SpartanMaker

I had been thinking the same. Mostly I'm just doing my thing, trying to figure out how to live with all the changes I'm experiencing. My challenges lately: I'm still not regular, with my guts bouncing between one extreme and another. I'd really like to find the right balance, but haven't found it quite yet. I'm struggling with water more now that I have to not drink 30 mins before and after a meal. If I take ~30 minutes to eat, than means I'm not drinking for and hour and a half per meal, or roughly 4.5 hours out of the day with 3 meals a day. Add in a snack to hit my protein goals (which I often have to do), and we're at 6 hours sans liquids. Some days I do okay, but I find once I get behind, it's almost impossible to catch back up. I'm still struggling to slow down my eating and chew better. I knew this would be a problem for me and it is. Thankfully it's not been too big an issue as my pouch seems to be surviving me not doing this quite as well as I'm supposed to. I'm trying to understand what both being hungry and being satisfied feels like with limited success. About all I can tell at this point is no pain and some pain. Some foods seem "different" than before. Because I'm never really actually hungry, I sometimes either don't eat at all, or don't eat very much, just because I don't like what I'm eating. I have the alternate issue sometimes as well. When I actually find I enjoy something, I find I can eat more than i thought and more than my team says I should be able to. (See previous bullets about trying to understand fullness). I'm not concerned, but on occasion I have found myself pushing the limits of this capability and paying the price afterward. Enough for now. What about everyone else? What's working or not for you right now?

20 pounds seems excessive, especially considering where you started. I lost 16 pounds the first month and was quite thrilled with that! I'm also a guy and starting from a lot heavier weight than you. I think the only people losing 20+ pounds in a month are a lot heavier.

There's actually a whole host of things they look at, but I think it can be summed up by saying they are evaluating if you are ready for bariatric surgery. They look to see if you have a history or tendency toward addictive behavior, if you are a suicide risk, if they think you will be able to be compliant with your program, if you actually mentally understand what's being proposed and why, if you have any other mental disorders that might cause issues, etc.

Can you please provide references for this? Everything I've seen or read in the scientific literature suggests that RMR testing by direct calorimetry is considered the gold standard for determining calories burned. Indirect calorimetry may be slightly less accurate, but is still far and away better than anything else available to us. Where things get "fuzzy", is that we are not always at rest, so just knowing your RMR is not enough. This is where activity level estimates or heart-rate based calorie estimators like fitbits try to make up the difference. These will obviously be less accurate, but are certainly better than a wild guess or deciding based on something much less accurate like height and weight charts.

Exactly this. There are unfortunately no standards at all when it comes to pre and post bariatric surgery diets. I found this incredibly frustrating early on as it makes it seem like it's not science, but guess work. On reflection, I suspect it has more to do with how long a particular program has been doing bariatric surgery and the experiences of their patients over that time. Most teams probably only update their plans rarely. Some may still be clinging to recommendations that were more common a long time ago. Also, some doctors are just more conservative than others. Anyway, whatever the reason, every bariatric program is free to design their own plans. Some are very strict, and some not so much. When I asked my team about this, I was specifically told to ignore what other programs were doing. They designed their plan around the outcomes that work for them. In terms of conflicting advice between your written plan and what you were told, I agree it's best to ask. I had this happen a few times, but I always asked about it and was given a reason why they wanted me to deviate. For example, at my 2 week post-op visit, I was told I could progress faster than the written plan. This was specifically done for me because I was healing well and had no nausea.

None here at all, including spicy heat. My wife and I really love flavorful dishes, so we cook a lot of Indian, Chinese, Japanese, Taiwanese, Vietnamese, Mexican, Peruvian, etc. dishes and I've had no issues with anything so far.

Sounds like a plan. I would also definitely recommend strength training. It does not have to be anything fancy, even a solid bodyweight only routine would help. You can google something like "bodyweight exercises for beginners" and use that to get started. Note that it's not unusual for beginners to see both extra water retention and even muscle growth when starting strength training, so don't be surprised if you see a jump up on the scale. This type of exercise will not only burn calories, but will also boost your overall metabolic rate, meaning you'll burn more calories, even at rest.

An endocrinologist works with pretty much any issue related to the endocrine system, meaning your thyroid, pituitary gland, hypothalamus, adrenal gland, etc. Basically most anything hormone related is something they can help treat. You can always ask you PCP for a referral, but depending on your doc and your insurance, they may be loathe to do so if you don't have anything showing up on your blood tests. If you're insurance does not require a referral to see a specialist, the you can always just make an appointment. There definitely are some hormone imbalances that can slow your metabolism such that your maintenance calories will be pretty low. Alternately, it may not be a hormone imbalance at all. It may just be what's normal for you. One additional thing for you to consider is that exercise, especially strength training, would allow you to eat more without gaining. What's your exercise routine look like right now?

