough to tolerate. Just play with it and try different things. I also had good luck with putting unflavored Protein powder in chicken broth/bouillon (just mix it with warm Water in a blender first, then mix that into the hot liquid to avoid clumping). I also did well freezing the fruit juice "clear" Protein drinks into ice pops and getting them down that way early on.

I'm SO glad I don't watch network TV anymore.

Just get one of these and go on the cruise!!

https://www.amazon.com/Drive-Medical-Aluminum-Steerable-Alternative/dp/B003VMAKVS

I worked in an ER where one of our techs ruptured an achilles tendon or somesuch, and she kept right on working using one of these things... I'd have never believed it until I saw it. But it meets the "non-weightbearing" restriction for the orthopedist, but still lets you do a lot of stuff!

Seriously, I've had a lot of ortho stuff (mostly knee) and it always sucks. Sorry that you're going to have to have surgery, but think how much better recovery and PT will be at a lighter weight!!

Actually, I'm going to strike my last statement. I remembered that when I was first researching this surgery, I bought Alex's book on the subject, and it was great. I'd forgotten it had a whole section on the post-op diet, because my doc's info was thorough enough I hadn't needed to reference it. I just pulled it down from my cloud reader and skimmed the diet sections, and it's all there. I have no need to re-create the wheel, and no time to research and write a book when it's already done.

So.... if your doc hasn't given you good/complete/thorough information, please get Alex's Big Book about the VSG. It's VERY well researched and I didn't find a single thing in there that was wrong. Obviously, if your doc has information that is contrary to the book, your doc's info should trump it. But in the absence of info from your doc, this is really good reference material: (two enthusiastic thumbs up):

https://store.bariatricpal.com/collections/weight-loss-book/products/the-big-book-on-the-gastric-sleeve

I am already used to cold food, I have a 2 and 4 year old. lol I got detailed instructions up to the 'normal diet' which for me started on the 25th. Being new I asked what questions I thought of but wasn't 100% sure other than Protein first and keep it to a 1/4 cup.

I ended up with an appointment with another nutritionist than the one I saw the whole time so that threw me off too.

My initial packet included even maintenance diet examples and planning instructions. I first met my surgeon in Feburary. I likely won't hit maintenance until summer 2017. So she was giving me information I wouldn't need for some 18 months in the future. We didn't spend any time on it, but the information was there. Repetition is the key to giving information to patients, so giving them information *well before* they need it is part of that process. I've even seen programs that send a 3-ring binder "book" home with the patients so the packets don't get lost.

Patients often don't know what to ask until they're home and actually trying to figure out what to do. If the information is there, and someone with the team has at least glossed over it with them, they usually open the packet and go "oh yeah, here it is".

You went to a full diet on the 25th, but you don't have a nutritionist appointment until sometime in January. You at the VERY least should have been given written information about how to proceed into a full diet and what kinds of foods to avoid and what to focus on when you entered the soft foods phase.

I swear, I need to write a supplement patient manual and sell it on Amazon.< /p>

I just don't understand why some docs are doling out information about the post-op plan like it's uranium or something. I walked away from my first one-on-one with my surgeon with the entire pre- and post-operative diet progression plan in my information folder.

I then met with the nutritionist who was ready to answer any questions I had about food, preparation, diet, nutrition, etc. (I didn't have any, but I've had a lot of schooling on the subject that the average patient hasn't) months before my surgery date.

I then had two more meetings with my surgeon before the surgery day and at the last one she went over the immediate pre-op diet and how to eat for the 2 weeks post (until my 1st checkup) one more time just to make sure I didn't have any questions.

I then had teaching from my nurse again before discharge with my first month's diet program printed out yet again in my discharge paperwork.

We were taught in nursing school that the patient should be presented with teaching information no less than three times, with no less than one set of printed information to be given at the first teaching (and giving it again at the last teaching was advised). I am amazed and frankly appalled that something this life-changing and serious is not being addressed with appropriate patient teaching from each and every surgeon's team out there.

As patients, we should demand no less. If anyone is reading this and has not been given information about what the ENTIRE program will look like, and what will be expected at EVERY stage of the diet plan, ask for it. There is no reason for the doc/team to wait until the very last minute to give this information.

I just don't get it. (obviously, or I'd not be on a soap box about it)

At 4-5 weeks out I was doing good if I could get down more than about 2-3 oz of anything at one time, and if it was solid food, not even that. It would take me hours to get through a Protein shake.

Get used to food going cold while you try to eat it, LOL.

