SoCalLaura

I had RNY revision from VSG for severe reflux in October 2020. Since my revision surgery, I've lost 65 pounds. I had only lost, and sustained a 30 pound loss after VSG. And I haven't had an episode of reflux since surgery. Best decision I ever made!

Okay, this made me laugh out loud...makes it sound like some kind of fly by night vocational school or something. I went to school at UT for both my baccalaureate and masters degrees in the School of Nursing. The nursing model and the medical model are completely different and while there is some overlap there are also key differences. I am proud to be a nurse first and foremost. Texas started referring to us as Advanced Practice Nurses (APNs) quite a few years back and I am okay with that.

Not sure about Michigan but the places I have practiced (Texas and Nevada) in for the past 28 years are NOT like this. I am credentialed and empaneled with insurance companies as a nurse practitioner and assigned to patients as their primary care manager. I worked for several years on a military installation and was the only pediatric person in our area so there was no one supervising me. There is a collaborating relationship between a NP and a doctor that is pretty vague. Many states do not even require that. The Texas Board of Medicine dropped the requirement years ago that a doctor had to register the NPS that had a collaborative relationship with them.
I provide whatever level of care the patient needs, including ordering tests, treatments and medications and referring patients to specialists or other facilities as needed. A few situations (usually the school system or preop physical for sedation) require a physician signature on paper work and guess what, I have a signature stamp in my drawer for that.
I have stabilized very ill children while waiting for an ambulance when none of the doctors was even in the building. Say I have a child sick with the flu who also happens to have lupus. I call the pediatric rheumatologist to discuss with them the management of the child in terms of medications and labs. The only time one of the MDs in the office gets involved is if I want to discuss it with them. I have never been told that a referral had to come from one of the doctors I work with by an insurance company or a specialists' office.
What you are describing may still exist in some backwoods places but NPs are consistently found to be as good and often better at primary care than physicians, in terms of patient satisfaction and outcomes.
Okay, stepping off my soapbox.

Wow! Interesting thread!!!

I’ve always believed that while doctors treat a condition or disease nurses treat a whole person, and usually have way more time to spend and discuss and explore. So I don’t mind at all when one opens up conversations. I mean I wouldn’t want them to keep on the topic if I didn’t “bite” but I’m totally up for them bringing it up.

And I love talking with all sorts of things with my PT for the same reason including diagnosis and medications ha. Same reason... and I honestly have had times I trusted my PT’s call more than my ortho and have discussed prescriptions too.

So yeah you clearly might piss some people off as this thread shows. But if you caught any someone else at the right moment and changed a life.... I dunno. This is a tough call. I never ft asked just bringing it up (not pushing) would be so polarizing.

Yikes

Thank you for all of the thoughtful responses. I have a few options to refer patients to for help and will do so. Most people seem to agree that a weight loss discussion is better if help is offered at the same time.
I was trying to have a discussion on this thread without revealing all of my personal information. Instead this thread was hijacked by people wanting to tell me my scope of practice and what they think I am qualified to do.
Since no one can do that: I am a DNP. Which means that I have a doctoral degree. I can refer and prescribe, yes that can vary state to state. I am also a nurse, it is officially part of my title and the most generic way to describe myself on an online forum where I prefer to have some anonymity.
Going to unfollow my own thread now.

I’m a nurse, this is a common side effect of scopolamine. You did the right thing in removing the patch.< /p>

I never used any particular product, but working with my RD on this problem she suggested that the classic nutritional approach is to have a small meal/snack an hour or so before that is high in complex carbohydrates, moderate in Protein and low to moderate in fat. I played with that and settled on a small sandwich with a slice of whole grain bread/toast, meat and cheese, and that worked well, extending my workouts in the pool beyond and hour, where I had been hitting a wall. Going higher fat and lower protein like a Peanut Butter sandwich didn't work as well, so there seems to be something to that particular mix, at least for me. On days that I did a strength circuit, it didn't seem to matter, as I could readily work around an hour and a half without distress no matter what I ate beforehand, so this also seems to be somewhat task dependent - what is your body looking for.
My nephew, who is an RD in training likes to use a classic CLIF bar for convenience and a similar nutritional profile. It seems to be a big YMMV thing, so play around with it and see what works for your routine.

I am a RN in a busy ER, I went back to work after one week because that is all I could take off financially. I was fine. Fill a water bottle and sip any chance you get. Don’t bring foods to eat that you haven’t tested on your days off...there were a couple of times I had to quickly excuse myself and vomit. Bring easy to digest foods...like Protein Shakes, yougurt, oatmeal, etc... Plan ahead.. I never had any pain.

Things are not as complicated as people seem to make them sometimes.
How do nurses, physicians etc. on 12 or 24 h shifts find time to eat and drink after WLS? In the same way they did before WLS.
Don't create a problem where there is non.

Here the thing though. I don’t agree with this anymore. I was raised by a dieter, dieting. I was taught calories in calories out. Calories = weight gain. That’s what got me fat!! Trying to restrict my calories, failing, Binging, gaining more than before the diet, screwing my metabolism. There is no way I could be happy on less calories than my body is hungry for.

When I went to eating disorder treatment I was taught that more calories doesn’t equal weight gain if you are eating for your respective metabolism, which is what I do. If you had told me I could maintain my weight averaging 2500 calories I would have said you were crazy. But now I believe differently because I’m living it.