I have something sort of similar going on, but maybe a little different? I can't walk a straight line to save my life! If I ever get pulled over and am asked to do a drunk test, I'd fail miserably, even though I'm stone cold sober. I'm thinking it has something to do with my center of gravity changing and my body not being able to adjust fast enough? Maybe that, combined with just being a bit light headed all the time from a drop in blood pressure? Whatever it is, I'd like to get over it soon!

Are you talking about a metallic taste? I don't have this problem, but I understand it can happen to some people. I'm not saying this is the cause, but it might be an indication that you actually are suffering from hypercalcemia, which means you have an excess of calcium in your blood. It might be worth talking to your medical team and having some test run to rule out medical issues? If it's not a metallic taste, then all bets are off, but I still think it would be worth a discussion with your doctor and maybe some blood test, just to rule out anything.

The only real way to know this would be to have your Basal or Resting Metabolic Rate analyzed. While BMR and RMR are technically slightly different, they are often used interchangeably. The tests to determine this are readily available in clinics and even some gyms. You should be able to find some options by googling something like "metabolic testing near me". Note that there are a few different types of tests used (feel free to research them), and some are a bit more accurate than others, but they are generally pretty close. Alternately, there are online calculators that you can use, and even some digital scales (those that use BIA), that can also provide either your BMR or RMR. Unfortunately, neither the scales or calculators are all that accurate. It's not uncommon for those to be off by 10 or even 20%. Obviously more than enough to have you potentially eating too much.

My team actually had me hold off on the ursodiol until the 2 week follow-up. They didn't explain why, but I suspect it's just because that's a pretty large capsule.

I hear ya. I think for some people, they have them open up the capsule and add it to yogurt or something. I didn't have to do that, so didn't worry about it.

Capsules were recommended by my team right out of the gate, so that's where I started and never had a problem. I also agree that the chewables are just plain bad.

It's hard to know ahead of time how you may feel 3-4 weeks post-op. Some people are fine or even have more energy than before, and some can get tired pretty quick due to the low caloric intake. You may just have to bow out of some activities based on your energy levels. I'd honestly be more worried about lots of eating out (if that's what your family does during this time), and your ability to follow your program.

Sorry for the novel folks, but maybe before getting to tips and tricks, let's talk a bit about what causes plateaus: First, the most common reason for any stall, including the dreaded 3-week stall is simply that you are retaining more water. There are a few reasons this happens, but around the 3-week mark it comes down to the fact that your body is adjusting to a low carb intake after converting from glycogen to ketones for energy. More water is needed to burn glycogen, so you were retaining more water pre-surgery than you are now that you're using primarily ketones for energy. At about the 3-week mark, your body eventually recognizes that the water loss is long term, so other mechanisms have started kicking in to start holding on to more water. This water loss due to the change between glycogen and ketones is the primary reason for "keto flu", and something that increases your risk of dehydration early after surgery. The other "reasons" for plateaus really don't apply as much at the 3 week mark, but will become more important later in the process. Let's cover those too though so you're prepared: As you lose more weight, your overall metabolic rate will slow down. People sometimes think fat is not metabolically active, but that's not true. Less fat means your metabolism slows down, even if you retain the same amount of muscle. As you lose weight, it takes less effort to move, so the amount of calories you burn from activity also drops quite a bit. As you progress, you'll be able to eat more and especially if you're not tracking intake closely by weighing and measuring your food, you can easily be eating a lot more than you think. This one may be TMI for some, but you may simply be retaining more stool. This is going to be hard for some people to hear, but I can tell you one thing it's not, and that's hormones. Yes, various hormonal processes negatively impact weight loss in a myriad of ways, but they don't overcome basic physics: if you eat less than you are burning, you'll lose weight. What these hormones can do if they're out of whack, is not good things like slowing your metabolism, increasing your hunger, screwing with water weight, or even fooling you into thinking you're eating less than you are. So, with all that sciency stuff out of the way, what do we actually do if we're in a stall? Well, I think it depends on when it happens and how long it lasts: If it's early (a.k.a. the 3-week stall), just keep doing what you're doing and you should be fine. I know people don't like that advice, but as I said, it's just water, so don't worry about it. Later on, especially if the stall is lasting longer than 2-3 weeks. that's when I think it's important that you look closely at what you are actually burning, as well as really tracking what you are eating. If you don't know your BMR (Basal Metabolic Rate), you should. The closer you are to goal, the harder it is to get the balance right between intake and output to make sure you're not eating too much, so fixing this starts with knowing your BMR and accurate food logging. There's a lot of anecdotal advice thrown around about "ways to break a stall", but there seems to be little scientific evidence for any of it. Most of it certainly won't hurt to try, e.g. breaking up your routine in terms of diet or exercise, but just understand that this change may or may not have had any impact. If it makes you feel better to be proactive, go for it. Longer term, there is one piece of solid advice that's backed up by lots of research: Even if you don't really like working out, do it anyway. Those WLS patients that make a regular habit of exercising for 45 minutes to an hour most days a week are significantly more likely to reach their goal and maintain the weight loss. (One caveat here: significantly changing your exercise routine can make you retain water and possibly even add muscle, so don't freak out if you see a stall or even a gain.) I'll take that exercise advice one step further and say you really should be doing some form of strength training. This is also backed up by lots of studies, but the great thing about strength training is that it makes your burn more calories even at rest (in other words, it increases your metabolic rate). There are lots of other benefits, but the metabolic benefit is the most germaine to the stall question. Those that do strength training are less likely to stall during weight loss.

