Hammer_Down

I paid out of pocket for my procedure, and I knew that if my liver wasn't shrunk down sufficiently, the surgeon would be going in and not doing the procedure. No refunds once he's in there.
That was a great incentive to keep me on track, plus I didn't find the pre-op diet to be that challenging. I wasn't hungry, and was super excited about the procedure. I want to do exactly what my surgeon told me to, because it would be a shame to go through all of this for naught.

I think there is a clear distinction between sitting in judgement and enabling behaviour. Adults should be able to criticize behaviour without being accused a bullying or sending someone off the emotional deepend.
I worked with youth in a Cadet program, and most of my 12-18 year olds could handle criticism better than some of the people on this forum. We taught the. No excuses, take the advice and make the correction and move on. No hard feelings.
I consider food to be a bonafide addiction. Withdrawals, denial of the problem, denial of the consequences, inability to accept the finality of quitting, inability to
imagine life without the comfort foods they are so addicted to.
When I see people seeking validation for cheating their "rehab" from food addiction, I mentally replace the Halloween candy, chips, or whatever with alcohol, smack, crack, cocaine, meth, morphine, heroin, cigarettes or whatever.
If someone was attempting to quit one of those addictive and destructive substances after years of abuse and destroying their health, how understanding would you be? "it's ok, a little won't hurt, get back on the wagon tomorrow, we all have setbacks, it happens to everyone, try not to be too hard on yourself, etc etc"
Or maybe a "what the hell are you thinking? Are you crazy? Why would you set yourself back to day 1?"
Just my opinion.

I think there is a clear distinction between sitting in judgement and enabling behaviour. Adults should be able to criticize behaviour without being accused a bullying or sending someone off the emotional deepend.
I worked with youth in a Cadet program, and most of my 12-18 year olds could handle criticism better than some of the people on this forum. We taught the. No excuses, take the advice and make the correction and move on. No hard feelings.
I consider food to be a bonafide addiction. Withdrawals, denial of the problem, denial of the consequences, inability to accept the finality of quitting, inability to
imagine life without the comfort foods they are so addicted to.
When I see people seeking validation for cheating their "rehab" from food addiction, I mentally replace the Halloween candy, chips, or whatever with alcohol, smack, crack, cocaine, meth, morphine, heroin, cigarettes or whatever.
If someone was attempting to quit one of those addictive and destructive substances after years of abuse and destroying their health, how understanding would you be? "it's ok, a little won't hurt, get back on the wagon tomorrow, we all have setbacks, it happens to everyone, try not to be too hard on yourself, etc etc"
Or maybe a "what the hell are you thinking? Are you crazy? Why would you set yourself back to day 1?"
Just my opinion.

I thought I would post up my entire experience with ALM in Tijuana while the details are still fresh in my mind. This will be a bit of a long read, but hopefully someone who is investigating the possibilities will find some useful information, answers to some questions and some reassurances! Here goes:
I was introduced to the idea of bariatric surgery about 6 months ago during a conversation with a friend, who has been struggling for a few years with a significant (100lbs+) weight gain. I, too, had been gaining weight steadily since losing 100lbs four years ago. She said that if she couldn't lose the weight in the next year, she was "gonna get the gastric surgery" and be done of it. Of course, I had heard about gastric bypasses and lap bands, but I always associated it with Hollywood stars (ie, the very wealthy) or people who were much larger than 250lbs.
I walked away from that conversation with a seed planted, and over the next few days I began doing some preliminary online research. This was one of the sites I came across at that time. I learned about the different procedures, and researched some of the worst case scenarios associated with each. I researched long term consequences, health outcomes, the effects on women of childbearing age who want to become pregnant, etc. I tried not to get bogged down by only reading positive stories or looking at #vsgbeforeandafter pictures and imagining my weight disappearing effortlessly overnight.
I decided that this was something that really piqued my interest. I went to my provincial health authority's website (I live in Nova Scotia) and saw that the wait times here for an insurance covered procedure were more than 5 years, as there is only 1 bariatric surgeon in the province. Dismayed, I googled some bariatric centres close to where my above mentioned friend lives (Houston) and saw the procedures ranged from $12,000 USD up to $20,000 USD. There was simply no way I could afford that, even though I travelled to Houston on a weekly basis for work and could stay with my friend free of charge.
I put the idea out of my head. I thought, "this really IS for rich folks, $28,000 (Canadian dollars) isn't feasible for a normal working person."
But I kept coming back to pages like this, and others and on one of my google searches a sponsored ad result for ALM popped up at the top of the screen. "Affordable bariatric surgery at a top hospital in Tijuana, Mexico" or something to that effect.
Intrigued, I clicked through the ad and read the entire content of the page. All the procedures were available, starting in the low $4000s (about $5500 CAD). I'm not naive (in fact, cynical would be a much more appropriate adjective), so I thought "what's the catch?"
I took note of the doctor's names from ALM's website. I checked them on linked in, I read forums like this one, I entered search terms like "Dr So-So Tijuana deaths" and read well beyond the first page of Google results. I read about ALM, again entering morbid search terms, digging through online forums and basically trying to find that one piece of information where I would say "AHA! Gotcha! Of course that's a terrible idea!"
I didn't find much. The company seemed legit, plenty of online posts dating back a few years to a few days about people who used their services and had successful operations with the surgeons they work with. This was around June.
So I sent an email to a link on their page. I explained my personal experiences with weight loss and gain, my concerns about some members of my family and their onset health problems, and asking if I would be a candidate for the procedure at 5'8", fairly muscular and 250lbs. I don't wear plus sized clothing, but I'm at the point where if I gained another 15-20 lbs I would have to.
I clicked send, and wondered if/when I would hear back and went on with my life. To my surprise, I heard back only an hour later. My coordinator, Crystal, answered my questions thoroughly (I was surprised it wasn't a generic "form" email, thank you for contacting us, don't call us - we'll call you blah blah blah). We opened a line of communication back and forth, and I felt pretty confident with the answers I was getting.
So now I was getting excited. Possibilities. What seemed unattainable just a few weeks earlier was now suddenly in reach. It was time to discuss my findings with my wife. I chewed this over in my head, how to bring it up, was I ready to answer her questions, should I nerd out with all the info I had learned, or should I nonchalantly just throw it out there?
I brought it up, and she was surprised but open minded. I explained all the options I had looked into, and what, exactly, a vertical sleeve gastrecromy is and isn't. She listened to my spiel, and said "Okay. Would I qualify for the procedure?".
She is not fat, but has lost and gained 60lbs in the past few years and has an obese parent with diabetes. Her BMI was 32 when we had this conversation, and she wears size 12 jeans.
We emailed Crystal with her concerns and questions, and again, she got right back to us. She emailed us forms and questionnaires for the doctor's review and we set to filling them out.
We were on holidays for most of July, and when we returned we set a date, Oct 27 and paid our $500 each deposit to hold that date.
In early August, it seemed like an eternity but since we both travel for work and work 70 hours a week, we knew the time would surely pass. We talked about little else but how excited we were. How we were going to do everything right, get back to the gym, change our lives and how this would help us when we start our family in a few years. We booked plane tickets. We changed companies in September, which was a welcome distraction from all the VSG this and VSG that.
Starting about 3 weeks prior to our travel dates, we started receiving emails from Cindy Rios, an RN who works with (for?) ALM regarding diet, lifestyle changes, phases of the surgery recovery and suggestions for streamlining and making the most of our pending surgeries.
We had quit caffeine and carbonated drinks in August, in a bid to make it easier down the road. We went to costco and loaded up on Premier Protein (like a shopping cart full) because we are on the road with work and didn't want to be short on supplies and maybe tempted to cheat. We didn't do "food funerals" in the same way I wouldn't attend the funeral of a nemesis or adversary who had stolen some of my life and made me unhappy with who I was. We bought enough salad to get us through the work week when we were home each week.
The pre-op diet was easy, for the most part. Not wanting to risk enlarging our livers with excess carbs and losing our hard earned money if the surgery couldn't be completed made it easier. We had a supply of Keto-strips from previous ketogenic dieting and made sure we were staying in ketosis throughout the entire time.
We flew out of Nova Scotia at 5am on the 26th. We arrived at the San Diego airport before noon (4 hour time difference) after changing planes in Toronto.
We had a text message waiting for us when we landed from our driver, asking what our schedule looked like. We told him we were on the ground, and just waiting to deplane and on our way. We received a call immediately saying they would pick us up at the cab stand at Terminal 1 in about an hour. We carried on our luggage (not wanting to risk the airline losing our luggage with multiple connections) so we strolled from Terminal 2 down to Terminal 1. We received a text message with a picture of the driver's license, Rafael and his personal information.
When an hour came and went, I sent a text asking where he was and got a call right back. He was stuck in traffic at the border, but wouldn't be much longer. We got a description of the van he was driving so we knew who to watch for.
He arrived not much longer, and we picked up 2 other people on the way. We made our introductions and were off on I5 towards Mexico.
Rafael informed us that because we had landed quite early, we would head straight to Mi Doctor Hospital and do our preoperarion check ups instead of waiting for surgery day.
The hospital is literally 5 mins from the border. Rafael took us from place to place in the hospital, and stayed with us the entire time.
First we had blood taken for a full work up. Next, we went for an EKG to monitor heart function. I then met with Dr Elias Ortiz in his office, as I was the first surgery of the day the next morning. My wife filled out paperwork upstairs, and after my meeting with Dr Ortiz, I filled out the same paperwork. All the paperwork is in English and Spanish, so you'll sign everything twice. I was the only patient to meet Dr Ortiz that afternoon, as he would meet with the others during the day between surgeries.
I asked him to visually inspect my gallbladder, as I have a family history of gall bladder disease and he said he couldn't see if there stones, but the general health would be evident. I asked him about taking Advil (i take a HUGE dose of Advil once a month for period cramps) and he assured me that NSAIDs would not be an issue once the sleeve was healed. I have an alternative medication, but I don't take it because it causes drowsiness and he assured me that it was fine until I can handle NSAIDs again.
He was friendly, knowledgable, and overall seemed like a really friendly fellow. I felt like I was in good hands.
Rafael was waiting for us when everything was signed, and we piled into the van to head to the hotel.
We stayed at the Grand Hotel Tijuana, which was about 10 mins by van from the hospital. Rafael ushered us through the lobby and into the elevators to the 11th floor. He collected our IDs and did the check in process on the medical floor while we lounged and admired the view. Rafael told us what time we would each be picked up the next morning, 5:40am for my wife and I. One by one, we got our rooms and he passed us off the concierges to take us to our rooms.
The medical rooms were nice - spacious bathroom and shower, we had a king size bed and several pillows each. ALM provides each patient with 3 room service orders of broth, - sugar free popsicle and a glass of apple juice. We ordered twice and it arrived promptly. I skipped the juice, because I had worked so hard at cutting all the sugar out of my diet and I wasn't going to reindulge the night before the surgery. We were pretty tired from the flying, and even though it was only 6pm in Tijuana, it was 10pm at home and we had been at the airport for 3am. So we enjoyed our broth, watched some Netflix on the iPad and went to sleep.< /p>
We had to bring our luggage to the hospital the next morning, as we weren't returning to the same room after the procedure and would be staying 2 nights at Mi Doctor.
We got up at 4, had a shower and packed up our things. We met Rafael downstairs in the lobby and headed over to the hospital. We were greeted there by a nurse who gave us compression socks and gowns and told us to change into them. We changed, and the nurse came back in to put in the IV. She said it would be a little while before doctors were ready for us, so we puttered around the room and waited.
A series of doctors from the surgical team came in, we shook hands, saw pictures of their kids and talked a little about how the day would progress. I was first up, and my wife was second on the lineup. They explained that after surgery, I would be wheeled into a recovery room right beside the OR and would be waking up just as my wife was coming out of her surgery before we were both moved into our room upstairs.
After what seemed like eternity (maybe 4 hours, from the time we arrived) a knock came at the door. A nurse sat me in a wheelchair and I was brought upstairs to the OR. My wife was lead shortly after I left to our room upstairs. While in the room, nurses were in and out to hang some signs over our hospital beds and get it ready for us. They moved our luggage in for us, and she waited for her knock on the door.
When I was wheeled into the OR, I was given a hairnet and booties and told to untie my gown from the back and hop up on the OR table. I was wearing underwear, but no bra and nothing was said (many people seem to have concerns about this). I was never asked to remove them or asked if I was on my period.
The doctors I had met that morning were all there in their scrubs, and we had a grand chat about my work, including lots of questions from them. The anesthesiologist was busy hooking this and that up, and he said I would feel a bit woozy as he injected something into my IV. I felt elated, ecstatic and silly all at the same time. I was still chatting animatedly with all the guys when the anesthesiologist put a mask over my mouth and nose. I do not remember anything after that point.
I awoke in the room outside the OR (although I didn't know that at the time) and immediately tried to sit up. I had some pains under my collar bones, and looking down I could see the row of incisions on my belly. I remember asking for wife, was she ok? Yes, they said, she is fine and right beside me. I looked over at her, and then asked "did you do the surgery?" (As if the incisions weren't proof enough) and they said "yes, you did great and your wife too!" Then I went back to sleep.
When I was brought out of the OR and still under, my wife was summoned from our room to the OR. She sat with Dr Ortiz who informed her that my surgery had gone just fine, and that I was still in the OR preparing to be moved to recovery. They chatted about what would happen after her surgery, and she was brought into the other OR to be anesthetitized. While laying on the table, the anesethesiologist said "you look nervous, I'm going to give you something to relax and then we'll chat about what comes next." That's the last thing she remembers.
I vaguely remember being bumped around off one bed and on to another. This was in our room. It was still light outside, and I immediately went to sleep. I awoke shortly after when they brought my wife to our room, and I was very relieved to see her sleeping soundly in the next bed. We both slept for what I can only assume is a few hours.
I awoke suddenly and was incredibly nauseated. I tried to take a deep breath, but my shoulders were hurting and I couldn't breathe deeply. I vomited in my mouth, and threw myself out of bed to the bathroom and spit it in the toilet. It was dark coloured blood, which would have been alarming if I hadn't been so medicated. Feeling better, I went back to bed.
A nurse woke us up to check our vitals, and change the IV bags of medication. I asked about the bloody vomit and was told it's completely normal. They gave us an IV shot for nausea and we drifted off to sleep again.
This process was repeated every few hours (not the vomiting) until the next day. They brought some warm bags to place on my shoulders, the left of which was developing a very sharp pain.
I had some pain in my stomache, like a hunger pain right before your stomache rumbles when it's empty, except it would not rumble. Just a twisting, painful sensation.
I didn't have my watch or phone and had no idea what time of the day or night it was. The time difference made it impossible to guess, but I was feeling wide awake. I could sit up in bed, albeit with some pain, and took stock of my surroundings.
It was a good sized room, there was some free space to walk around the side of the bed and to foot with a private bathroom and shower in the room. A nurse came in and told us to take a shower, and they would change the dressing on our incisions and we would get dressed in our own clothes.
For the rest of that day (day 2), we walked a little inside the hospital, took a few walks outside and wandered around the parking lot (dragging an IV tree) and I tried to walk off the pain in my shoulder. The other shoulder felt fine, but the pain on the left side was making it difficult to draw breaths.
We relaxed in our room, played on our phones and chatted. Shoulder pain aside, we were feeling pretty good and mobile. My IV stopped working (unfortunately after they injected a nauseau shot into it, which swelled my hand up a bit). They switched hands for the IV, but my blood kept clotting inside the port and they had to keep cleaning it out to get the IV working. Finally, they asked me if I was feeling ok and just took the IV out, so I was pain med free.
The doctor came in to remove the drains the night before we were to be discharged. It was mildly uncomfortable coming out, but my shoulder pain disappeared immediately. We were bandaged up, and told that we would meet at 7:30am the next day to meet for aftercare instructions. We were both brought downstairs for an X-ray leak test with the radiologist, which both showed no leaks.
Dr Ortiz came in and told us that our organs looked great and healthy when he did the surgery, and that we had obviously followed the preop diet closely and that he appreciated it, as it makes his job easier. We thanked him and shook hands, and did not see him again.
About 20 mins after, I noticed a bloodstain on my inner left arm, but I was wearing a dark coloured t-shirt and could not see that my drain wound had bled through the bandages. A nurse came in right then, and I lifted up my shirt to look for the bleeding. She immediately changed the bandages, but about 5 minutes later it bled through again.
This happened 5 times, using a variety of pressure banding and trying to close the drain with bandages before a call was made to a doctor.
A doctor in scrubs appeared shortly after, and she lifted off the bandages to check me out. She was surprised that the drain hole was still bleeding and decided to stitch it up. She put in 3 stitches, which immediately stopped the bleeding and bandaged me back up. I told her that I suspected the drain wasn't working properly, since the drain balloon was full of large clots and my IV had been clotting, and told her about the intense pain in my shoulder that had dissipated as soon as the drain was removed. She agreed that it had probably gotten blocked and caused some buildup and pressure, but there was nothing to worry about.
We walked, talked, napped through the night and arose at 6:30 for our morning meeting. We showered, had our bandages changed and packed our bags to head downstairs.
During the meeting, we all received a little purple reusable shopping bag with some medications, copies of our blood work and leak test paperwork, as well as some ALM goodies, like a tshirt, button, pen and bumper sticker.
We were all shuttled over the Grand, and has a debrief while waiting for our new room assignments. It was about 9am, and we had a tour of TJ lined up at noon. We weren't sure if we would go, as the time change was really messing with our sleep schedule and we had been up most of the night. We got to our room, and decided we'd set the alarm for 2 hours and if we felt well, we'd go. Sure enough, a 2 hour solid nap did the trick and we headed out for the tour.
Rafael drove the bus with about a dozen patients and friends of patients. We went to a place with tasty ice cream (I was a bit nervous, since ice cream isn't exactly "clear liquids", but I ate a few mouthfuls anyway). I ordered the tiniest child size and couldn't get through half of it.
Next they took us to a pharmacy where the pharmacist gave a very entertaining presentation of all the medications they recommend for bariatric patients. B12 shots, pain killers, half a dozen kinds of antibiotics, anti diarreah, medicine for nauseau, and a whole host of others. He wrote prescriptions for whichever medecines you were choosing, so as to not cause problems crossing the border back into the USA. Everyone was filling up baskets, and even getting some of their medications from home unrelated to the surgery like Ritalin, Valium and Viagara.
We then went to the "main drag", where lots of tourists buy trinkets, get pictures with brightly coloured backgrounds set up and eat tacos (if they haven't just had surgery, of course). We were supposed to go to a restaurant that serves excellent broth afterwards, but there was a mixup with times and they were closed so we went back to the hotel. We were pretty tired, and basically just lounged around the room and had some broth and went to bed.
The next day, we had nothing lined up through ALM so we found our own action. We got dressed, changed our bandages and headed out into the sunshine. There is a restaurant across th street, Fonda Argentine that we had read online serves excellent broth. The door was open, and we stood inside at the maitre'd stand for about 10 minutes. Employees were sitting at a table, looked at us and turned their backs and refused to acknowledge us so we left.
All together, we walked about 2 miles around the neighbourhood, checked out the little ice cream stand again, and stopped by a little grocery store on the way to the hotel. We purchased a few of those "3 minute lunch" cups, where you just add Water to ramen noodles. We got some spicy beef and chicken ones, and microwaved them at the hotel in the medical floor lobby. We strained the broth out, and it was a welcome and delicious change from the bland chicken broth at the hotel.
The next day was our travel day, and we met Jack at 11am in front the Grand. There were 2 others who were there with their daughter heading to San Diego with us. Their flight was at 3pm, ours was at 6pm. It took about an hour and a half to get to the airport, which was much faster than we had expected.
We printed our boarding passes for the 3 flights home, and left the airport to take a trolley tour of San Diego. It was about $40 each, and took 2 hours. You could hop on and off at any of the stops, but we were anxious to get back in time in case security was busy.
There is an excellent little restaurant past security at terminal 2 called Saffron that sells delicious chicken broth. We got a cup of broth to go each, and boarded our first flight home. LAX had absolutely nothing that could pass as "clear liquids", it was all burger joints and pubs and none even had Soup on the menu, so we just walked the entire 2 hour layover. We did stop and have a glass of cranberry juice. We clocked about 3 miles of walking that day, and that included carrying our backpacks everywhere (remember, we carried on our luggage) and we were feeling great.
We had the same problem with lack of hot food options in Newark, the only place that serves soup didn't have any soup ready at 7:30am. So we wandered around the tiny terminal, just getting some walking in.
On our way home from the airport yesterday, we ran errands in a few stores, stocking up on broths and Soups we can strain for the next phase of our diet, starting tomorrow. I was in the kitchen all afternoon making a huge pot of butternut squash soup and a spinach dip with soup like consistency to portion up for work later this week.
Tomorrow we are back to our regular schedule!
If you're still with me, I hope this will help someone who is thirsty for the details on how this all works! Ask me anything, I'll do my best to answer it!

