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Tex Slim 66

Gastric Sleeve Patients
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About Tex Slim 66

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+ Before surgery Sep 2017
Hi, I'm a 51 year old male, 6'2" and 305 lbs (BMI 39), living in the Houston area who like many has struggled with managing my weight ever since college.
My weight began to yo-yo in my 30's and has fluctuated by 30 -50 pounds per year since then. Initially I could lose 20-30 pounds just by getting more active, cycling and some gym work. As I got into my late 30's I needed some caloric restriction and a much more active gym regimen. Also from my late 30's I began a gradual increase in my weight, adding about 25 pounds every 5 years.
In my early 40's I added things like CrossFit and severe caloric restriction, even with months of this I could only get down to a weight that was about 50 pounds over my goal weight of 225 lbs (BMI 29). At 45 I added a personal trainer 3x/week to my routine to try and get back in control, I was fluctuating from 70 - 90 pounds over my goal weight.I have kept up this regime into my 50's but have gotten as high at 330 lbs in the last year or so. I did a 21 day Vegan cleanse to bring my weight back down towards 300 lbs, but don't feel like this is a sustainable approach to manage my weight for the rest of my life. 
ESG is a good fit with my work and lifestyle, I can't be out of the office for an extended period of time and prefer the endoscope to an incision and recovery period (VSG).
I considered two doctors in the Houston area:
Dr. Todd Wilson - University of Texas Minimally Invasive Surgeons of Texas (UT MIST) Dr. Robert Marvin - Houston Surgical Specialists  
+ ESG Procedure - Nov 21, 2017
I chose ESG because I wanted a permanent change (not the balloons) and felt more comfortable with the endoscope procedure (no incisions) than a vertical gastric sleeve.
In the end I chose Dr. Todd Wilson and was very pleased with his initial consultation and dietician counseling before the procedure and his post op follow-up has been excellent. I'm a pretty demanding patient with lots of questions, he has never flinched from answering a single question and has given me many good suggestions that were very practical about how to prepare and go through the procedure and recover. 
I had my ESG Tuesday November 21, 2017, procedure went very smoothly, I was not in pain, did not get nausea and was up and about within a day or two following procedure. After the long weekend I went back to work on Monday and there were no complications.
+ Clear liquids diet pre/post procedure
I stopped drinking coffee and alcohol in the 2 weeks before my procedure, this was part of my mental preparation to move to a healthier lifestyle. I don't drink soda, so no loss there. 
Pre procedure I liked Premier Protein chocolateshakes (Sam's club) and did those for 3 days and then the last 2 days before procedure shifted to clear liquid diet. For clear liquids I liked chicken broth (bouillon), I'm not a big Water fan so drank Crystal Light flavored iced tea (Red Raspberry is my fav). 
+ Meds before and after procedure
Main drugs were for anti-nausea, I did use Emend pre procedure, also had a patch behind my ear for anti-nausea the day of the procedure and Zofran for 2 days post procedure all together they worked awesome. I did not have any nauseous symptoms.  I continue to take Gummy multi Vitamins and a separate gummy Calcium supplement each day.
+ Post Procedure recommendations
Best tip from Dr. Wilson, on sleeping, if we lay down fully horizontally to sleep there's a greater chance of Fluid progressing back up from the stomach towards the esophagus. His recommendation was to be more vertical (doesn't have to be fully upright) as a way to reduce the chance of reflux or getting that feeling of reflux, etc. I did the first two nights on the couch, almost upright and had no problems with gas pain or reflux. Particularly in the first couple of days following the procedure when the sutures are still new this is a big deal.
2nd best tip- Post procedure your stomach is still adjusting and you get feelings of gas or pressure building up, which can be uncomfortable. Just get up and walk around when you begin to feel gas pains coming on. The movement is enough to allow the gas bubbles to get broken up and you will feel better within a few minutes. For me this was usually less than a minute of walking around before I felt better.
+ Post op diet until week 6+
My procedure went smoothly, did not have a sore throat from the endoscope, did not have nausea afterwards (thanks to the meds provided, just take them and relax). I slept a lot the day of my procedure and was up and around the day after.
Clear liquids- first 2-3 days, I liked chicken broth (bouillon) and not a big Water fan so drank Crystal Light flavored iced tea (Red Raspberry is my fav). Clear liquids ended quickly for me, after I was up and about (~2 days)  moved to yogurt, chicken Soup and back to Protein Shakes. My goal was 80+ounces of water / Crystal Light per day. Took some doing to drink this much, but it made a big difference to my weight loss. When I drank enough I was losing weight, if I slowed down and my urine got very yellow my weight loss seemed to stall.
Liquid diet + Yogurt- I drank 3x per day a Premier Protein chocolate shake (Sam's club are my favorite, 2nd choice Muscle Milk). My yogurt favorite is Dannon Light & Fit Greek Yogurt. Keep drinking 80+ ounces of water or Crystal light per day. I stayed on the yogurt and protein shake routine about 2 weeks longer than my Dr. suggested because I was losing weight at a nice rate about 30 pounds in first 2 months.
+ Beginning of solid food diet - late Jan 2018
After about 8 weeks I transitioned off the protein shakes back to solid food. My Dr. really wanted to see this happen as part of my body adjusting post procedure. He let me know the risks of my ESG sutures coming loose would only be from vomiting, not from normal eating. 
Here's my daily eating routine since end of January:
Breakfast - 2 eggs fried Morning snack - Dannon Light & Fit greek yogurt ~80 calories Lunch - 3 ounces protein - typically chicken breast grilled at home and sliced or 2 days per week grilled salmon Afternoon snack - sugar free snack pack chocolate pudding or protein bar (<140 calories and >8 grams protein, favorite Orgain Organic Protein from Sam's Club, 2nd choice Atkins Chocolate Crisp Bar) Dinner - 3 ounces protein, 1/4 cup brown rice or pasta, 1/4 cup vegetables, 2 days/week grilled Salmon, 2 days/week steak , rest is chicken One observation in the last couple of weeks (about week 8 post ESG) I need to drink water or Crystal Light in the evenings, when I get home from work (>30 minutes before dinner) and >30 minutes after dinner. I would say on average I'm drinking 20-30 ounces of water in the evening. I stopped doing this and eating a 1/4 cup of nuts and ended up stalling for 10 days in weight loss. I make it a point to keep my system flushed and needing to go to bathroom at least 5 times per day (#1), each time checking for clear urine and if not then drink more water. 
+ Restriction - it is real for me
I had the same challenge with the pre-op liquid diet. I was still feeling my pm cravings, for me the worst hours were from 4-8 pm, seemed like I couldn't stop munching. I just don't have this physical or mental desire now post ESG, the procedure really helped my hormones in addition to reducing my stomach volume. Occasionally in the late afternoon or evening (which was my previous munching prime time) I will "feel" hungry, if I just drink 2-3 glasses of Crystal light this feeling passes and I am fine until dinner. Similarly about 30+ minutes after dinner I will try to drink two more glasses of Crystal light before I go to bed. 

