ChunkCat

When they do surgery often they tilt the table and it can put a lot of pressure on your lower spine/back. I've had multiple surgeries done and each time I have lower back pain for weeks because it pisses off the arthritis in my back when they tilt the table and I lay that way for hours. LOL I also got back pain as the weight started to come off at first. I don't know why it was worse then than now, but it was. I think it is because of the change in center of gravity, as noted above.
If you notice you are needing pain meds for it or it is worsening, definitely ping your doctor about it.
Oh and if you still have a uterus it could be cramping from that locale too. I used to feel that a LOT in my lower back before my hysterectomy.

Hi, welcome! I read the posts here a lot before my first post too and felt like I knew everyone even though they didn't know me! LOL It is a funny feeling...

My first thought is you aren't eating enough to be physically active. The body is pretty particular about how much energy it gets and after bariatric surgery our metabolism gets a nice reset (it is part of what helps us lose the weight) but to maintain that nice, new metabolism we need to EAT. And what is enough when you are mildly active isn't near enough when you are doing things that strain your heart, muscles, and burn a good bit of fuel. So I agree with the above, I'd eat more on days you work out. 65 grams of Protein isn't enough for working out, I'd add in at least a Protein Shake, a little healthy fat, and some complex carbs.
Second, it is normal to stall for a few weeks at any point, but it is especially normal if you start working out, or if you increase your workouts. This is because it changes the Fluid balance in our bodies and the body takes a bit to even out. Some people even see increases on their scale when they start adding in more workouts! So if that happens, don't panic. We can also stall when our food intake changes. This is commonly seen when you go from fluids to solid food, but it can also happen if you jump in calories at any point, even if it is a needed point. My stalls seem to last for 6 weeks at a time. It is super irritating.
At 4 months out you are not likely to be done losing weight yet. You may lose a little bit more. But weight loss slows WAY down the closer to goal we get and you are on the small end at this point so I wouldn't be surprised if it slows now. The most rapid weight loss is the first 3 months, then it tapers off slowly depending on how much you need to lose. Since you are used to being at the lower end of your BMI it is reasonable to expect you may drop a bit more to have the space you want if you rebound some. Just be careful not to starve yourself to get those extra lbs off, if it isn't sustainable for your body you'll really have to fight for it and it could damage that nice new metabolism in the process!
Oh, and weight redistributes after weight loss. So you may look a little thin now and it may balance out a bit in the next year. This happens especially around the face for some people.

You can do this!! You are a beast woman!! If you need any support after the hysterectomy feel free to message, I've lived that recovery. Honestly with all the other surgeries you've had, I hope this one will be par for the course and you'll be back on your feet in no time, feeling better than ever.
I highly recommend you get the disposable mesh postpartum underwear from Amazon, they are the only thing I could tolerate on my abdomen for weeks. Also, yoga blocks or something to prop your feet up a bit on when you go to the bathroom will make those bowel movements easier post op when you aren't supposed to bear down at all. I lived on prunes for 12 weeks because for me they work gentler than laxatives! But you are probably an old hand at the post surgery bowel game by now...
For me the hardest thing was to stay down and REST!! You wear out much faster than you'd expect for the first few months, and honestly it was pretty close to a year before I felt back to a normal normal. All the changes in the body are weird. Feeling my bowel drop into the space when I rolled over one night was VERY strange! LOL But I'm sure you know all this. I'll be sending you tons of good juju! You will be amazed and delighted at how light your pelvis feels once those fibroids are out of there! I am still amazed at how light my lower abdomen feels. I didn't realize how accustomed I had become to feeling that boggy heaviness in that area all the time...