I think there is a clear distinction between sitting in judgement and enabling behaviour. Adults should be able to criticize behaviour without being accused a bullying or sending someone off the emotional deepend.
I worked with youth in a Cadet program, and most of my 12-18 year olds could handle criticism better than some of the people on this forum. We taught the. No excuses, take the advice and make the correction and move on. No hard feelings.
I consider food to be a bonafide addiction. Withdrawals, denial of the problem, denial of the consequences, inability to accept the finality of quitting, inability to
imagine life without the comfort foods they are so addicted to.
When I see people seeking validation for cheating their "rehab" from food addiction, I mentally replace the Halloween candy, chips, or whatever with alcohol, smack, crack, cocaine, meth, morphine, heroin, cigarettes or whatever.
If someone was attempting to quit one of those addictive and destructive substances after years of abuse and destroying their health, how understanding would you be? "it's ok, a little won't hurt, get back on the wagon tomorrow, we all have setbacks, it happens to everyone, try not to be too hard on yourself, etc etc"
Or maybe a "what the hell are you thinking? Are you crazy? Why would you set yourself back to day 1?"
Just my opinion.

I think there is a clear distinction between sitting in judgement and enabling behaviour. Adults should be able to criticize behaviour without being accused a bullying or sending someone off the emotional deepend.
I worked with youth in a Cadet program, and most of my 12-18 year olds could handle criticism better than some of the people on this forum. We taught the. No excuses, take the advice and make the correction and move on. No hard feelings.
I consider food to be a bonafide addiction. Withdrawals, denial of the problem, denial of the consequences, inability to accept the finality of quitting, inability to
imagine life without the comfort foods they are so addicted to.
When I see people seeking validation for cheating their "rehab" from food addiction, I mentally replace the Halloween candy, chips, or whatever with alcohol, smack, crack, cocaine, meth, morphine, heroin, cigarettes or whatever.
If someone was attempting to quit one of those addictive and destructive substances after years of abuse and destroying their health, how understanding would you be? "it's ok, a little won't hurt, get back on the wagon tomorrow, we all have setbacks, it happens to everyone, try not to be too hard on yourself, etc etc"
Or maybe a "what the hell are you thinking? Are you crazy? Why would you set yourself back to day 1?"
Just my opinion.

You need to clarify what, exactly, they are testing you for and why.
There are 3 substances that could be ordered on the test from your surgeon:
1) Nicotine itself, which passes out of urine in a few days.
2) Cotinine, which is a metabolite produced when your body processes nicotine (I would suspect this is the more likely test, as most nicotine will be broken down into this metabolite) Cotinine is detectable in urine for about a week.
3) Anabasine is a metabolite that is produced ONLY when you use tobacco products. Nicorette, e-cigs, Nicoderm etc will not show a positive test for Anabasine. Only cigarettes, cigars, chew, snuff, etc will. This test. Ales the most logical sense, since it is smoking that causes blood clots after surgery and not nicotine.
hair tests are very expensive, and you would need to be clean for a minimum of 90 days to pass a hair follicle.
Blood tests have a much smaller detection window, hours instead of days. Urine testing is cheap, easy, and instant. You can buy a home urine test yourself on Amazon for any substance(s) you like for a few bucks. If you're concerned going into the surgery, I would do so for the peace of mind.

Sounds like ketosis, the metallic taste is a dead ringer.
Ketosis is the state of your metabolism switching from
Ironing glucose as a primary fuel source to burning fat. It can be burning stored fat, or dietary fat and most likely a mix of both.
Your body contains approximately 300g of glucose "on hand" stored in your muscle tissue. Once you cut your carbs, those stores get depleted and your body turns to an alternate fuel source, fat. Your liver generates 280g of glucose every day for brain function and cellular functions every day regardless of your diet, so there is no danger to remaining in ketosis.
When fat cells are burned, there are by products called "ketone bodies" or ketones created. There are 3 types of ketones, and you can buy urine strips that will test for 1 of them.
When you first start ketosis, your body sucks at using ketones and so that "spill" over into urine. The longer you remain ketogenic, the more efficient you become at burning them.
Beta-hydroxybuterate is one of the ketone bodies that has been shown to have very beneficial results on the heart, and is a preferred source of fuel for the brain.
While initially in carb withdrawal and your body can't uptake ketones properly, there is a syndrome known as "keto flu". But after the initial withdrawal subside and your body adapts to using ketones as well as fats for energy and fuel, there is evidence of increased mental clarity and acuity as well as dramatic improvement in heart conditions.
Sorry if this is more info than you wanted, just chewing the fat, so to speak.

I paid out of pocket for my procedure, and I knew that if my liver wasn't shrunk down sufficiently, the surgeon would be going in and not doing the procedure. No refunds once he's in there.
That was a great incentive to keep me on track, plus I didn't find the pre-op diet to be that challenging. I wasn't hungry, and was super excited about the procedure. I want to do exactly what my surgeon told me to, because it would be a shame to go through all of this for naught.

Sounds like ketosis, the metallic taste is a dead ringer.
Ketosis is the state of your metabolism switching from
Ironing glucose as a primary fuel source to burning fat. It can be burning stored fat, or dietary fat and most likely a mix of both.
Your body contains approximately 300g of glucose "on hand" stored in your muscle tissue. Once you cut your carbs, those stores get depleted and your body turns to an alternate fuel source, fat. Your liver generates 280g of glucose every day for brain function and cellular functions every day regardless of your diet, so there is no danger to remaining in ketosis.
When fat cells are burned, there are by products called "ketone bodies" or ketones created. There are 3 types of ketones, and you can buy urine strips that will test for 1 of them.
When you first start ketosis, your body sucks at using ketones and so that "spill" over into urine. The longer you remain ketogenic, the more efficient you become at burning them.
Beta-hydroxybuterate is one of the ketone bodies that has been shown to have very beneficial results on the heart, and is a preferred source of fuel for the brain.
While initially in carb withdrawal and your body can't uptake ketones properly, there is a syndrome known as "keto flu". But after the initial withdrawal subside and your body adapts to using ketones as well as fats for energy and fuel, there is evidence of increased mental clarity and acuity as well as dramatic improvement in heart conditions.
Sorry if this is more info than you wanted, just chewing the fat, so to speak.

