Creekimp13

Medical rule of thumb: if it is not within your scope of licensed practice to assess medical conditions and write the appropriate referral or medical recommendation, you are opening yourself and your institution up to liability by discussing said condition. If, specifically as a nurse practitioner (which requires a Master's degree), you are overseeing routine patient care under the supervision of a physician who you know will make the referral based on your recommendation and the patient's stats....this is a different sort of situation. Nurse Practitioners generally work in tandem with a supervising primary care physician. Ultimately, though, most insurance companies will require dietitian and bariatric surgery referrals to come from a physician. Your insurance will also almost universally want your referral to come from a medical doctor. What Nurse Practitioners are authorized to do, and what they cannot do varies widely state to state...and also insurance company to insurance company. Obesity treatment, diet and exercise recommendations can have grave consequences if given by someone who doesn't have the skillset to evaluate a patient's whole health profile. If you are a nurse and a doctor has not specifically asked you to discuss weight issues with clients, you really have no business doing so. You cannot make recommendations. You cannot write referrals to dietitians . You cannot prescribe medication. You cannot make a surgery referral. You cannot even give out a printed diet or suggest Jenny Craig...unless a physician has authorized you to do so. Your best course of action as a nurse is to advise patients you are concerned about to discuss how their weight could be affecting their medical issues with their primary physician and advise them to consider asking what options might be available for them.

Ya know what they say about doing the same thing over again and expecting a different result.... Maybe try something different this time? Or not. Whatever works for you. Best wishes:)

If you're eating 700 calories and 300 of them are wine...and you don't see this as an issue...you might have an alcohol dependence problem. Just sayin.

They should become a doctor, first. As a nurse, you are not typically in a position to comment on patient's weight. Like any other health condition....Doctors should present factual information about the health risks of obesity and offer treatment advice, lifestyle advice, and referrals.

My diet was all protein drinks and clear liquids......and one serving per day of like four or so options...a yogurt, or a sugar free pudding, a cup of cream based soup, a serving of sugar free oatmeal. Pre-surgical diet was pure hell. Worse than the surgery, in my opinion. The first two weeks after surgry sucked, too....but at least the scary part is over and you can see the light at the end of the tunnel. All in all....that month of hell sucked the big one. I don't envy any of ya'll going through it!

As you've discovered....it's you who does the work, not the sleeve:) Tomorrow is a new day. Your stomach didn't grow back...the tool is still there. Time to work on figuring out how to use it. You can do this!

I took my meds crushed up in a dollop of sugar free cool whip the day after surgery as per my doctor. Some of my meds were discontinued after surgery and I never needed them again.

Could not disagree with you more about the carbs. And could not disagree with you more about not having carbs in your maintenance diet. I eat a metric ton of healthy carbs with lots of healthy plant based protein in them. Has worked awesome for me for slow steady weight loss. My diet is delicious, satisfying and never leaves me feeling deprived or hungry. I value my kidneys....so I don't want to damage them and shorten my lifespan by grossly over eating protein for the rest of my life. I don't have problems with cravings. Sometimes I choose to eat a little junk, but I feel absolutely in control when I do and can stop at a few bites (and enjoy the hell out of them) Part of this, very likely, has to do with my diet full of low glycemic index healthy carbs that keep my blood sugar stable....which keeps me from Jonesing like an addict so I can make sane measured choices on a sustainable plan. I get that you think carbs are the devil. Not everyone does. Not everyone is a ketovangelist. I don't want to live in a world without black beans, health nut bread, watermelon and apples:) (and the occasional bite or two of a naughy assed dessert) And I don't have to.

PS.. For the sake of full disclosure.... My surgery was complication free. I had a very easy recovery. No nausea. Little pain. Before surgery I had prediabetes. My blood sugar A1C is now well within normal range. My fasting blood sugar is in the 70's. Before surgery I took medication for high blood pressure. My blood pressure is normal now and I'm off meds. Before surgery I had very swollen legs at night and especially on hot days, and took diuretics for my edema. My legs are gorgeous now, no swelling....and no diuretics. Before surgery I had the occasional flare up of a hemorrhoid I got during pregnancy. My butt is great now....no sign of the nasty roid. LOL. The only prescription medication that I still take...is thyroid cause my thyroid is permanently feckered:) But yeah....I can run again. I can walk miles without my back screaming. I can get a good night's sleep without my hip and sciatic nerve pain waking me up at night. I feel like a normal 46 year old again. It SUCKED to feel 66 at 46. No regrets. Nada.

Nothing in life is without risk. Driving your car to the store carries a certain amount of risk. Before allowing yourself to be paralyzed by some instances of side effects after surgery (which are actually fairly rare, and nearly all are readily treatable)...consider this: What is the risk of remaining fat? Diabetes is statistically correlated to a shorter life. Type One...by nearly 20 years, Type Two by 10 years. Diabetics have a harder time losing weight. It can lead to poor wound healing, amputations, blindness... it is something you want to avoid. It is something WORTH SOME RISK to avoid because it will shorten your lifespan and quality of life. High blood pressure will cause debilitating issues over time, too, Kidney issues, risk of stroke. People with high blood pressure have shorter lifespans (by about five years) than those who don't. You are reading some scary stuff on this board.....because YES, this surgery carries SOME risk. (Less than a gallbladder surgery) But you are not considering the multitude of stories of people who chose to remain fat, who did not aggressively try to reverse their poor health conditions.....who died of heart attacks and strokes and complications of metabolic decline. Remaining fat carries more risk. When I considered this surgery, I asked myself and I asked my doctor to justify it.....Do the benefits outweigh the risks? Research overwhelmingly concludes....yes, they do. Wishing you the best no matter what you decide.