A good way to remember the difference is to ask yourself "Is this processed? If so, how much?" For instance, white flour is a simple carb, it has had the Fiber and such stripped from it, which causes the carbohydrate in it to hit the system faster and spike blood sugar rapidly. Stone ground whole wheat flour is more of a complex carb, because it has the fiber intact along with all the nutrients that come with it and spikes the blood sugar less rapidly because of that fiber slowing the release. Eating it with Protein and fat will slow the spike of blood sugar even further.
Potato chips? Simple carb--they are white, starchy, and fried. A baked sweet potato? Technically a complex carb, though it does have a lot of sugar in it. Still, much better choice nutritionally than potato chips! Most fruits and vegetables are complex carbs, as their fiber and nutrients are intact. But some can be higher in sugar than others, so it is good to be mindful of their glycemic load as well. Whole grains like quinoa or brown rice and Beans are complex carbs, though due to their high carb content they are best eaten in moderation. Most white, starchy, processed things you buy in boxes or bags are simple carbs. Cakes, Cookies, white rice, sugar, semolina Pasta, ice cream, all simple carbs.
Most SADI and DS patients have issues with simple carbs causing gas, or large amounts of complex carbs. So, a big slice of cake may cause gas. A large fruit salad could also cause gas. Their sugar sources are different, but the digestive system sees sugar as sugar and reacts in kind. Apples in chicken salad? Probably fine once you are far enough out to digest fruit. A wedge of watermelon with a bunless hamburger? Also fine once you are far enough out to digest fruit. A few bites of cake or fruit salad? That may also be fine if you are able to practice restraint!
Personally, at 6 months out, I have never had any issues with onions like I used to. But I cannot eat beans in any form, not even pureed on the soft food diet, they immediately went through me and caused gas! I can eat small amounts of a cooked fruit, like blueberry muffins, or frozen blueberries microwaved and stirred into yogurt. But I cannot yet eat fresh/frozen fruit. The nutritionist suspects it is because berries are really fiber dense. This is likely to change in the next year. But that first 18 months is prime weight loss time and prime weight loss is boosted by being in ketosis, which means I have to keep my fruit portions small anyways for now. Once I'm at maintenance I'll worry about adding fruit and complex carbs in. Right now I focus on protein, then low starch veggies, then a bit of starch if I have room, like a bite or two of potatoes (I'm Irish, I can't cut them out forever), or a few bites of quinoa.

You can do this!! You are a beast woman!! If you need any support after the hysterectomy feel free to message, I've lived that recovery. Honestly with all the other surgeries you've had, I hope this one will be par for the course and you'll be back on your feet in no time, feeling better than ever.
I highly recommend you get the disposable mesh postpartum underwear from Amazon, they are the only thing I could tolerate on my abdomen for weeks. Also, yoga blocks or something to prop your feet up a bit on when you go to the bathroom will make those bowel movements easier post op when you aren't supposed to bear down at all. I lived on prunes for 12 weeks because for me they work gentler than laxatives! But you are probably an old hand at the post surgery bowel game by now...
For me the hardest thing was to stay down and REST!! You wear out much faster than you'd expect for the first few months, and honestly it was pretty close to a year before I felt back to a normal normal. All the changes in the body are weird. Feeling my bowel drop into the space when I rolled over one night was VERY strange! LOL But I'm sure you know all this. I'll be sending you tons of good juju! You will be amazed and delighted at how light your pelvis feels once those fibroids are out of there! I am still amazed at how light my lower abdomen feels. I didn't realize how accustomed I had become to feeling that boggy heaviness in that area all the time...

I like mine with roasted veggies too. It is pretty good as long as you rinse it well, cook it long enough, and flavor it well. My favorite way to eat quinoa actually is in these little canned tuna meals. https://www.amazon.com/Wild-Planet-Organic-Sweetcorn-Zucchini/dp/B0CHXRKKB2 Expensive, yes, but handy when I don't want to cook!
I have never tried a boil in bag quinoa but I think it is worth a go! I'd probably put some chicken stock paste in the Water to flavor it though...

Dandelion can help with excess Fluid. If I'm taking it in capsules, I usually take it in conjunction with milk thistle. Milk thistle is great for the liver and can help with excess fluid too. GAIA is a great brand that has a Milk Thistle blend I've taken before and liked, though I didn't take it for fluid issues. It may be worth talking with an herbalist to see what they'd advise. Sometimes herbs can be just as effective as prescription meds when given in the right ratios to the right person.
I also know compression socks can help with fluid too, I wear them every time I travel and for weeks after any surgery... They can be annoying to find in the right size but wow do they help my legs not swell up! These are my favorite brand for compression. https://www.amazon.com/gp/product/B0897RWF54/ Way more comfortable than the socks and since they are open foot I can wear them with dresses and sandals all year round!

I like it as a tea mixed with my coffee! I like chickory that way too. But yeah, dandelion is amazing. You could ask your surgeon. Far as I know it shouldn't be contraindicated after surgery once you are cleared for pills. It doesn't thin the blood or anything like that and it isn't a stomach irritant.

I haven't tried a boil in bag, but I incorporate quinoa regularly into what I eat these days. It is easy to prepare from scratch. I found this site that is a good introduction into cooking it:
https://www.epicurious.com/expert-advice/how-to-cook-quinoa-perfectly-article
Hope you enjoy it! I like it with roasted veggies on the side, or topped with melted cheese.

You might want to find another doctor. Not doing an ultrasound, not mentioning even the possibility of pcos, not entertaining the idea that cysts and/or fibroids could be the problem....not good.

I have pcos, and this is what I experience all the time. Before and after my surgery. An ultrasound should have been one of the first things they did. I would insist on it before they put you through more invasive testing.