I should probably keep my comments to myself regarding not following your surgeon's plan for post op. It seems just incredible to me to disregard medical advice and start eating solid food just 2 weeks after having most of your stomach removed. If radical surgery isn't an incentive to follow the plan, what IS an incentive?
But I digress.
Regarding the emotional rollercoaster, fat cells were previously thought of as sort of stagnant (it was at one time believed that once fat went in, it stayed there until it was burned created "old, dangerous" fat).
That is totally debunked. Fat circulates in and out of your cells all the times, constantly rearranging and being replaced with new fats. It has also been discovered that fat that is extremely hormonally active.
All kinds of fat soluble hormones end up stored in the fat, inside the cells. Estrogen is one of them. In men, estrogens stored in fat cells often result in some "feminizing" features, such as developing breasts or "manboobs" and softening of chin lines.
In women, a sudden abdundance of estrogen is equally disturbing. But in different ways.
Excess estrogen greatly diminishes sex drive in men and women.
Estrogen dominance in women is linked to extreme rage, sometimes violent behaviour and extreme emotional volatility or becoming emotionally labile.
Estrogen dominance can mimic the symptoms of some personality disorders, like Borderline Personalty Disorder and antisocial tendencies.
It's important to have someone to talk to, and activities to distract while your hormonally active fat cells are being depleted and all the pent up fury within is being released as well. It can be very overwhelming, and not just for the patient.

I am feeling the effects of the perfect storm - nerves healing up, off pain meds completely (have to be drug screened for work and most pain meds are not approved) and beginning the healing process while learning what and how much my new stomach wants and needs.
The good news is, from what I've read there's nowhere to go but up as I start to heal and mobility improves.
I am following my surgeon's plan to the letter, because I am terrified of complication that would result in more time off work than I can afford.

No one said anything to me about eating spicy food and there was nothing in the pre and post op diet information I received. Spicy food has never bothered me, so i didn't think to ask.
Post op day 4, I went to the grocery store across the street from the hotel in Tijuana and bought some spicy ramen cups and strained the broth off because I found the broth at the hotel to be unappealingly bland. It didn't cause any issues (that I'm aware of, day 8 now). I've never had chronic heartburn, diarreah or hiccups or anything from spicy food, so I thought nothing of it.
In July, I was in South Korea, Japan and China and they prepare VERY spicy food and I couldn't get enough.

I thought I would post up my entire experience with ALM in Tijuana while the details are still fresh in my mind. This will be a bit of a long read, but hopefully someone who is investigating the possibilities will find some useful information, answers to some questions and some reassurances! Here goes:
I was introduced to the idea of bariatric surgery about 6 months ago during a conversation with a friend, who has been struggling for a few years with a significant (100lbs+) weight gain. I, too, had been gaining weight steadily since losing 100lbs four years ago. She said that if she couldn't lose the weight in the next year, she was "gonna get the gastric surgery" and be done of it. Of course, I had heard about gastric bypasses and lap bands, but I always associated it with Hollywood stars (ie, the very wealthy) or people who were much larger than 250lbs.
I walked away from that conversation with a seed planted, and over the next few days I began doing some preliminary online research. This was one of the sites I came across at that time. I learned about the different procedures, and researched some of the worst case scenarios associated with each. I researched long term consequences, health outcomes, the effects on women of childbearing age who want to become pregnant, etc. I tried not to get bogged down by only reading positive stories or looking at #vsgbeforeandafter pictures and imagining my weight disappearing effortlessly overnight.
I decided that this was something that really piqued my interest. I went to my provincial health authority's website (I live in Nova Scotia) and saw that the wait times here for an insurance covered procedure were more than 5 years, as there is only 1 bariatric surgeon in the province. Dismayed, I googled some bariatric centres close to where my above mentioned friend lives (Houston) and saw the procedures ranged from $12,000 USD up to $20,000 USD. There was simply no way I could afford that, even though I travelled to Houston on a weekly basis for work and could stay with my friend free of charge.
I put the idea out of my head. I thought, "this really IS for rich folks, $28,000 (Canadian dollars) isn't feasible for a normal working person."
But I kept coming back to pages like this, and others and on one of my google searches a sponsored ad result for ALM popped up at the top of the screen. "Affordable bariatric surgery at a top hospital in Tijuana, Mexico" or something to that effect.
Intrigued, I clicked through the ad and read the entire content of the page. All the procedures were available, starting in the low $4000s (about $5500 CAD). I'm not naive (in fact, cynical would be a much more appropriate adjective), so I thought "what's the catch?"
I took note of the doctor's names from ALM's website. I checked them on linked in, I read forums like this one, I entered search terms like "Dr So-So Tijuana deaths" and read well beyond the first page of Google results. I read about ALM, again entering morbid search terms, digging through online forums and basically trying to find that one piece of information where I would say "AHA! Gotcha! Of course that's a terrible idea!"
I didn't find much. The company seemed legit, plenty of online posts dating back a few years to a few days about people who used their services and had successful operations with the surgeons they work with. This was around June.
So I sent an email to a link on their page. I explained my personal experiences with weight loss and gain, my concerns about some members of my family and their onset health problems, and asking if I would be a candidate for the procedure at 5'8", fairly muscular and 250lbs. I don't wear plus sized clothing, but I'm at the point where if I gained another 15-20 lbs I would have to.
I clicked send, and wondered if/when I would hear back and went on with my life. To my surprise, I heard back only an hour later. My coordinator, Crystal, answered my questions thoroughly (I was surprised it wasn't a generic "form" email, thank you for contacting us, don't call us - we'll call you blah blah blah). We opened a line of communication back and forth, and I felt pretty confident with the answers I was getting.
So now I was getting excited. Possibilities. What seemed unattainable just a few weeks earlier was now suddenly in reach. It was time to discuss my findings with my wife. I chewed this over in my head, how to bring it up, was I ready to answer her questions, should I nerd out with all the info I had learned, or should I nonchalantly just throw it out there?
I brought it up, and she was surprised but open minded. I explained all the options I had looked into, and what, exactly, a vertical sleeve gastrecromy is and isn't. She listened to my spiel, and said "Okay. Would I qualify for the procedure?".
She is not fat, but has lost and gained 60lbs in the past few years and has an obese parent with diabetes. Her BMI was 32 when we had this conversation, and she wears size 12 jeans.
We emailed Crystal with her concerns and questions, and again, she got right back to us. She emailed us forms and questionnaires for the doctor's review and we set to filling them out.
We were on holidays for most of July, and when we returned we set a date, Oct 27 and paid our $500 each deposit to hold that date.
In early August, it seemed like an eternity but since we both travel for work and work 70 hours a week, we knew the time would surely pass. We talked about little else but how excited we were. How we were going to do everything right, get back to the gym, change our lives and how this would help us when we start our family in a few years. We booked plane tickets. We changed companies in September, which was a welcome distraction from all the VSG this and VSG that.
Starting about 3 weeks prior to our travel dates, we started receiving emails from Cindy Rios, an RN who works with (for?) ALM regarding diet, lifestyle changes, phases of the surgery recovery and suggestions for streamlining and making the most of our pending surgeries.
We had quit caffeine and carbonated drinks in August, in a bid to make it easier down the road. We went to costco and loaded up on Premier Protein (like a shopping cart full) because we are on the road with work and didn't want to be short on supplies and maybe tempted to cheat. We didn't do "food funerals" in the same way I wouldn't attend the funeral of a nemesis or adversary who had stolen some of my life and made me unhappy with who I was. We bought enough salad to get us through the work week when we were home each week.
The pre-op diet was easy, for the most part. Not wanting to risk enlarging our livers with excess carbs and losing our hard earned money if the surgery couldn't be completed made it easier. We had a supply of Keto-strips from previous ketogenic dieting and made sure we were staying in ketosis throughout the entire time.
We flew out of Nova Scotia at 5am on the 26th. We arrived at the San Diego airport before noon (4 hour time difference) after changing planes in Toronto.
We had a text message waiting for us when we landed from our driver, asking what our schedule looked like. We told him we were on the ground, and just waiting to deplane and on our way. We received a call immediately saying they would pick us up at the cab stand at Terminal 1 in about an hour. We carried on our luggage (not wanting to risk the airline losing our luggage with multiple connections) so we strolled from Terminal 2 down to Terminal 1. We received a text message with a picture of the driver's license, Rafael and his personal information.
When an hour came and went, I sent a text asking where he was and got a call right back. He was stuck in traffic at the border, but wouldn't be much longer. We got a description of the van he was driving so we knew who to watch for.
He arrived not much longer, and we picked up 2 other people on the way. We made our introductions and were off on I5 towards Mexico.
Rafael informed us that because we had landed quite early, we would head straight to Mi Doctor Hospital and do our preoperarion check ups instead of waiting for surgery day.
The hospital is literally 5 mins from the border. Rafael took us from place to place in the hospital, and stayed with us the entire time.
First we had blood taken for a full work up. Next, we went for an EKG to monitor heart function. I then met with Dr Elias Ortiz in his office, as I was the first surgery of the day the next morning. My wife filled out paperwork upstairs, and after my meeting with Dr Ortiz, I filled out the same paperwork. All the paperwork is in English and Spanish, so you'll sign everything twice. I was the only patient to meet Dr Ortiz that afternoon, as he would meet with the others during the day between surgeries.
I asked him to visually inspect my gallbladder, as I have a family history of gall bladder disease and he said he couldn't see if there stones, but the general health would be evident. I asked him about taking Advil (i take a HUGE dose of Advil once a month for period cramps) and he assured me that NSAIDs would not be an issue once the sleeve was healed. I have an alternative medication, but I don't take it because it causes drowsiness and he assured me that it was fine until I can handle NSAIDs again.
He was friendly, knowledgable, and overall seemed like a really friendly fellow. I felt like I was in good hands.
Rafael was waiting for us when everything was signed, and we piled into the van to head to the hotel.
We stayed at the Grand Hotel Tijuana, which was about 10 mins by van from the hospital. Rafael ushered us through the lobby and into the elevators to the 11th floor. He collected our IDs and did the check in process on the medical floor while we lounged and admired the view. Rafael told us what time we would each be picked up the next morning, 5:40am for my wife and I. One by one, we got our rooms and he passed us off the concierges to take us to our rooms.
The medical rooms were nice - spacious bathroom and shower, we had a king size bed and several pillows each. ALM provides each patient with 3 room service orders of broth, - sugar free popsicle and a glass of apple juice. We ordered twice and it arrived promptly. I skipped the juice, because I had worked so hard at cutting all the sugar out of my diet and I wasn't going to reindulge the night before the surgery. We were pretty tired from the flying, and even though it was only 6pm in Tijuana, it was 10pm at home and we had been at the airport for 3am. So we enjoyed our broth, watched some Netflix on the iPad and went to sleep.< /p>
We had to bring our luggage to the hospital the next morning, as we weren't returning to the same room after the procedure and would be staying 2 nights at Mi Doctor.
We got up at 4, had a shower and packed up our things. We met Rafael downstairs in the lobby and headed over to the hospital. We were greeted there by a nurse who gave us compression socks and gowns and told us to change into them. We changed, and the nurse came back in to put in the IV. She said it would be a little while before doctors were ready for us, so we puttered around the room and waited.
A series of doctors from the surgical team came in, we shook hands, saw pictures of their kids and talked a little about how the day would progress. I was first up, and my wife was second on the lineup. They explained that after surgery, I would be wheeled into a recovery room right beside the OR and would be waking up just as my wife was coming out of her surgery before we were both moved into our room upstairs.
After what seemed like eternity (maybe 4 hours, from the time we arrived) a knock came at the door. A nurse sat me in a wheelchair and I was brought upstairs to the OR. My wife was lead shortly after I left to our room upstairs. While in the room, nurses were in and out to hang some signs over our hospital beds and get it ready for us. They moved our luggage in for us, and she waited for her knock on the door.
When I was wheeled into the OR, I was given a hairnet and booties and told to untie my gown from the back and hop up on the OR table. I was wearing underwear, but no bra and nothing was said (many people seem to have concerns about this). I was never asked to remove them or asked if I was on my period.
The doctors I had met that morning were all there in their scrubs, and we had a grand chat about my work, including lots of questions from them. The anesthesiologist was busy hooking this and that up, and he said I would feel a bit woozy as he injected something into my IV. I felt elated, ecstatic and silly all at the same time. I was still chatting animatedly with all the guys when the anesthesiologist put a mask over my mouth and nose. I do not remember anything after that point.
I awoke in the room outside the OR (although I didn't know that at the time) and immediately tried to sit up. I had some pains under my collar bones, and looking down I could see the row of incisions on my belly. I remember asking for wife, was she ok? Yes, they said, she is fine and right beside me. I looked over at her, and then asked "did you do the surgery?" (As if the incisions weren't proof enough) and they said "yes, you did great and your wife too!" Then I went back to sleep.
When I was brought out of the OR and still under, my wife was summoned from our room to the OR. She sat with Dr Ortiz who informed her that my surgery had gone just fine, and that I was still in the OR preparing to be moved to recovery. They chatted about what would happen after her surgery, and she was brought into the other OR to be anesthetitized. While laying on the table, the anesethesiologist said "you look nervous, I'm going to give you something to relax and then we'll chat about what comes next." That's the last thing she remembers.
I vaguely remember being bumped around off one bed and on to another. This was in our room. It was still light outside, and I immediately went to sleep. I awoke shortly after when they brought my wife to our room, and I was very relieved to see her sleeping soundly in the next bed. We both slept for what I can only assume is a few hours.
I awoke suddenly and was incredibly nauseated. I tried to take a deep breath, but my shoulders were hurting and I couldn't breathe deeply. I vomited in my mouth, and threw myself out of bed to the bathroom and spit it in the toilet. It was dark coloured blood, which would have been alarming if I hadn't been so medicated. Feeling better, I went back to bed.
A nurse woke us up to check our vitals, and change the IV bags of medication. I asked about the bloody vomit and was told it's completely normal. They gave us an IV shot for nausea and we drifted off to sleep again.
This process was repeated every few hours (not the vomiting) until the next day. They brought some warm bags to place on my shoulders, the left of which was developing a very sharp pain.
I had some pain in my stomache, like a hunger pain right before your stomache rumbles when it's empty, except it would not rumble. Just a twisting, painful sensation.
I didn't have my watch or phone and had no idea what time of the day or night it was. The time difference made it impossible to guess, but I was feeling wide awake. I could sit up in bed, albeit with some pain, and took stock of my surroundings.
It was a good sized room, there was some free space to walk around the side of the bed and to foot with a private bathroom and shower in the room. A nurse came in and told us to take a shower, and they would change the dressing on our incisions and we would get dressed in our own clothes.
For the rest of that day (day 2), we walked a little inside the hospital, took a few walks outside and wandered around the parking lot (dragging an IV tree) and I tried to walk off the pain in my shoulder. The other shoulder felt fine, but the pain on the left side was making it difficult to draw breaths.
We relaxed in our room, played on our phones and chatted. Shoulder pain aside, we were feeling pretty good and mobile. My IV stopped working (unfortunately after they injected a nauseau shot into it, which swelled my hand up a bit). They switched hands for the IV, but my blood kept clotting inside the port and they had to keep cleaning it out to get the IV working. Finally, they asked me if I was feeling ok and just took the IV out, so I was pain med free.
The doctor came in to remove the drains the night before we were to be discharged. It was mildly uncomfortable coming out, but my shoulder pain disappeared immediately. We were bandaged up, and told that we would meet at 7:30am the next day to meet for aftercare instructions. We were both brought downstairs for an X-ray leak test with the radiologist, which both showed no leaks.
Dr Ortiz came in and told us that our organs looked great and healthy when he did the surgery, and that we had obviously followed the preop diet closely and that he appreciated it, as it makes his job easier. We thanked him and shook hands, and did not see him again.
About 20 mins after, I noticed a bloodstain on my inner left arm, but I was wearing a dark coloured t-shirt and could not see that my drain wound had bled through the bandages. A nurse came in right then, and I lifted up my shirt to look for the bleeding. She immediately changed the bandages, but about 5 minutes later it bled through again.
This happened 5 times, using a variety of pressure banding and trying to close the drain with bandages before a call was made to a doctor.
A doctor in scrubs appeared shortly after, and she lifted off the bandages to check me out. She was surprised that the drain hole was still bleeding and decided to stitch it up. She put in 3 stitches, which immediately stopped the bleeding and bandaged me back up. I told her that I suspected the drain wasn't working properly, since the drain balloon was full of large clots and my IV had been clotting, and told her about the intense pain in my shoulder that had dissipated as soon as the drain was removed. She agreed that it had probably gotten blocked and caused some buildup and pressure, but there was nothing to worry about.
We walked, talked, napped through the night and arose at 6:30 for our morning meeting. We showered, had our bandages changed and packed our bags to head downstairs.
During the meeting, we all received a little purple reusable shopping bag with some medications, copies of our blood work and leak test paperwork, as well as some ALM goodies, like a tshirt, button, pen and bumper sticker.
We were all shuttled over the Grand, and has a debrief while waiting for our new room assignments. It was about 9am, and we had a tour of TJ lined up at noon. We weren't sure if we would go, as the time change was really messing with our sleep schedule and we had been up most of the night. We got to our room, and decided we'd set the alarm for 2 hours and if we felt well, we'd go. Sure enough, a 2 hour solid nap did the trick and we headed out for the tour.
Rafael drove the bus with about a dozen patients and friends of patients. We went to a place with tasty ice cream (I was a bit nervous, since ice cream isn't exactly "clear liquids", but I ate a few mouthfuls anyway). I ordered the tiniest child size and couldn't get through half of it.
Next they took us to a pharmacy where the pharmacist gave a very entertaining presentation of all the medications they recommend for bariatric patients. B12 shots, pain killers, half a dozen kinds of antibiotics, anti diarreah, medicine for nauseau, and a whole host of others. He wrote prescriptions for whichever medecines you were choosing, so as to not cause problems crossing the border back into the USA. Everyone was filling up baskets, and even getting some of their medications from home unrelated to the surgery like Ritalin, Valium and Viagara.
We then went to the "main drag", where lots of tourists buy trinkets, get pictures with brightly coloured backgrounds set up and eat tacos (if they haven't just had surgery, of course). We were supposed to go to a restaurant that serves excellent broth afterwards, but there was a mixup with times and they were closed so we went back to the hotel. We were pretty tired, and basically just lounged around the room and had some broth and went to bed.
The next day, we had nothing lined up through ALM so we found our own action. We got dressed, changed our bandages and headed out into the sunshine. There is a restaurant across th street, Fonda Argentine that we had read online serves excellent broth. The door was open, and we stood inside at the maitre'd stand for about 10 minutes. Employees were sitting at a table, looked at us and turned their backs and refused to acknowledge us so we left.
All together, we walked about 2 miles around the neighbourhood, checked out the little ice cream stand again, and stopped by a little grocery store on the way to the hotel. We purchased a few of those "3 minute lunch" cups, where you just add Water to ramen noodles. We got some spicy beef and chicken ones, and microwaved them at the hotel in the medical floor lobby. We strained the broth out, and it was a welcome and delicious change from the bland chicken broth at the hotel.
The next day was our travel day, and we met Jack at 11am in front the Grand. There were 2 others who were there with their daughter heading to San Diego with us. Their flight was at 3pm, ours was at 6pm. It took about an hour and a half to get to the airport, which was much faster than we had expected.
We printed our boarding passes for the 3 flights home, and left the airport to take a trolley tour of San Diego. It was about $40 each, and took 2 hours. You could hop on and off at any of the stops, but we were anxious to get back in time in case security was busy.
There is an excellent little restaurant past security at terminal 2 called Saffron that sells delicious chicken broth. We got a cup of broth to go each, and boarded our first flight home. LAX had absolutely nothing that could pass as "clear liquids", it was all burger joints and pubs and none even had Soup on the menu, so we just walked the entire 2 hour layover. We did stop and have a glass of cranberry juice. We clocked about 3 miles of walking that day, and that included carrying our backpacks everywhere (remember, we carried on our luggage) and we were feeling great.
We had the same problem with lack of hot food options in Newark, the only place that serves soup didn't have any soup ready at 7:30am. So we wandered around the tiny terminal, just getting some walking in.
On our way home from the airport yesterday, we ran errands in a few stores, stocking up on broths and Soups we can strain for the next phase of our diet, starting tomorrow. I was in the kitchen all afternoon making a huge pot of butternut squash soup and a spinach dip with soup like consistency to portion up for work later this week.
Tomorrow we are back to our regular schedule!
If you're still with me, I hope this will help someone who is thirsty for the details on how this all works! Ask me anything, I'll do my best to answer it!