I suspect this is one of the reasons many doctors (like mine), recommend a lower carb diet, at least initially after WLS. I personally have a love/hate relationship with low carb dieting. I lost a great deal of weight doing low carb ~20 years ago, but ended up gaining it all back and then some, because I found it unsustainable long-term. As a result, I'm intending to take more of a "smart-carb" approach this time. The reality is, not all carbs are the same. My plan is to limit my intake of simple carbs, especially processed foods as much as possible, while adding in complex carbs via whole foods as tolerated.

My surgeon and I agreed that at 6 months post-op, it would be a good time for me to get retested. Your results may vary, because where I started, the rate I'm losing at and the amount of weight I lost pre-op are all different than you. I suspect I'll be at most, within 20 pounds of my initial goal weight at the 6 month mark and very likely less than that.

Maybe I'm hungry or something, but I keep reading the title of this thread as FOOD shrinkage, and I think, duh, what did you think would happen when your stomach shrunk! That's all. You can all go back to talking about feet now.

I had another anecdote to share: My wife is also overweight, but she's decided WLS is not for her. That said, she's been doing a fantastic job of losing on her own. She told me yesterday that apparently the rumor going around her work is that SHE had weight loss surgery. She even had people ask her if she had surgery and some people didn't believe her when she told them no. According to her, these almost universally seem to be other overweight/obese people? It's as if they are saying that she must have some magic secret for all her weight loss and we all know that weight loss surgery is magic so that must be it...

We kind of played it by ear. My doctor suggested I ask for 6 weeks up front because that should be about the max I might want, even if we had major complications like having to do the surgery as an open procedure instead of laparoscopically. I went into things actually expecting to only need roughly 2 weeks. At my 2 week follow-up, the PA and I agreed that I'd do another 2 weeks part time just to make sure I didn't overdo things and end up hurting my recovery. One of my biggest challenges with going back to work has been getting my fluids in. I sometimes forget to drink while I'm mentally focused on a task or in meetings. Pre-op, I could just gulp some water whenever and be fine, but that no longer works! I think a lot of people can successfully go back to work sooner than i did, but I like that I had the freedom to choose what was right for me. I wasn't rushed to go back because I was worried about burning through my PTO hours, or because I'd only asked for a certain amount of time off. Here's the thing. I had virtually no pain or nausea, so those weren't even considerations. The challenge for me was (and still is), that eating so little leaves me fairly fatigued and mentally drained. Even though I work from home, it was better for me to take a little more time to make sure I was ready to actually do what I'm paid to do. That said, I'm also 58. If I was younger, I probably could have started back sooner. I know some people do successfully go back to work sooner than I did and understand some don't have the luxury to decide for themselves. In the end we all have to do what's right for us based on our own set of circumstances. TL;DR: if you have the benefit, I'd definitely use it. You should be able to work with your bariatric team to decide when going back to work is right for you. (Which sounds a lot like a commercial for disability insurance, though I promise I don't work for an insurance company!)

I didn't really have a choice. Per my companies policy, if I'm going to be out more than 3 works days due to a medical issue, I'm required to file for short term disability. Could I have tried to do it under the table? I suppose, but what if something went wrong and I wasn't able to return as scheduled? Process wise, it depends on your company and their provider, but most likely you'll start the process by contacting your HR department or the insurance carrier, or both. They then request paperwork from the surgeon and make a case decision at that point. To be released back to work, the insurance carrier also typically needs the doctor to sign-off, so there will be a little more paperwork post surgery for you and the doctor. For me personally, the thing that I have always hated about using short term disability is that 30% of my compensation is a bonus plan. The short term disability pays my salary at 100%, but my company does not use the disability pay when calculating my bonus, thus i lose a little bit of money overall. Aside from that, you pay for the insurance so you might as well use it, right?

Congrats on your success and thanks for sharing! Though I never played any sports at your level, I was very active when younger until sidelined by a serious injury. Continuing to eat like I needed to when i was burning through 5-6k calories a day had a pretty detrimental impact on my health. Glad you finally found something that worked for you!

Same here. Didn't bother and didn't need to, but for some folks it may be useful.

I got a bunch of the 1oz cups from the hospital, but stopped using them after the first few days. What I did use a little longer was Dixie cups like you use in the bathroom. These are cheap for a huge amount and supposedly hold 3 oz filled to the top. I just learned where the 2oz line was and filled things to there.