Good bugs eat fiber. Make sure you're getting some healthy fiber in your diet. Beans, peas, raspberries, figs, oatmeal, apple ,broccoli, squash, flax, lentils, chick peas. Feeds the good gut bugs and helps firm up stools. Introduce beans and peas in very small amounts to avoid uncomfortable gas. You will develop a tolerance to them if you go slow:) Natural probiotics....yogurt, sauerkraut, miso paste, pickles, olives, kefir, tempeh, Kombucha tea, apple cider vinegar with the mother, kimchi.....anything fermented. (that said, you should use caution to find only SAFETY REGULATED products until you are on the mend)

Looking gorgeous, Ash! I did water slides with my niece last month and it was a blast! I second the recommendation.

At a real life support group meeting, we talked a little about how different doctor's groups offer such WIDELY VARIED advice on nutrition post surgery. Some programs have folks eating tiny amounts for extended times, no carbs, give strict weight loss goals, have no flexibility on diet choices, run to being extreme. Some are extremely lenient to the point of passivity. Don't worry about calories. Don't weight yourself, we won't weigh you. Just listen to your body. It's all good. Most are somewhere in between. So who's right? We had three dietitians at our meeting who had worked for different clinics...who had some interesting comments on this. The gist of their concern......was that some clinics push hard...not for the health of their clients....but because the faster they can make their fat clients skinny....the more business they'll attract. Yeah...seriously. How sick is that? You get put on a brutally demanding plan that might not be in your best interests....to be a walking bulletin board for your clinic. The consensus was that the vast majority of clinics are NOT like this...and do a good balanced job with nutrition....but that each of these women had encountered this situation in their careers (or had known someone who had)....where they felt pushed to advise people to push too hard for the sake of the clinic's image. Your clinic should listen to your concerns, offer flexibility, choice, and sound nutritional practices. I'm so damned glad I went to a clinic that serves an international clientele. Our nutritionists do a great job with supporting different global eating styles and have awesome educations, attend current conferences, etc. Beats the hell out of a "nutrition consultant" with a stack of printed rules for everyone...regardless of their gender, health issues, etc.

Maybe he's scared you'll see a message from his internet girlfriend or his weird porn. Who know?

Boogie, you mind your P's and Q's and do everything they tell you to. You don't want to screw around with pancreatitis. Thinking of you and hoping you're feeling better ASAP. What crappy luck!

My diet has 75 discretionary calories per day that I can use on whatever naughty thing I want. I can use them daily or bank them. If I were going on vacation, I'd bank them for a couple of weeks:) I'd try to stick to my 1200 calories a day, but wouldn't sweat it too much. Meh....ya gotta live. It's good for your metabolism to get a shake up sometimes. Back home...I'd get right back on the wagon.

Love it!

Ok....so that's breakfast. What about the rest of the day?

I never said it was. What I said....was that if you're eating 500 calories...and Jonesing like a maniac for junkfood....maybe you should try eating more healthy food and see if it takes the edge off. And I'm wondering why this isn't an option?

My Mayo Clinic Diet has the 75 calorie per day cheat built in. My doctor knows about it, and approves. I can use them daily, or I can bank them for a special occasion. If I know I'm going to dinner for my anniversary or whatever and know I'll want to be a little dumb...I'll save all my mad calories all week...and have plenty of wiggle room:)

Ash, I eat six times a day, generally. Your schedule is pretty close to what i follow. I rarely eat more than 200 calories in one sitting. Some days I'll bank for certain meals that might run heavier, and skip a snack or make other meals light.....but I know there are limits to what fits in the sleeve...and at about 250-300 calories, I'm Thanksgiving Day stuffed. Needless to say, I'm no longer a buffet candidate. LOL. But yeah...I spread it out to get my 1200 in. Have to.

Awesome chart, Ash!

SillyKitty, I want to ask a question, but I'm scared it's going to sound facetious...and I really don't mean it that way. I'm honestly trying to understand here, and I hope you get that I'm sincere. So here goes... You're eating 500 calories at day at about 5 months out....and you're not interested, for the most part, in eating the healthy options you keep at home beyond 500 calories......but find yourself struggling with cravings for unhealthy foods, take out, etc. Is this all correct? Now, here's my question...and please don't take this as a criticism or in any way a negative....I just want to try to get my head around where you're coming from... But...why don't you try to eat 1000 calories or so of healthy foods (even if you're not that interested)...and see if it doesn't help with the cravings for the naughty stuff? Wouldn't it make sense that having really good nutrition in ya would help ease the cravings? To me, that'd be the place to start. I totally get that I'm not you....but I'd like to understand why this isn't an option?

That's true, but for Johns Hopkins to bring this up...this assertively...gives me serious pause.

I had WEIRD insomnia right after surgery! Cleared up after a month or so:)