Like many others, I didn't tell anyone until immediately before the surgery.
My wife and I told her parents about 2 weeks before we left for Mexico. They were curious about why we would plan an anniversary trip to Tijuana instead of the Rivieria Maya or some resort somewhere. We were very well researched, to the point that I think they were worried about insulting us with banal questions like "Isn't Mexico too dangerous to visit?".
I told my own parents last night, a week after the surgery was done. My mother is a pharmacist and I knew she would be worried sick, no matter where we were going. She is adamantly anti-drugs, and won't even take Tylenol because she knows how toxic many drugs are.
Naturally, she didn't exactly approve of my choice. I riddled off all the prescribed meds we brought home, and she gave me advice on each one and any side effects I might have. But ultimately, she said she was grateful because she wouldn't have slept a wink had she known why we were in Mexico.
No one else knows. I won't lie about it if they ask, but i plan on keeping it to myself.

We just returned from Tijuana yesterday.
As a truck driver, I have frequented some of the seediest areas in large metropolitan areas all over the USA. On 2 occasions I have been sleeping in my bunk in the trunk and awoken to ringing gunshots (once in Baltimore, parked curbside outside of a barbed wire fence with a trailer full of beer) and once in Chicago (parked in an alleyway beside my customer's locked up facility with a trailer load of car tires). The Chicago Tribune has an online violent crime map that details all sorts of crimes, like homicides, rapes and violent robberies. That week alone there had been 5 shooting deaths in a 1 square mile radius of Parklawn, where I was parked. My truck and trailer has Canadian plates, from which anyone could figure out means I am unarmed.
What I'm trying to show is that I have to laugh a little when I see people making claims about how unsafe it is in Mexico. At no point did I see homeless encampments or feel unsafe walking the streets of Mexico. The same cannot be said for many neighbourhoods I have visited in Houston, Birmingham, Miami, Charlotte, Baltimore, Newark, New York City and Boston. My friend was robbed at gunpoint after using an ATM in a service plaza in Connecticut when someone followed him out to the truck parking lot.
The principles are the same: I don't flash money around, I mind my own business and I stay aware of my surroundings at all times when I visit the USA. I followed those same principles in Mexico and at no point did I feel unsafe.

Like many others, I didn't tell anyone until immediately before the surgery.
My wife and I told her parents about 2 weeks before we left for Mexico. They were curious about why we would plan an anniversary trip to Tijuana instead of the Rivieria Maya or some resort somewhere. We were very well researched, to the point that I think they were worried about insulting us with banal questions like "Isn't Mexico too dangerous to visit?".
I told my own parents last night, a week after the surgery was done. My mother is a pharmacist and I knew she would be worried sick, no matter where we were going. She is adamantly anti-drugs, and won't even take Tylenol because she knows how toxic many drugs are.
Naturally, she didn't exactly approve of my choice. I riddled off all the prescribed meds we brought home, and she gave me advice on each one and any side effects I might have. But ultimately, she said she was grateful because she wouldn't have slept a wink had she known why we were in Mexico.
No one else knows. I won't lie about it if they ask, but i plan on keeping it to myself.