It gets better.

Keep in mind that the body can only absorb 30g of Protein at a time.

I actually read a study about this that said that's outdated information. The body will absorb whatever you eat, it just takes longer to do it. The 30g was what could be absorbed and converted in the timeframe that was being studied, but meals that have more than 30g are not just discarded, the remaining Protein is held and converted slowly throughout the rest of the day.

That is not to say that it's good to load up 100g of protein in one meal or anything, it's best to spread it out through all of the meals for a number of reasons, but extra protein at a given meal isn't just "lost".

My exasperation is directed at your surgeon, not at you, by the way.

It seems too many docs are sending people out into the world without any information to help them be successful, and as an RN that just drives me batty.

If you've been released to a full diet, but not given any specific diet plan, you'll need to do some research and figure out how you're going to approach eating going forward. I suggest contacting your team and asking for a referral to a nutritionist if they don't have a plan to give you.

Most of the successful vets on this board will tell you that their success has been based on some form of a low-carb eating plan. What "low-carb" means varies from person to person and plan to plan. I can tell you that a total carb intake of less than about 50g per day will put your body into a compensatory metabolic condition known as ketosis. This is the goal of most ketogenic diets such as Atkins or to an extent South Beach or some Paleo programs.

For reasons we aren't quite sure of, ketosis makes me personally very ill. So my program is to stay away from refined sugars and carbs, but my carbs end up being about 80-100g a day, focused on complex carbs like whole grains, long grain/wild rice, some potatoes, etc. I can't give recommendations about my program, because I'm not to maintenance yet. I don't have any information about how it's going to work long-term, we're kinda playing it by ear.

Regardless of how low you take your carbs, you need to focus your limited sleeve capacity on your Protein first at every meal. Protein and fluids will always be your primary concern. If you have room, then you can get your veggies and a little bit of carbs in. food choices need to be about nutrition, and your relationship to food becomes about fuel instead of comfort or emotion.

Most programs require you to not drink anything 30 minutes after you eat, because it will essentially flush the sleeve and you'll get hungry faster. Programs vary on how many meals a day and how many total calories, the danger is in getting into a habit of grazing all day because you can load up on too many calories very quickly.

Hope this helps get you started.

My favorite was the Minute Maid lemonade, but they quit making them.

Currently I like the Crystal Light strawberry lemonade the best. I have to be careful as aspartame/Nutrasweet is a Migraine trigger, most of the powdered Water enhancers have it, but the drops tend to have Splenda/sucralose which is OK for me but I have to check. The MIO sport ones are pretty good.

That's the only instruction, a Protein goal? You're cleared for a full diet? No restrictions on any types of food or guidelines regarding carbs or total calories? No information from a nutritionist or anything?

what are your diet instructions from your surgeon?

Absolutely. My surgeon is pretty liberal with her diet progression compared to many I've seen here as well. But each surgeon has developed their protocol based on their training and experience. After surgery when you're experiencing cravings and head hunger is not the time to compare my plan with yours and decide your surgeon is being too conservative because you're wanting to move more quickly. Follow your doctor's instructions. Period.

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@@LittleBill, I've loved all of your posts! The only .45 I've shot kicked like a beast, and I have weak wrists with arthritis, so I didn't enjoy it. I have a lovely 9mm Ruger that I love and is smooth as butter to fire, but it's only really concealable for a large guy with a shoulder rig and a jacket. I grew up in Alaska and live down in the hellfire that is Texas, so I'm pretty comfortable with guns and such. LOL.

And yes, I thought that the shrinking molecules was pretty crazy when I first read about it, but when you realize they're trying to explain a complicated chemical process on a 4th grade level, it tends to come across pretty Marvel-comic-like. LOL. Since they haven't been named in any of the Protein spiking lawsuits, they likely have some decent evidence that their stuff is on the level.

"What makes GENEPRO so unique is that we are able to reduce the Protein molecule to half the size of normal Protein through a process called Electrophoresis. This is a reverse electrical polarity method of extracting pure protein. In essence we take protein molecules that, for reference, are the size of a baseball. We push these baseball sized protein molecules through a Polyacrylamide gel (the gel stays below 87 degrees F) and introduce electricity through the gel. This process removes hydrogen ions, allergens and any fillers or binders so we are able to then bind the protein with a strand of six amino acids called a Hexapeptide which stabilizes the molecular structure. This hexapeptide increases shelf life of the protein as well as balancing the bitter taste that is present with the protein after electrophoresis and actually gives the protein a slightly sweet undertone. The protein is pushed through a filtration system and into a centrifuge which results in a pure protein molecule that is now the size of a golf ball (for reference). You may not be able to fit 30 baseballs into a shoe box but you can fit 30 golf balls. Thus giving us the ability to get 30grams of protein in a 1TBS serving size."