I don’t know exactly how many calories I eat a day because I don’t track, and yes I am active. I don’t work out but i do stay on the move. But I do tally my calories up once in awhile and I believe I average around 2500. I gained weight from my lowest and then it stopped. I maintain where I am easily now- except when I don’t make sure and eat enough (which can be hard sometimes given my physical restrictions from surgery), and then I lose weight, which i do not want.

My belief is that my metabolism is restored and my body is able to handle the calories. If I had eaten this much when I was dieting back in the day, I would have gained weight because weight gain is the result of a poorly functioning metabolism due to dieting cycles.

For women 2500 calories is a reasonable amount of food that is a full and satisfied life. It may not mean super thin but it can equal a nice maintainable set point weight.

I know this isn’t for everyone and I’m challenging a lot of beliefs here. I’m sharing my knowledge of what works for me.

I'm 5 months postop as of 11/1/17 & I truly hadn't compared any of my photos until lastweek, and it almost floored me... the photo on the left was on 11/4/17 & the one on the right was 3/7/17. I'm 60+ pounds down & 1 pound from my goal weight!
HW: 247 VSG:6/1/17 CW:186(11/04/17) GW:185🙄

We do because almost everyone on a diet falls off the wagon - that's why diets usually don't work in the long run.
And that is why I think it's sad that so many WLS patients don't stop the restrictive dieting after surgery. On the contrary, some even top their former dieting by adopting even stricter rules, believing that "this time it will surely work".

People hear the term "intuitive eating" and have that reflex gut reaction of "oh, that means stuffing my face with all the crap I can find" (and that's simply not true).
Restricted eating doesn't work long term for that many people. We see it all the time on the boards as well: "HELP! I started eating "crap" again"!!!!!! (on this board that usually means eating something containing carbohydrates). People make the same mistakes they made before WLS: going on a restrictive diet, wanting to be 110% perfect, having great success and then finally burning out, not being able to follow the diet anymore.
All that "educated eating" got you in the place of needing WLS in the end. At least I don't think that the pre- and post-WLS diet was your first shot at "educated eating". If so, you had WLS way too early when it comes to the opinion of the so-called experts.
However, I know that I'm quite (luckily not entirely) alone with this opinion.

I lived off Pho for pre and post-op!!

Wow- Surprised someone with 8000 posts who is a "bariatric legend" would be so forthcoming with personal attacking and questioning one's integrity? Is that ok if they don't match your own philosophy or personal plan?
For your information, many therapists use intuitive eating for all types of eating disorders including compulsive eating and food addictions. While it may be easy for you to make ignorant claims of "unethical," it only represents your own limited knowledge about the subject than actual truth. (Are you a therapist? Have you read the book?) I don't mind people countering with facts, but personal insults and actual mistruths don't benefit anyone.
Are you claiming she didn't lose the weight? Are you claiming, she isn't enjoying a new relationship with food and that others can't enjoy it either? Why is this approach to food such a threat to you or your psyche? I appreciate we all fear failure and returning to our unhealthy selves that needed surgery to become healthy, but I hope we can support each other in their processes rather than insult and make even more difficult to accomplish our collective goals in our individual journeys.
I don't know you, and I assume you are a great person, but I hope we can all share our experiences, successes, and failures without being personally attacked for sharing.

I am surprised reading the many comments in direct conflict with this post. It is my experience it is what we should all be working towards. Eating "what your want, when you want" does not mean binge without consequence, rather it means listening to your body and trust it to tell you what you need or want when and how much. Our bodies have amazing and complex feedback loops, but all of us spent years ignoring them and eating for emotional reasons, not physical ones. Relearning to listen and to trust your feedback loops is the ideal state of being. A constant diet mentality with or without surgery is not healthy or ideal, and statistically speaking won't work. I also realize learning to listen to your feedback loops and not your emotions is a difficult transition that should not be attempted when in the weight loss phase, but to maintain that phase I think it is essential.

Intuitive eating IS mindful eating. Geneen Roth is a proponent of this style and she has workshops for disordered eating. She conquered disordered eating herself.
The OP is trying to eat normal. Normal people don't endlessly think about food. They eat when hungry, stop when full, and go on about their day forgetting about food. It's when you give up the anxiety about food because you no longer USE food the same way that you did, when you used it to fulfill an unmet need, quell anxiety/grief rejection, worthiness love hate fear etc. It just becomes food, you learn to trust yourself.
I am working on this prior to surgery.

Probably because they are miserable in theirs and making someone else feel bad is a temporary victory for them. Would they talk to their mother like that or a close friend...gosh I hope not but the more this goes on I think they would....

Well said [emoji122][emoji122][emoji122][emoji122][emoji122][emoji122][emoji122] there are a few regular bashers that I cringe when I see there name...I scroll right past because I can't bare to read ho they are gonna degrade that person

169

Worthy of your time and/or experience??? Ouch! Way to be humble....

This.

We had a lot of that here before certain users decided to leave. Talking about "wearing the big girl's panties" and "hey, this is rants & raves" while their own big girl's panties were hiding in the closet when someone fired back in the same manner.

I think you're unreasonably angry. Maybe you need to eat a peep

Surely you can see the irony in a person dishing out tough love, then complaining about tough feedback?
Whining about a whiner is still whining..
People that demand others have thick skin should prepare to have theirs tested too. That I learned from teaching adults. It's not as safe as facing anonymous strangers online..
Sent from my SM-N900P using BariatricPal mobile app

You're right but this is not how this board works. Post something about eating "off plan" and you will get the heat and/or the self-righteous standard sermon from certain users. It's 100% predictable. Some users are calling this - ahem - "tough love".
If users continue to bother you with their style of writing put them on ignore. It's a helpful feature.