I thought I would post up my entire experience with ALM in Tijuana while the details are still fresh in my mind. This will be a bit of a long read, but hopefully someone who is investigating the possibilities will find some useful information, answers to some questions and some reassurances! Here goes:
I was introduced to the idea of bariatric surgery about 6 months ago during a conversation with a friend, who has been struggling for a few years with a significant (100lbs+) weight gain. I, too, had been gaining weight steadily since losing 100lbs four years ago. She said that if she couldn't lose the weight in the next year, she was "gonna get the gastric surgery" and be done of it. Of course, I had heard about gastric bypasses and lap bands, but I always associated it with Hollywood stars (ie, the very wealthy) or people who were much larger than 250lbs.
I walked away from that conversation with a seed planted, and over the next few days I began doing some preliminary online research. This was one of the sites I came across at that time. I learned about the different procedures, and researched some of the worst case scenarios associated with each. I researched long term consequences, health outcomes, the effects on women of childbearing age who want to become pregnant, etc. I tried not to get bogged down by only reading positive stories or looking at #vsgbeforeandafter pictures and imagining my weight disappearing effortlessly overnight.
I decided that this was something that really piqued my interest. I went to my provincial health authority's website (I live in Nova Scotia) and saw that the wait times here for an insurance covered procedure were more than 5 years, as there is only 1 bariatric surgeon in the province. Dismayed, I googled some bariatric centres close to where my above mentioned friend lives (Houston) and saw the procedures ranged from $12,000 USD up to $20,000 USD. There was simply no way I could afford that, even though I travelled to Houston on a weekly basis for work and could stay with my friend free of charge.
I put the idea out of my head. I thought, "this really IS for rich folks, $28,000 (Canadian dollars) isn't feasible for a normal working person."
But I kept coming back to pages like this, and others and on one of my google searches a sponsored ad result for ALM popped up at the top of the screen. "Affordable bariatric surgery at a top hospital in Tijuana, Mexico" or something to that effect.
Intrigued, I clicked through the ad and read the entire content of the page. All the procedures were available, starting in the low $4000s (about $5500 CAD). I'm not naive (in fact, cynical would be a much more appropriate adjective), so I thought "what's the catch?"
I took note of the doctor's names from ALM's website. I checked them on linked in, I read forums like this one, I entered search terms like "Dr So-So Tijuana deaths" and read well beyond the first page of Google results. I read about ALM, again entering morbid search terms, digging through online forums and basically trying to find that one piece of information where I would say "AHA! Gotcha! Of course that's a terrible idea!"
I didn't find much. The company seemed legit, plenty of online posts dating back a few years to a few days about people who used their services and had successful operations with the surgeons they work with. This was around June.
So I sent an email to a link on their page. I explained my personal experiences with weight loss and gain, my concerns about some members of my family and their onset health problems, and asking if I would be a candidate for the procedure at 5'8", fairly muscular and 250lbs. I don't wear plus sized clothing, but I'm at the point where if I gained another 15-20 lbs I would have to.
I clicked send, and wondered if/when I would hear back and went on with my life. To my surprise, I heard back only an hour later. My coordinator, Crystal, answered my questions thoroughly (I was surprised it wasn't a generic "form" email, thank you for contacting us, don't call us - we'll call you blah blah blah). We opened a line of communication back and forth, and I felt pretty confident with the answers I was getting.
So now I was getting excited. Possibilities. What seemed unattainable just a few weeks earlier was now suddenly in reach. It was time to discuss my findings with my wife. I chewed this over in my head, how to bring it up, was I ready to answer her questions, should I nerd out with all the info I had learned, or should I nonchalantly just throw it out there?
I brought it up, and she was surprised but open minded. I explained all the options I had looked into, and what, exactly, a vertical sleeve gastrecromy is and isn't. She listened to my spiel, and said "Okay. Would I qualify for the procedure?".
She is not fat, but has lost and gained 60lbs in the past few years and has an obese parent with diabetes. Her BMI was 32 when we had this conversation, and she wears size 12 jeans.
We emailed Crystal with her concerns and questions, and again, she got right back to us. She emailed us forms and questionnaires for the doctor's review and we set to filling them out.
We were on holidays for most of July, and when we returned we set a date, Oct 27 and paid our $500 each deposit to hold that date.
In early August, it seemed like an eternity but since we both travel for work and work 70 hours a week, we knew the time would surely pass. We talked about little else but how excited we were. How we were going to do everything right, get back to the gym, change our lives and how this would help us when we start our family in a few years. We booked plane tickets. We changed companies in September, which was a welcome distraction from all the VSG this and VSG that.
Starting about 3 weeks prior to our travel dates, we started receiving emails from Cindy Rios, an RN who works with (for?) ALM regarding diet, lifestyle changes, phases of the surgery recovery and suggestions for streamlining and making the most of our pending surgeries.
We had quit caffeine and carbonated drinks in August, in a bid to make it easier down the road. We went to costco and loaded up on Premier Protein (like a shopping cart full) because we are on the road with work and didn't want to be short on supplies and maybe tempted to cheat. We didn't do "food funerals" in the same way I wouldn't attend the funeral of a nemesis or adversary who had stolen some of my life and made me unhappy with who I was. We bought enough salad to get us through the work week when we were home each week.
The pre-op diet was easy, for the most part. Not wanting to risk enlarging our livers with excess carbs and losing our hard earned money if the surgery couldn't be completed made it easier. We had a supply of Keto-strips from previous ketogenic dieting and made sure we were staying in ketosis throughout the entire time.
We flew out of Nova Scotia at 5am on the 26th. We arrived at the San Diego airport before noon (4 hour time difference) after changing planes in Toronto.
We had a text message waiting for us when we landed from our driver, asking what our schedule looked like. We told him we were on the ground, and just waiting to deplane and on our way. We received a call immediately saying they would pick us up at the cab stand at Terminal 1 in about an hour. We carried on our luggage (not wanting to risk the airline losing our luggage with multiple connections) so we strolled from Terminal 2 down to Terminal 1. We received a text message with a picture of the driver's license, Rafael and his personal information.
When an hour came and went, I sent a text asking where he was and got a call right back. He was stuck in traffic at the border, but wouldn't be much longer. We got a description of the van he was driving so we knew who to watch for.
He arrived not much longer, and we picked up 2 other people on the way. We made our introductions and were off on I5 towards Mexico.
Rafael informed us that because we had landed quite early, we would head straight to Mi Doctor Hospital and do our preoperarion check ups instead of waiting for surgery day.
The hospital is literally 5 mins from the border. Rafael took us from place to place in the hospital, and stayed with us the entire time.
First we had blood taken for a full work up. Next, we went for an EKG to monitor heart function. I then met with Dr Elias Ortiz in his office, as I was the first surgery of the day the next morning. My wife filled out paperwork upstairs, and after my meeting with Dr Ortiz, I filled out the same paperwork. All the paperwork is in English and Spanish, so you'll sign everything twice. I was the only patient to meet Dr Ortiz that afternoon, as he would meet with the others during the day between surgeries.
I asked him to visually inspect my gallbladder, as I have a family history of gall bladder disease and he said he couldn't see if there stones, but the general health would be evident. I asked him about taking Advil (i take a HUGE dose of Advil once a month for period cramps) and he assured me that NSAIDs would not be an issue once the sleeve was healed. I have an alternative medication, but I don't take it because it causes drowsiness and he assured me that it was fine until I can handle NSAIDs again.
He was friendly, knowledgable, and overall seemed like a really friendly fellow. I felt like I was in good hands.
Rafael was waiting for us when everything was signed, and we piled into the van to head to the hotel.
We stayed at the Grand Hotel Tijuana, which was about 10 mins by van from the hospital. Rafael ushered us through the lobby and into the elevators to the 11th floor. He collected our IDs and did the check in process on the medical floor while we lounged and admired the view. Rafael told us what time we would each be picked up the next morning, 5:40am for my wife and I. One by one, we got our rooms and he passed us off the concierges to take us to our rooms.
The medical rooms were nice - spacious bathroom and shower, we had a king size bed and several pillows each. ALM provides each patient with 3 room service orders of broth, - sugar free popsicle and a glass of apple juice. We ordered twice and it arrived promptly. I skipped the juice, because I had worked so hard at cutting all the sugar out of my diet and I wasn't going to reindulge the night before the surgery. We were pretty tired from the flying, and even though it was only 6pm in Tijuana, it was 10pm at home and we had been at the airport for 3am. So we enjoyed our broth, watched some Netflix on the iPad and went to sleep.< /p>
We had to bring our luggage to the hospital the next morning, as we weren't returning to the same room after the procedure and would be staying 2 nights at Mi Doctor.
We got up at 4, had a shower and packed up our things. We met Rafael downstairs in the lobby and headed over to the hospital. We were greeted there by a nurse who gave us compression socks and gowns and told us to change into them. We changed, and the nurse came back in to put in the IV. She said it would be a little while before doctors were ready for us, so we puttered around the room and waited.
A series of doctors from the surgical team came in, we shook hands, saw pictures of their kids and talked a little about how the day would progress. I was first up, and my wife was second on the lineup. They explained that after surgery, I would be wheeled into a recovery room right beside the OR and would be waking up just as my wife was coming out of her surgery before we were both moved into our room upstairs.
After what seemed like eternity (maybe 4 hours, from the time we arrived) a knock came at the door. A nurse sat me in a wheelchair and I was brought upstairs to the OR. My wife was lead shortly after I left to our room upstairs. While in the room, nurses were in and out to hang some signs over our hospital beds and get it ready for us. They moved our luggage in for us, and she waited for her knock on the door.
When I was wheeled into the OR, I was given a hairnet and booties and told to untie my gown from the back and hop up on the OR table. I was wearing underwear, but no bra and nothing was said (many people seem to have concerns about this). I was never asked to remove them or asked if I was on my period.
The doctors I had met that morning were all there in their scrubs, and we had a grand chat about my work, including lots of questions from them. The anesthesiologist was busy hooking this and that up, and he said I would feel a bit woozy as he injected something into my IV. I felt elated, ecstatic and silly all at the same time. I was still chatting animatedly with all the guys when the anesthesiologist put a mask over my mouth and nose. I do not remember anything after that point.
I awoke in the room outside the OR (although I didn't know that at the time) and immediately tried to sit up. I had some pains under my collar bones, and looking down I could see the row of incisions on my belly. I remember asking for wife, was she ok? Yes, they said, she is fine and right beside me. I looked over at her, and then asked "did you do the surgery?" (As if the incisions weren't proof enough) and they said "yes, you did great and your wife too!" Then I went back to sleep.
When I was brought out of the OR and still under, my wife was summoned from our room to the OR. She sat with Dr Ortiz who informed her that my surgery had gone just fine, and that I was still in the OR preparing to be moved to recovery. They chatted about what would happen after her surgery, and she was brought into the other OR to be anesthetitized. While laying on the table, the anesethesiologist said "you look nervous, I'm going to give you something to relax and then we'll chat about what comes next." That's the last thing she remembers.
I vaguely remember being bumped around off one bed and on to another. This was in our room. It was still light outside, and I immediately went to sleep. I awoke shortly after when they brought my wife to our room, and I was very relieved to see her sleeping soundly in the next bed. We both slept for what I can only assume is a few hours.
I awoke suddenly and was incredibly nauseated. I tried to take a deep breath, but my shoulders were hurting and I couldn't breathe deeply. I vomited in my mouth, and threw myself out of bed to the bathroom and spit it in the toilet. It was dark coloured blood, which would have been alarming if I hadn't been so medicated. Feeling better, I went back to bed.
A nurse woke us up to check our vitals, and change the IV bags of medication. I asked about the bloody vomit and was told it's completely normal. They gave us an IV shot for nausea and we drifted off to sleep again.
This process was repeated every few hours (not the vomiting) until the next day. They brought some warm bags to place on my shoulders, the left of which was developing a very sharp pain.
I had some pain in my stomache, like a hunger pain right before your stomache rumbles when it's empty, except it would not rumble. Just a twisting, painful sensation.
I didn't have my watch or phone and had no idea what time of the day or night it was. The time difference made it impossible to guess, but I was feeling wide awake. I could sit up in bed, albeit with some pain, and took stock of my surroundings.
It was a good sized room, there was some free space to walk around the side of the bed and to foot with a private bathroom and shower in the room. A nurse came in and told us to take a shower, and they would change the dressing on our incisions and we would get dressed in our own clothes.
For the rest of that day (day 2), we walked a little inside the hospital, took a few walks outside and wandered around the parking lot (dragging an IV tree) and I tried to walk off the pain in my shoulder. The other shoulder felt fine, but the pain on the left side was making it difficult to draw breaths.
We relaxed in our room, played on our phones and chatted. Shoulder pain aside, we were feeling pretty good and mobile. My IV stopped working (unfortunately after they injected a nauseau shot into it, which swelled my hand up a bit). They switched hands for the IV, but my blood kept clotting inside the port and they had to keep cleaning it out to get the IV working. Finally, they asked me if I was feeling ok and just took the IV out, so I was pain med free.
The doctor came in to remove the drains the night before we were to be discharged. It was mildly uncomfortable coming out, but my shoulder pain disappeared immediately. We were bandaged up, and told that we would meet at 7:30am the next day to meet for aftercare instructions. We were both brought downstairs for an X-ray leak test with the radiologist, which both showed no leaks.
Dr Ortiz came in and told us that our organs looked great and healthy when he did the surgery, and that we had obviously followed the preop diet closely and that he appreciated it, as it makes his job easier. We thanked him and shook hands, and did not see him again.
About 20 mins after, I noticed a bloodstain on my inner left arm, but I was wearing a dark coloured t-shirt and could not see that my drain wound had bled through the bandages. A nurse came in right then, and I lifted up my shirt to look for the bleeding. She immediately changed the bandages, but about 5 minutes later it bled through again.
This happened 5 times, using a variety of pressure banding and trying to close the drain with bandages before a call was made to a doctor.
A doctor in scrubs appeared shortly after, and she lifted off the bandages to check me out. She was surprised that the drain hole was still bleeding and decided to stitch it up. She put in 3 stitches, which immediately stopped the bleeding and bandaged me back up. I told her that I suspected the drain wasn't working properly, since the drain balloon was full of large clots and my IV had been clotting, and told her about the intense pain in my shoulder that had dissipated as soon as the drain was removed. She agreed that it had probably gotten blocked and caused some buildup and pressure, but there was nothing to worry about.
We walked, talked, napped through the night and arose at 6:30 for our morning meeting. We showered, had our bandages changed and packed our bags to head downstairs.
During the meeting, we all received a little purple reusable shopping bag with some medications, copies of our blood work and leak test paperwork, as well as some ALM goodies, like a tshirt, button, pen and bumper sticker.
We were all shuttled over the Grand, and has a debrief while waiting for our new room assignments. It was about 9am, and we had a tour of TJ lined up at noon. We weren't sure if we would go, as the time change was really messing with our sleep schedule and we had been up most of the night. We got to our room, and decided we'd set the alarm for 2 hours and if we felt well, we'd go. Sure enough, a 2 hour solid nap did the trick and we headed out for the tour.
Rafael drove the bus with about a dozen patients and friends of patients. We went to a place with tasty ice cream (I was a bit nervous, since ice cream isn't exactly "clear liquids", but I ate a few mouthfuls anyway). I ordered the tiniest child size and couldn't get through half of it.
Next they took us to a pharmacy where the pharmacist gave a very entertaining presentation of all the medications they recommend for bariatric patients. B12 shots, pain killers, half a dozen kinds of antibiotics, anti diarreah, medicine for nauseau, and a whole host of others. He wrote prescriptions for whichever medecines you were choosing, so as to not cause problems crossing the border back into the USA. Everyone was filling up baskets, and even getting some of their medications from home unrelated to the surgery like Ritalin, Valium and Viagara.
We then went to the "main drag", where lots of tourists buy trinkets, get pictures with brightly coloured backgrounds set up and eat tacos (if they haven't just had surgery, of course). We were supposed to go to a restaurant that serves excellent broth afterwards, but there was a mixup with times and they were closed so we went back to the hotel. We were pretty tired, and basically just lounged around the room and had some broth and went to bed.
The next day, we had nothing lined up through ALM so we found our own action. We got dressed, changed our bandages and headed out into the sunshine. There is a restaurant across th street, Fonda Argentine that we had read online serves excellent broth. The door was open, and we stood inside at the maitre'd stand for about 10 minutes. Employees were sitting at a table, looked at us and turned their backs and refused to acknowledge us so we left.
All together, we walked about 2 miles around the neighbourhood, checked out the little ice cream stand again, and stopped by a little grocery store on the way to the hotel. We purchased a few of those "3 minute lunch" cups, where you just add Water to ramen noodles. We got some spicy beef and chicken ones, and microwaved them at the hotel in the medical floor lobby. We strained the broth out, and it was a welcome and delicious change from the bland chicken broth at the hotel.
The next day was our travel day, and we met Jack at 11am in front the Grand. There were 2 others who were there with their daughter heading to San Diego with us. Their flight was at 3pm, ours was at 6pm. It took about an hour and a half to get to the airport, which was much faster than we had expected.
We printed our boarding passes for the 3 flights home, and left the airport to take a trolley tour of San Diego. It was about $40 each, and took 2 hours. You could hop on and off at any of the stops, but we were anxious to get back in time in case security was busy.
There is an excellent little restaurant past security at terminal 2 called Saffron that sells delicious chicken broth. We got a cup of broth to go each, and boarded our first flight home. LAX had absolutely nothing that could pass as "clear liquids", it was all burger joints and pubs and none even had Soup on the menu, so we just walked the entire 2 hour layover. We did stop and have a glass of cranberry juice. We clocked about 3 miles of walking that day, and that included carrying our backpacks everywhere (remember, we carried on our luggage) and we were feeling great.
We had the same problem with lack of hot food options in Newark, the only place that serves soup didn't have any soup ready at 7:30am. So we wandered around the tiny terminal, just getting some walking in.
On our way home from the airport yesterday, we ran errands in a few stores, stocking up on broths and Soups we can strain for the next phase of our diet, starting tomorrow. I was in the kitchen all afternoon making a huge pot of butternut squash soup and a spinach dip with soup like consistency to portion up for work later this week.
Tomorrow we are back to our regular schedule!
If you're still with me, I hope this will help someone who is thirsty for the details on how this all works! Ask me anything, I'll do my best to answer it!