I've read the same stuff.

They're not claiming that it's the same chemical structure. They're trying to explain in layman's terms how they're changing the chemical structure. They're describing stripping out everything but the protein chain and then binding the protein chain to less stuff but still stabilizing the protein chain and in the process making it more bioavailable. In trying to make it understandable to non scientists they've actually made their description not scientifically accurate. My scientist dad used to get driven crazy by this, he called it "simplification to the point of error".

I've read some other documents by the company, and it appears to me they're claiming that their process of refining the Proteins reduces allergens and makes more of the protein bioavailable and that's what they're basing the claim on. I've also read the outcomes from the clinical trial. While I think there are some basic flaws in the study design, my conclusion based on the raw data from the study (available at clinical trials dot gov) is that GENEPRO is as good as any other Protein powder. I have found it to be easier to mix in more foods at more temperatures than other brands, so I'll stick with it.

For me, it's like the question of which is better, a .380 or a 9mm? The answer is the one you'll actually carry. My 9mm is a much better weapon, but it's not concealable. My .380 is, so it's the one I'm more likely to actually have at hand. If another Protein Powder is better, but I won't use it because it's gritty or changes the texture too much, or won't dissolve well in hot liquids, is it really better?

you should share that recipe, I'm one of those crazy folks who loved prunes and prime juice.

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1 cup unsweetened applesauce

1 cup unprocessed wheat bran

1/2 cup prune juice

mix well, store in refrigerator

each morning, take 1-2 Tbsp with 8 oz or more of Water.

My PCP says most of her patients, even those with IBS-C, manage to stay regular with this and don't need stool softeners or laxatives if they'll use this regularly and drink lots of Water.< /p>

I told her I couldn't stomach the prune juice, we talked about alternatives and I'm going to try to make some up with some fig preserves once I make it to the farmer's market again, I'll report on if that worked or not.

I'm two weeks post-op, struggling with Protein drink "burn out" I get sick to my stomach just looking at the drinks now. What can I do tp get in my Protein? I have another 9 days to go in first stage. Also struggle with Constipation. Help

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I was terribly sick of the Protein shakes by the end of my first 2 weeks as well. I found zip-lock style freeze pop tubes on Amazon and used them to freeze Syntrax nectar drink (roadside lemonade flavor) into freeze pops and would eat those. I used unflavored Protein powder in chicken and beef bouillon (the trick is to dissolve it in warm Water with a blender and then mix it with the hot bouillon) to get something more savory and not sweet. I drank apple cider (not an option for everyone because of the carbs, but maybe a Decaf herbal tea?) for something hot and sweet. I added unflavored Protein Powder to everything I could stand adding it to. (Didn't change the flavor, but changed texture for some things that I didn't like.) My surgeon included greek yogurt in the full liquids list, so I ate that for protein as well.

Another thing to keep in mind is that while it's GREAT if you can get the protein in the first couple of weeks, and you should certainly try to, the MOST important thing is the fluids. The body can get by with less than ideal protein for a while, but if you get dehydrated it can mean a trip to the ER, so if nothing else, get the fluids in.

For constipation, check with your team. I was advised to use a stool softener (Dulcolax) and if that didn't help in a day or two, to add Fiber to drinks (Metamucil) and if that didn't help to try Milk of Magnesia. And as a last-ditch effort if nothing else worked, I could try Magnesium Citrate. But my surgeon told me it's not abnormal to go several days between BMs early on after surgery because we're eating so much less bulk, and the high protein does tend to back us up. So not to expect a BM every day or necessarily even every other day. I've had to keep Fiber added to my diet daily since surgery to keep things regular and add in stool softeners periodically. My PCP gave me a recipe for a "fiber applesauce" but it calls for prune juice and I just can't stomach it.

The standards for most insurance companies are BMI of 40 or BMI of 35 with two or more co-morbidities such as diabetes, high blood pressure, sleep apnea, etc. So there are lots of people who have WLS with BMIs lower than 40. I agree that WLS should be available to people with BMI lower than 40. And ultimately, it's a physician who needs to be looking at the totality of the medical history to determine if there's medical indication for the surgery, and that physician who has to be accountable to his medical practice board for his medical decisions.