+ Cheating - my experience
I had a bad experience over the Christmas - New Year's period, we were on vacation and I thought I would "treat" myself to one of my favorite side dishes when having dinner at a nice restaurant. I had ordered a steak and a side of sautéed mushrooms (no one else in the family eats these). When the mushrooms came they smelled so good, rich with oil and garlic that I ate about half of the side dish (in the past I would have easily eaten the whole thing). By the time I was half way through I wasn't feeling so well. It was not a pleasant night's sleep or next morning, upset stomach with a fair amount pain/gas until about noon the next day. This took away my desire to explore the edge of what I eat. I will still have steak 1-2x per week, I stick to the portion size of 3 ounces (sliced and weighed) and put the rest away for another day. Pre ESG it wasn't even a question, of course I ate the whole steak and some of my wife's too! Now I just don't have the desire to "go there". Also talked about cheating with my Dr. and post six weeks it's not an issue with sutures, real thing to avoid is vomiting, which can tear out sutures.
+ Social Drinking Pre and Post ESG
On the alcohol front, I was a social drinker Pre-ESG, about two nights a week and several glasses of red wine usually. Post ESG I have had a total of <6 glasses of wine. Really working to avoid the sugar also not feeling such a strong desire for a drink socially. My taste for wine has changed, maybe it's because I'm so deep in ketosis? "Big" and complex red wine fan pre ESG, really tasting enjoying the complexity of red wines post procedure. I'm only halfway so not an issue for me yet, hope when I'm done and at my target I can enjoy an occasional glass of wine, until now not so much.

Height: 6 feet 2 inches
Starting Weight: 308 lbs
Weight on Day of Surgery: 313 lbs
Current Weight: 265 lbs
Goal Weight: 225 lbs
Weight Lost: 43 lbs
BMI: 34
Surgery: Gastric Sleeve
Surgery Status: Post Surgery
First Dr. Visit: 07/20/2017
Surgery Date: 11/21/2017
Hospital Stay: Outpatient
Surgery Funding: Self Paid
Insurance Outcome: Not covered

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