Your post is amazing!! Even if just one person reads this and realizes that Tijuana, Mexico is the best option for them, would make the world of difference between getting or not getting WLS. My hubby just went thru BeLiteWeight and we went to Juarez, Mexico, and our experience was NOT at all like yours. His Surgeon was pretty good, but in was there early in the morning and didn't leave until 9:30 or 10:00pm. He was doing surgery's all day back to back. We had a very bad experience in 2013 when his Lap Band malfunctioned and had eroded into his liver so I was kind of on high alert while I was waiting for someone to come let me know how he was. His DR had told me to wait in his room and he would come let me know how he was...he didn't!! I was so upset, it seemed like it was going to be just like his failed revision in which he almost died. Just when I was ready to go and find out something they wheeled him back to his room. The hospital wasn't quite up to par. The staff didn't speak English much. That was a huge problem. Anyway, I so wish he would have used BARIATRICPAL!!!!! He had looked into this site but he thought that with the other outfit being higher in their price that he would have better care. NOT!! The old saying YOU GET WHAT YOU PAID FOR didn't work for him. He wanted and needed the RNY but his right side was solid scar tissue from the BAND and the failed revision. Again so happy you both had such a great experience!! Take care

I thought I would post up my entire experience with ALM in Tijuana while the details are still fresh in my mind. This will be a bit of a long read, but hopefully someone who is investigating the possibilities will find some useful information, answers to some questions and some reassurances! Here goes:
I was introduced to the idea of bariatric surgery about 6 months ago during a conversation with a friend, who has been struggling for a few years with a significant (100lbs+) weight gain. I, too, had been gaining weight steadily since losing 100lbs four years ago. She said that if she couldn't lose the weight in the next year, she was "gonna get the gastric surgery" and be done of it. Of course, I had heard about gastric bypasses and lap bands, but I always associated it with Hollywood stars (ie, the very wealthy) or people who were much larger than 250lbs.
I walked away from that conversation with a seed planted, and over the next few days I began doing some preliminary online research. This was one of the sites I came across at that time. I learned about the different procedures, and researched some of the worst case scenarios associated with each. I researched long term consequences, health outcomes, the effects on women of childbearing age who want to become pregnant, etc. I tried not to get bogged down by only reading positive stories or looking at #vsgbeforeandafter pictures and imagining my weight disappearing effortlessly overnight.
I decided that this was something that really piqued my interest. I went to my provincial health authority's website (I live in Nova Scotia) and saw that the wait times here for an insurance covered procedure were more than 5 years, as there is only 1 bariatric surgeon in the province. Dismayed, I googled some bariatric centres close to where my above mentioned friend lives (Houston) and saw the procedures ranged from $12,000 USD up to $20,000 USD. There was simply no way I could afford that, even though I travelled to Houston on a weekly basis for work and could stay with my friend free of charge.
I put the idea out of my head. I thought, "this really IS for rich folks, $28,000 (Canadian dollars) isn't feasible for a normal working person."
But I kept coming back to pages like this, and others and on one of my google searches a sponsored ad result for ALM popped up at the top of the screen. "Affordable bariatric surgery at a top hospital in Tijuana, Mexico" or something to that effect.
Intrigued, I clicked through the ad and read the entire content of the page. All the procedures were available, starting in the low $4000s (about $5500 CAD). I'm not naive (in fact, cynical would be a much more appropriate adjective), so I thought "what's the catch?"
I took note of the doctor's names from ALM's website. I checked them on linked in, I read forums like this one, I entered search terms like "Dr So-So Tijuana deaths" and read well beyond the first page of Google results. I read about ALM, again entering morbid search terms, digging through online forums and basically trying to find that one piece of information where I would say "AHA! Gotcha! Of course that's a terrible idea!"
I didn't find much. The company seemed legit, plenty of online posts dating back a few years to a few days about people who used their services and had successful operations with the surgeons they work with. This was around June.
So I sent an email to a link on their page. I explained my personal experiences with weight loss and gain, my concerns about some members of my family and their onset health problems, and asking if I would be a candidate for the procedure at 5'8", fairly muscular and 250lbs. I don't wear plus sized clothing, but I'm at the point where if I gained another 15-20 lbs I would have to.
I clicked send, and wondered if/when I would hear back and went on with my life. To my surprise, I heard back only an hour later. My coordinator, Crystal, answered my questions thoroughly (I was surprised it wasn't a generic "form" email, thank you for contacting us, don't call us - we'll call you blah blah blah). We opened a line of communication back and forth, and I felt pretty confident with the answers I was getting.
So now I was getting excited. Possibilities. What seemed unattainable just a few weeks earlier was now suddenly in reach. It was time to discuss my findings with my wife. I chewed this over in my head, how to bring it up, was I ready to answer her questions, should I nerd out with all the info I had learned, or should I nonchalantly just throw it out there?
I brought it up, and she was surprised but open minded. I explained all the options I had looked into, and what, exactly, a vertical sleeve gastrecromy is and isn't. She listened to my spiel, and said "Okay. Would I qualify for the procedure?".
She is not fat, but has lost and gained 60lbs in the past few years and has an obese parent with diabetes. Her BMI was 32 when we had this conversation, and she wears size 12 jeans.
We emailed Crystal with her concerns and questions, and again, she got right back to us. She emailed us forms and questionnaires for the doctor's review and we set to filling them out.
We were on holidays for most of July, and when we returned we set a date, Oct 27 and paid our $500 each deposit to hold that date.
In early August, it seemed like an eternity but since we both travel for work and work 70 hours a week, we knew the time would surely pass. We talked about little else but how excited we were. How we were going to do everything right, get back to the gym, change our lives and how this would help us when we start our family in a few years. We booked plane tickets. We changed companies in September, which was a welcome distraction from all the VSG this and VSG that.
Starting about 3 weeks prior to our travel dates, we started receiving emails from Cindy Rios, an RN who works with (for?) ALM regarding diet, lifestyle changes, phases of the surgery recovery and suggestions for streamlining and making the most of our pending surgeries.
We had quit caffeine and carbonated drinks in August, in a bid to make it easier down the road. We went to costco and loaded up on Premier Protein (like a shopping cart full) because we are on the road with work and didn't want to be short on supplies and maybe tempted to cheat. We didn't do "food funerals" in the same way I wouldn't attend the funeral of a nemesis or adversary who had stolen some of my life and made me unhappy with who I was. We bought enough salad to get us through the work week when we were home each week.
The pre-op diet was easy, for the most part. Not wanting to risk enlarging our livers with excess carbs and losing our hard earned money if the surgery couldn't be completed made it easier. We had a supply of Keto-strips from previous ketogenic dieting and made sure we were staying in ketosis throughout the entire time.
We flew out of Nova Scotia at 5am on the 26th. We arrived at the San Diego airport before noon (4 hour time difference) after changing planes in Toronto.
We had a text message waiting for us when we landed from our driver, asking what our schedule looked like. We told him we were on the ground, and just waiting to deplane and on our way. We received a call immediately saying they would pick us up at the cab stand at Terminal 1 in about an hour. We carried on our luggage (not wanting to risk the airline losing our luggage with multiple connections) so we strolled from Terminal 2 down to Terminal 1. We received a text message with a picture of the driver's license, Rafael and his personal information.
When an hour came and went, I sent a text asking where he was and got a call right back. He was stuck in traffic at the border, but wouldn't be much longer. We got a description of the van he was driving so we knew who to watch for.
He arrived not much longer, and we picked up 2 other people on the way. We made our introductions and were off on I5 towards Mexico.
Rafael informed us that because we had landed quite early, we would head straight to Mi Doctor Hospital and do our preoperarion check ups instead of waiting for surgery day.
The hospital is literally 5 mins from the border. Rafael took us from place to place in the hospital, and stayed with us the entire time.
First we had blood taken for a full work up. Next, we went for an EKG to monitor heart function. I then met with Dr Elias Ortiz in his office, as I was the first surgery of the day the next morning. My wife filled out paperwork upstairs, and after my meeting with Dr Ortiz, I filled out the same paperwork. All the paperwork is in English and Spanish, so you'll sign everything twice. I was the only patient to meet Dr Ortiz that afternoon, as he would meet with the others during the day between surgeries.
I asked him to visually inspect my gallbladder, as I have a family history of gall bladder disease and he said he couldn't see if there stones, but the general health would be evident. I asked him about taking Advil (i take a HUGE dose of Advil once a month for period cramps) and he assured me that NSAIDs would not be an issue once the sleeve was healed. I have an alternative medication, but I don't take it because it causes drowsiness and he assured me that it was fine until I can handle NSAIDs again.
He was friendly, knowledgable, and overall seemed like a really friendly fellow. I felt like I was in good hands.
Rafael was waiting for us when everything was signed, and we piled into the van to head to the hotel.
We stayed at the Grand Hotel Tijuana, which was about 10 mins by van from the hospital. Rafael ushered us through the lobby and into the elevators to the 11th floor. He collected our IDs and did the check in process on the medical floor while we lounged and admired the view. Rafael told us what time we would each be picked up the next morning, 5:40am for my wife and I. One by one, we got our rooms and he passed us off the concierges to take us to our rooms.
The medical rooms were nice - spacious bathroom and shower, we had a king size bed and several pillows each. ALM provides each patient with 3 room service orders of broth, - sugar free popsicle and a glass of apple juice. We ordered twice and it arrived promptly. I skipped the juice, because I had worked so hard at cutting all the sugar out of my diet and I wasn't going to reindulge the night before the surgery. We were pretty tired from the flying, and even though it was only 6pm in Tijuana, it was 10pm at home and we had been at the airport for 3am. So we enjoyed our broth, watched some Netflix on the iPad and went to sleep.< /p>
We had to bring our luggage to the hospital the next morning, as we weren't returning to the same room after the procedure and would be staying 2 nights at Mi Doctor.
We got up at 4, had a shower and packed up our things. We met Rafael downstairs in the lobby and headed over to the hospital. We were greeted there by a nurse who gave us compression socks and gowns and told us to change into them. We changed, and the nurse came back in to put in the IV. She said it would be a little while before doctors were ready for us, so we puttered around the room and waited.
A series of doctors from the surgical team came in, we shook hands, saw pictures of their kids and talked a little about how the day would progress. I was first up, and my wife was second on the lineup. They explained that after surgery, I would be wheeled into a recovery room right beside the OR and would be waking up just as my wife was coming out of her surgery before we were both moved into our room upstairs.
After what seemed like eternity (maybe 4 hours, from the time we arrived) a knock came at the door. A nurse sat me in a wheelchair and I was brought upstairs to the OR. My wife was lead shortly after I left to our room upstairs. While in the room, nurses were in and out to hang some signs over our hospital beds and get it ready for us. They moved our luggage in for us, and she waited for her knock on the door.
When I was wheeled into the OR, I was given a hairnet and booties and told to untie my gown from the back and hop up on the OR table. I was wearing underwear, but no bra and nothing was said (many people seem to have concerns about this). I was never asked to remove them or asked if I was on my period.
The doctors I had met that morning were all there in their scrubs, and we had a grand chat about my work, including lots of questions from them. The anesthesiologist was busy hooking this and that up, and he said I would feel a bit woozy as he injected something into my IV. I felt elated, ecstatic and silly all at the same time. I was still chatting animatedly with all the guys when the anesthesiologist put a mask over my mouth and nose. I do not remember anything after that point.
I awoke in the room outside the OR (although I didn't know that at the time) and immediately tried to sit up. I had some pains under my collar bones, and looking down I could see the row of incisions on my belly. I remember asking for wife, was she ok? Yes, they said, she is fine and right beside me. I looked over at her, and then asked "did you do the surgery?" (As if the incisions weren't proof enough) and they said "yes, you did great and your wife too!" Then I went back to sleep.
When I was brought out of the OR and still under, my wife was summoned from our room to the OR. She sat with Dr Ortiz who informed her that my surgery had gone just fine, and that I was still in the OR preparing to be moved to recovery. They chatted about what would happen after her surgery, and she was brought into the other OR to be anesthetitized. While laying on the table, the anesethesiologist said "you look nervous, I'm going to give you something to relax and then we'll chat about what comes next." That's the last thing she remembers.
I vaguely remember being bumped around off one bed and on to another. This was in our room. It was still light outside, and I immediately went to sleep. I awoke shortly after when they brought my wife to our room, and I was very relieved to see her sleeping soundly in the next bed. We both slept for what I can only assume is a few hours.
I awoke suddenly and was incredibly nauseated. I tried to take a deep breath, but my shoulders were hurting and I couldn't breathe deeply. I vomited in my mouth, and threw myself out of bed to the bathroom and spit it in the toilet. It was dark coloured blood, which would have been alarming if I hadn't been so medicated. Feeling better, I went back to bed.
A nurse woke us up to check our vitals, and change the IV bags of medication. I asked about the bloody vomit and was told it's completely normal. They gave us an IV shot for nausea and we drifted off to sleep again.
This process was repeated every few hours (not the vomiting) until the next day. They brought some warm bags to place on my shoulders, the left of which was developing a very sharp pain.
I had some pain in my stomache, like a hunger pain right before your stomache rumbles when it's empty, except it would not rumble. Just a twisting, painful sensation.
I didn't have my watch or phone and had no idea what time of the day or night it was. The time difference made it impossible to guess, but I was feeling wide awake. I could sit up in bed, albeit with some pain, and took stock of my surroundings.
It was a good sized room, there was some free space to walk around the side of the bed and to foot with a private bathroom and shower in the room. A nurse came in and told us to take a shower, and they would change the dressing on our incisions and we would get dressed in our own clothes.
For the rest of that day (day 2), we walked a little inside the hospital, took a few walks outside and wandered around the parking lot (dragging an IV tree) and I tried to walk off the pain in my shoulder. The other shoulder felt fine, but the pain on the left side was making it difficult to draw breaths.
We relaxed in our room, played on our phones and chatted. Shoulder pain aside, we were feeling pretty good and mobile. My IV stopped working (unfortunately after they injected a nauseau shot into it, which swelled my hand up a bit). They switched hands for the IV, but my blood kept clotting inside the port and they had to keep cleaning it out to get the IV working. Finally, they asked me if I was feeling ok and just took the IV out, so I was pain med free.
The doctor came in to remove the drains the night before we were to be discharged. It was mildly uncomfortable coming out, but my shoulder pain disappeared immediately. We were bandaged up, and told that we would meet at 7:30am the next day to meet for aftercare instructions. We were both brought downstairs for an X-ray leak test with the radiologist, which both showed no leaks.
Dr Ortiz came in and told us that our organs looked great and healthy when he did the surgery, and that we had obviously followed the preop diet closely and that he appreciated it, as it makes his job easier. We thanked him and shook hands, and did not see him again.
About 20 mins after, I noticed a bloodstain on my inner left arm, but I was wearing a dark coloured t-shirt and could not see that my drain wound had bled through the bandages. A nurse came in right then, and I lifted up my shirt to look for the bleeding. She immediately changed the bandages, but about 5 minutes later it bled through again.
This happened 5 times, using a variety of pressure banding and trying to close the drain with bandages before a call was made to a doctor.
A doctor in scrubs appeared shortly after, and she lifted off the bandages to check me out. She was surprised that the drain hole was still bleeding and decided to stitch it up. She put in 3 stitches, which immediately stopped the bleeding and bandaged me back up. I told her that I suspected the drain wasn't working properly, since the drain balloon was full of large clots and my IV had been clotting, and told her about the intense pain in my shoulder that had dissipated as soon as the drain was removed. She agreed that it had probably gotten blocked and caused some buildup and pressure, but there was nothing to worry about.
We walked, talked, napped through the night and arose at 6:30 for our morning meeting. We showered, had our bandages changed and packed our bags to head downstairs.
During the meeting, we all received a little purple reusable shopping bag with some medications, copies of our blood work and leak test paperwork, as well as some ALM goodies, like a tshirt, button, pen and bumper sticker.
We were all shuttled over the Grand, and has a debrief while waiting for our new room assignments. It was about 9am, and we had a tour of TJ lined up at noon. We weren't sure if we would go, as the time change was really messing with our sleep schedule and we had been up most of the night. We got to our room, and decided we'd set the alarm for 2 hours and if we felt well, we'd go. Sure enough, a 2 hour solid nap did the trick and we headed out for the tour.
Rafael drove the bus with about a dozen patients and friends of patients. We went to a place with tasty ice cream (I was a bit nervous, since ice cream isn't exactly "clear liquids", but I ate a few mouthfuls anyway). I ordered the tiniest child size and couldn't get through half of it.
Next they took us to a pharmacy where the pharmacist gave a very entertaining presentation of all the medications they recommend for bariatric patients. B12 shots, pain killers, half a dozen kinds of antibiotics, anti diarreah, medicine for nauseau, and a whole host of others. He wrote prescriptions for whichever medecines you were choosing, so as to not cause problems crossing the border back into the USA. Everyone was filling up baskets, and even getting some of their medications from home unrelated to the surgery like Ritalin, Valium and Viagara.
We then went to the "main drag", where lots of tourists buy trinkets, get pictures with brightly coloured backgrounds set up and eat tacos (if they haven't just had surgery, of course). We were supposed to go to a restaurant that serves excellent broth afterwards, but there was a mixup with times and they were closed so we went back to the hotel. We were pretty tired, and basically just lounged around the room and had some broth and went to bed.
The next day, we had nothing lined up through ALM so we found our own action. We got dressed, changed our bandages and headed out into the sunshine. There is a restaurant across th street, Fonda Argentine that we had read online serves excellent broth. The door was open, and we stood inside at the maitre'd stand for about 10 minutes. Employees were sitting at a table, looked at us and turned their backs and refused to acknowledge us so we left.
All together, we walked about 2 miles around the neighbourhood, checked out the little ice cream stand again, and stopped by a little grocery store on the way to the hotel. We purchased a few of those "3 minute lunch" cups, where you just add Water to ramen noodles. We got some spicy beef and chicken ones, and microwaved them at the hotel in the medical floor lobby. We strained the broth out, and it was a welcome and delicious change from the bland chicken broth at the hotel.
The next day was our travel day, and we met Jack at 11am in front the Grand. There were 2 others who were there with their daughter heading to San Diego with us. Their flight was at 3pm, ours was at 6pm. It took about an hour and a half to get to the airport, which was much faster than we had expected.
We printed our boarding passes for the 3 flights home, and left the airport to take a trolley tour of San Diego. It was about $40 each, and took 2 hours. You could hop on and off at any of the stops, but we were anxious to get back in time in case security was busy.
There is an excellent little restaurant past security at terminal 2 called Saffron that sells delicious chicken broth. We got a cup of broth to go each, and boarded our first flight home. LAX had absolutely nothing that could pass as "clear liquids", it was all burger joints and pubs and none even had Soup on the menu, so we just walked the entire 2 hour layover. We did stop and have a glass of cranberry juice. We clocked about 3 miles of walking that day, and that included carrying our backpacks everywhere (remember, we carried on our luggage) and we were feeling great.
We had the same problem with lack of hot food options in Newark, the only place that serves soup didn't have any soup ready at 7:30am. So we wandered around the tiny terminal, just getting some walking in.
On our way home from the airport yesterday, we ran errands in a few stores, stocking up on broths and Soups we can strain for the next phase of our diet, starting tomorrow. I was in the kitchen all afternoon making a huge pot of butternut squash soup and a spinach dip with soup like consistency to portion up for work later this week.
Tomorrow we are back to our regular schedule!
If you're still with me, I hope this will help someone who is thirsty for the details on how this all works! Ask me anything, I'll do my best to answer it!