I worry when I hear of people with low BMI (28-33) wanting such a drastic measure taken. The medical evidence does not point to WLS as being an appropriate intervention at those BMI levels. There is a good chance that the person is suffering from a body image disorder or eating disorder if they're trying to get the surgery at those levels. However, I don't know the person's medical history. They could be a serious yo-yo dieter who's been at much higher BMI and is at a low point now but is cycling up and wants to break the cycle before hitting another high. There is so much screwed up about body image and fat shaming in our society that plays into all of this.

I just remind myself that most of plastic surgery is not medically necessary, but we don't shame (mostly) people who get it done.

To the OP, I just say this... the sleeve is a VERY drastic surgery that cannot be reversed, and I would personally not recommend it for the amount of weight you have to lose. I would suggest you consider options that are reversible before pursuing this option. Many patients having the sleeve lose about the amount of weight you need to lose in the pre-operative phase by following a low-carb eating plan, which is what you'd likely be on post-operatively. You might consider trying a few months on a strict low-carb plan and see how that goes as far as curbing your hunger and cravings before taking a permanent surgical step.

I have RA/PsA. I am on Sulfasalazine. I had to stop the meds 3 weeks before surgery and was off for 2 months after surgery. I flared up pretty badly with joint/body aches following the surgery, by day 3 post-op my arthritis hurt worse than the surgical pain. But it had dulled down to just bad chronic ache by a few weeks post-op with pretty bad fatigue. Was hard to tell what was RA fatigue vs. post-op low calorie and low carb fatigue. I started feeling a little better when I went onto soft foods, but the real improvement came when I was able to go to full diet at about 6 weeks, which was also right about the same time I got back on my meds. My inflammatory factors were elevated in the blood draw before I started back on my meds, which was expected, but they weren't nearly as high as might be expected off meds. My rheumy says that the stomach tissue that is removed is responsible for a lot of inflammatory hormones, and of course the fat tissue that is lost also causes a lot of inflammatory process. Now that I'm back on meds the factors are coming back near normal, and we've tabled any discussion of biologics for the forseeable future. We may still have to increase the dose of the sulfasalazine and/or consider plaquenil, but prior to surgery we were planning to move to biologics. My overall joint pain has decreased and my fatigue has decreased. Not completely controlled, but certainly an improvement. And the 70# lost is very likely part of the decreased pain in my knees specifically.

I use MyFitnessPal. The paid version gives you more control over your display and mix of carbs/protein/fat, etc. I know some people use Baritastic. I looked at it briefly but was already used to MFP.

Mine's shedding like crazy, I'm hoping it stops soon.

I would have pains when my sleeve would get completely empty post-op that kinda felt like hunger pains. And I would get queasy and have an odd bubble pain behind my breast bone if I drank or ate too fast. For the first couple of weeks, the answer was to always be sipping on something - Water or Protein drink. That kept something in the sleeve, kept me hydrated, and the sipping (and I mean REALLY TINY sips) kept me from drinking too fast and getting pains. It's a learning experience to be sure.

I don't tend to take "multi" products since nursing school. It's too easy to overdose on Tylenol because it gets added into everything, plus you end up taking components you don't need. Instead, I take just what I need for the symptoms that are keeping me from sleeping or working or whatever:

Now, none of these are restricted by my surgeon, but you'll want to clarify with your team.

For ANY type of sinus issues use a saline rinse in whatever form you prefer - neti pot, spray, etc.

And a humidifier in the room unless you know humidity in your house is at least 45%.

For sinus congestion, get the "good" Sudafed that you have to sign in blood for at the pharmacy counter.

For drainage at night (or if you're lucky enough it doesn't make you drowsy) Benadryl.

For drainage during the day, Zyrtec or Clairitin, whichever works better for you.

For cough if your doc won't prescribe something better, Delsym. Plus whatever cough drop you like (I like Halls)

For chest congestion, the Mucinex that is just the guaifenesin (expectorant) - and drink TONS (and I mean an extra 24-32 oz at LEAST) of extra Water with it or it won't work as well.

And for the record, with any viral infection a *little* extra Vitamin C or Zinc can help, but don't overdo it or you're just making expensive urine. Homeopathic medicine is just expensive sugar pills. And every version of Airborne is a complete rip-off, medically speaking, all you're doing is making REALLY expensive urine.

Because my plan doesn't call for carb restriction (and I get very ill in ketosis), unsweetened applesauce has been in my diet since day 2, it was included in the full liquids list from my surgeon.