I thought I would post up my entire experience with ALM in Tijuana while the details are still fresh in my mind. This will be a bit of a long read, but hopefully someone who is investigating the possibilities will find some useful information, answers to some questions and some reassurances! Here goes:
I was introduced to the idea of bariatric surgery about 6 months ago during a conversation with a friend, who has been struggling for a few years with a significant (100lbs+) weight gain. I, too, had been gaining weight steadily since losing 100lbs four years ago. She said that if she couldn't lose the weight in the next year, she was "gonna get the gastric surgery" and be done of it. Of course, I had heard about gastric bypasses and lap bands, but I always associated it with Hollywood stars (ie, the very wealthy) or people who were much larger than 250lbs.
I walked away from that conversation with a seed planted, and over the next few days I began doing some preliminary online research. This was one of the sites I came across at that time. I learned about the different procedures, and researched some of the worst case scenarios associated with each. I researched long term consequences, health outcomes, the effects on women of childbearing age who want to become pregnant, etc. I tried not to get bogged down by only reading positive stories or looking at #vsgbeforeandafter pictures and imagining my weight disappearing effortlessly overnight.
I decided that this was something that really piqued my interest. I went to my provincial health authority's website (I live in Nova Scotia) and saw that the wait times here for an insurance covered procedure were more than 5 years, as there is only 1 bariatric surgeon in the province. Dismayed, I googled some bariatric centres close to where my above mentioned friend lives (Houston) and saw the procedures ranged from $12,000 USD up to $20,000 USD. There was simply no way I could afford that, even though I travelled to Houston on a weekly basis for work and could stay with my friend free of charge.
I put the idea out of my head. I thought, "this really IS for rich folks, $28,000 (Canadian dollars) isn't feasible for a normal working person."
But I kept coming back to pages like this, and others and on one of my google searches a sponsored ad result for ALM popped up at the top of the screen. "Affordable bariatric surgery at a top hospital in Tijuana, Mexico" or something to that effect.
Intrigued, I clicked through the ad and read the entire content of the page. All the procedures were available, starting in the low $4000s (about $5500 CAD). I'm not naive (in fact, cynical would be a much more appropriate adjective), so I thought "what's the catch?"
I took note of the doctor's names from ALM's website. I checked them on linked in, I read forums like this one, I entered search terms like "Dr So-So Tijuana deaths" and read well beyond the first page of Google results. I read about ALM, again entering morbid search terms, digging through online forums and basically trying to find that one piece of information where I would say "AHA! Gotcha! Of course that's a terrible idea!"
I didn't find much. The company seemed legit, plenty of online posts dating back a few years to a few days about people who used their services and had successful operations with the surgeons they work with. This was around June.
So I sent an email to a link on their page. I explained my personal experiences with weight loss and gain, my concerns about some members of my family and their onset health problems, and asking if I would be a candidate for the procedure at 5'8", fairly muscular and 250lbs. I don't wear plus sized clothing, but I'm at the point where if I gained another 15-20 lbs I would have to.
I clicked send, and wondered if/when I would hear back and went on with my life. To my surprise, I heard back only an hour later. My coordinator, Crystal, answered my questions thoroughly (I was surprised it wasn't a generic "form" email, thank you for contacting us, don't call us - we'll call you blah blah blah). We opened a line of communication back and forth, and I felt pretty confident with the answers I was getting.
So now I was getting excited. Possibilities. What seemed unattainable just a few weeks earlier was now suddenly in reach. It was time to discuss my findings with my wife. I chewed this over in my head, how to bring it up, was I ready to answer her questions, should I nerd out with all the info I had learned, or should I nonchalantly just throw it out there?
I brought it up, and she was surprised but open minded. I explained all the options I had looked into, and what, exactly, a vertical sleeve gastrecromy is and isn't. She listened to my spiel, and said "Okay. Would I qualify for the procedure?".
She is not fat, but has lost and gained 60lbs in the past few years and has an obese parent with diabetes. Her BMI was 32 when we had this conversation, and she wears size 12 jeans.
We emailed Crystal with her concerns and questions, and again, she got right back to us. She emailed us forms and questionnaires for the doctor's review and we set to filling them out.
We were on holidays for most of July, and when we returned we set a date, Oct 27 and paid our $500 each deposit to hold that date.
In early August, it seemed like an eternity but since we both travel for work and work 70 hours a week, we knew the time would surely pass. We talked about little else but how excited we were. How we were going to do everything right, get back to the gym, change our lives and how this would help us when we start our family in a few years. We booked plane tickets. We changed companies in September, which was a welcome distraction from all the VSG this and VSG that.
Starting about 3 weeks prior to our travel dates, we started receiving emails from Cindy Rios, an RN who works with (for?) ALM regarding diet, lifestyle changes, phases of the surgery recovery and suggestions for streamlining and making the most of our pending surgeries.
We had quit caffeine and carbonated drinks in August, in a bid to make it easier down the road. We went to costco and loaded up on Premier Protein (like a shopping cart full) because we are on the road with work and didn't want to be short on supplies and maybe tempted to cheat. We didn't do "food funerals" in the same way I wouldn't attend the funeral of a nemesis or adversary who had stolen some of my life and made me unhappy with who I was. We bought enough salad to get us through the work week when we were home each week.
The pre-op diet was easy, for the most part. Not wanting to risk enlarging our livers with excess carbs and losing our hard earned money if the surgery couldn't be completed made it easier. We had a supply of Keto-strips from previous ketogenic dieting and made sure we were staying in ketosis throughout the entire time.
We flew out of Nova Scotia at 5am on the 26th. We arrived at the San Diego airport before noon (4 hour time difference) after changing planes in Toronto.
We had a text message waiting for us when we landed from our driver, asking what our schedule looked like. We told him we were on the ground, and just waiting to deplane and on our way. We received a call immediately saying they would pick us up at the cab stand at Terminal 1 in about an hour. We carried on our luggage (not wanting to risk the airline losing our luggage with multiple connections) so we strolled from Terminal 2 down to Terminal 1. We received a text message with a picture of the driver's license, Rafael and his personal information.
When an hour came and went, I sent a text asking where he was and got a call right back. He was stuck in traffic at the border, but wouldn't be much longer. We got a description of the van he was driving so we knew who to watch for.
He arrived not much longer, and we picked up 2 other people on the way. We made our introductions and were off on I5 towards Mexico.
Rafael informed us that because we had landed quite early, we would head straight to Mi Doctor Hospital and do our preoperarion check ups instead of waiting for surgery day.
The hospital is literally 5 mins from the border. Rafael took us from place to place in the hospital, and stayed with us the entire time.
First we had blood taken for a full work up. Next, we went for an EKG to monitor heart function. I then met with Dr Elias Ortiz in his office, as I was the first surgery of the day the next morning. My wife filled out paperwork upstairs, and after my meeting with Dr Ortiz, I filled out the same paperwork. All the paperwork is in English and Spanish, so you'll sign everything twice. I was the only patient to meet Dr Ortiz that afternoon, as he would meet with the others during the day between surgeries.
I asked him to visually inspect my gallbladder, as I have a family history of gall bladder disease and he said he couldn't see if there stones, but the general health would be evident. I asked him about taking Advil (i take a HUGE dose of Advil once a month for period cramps) and he assured me that NSAIDs would not be an issue once the sleeve was healed. I have an alternative medication, but I don't take it because it causes drowsiness and he assured me that it was fine until I can handle NSAIDs again.
He was friendly, knowledgable, and overall seemed like a really friendly fellow. I felt like I was in good hands.
Rafael was waiting for us when everything was signed, and we piled into the van to head to the hotel.
We stayed at the Grand Hotel Tijuana, which was about 10 mins by van from the hospital. Rafael ushered us through the lobby and into the elevators to the 11th floor. He collected our IDs and did the check in process on the medical floor while we lounged and admired the view. Rafael told us what time we would each be picked up the next morning, 5:40am for my wife and I. One by one, we got our rooms and he passed us off the concierges to take us to our rooms.
The medical rooms were nice - spacious bathroom and shower, we had a king size bed and several pillows each. ALM provides each patient with 3 room service orders of broth, - sugar free popsicle and a glass of apple juice. We ordered twice and it arrived promptly. I skipped the juice, because I had worked so hard at cutting all the sugar out of my diet and I wasn't going to reindulge the night before the surgery. We were pretty tired from the flying, and even though it was only 6pm in Tijuana, it was 10pm at home and we had been at the airport for 3am. So we enjoyed our broth, watched some Netflix on the iPad and went to sleep.< /p>
We had to bring our luggage to the hospital the next morning, as we weren't returning to the same room after the procedure and would be staying 2 nights at Mi Doctor.
We got up at 4, had a shower and packed up our things. We met Rafael downstairs in the lobby and headed over to the hospital. We were greeted there by a nurse who gave us compression socks and gowns and told us to change into them. We changed, and the nurse came back in to put in the IV. She said it would be a little while before doctors were ready for us, so we puttered around the room and waited.
A series of doctors from the surgical team came in, we shook hands, saw pictures of their kids and talked a little about how the day would progress. I was first up, and my wife was second on the lineup. They explained that after surgery, I would be wheeled into a recovery room right beside the OR and would be waking up just as my wife was coming out of her surgery before we were both moved into our room upstairs.
After what seemed like eternity (maybe 4 hours, from the time we arrived) a knock came at the door. A nurse sat me in a wheelchair and I was brought upstairs to the OR. My wife was lead shortly after I left to our room upstairs. While in the room, nurses were in and out to hang some signs over our hospital beds and get it ready for us. They moved our luggage in for us, and she waited for her knock on the door.
When I was wheeled into the OR, I was given a hairnet and booties and told to untie my gown from the back and hop up on the OR table. I was wearing underwear, but no bra and nothing was said (many people seem to have concerns about this). I was never asked to remove them or asked if I was on my period.
The doctors I had met that morning were all there in their scrubs, and we had a grand chat about my work, including lots of questions from them. The anesthesiologist was busy hooking this and that up, and he said I would feel a bit woozy as he injected something into my IV. I felt elated, ecstatic and silly all at the same time. I was still chatting animatedly with all the guys when the anesthesiologist put a mask over my mouth and nose. I do not remember anything after that point.
I awoke in the room outside the OR (although I didn't know that at the time) and immediately tried to sit up. I had some pains under my collar bones, and looking down I could see the row of incisions on my belly. I remember asking for wife, was she ok? Yes, they said, she is fine and right beside me. I looked over at her, and then asked "did you do the surgery?" (As if the incisions weren't proof enough) and they said "yes, you did great and your wife too!" Then I went back to sleep.
When I was brought out of the OR and still under, my wife was summoned from our room to the OR. She sat with Dr Ortiz who informed her that my surgery had gone just fine, and that I was still in the OR preparing to be moved to recovery. They chatted about what would happen after her surgery, and she was brought into the other OR to be anesthetitized. While laying on the table, the anesethesiologist said "you look nervous, I'm going to give you something to relax and then we'll chat about what comes next." That's the last thing she remembers.
I vaguely remember being bumped around off one bed and on to another. This was in our room. It was still light outside, and I immediately went to sleep. I awoke shortly after when they brought my wife to our room, and I was very relieved to see her sleeping soundly in the next bed. We both slept for what I can only assume is a few hours.
I awoke suddenly and was incredibly nauseated. I tried to take a deep breath, but my shoulders were hurting and I couldn't breathe deeply. I vomited in my mouth, and threw myself out of bed to the bathroom and spit it in the toilet. It was dark coloured blood, which would have been alarming if I hadn't been so medicated. Feeling better, I went back to bed.
A nurse woke us up to check our vitals, and change the IV bags of medication. I asked about the bloody vomit and was told it's completely normal. They gave us an IV shot for nausea and we drifted off to sleep again.
This process was repeated every few hours (not the vomiting) until the next day. They brought some warm bags to place on my shoulders, the left of which was developing a very sharp pain.
I had some pain in my stomache, like a hunger pain right before your stomache rumbles when it's empty, except it would not rumble. Just a twisting, painful sensation.
I didn't have my watch or phone and had no idea what time of the day or night it was. The time difference made it impossible to guess, but I was feeling wide awake. I could sit up in bed, albeit with some pain, and took stock of my surroundings.
It was a good sized room, there was some free space to walk around the side of the bed and to foot with a private bathroom and shower in the room. A nurse came in and told us to take a shower, and they would change the dressing on our incisions and we would get dressed in our own clothes.
For the rest of that day (day 2), we walked a little inside the hospital, took a few walks outside and wandered around the parking lot (dragging an IV tree) and I tried to walk off the pain in my shoulder. The other shoulder felt fine, but the pain on the left side was making it difficult to draw breaths.
We relaxed in our room, played on our phones and chatted. Shoulder pain aside, we were feeling pretty good and mobile. My IV stopped working (unfortunately after they injected a nauseau shot into it, which swelled my hand up a bit). They switched hands for the IV, but my blood kept clotting inside the port and they had to keep cleaning it out to get the IV working. Finally, they asked me if I was feeling ok and just took the IV out, so I was pain med free.
The doctor came in to remove the drains the night before we were to be discharged. It was mildly uncomfortable coming out, but my shoulder pain disappeared immediately. We were bandaged up, and told that we would meet at 7:30am the next day to meet for aftercare instructions. We were both brought downstairs for an X-ray leak test with the radiologist, which both showed no leaks.
Dr Ortiz came in and told us that our organs looked great and healthy when he did the surgery, and that we had obviously followed the preop diet closely and that he appreciated it, as it makes his job easier. We thanked him and shook hands, and did not see him again.
About 20 mins after, I noticed a bloodstain on my inner left arm, but I was wearing a dark coloured t-shirt and could not see that my drain wound had bled through the bandages. A nurse came in right then, and I lifted up my shirt to look for the bleeding. She immediately changed the bandages, but about 5 minutes later it bled through again.
This happened 5 times, using a variety of pressure banding and trying to close the drain with bandages before a call was made to a doctor.
A doctor in scrubs appeared shortly after, and she lifted off the bandages to check me out. She was surprised that the drain hole was still bleeding and decided to stitch it up. She put in 3 stitches, which immediately stopped the bleeding and bandaged me back up. I told her that I suspected the drain wasn't working properly, since the drain balloon was full of large clots and my IV had been clotting, and told her about the intense pain in my shoulder that had dissipated as soon as the drain was removed. She agreed that it had probably gotten blocked and caused some buildup and pressure, but there was nothing to worry about.
We walked, talked, napped through the night and arose at 6:30 for our morning meeting. We showered, had our bandages changed and packed our bags to head downstairs.
During the meeting, we all received a little purple reusable shopping bag with some medications, copies of our blood work and leak test paperwork, as well as some ALM goodies, like a tshirt, button, pen and bumper sticker.
We were all shuttled over the Grand, and has a debrief while waiting for our new room assignments. It was about 9am, and we had a tour of TJ lined up at noon. We weren't sure if we would go, as the time change was really messing with our sleep schedule and we had been up most of the night. We got to our room, and decided we'd set the alarm for 2 hours and if we felt well, we'd go. Sure enough, a 2 hour solid nap did the trick and we headed out for the tour.
Rafael drove the bus with about a dozen patients and friends of patients. We went to a place with tasty ice cream (I was a bit nervous, since ice cream isn't exactly "clear liquids", but I ate a few mouthfuls anyway). I ordered the tiniest child size and couldn't get through half of it.
Next they took us to a pharmacy where the pharmacist gave a very entertaining presentation of all the medications they recommend for bariatric patients. B12 shots, pain killers, half a dozen kinds of antibiotics, anti diarreah, medicine for nauseau, and a whole host of others. He wrote prescriptions for whichever medecines you were choosing, so as to not cause problems crossing the border back into the USA. Everyone was filling up baskets, and even getting some of their medications from home unrelated to the surgery like Ritalin, Valium and Viagara.
We then went to the "main drag", where lots of tourists buy trinkets, get pictures with brightly coloured backgrounds set up and eat tacos (if they haven't just had surgery, of course). We were supposed to go to a restaurant that serves excellent broth afterwards, but there was a mixup with times and they were closed so we went back to the hotel. We were pretty tired, and basically just lounged around the room and had some broth and went to bed.
The next day, we had nothing lined up through ALM so we found our own action. We got dressed, changed our bandages and headed out into the sunshine. There is a restaurant across th street, Fonda Argentine that we had read online serves excellent broth. The door was open, and we stood inside at the maitre'd stand for about 10 minutes. Employees were sitting at a table, looked at us and turned their backs and refused to acknowledge us so we left.
All together, we walked about 2 miles around the neighbourhood, checked out the little ice cream stand again, and stopped by a little grocery store on the way to the hotel. We purchased a few of those "3 minute lunch" cups, where you just add Water to ramen noodles. We got some spicy beef and chicken ones, and microwaved them at the hotel in the medical floor lobby. We strained the broth out, and it was a welcome and delicious change from the bland chicken broth at the hotel.
The next day was our travel day, and we met Jack at 11am in front the Grand. There were 2 others who were there with their daughter heading to San Diego with us. Their flight was at 3pm, ours was at 6pm. It took about an hour and a half to get to the airport, which was much faster than we had expected.
We printed our boarding passes for the 3 flights home, and left the airport to take a trolley tour of San Diego. It was about $40 each, and took 2 hours. You could hop on and off at any of the stops, but we were anxious to get back in time in case security was busy.
There is an excellent little restaurant past security at terminal 2 called Saffron that sells delicious chicken broth. We got a cup of broth to go each, and boarded our first flight home. LAX had absolutely nothing that could pass as "clear liquids", it was all burger joints and pubs and none even had Soup on the menu, so we just walked the entire 2 hour layover. We did stop and have a glass of cranberry juice. We clocked about 3 miles of walking that day, and that included carrying our backpacks everywhere (remember, we carried on our luggage) and we were feeling great.
We had the same problem with lack of hot food options in Newark, the only place that serves soup didn't have any soup ready at 7:30am. So we wandered around the tiny terminal, just getting some walking in.
On our way home from the airport yesterday, we ran errands in a few stores, stocking up on broths and Soups we can strain for the next phase of our diet, starting tomorrow. I was in the kitchen all afternoon making a huge pot of butternut squash soup and a spinach dip with soup like consistency to portion up for work later this week.
Tomorrow we are back to our regular schedule!
If you're still with me, I hope this will help someone who is thirsty for the details on how this all works! Ask me anything, I'll do my best to answer it!

Hello all!
None of you know who I am, but I know many of you from obsessively reading your posts, trials and success stories for the past several months. I'd like to thank everyone who puts themselves out there to the broader public to educate us about this procedure and many of the bumps in the road.
Like many of you, I have struggled with my weight for most of my life, starting in adolescence. Despite assurances from my friends and family that I looked fine, and that I wasn't really fat (just a little fat, I guess) I was never at a weight where I felt truly confident in my own skin. More importantly, I never truly felt that I was fulfilling my physical capabilities. I excelled at sports when I was younger, but I could recognize even then that my weight was holding me back from taking it to the next level.
Jump ahead 15 years (I am 32 now) and my "normal" fluctuations of weight went from about 20 lbs (I stayed between 185-205 for most of a decade) to more like 60lbs (getting as high as 250, doing Keto for 2 years and getting down to 150, only to gradually start gaining back to 250. I work as a long haul truck driver, and although I don't indulge myself at most truck stops, the sheer lack of physical activity is certainly part of my weight issue now.
After maintaining this new (disappointing) weight, I decided it was time to avail myself of every tool in the box. During a very drunken conversation with an old friend, she said that I she couldn't lose her excess 120lbs by her birthday, she was just "gonna get the gastric surgery". This sent me searching for more information, and one of the sites I found was this one.
Never one to say or do things I don't mean, I ended up researching the process with my mind set on making it happen. Unfortunately, in my part of Canada, the wait is very long (more than 5 years, start to finish) and at a BMI of 36, there was no hope I would be approved. I could never afford $20000USD+ to have it done south of the border, so I contacted A Lighter Me and got the ball rolling.
I just had my surgery last week, I am 6 days post-op and just got back home today. I feel prepared for some of the challenges coming my way, and hope that I can be of some help to someone else who is out there, reading this and trying to decide what to do.
Thanks for reading!

Hello all!
None of you know who I am, but I know many of you from obsessively reading your posts, trials and success stories for the past several months. I'd like to thank everyone who puts themselves out there to the broader public to educate us about this procedure and many of the bumps in the road.
Like many of you, I have struggled with my weight for most of my life, starting in adolescence. Despite assurances from my friends and family that I looked fine, and that I wasn't really fat (just a little fat, I guess) I was never at a weight where I felt truly confident in my own skin. More importantly, I never truly felt that I was fulfilling my physical capabilities. I excelled at sports when I was younger, but I could recognize even then that my weight was holding me back from taking it to the next level.
Jump ahead 15 years (I am 32 now) and my "normal" fluctuations of weight went from about 20 lbs (I stayed between 185-205 for most of a decade) to more like 60lbs (getting as high as 250, doing Keto for 2 years and getting down to 150, only to gradually start gaining back to 250. I work as a long haul truck driver, and although I don't indulge myself at most truck stops, the sheer lack of physical activity is certainly part of my weight issue now.
After maintaining this new (disappointing) weight, I decided it was time to avail myself of every tool in the box. During a very drunken conversation with an old friend, she said that I she couldn't lose her excess 120lbs by her birthday, she was just "gonna get the gastric surgery". This sent me searching for more information, and one of the sites I found was this one.
Never one to say or do things I don't mean, I ended up researching the process with my mind set on making it happen. Unfortunately, in my part of Canada, the wait is very long (more than 5 years, start to finish) and at a BMI of 36, there was no hope I would be approved. I could never afford $20000USD+ to have it done south of the border, so I contacted A Lighter Me and got the ball rolling.
I just had my surgery last week, I am 6 days post-op and just got back home today. I feel prepared for some of the challenges coming my way, and hope that I can be of some help to someone else who is out there, reading this and trying to decide what to do.
Thanks for reading!