Having my total hysterectomy on May 7th. They can't go in laparoscopically, so it'll be an abdominal hysterectomy. Taking out everything: uterus, ovaries, fallopian tubes, cervix. I have 3 VERY large uterine fibroids that have made my uterus (and stomach now) the size of someone who is 5 or 5 1/2 months pregnant. I may, in the next couple of years, get skin surgery but I'm still thinking about it. Let's see if I have any cardiac issues with this surgery (like I did with the hernia repair surgery) before I make anymore decisions about elective surgeries. I can't wait for this to be done and over with and I can finally just live my dang life!!!
From my initial sleeve surgery in May 2022 to the hysterotomy in May 2024, I will have had 10 surgeries in 2 years (thanks to all the complications from the sleeve surgery). The uterine fibroids were actually discovered while doing tests for the other issues caused by the sleeve, so it still counts as the reason for the surgery being caused by the sleeve lol Anyway, so happy to finally be at the last chapter of this book!!!

The gas is probably from the carbs. Especially simple carbs, though complex carbs can cause it too. DS/SADI patients have altered small intestines and those shorter lengths digest carbs differently than the full length did pre-op. Things with sugars in them, like carbs, can cause gas to build up as part of the digestion process.
In addition to this, some people are sensitive to FODMAPS. That can happen with or without surgery. Onions are a huge FODMAP trigger food! Your gut may be reacting to these foods. You can try an elimination diet to see if it helps.
But really, cut the carbs if you want peace. DS/SADI patients need about 90-120 grams of Protein (120 grams is ideal, or whatever it takes to keep your protein levels at 7 or above) about 100-150 grams of fat depending on the surgery, and ideally we keep carbs below 50 grams during active weight loss, some go below 30 grams. But even in maintenance, we need to watch the carbs if we want to avoid gas and other digestive issues.

This is totally normal---but freaks you out just the same because what if it stops, right!?! The first 3 months are normally fastest. But the closer you are to your goal weight, the slower it gets. Each surgery has a bit different loss rate, but if you stay the course, even as you slow down, you will get to goal. If you have hit 50% of your excess weight by 6 months you are doing really well according to most surgeons.
I definitely didn't lose 50% in the first 3 months, most people I see lose 50% by month 5 or 6. But it also depends on how much you have to lose and your individual body's pace. Some lose it really rapidly and are at goal by month 7 or 8. Some take 18 months to hit the same goal. My body is a slow poke and likes to have 6 week stalls! So I hit my 50% mark at close to 5 months but have been stalled for a month since and actually regained 6 lbs, lost it, and then just gained 15 lbs in Fluid from surgery again. My weight tracking app looks like an absolute mess. LOL
Working out can seem to cause stalls and slowing down too, because you are trading fat for muscle and muscle weighs more. Plus the act of working out changes the fluid balance and such in your body, so sometimes you appear to gain some weight when you start working out in earnest, but it'll balance out over time.

My dietitian explained the reason the diet progresses so slow is because there are a lot of sutures holding your stomach (and intenstines) together and you want those raw edges to heal together without the obstruction of bits of food getting in their way irritating them. You want nice, smoothly healed suture lines. I don't think you've done irreversible damage from going off plan, but I agree with the others, I'd examine why you felt you needed to go off plan, and I'd return to it. If you feel you've healed faster than others and should advance, call your team and talk to them about it. They might let you advance sooner, or they might tell you to stay the course.
This surgery and the aftermath take a lot of willpower. We can choose to stay with the guidelines we've been given from our team, or we can do our own thing, but there will be consequences for each choice. If you bend the rules for earlier food progression, will you bend the rules when it comes to what you should eat as you begin to lose weight? Will you go off course throughout your weight loss phase because you don't feel like adhering to it? We all have those moments, it is understandable, we are human. But we have to be willing to confront ourselves when we do have those moments and look deeper into what is going on there that caused us to make those choices. Because one choice is one choice, but one choice made repeatedly is a pattern, and a pattern can either heal or hinder us.

I find the calculator on the Mexico site to be rather inaccurate for me, but everyone varies. Age and surgery type, as well as co-morbidities all impact weight loss rate. It thinks I should be at 212lbs at 6 months but I'm at 240 with 6 days to go. Not gonna happen. It also thinks I should be at 170 by 12 months, but that's not very likely either.

I've always used the following one as it takes into account the different surgeries and looks just like the one my surgeon uses. They calculate from the highest weight, it is important to include that because if you have a lot of weight loss before surgery your percentages may track differently and your post op weight loss may be slower. I've seen this happen to several people with surgeons calculating it improperly, or applying the bypass trajectory to a DS patient, which is a disaster and very stressful for the patient! This one takes into account much more like your age, ethnicity, and pre-existing conditions:
https://riskcalculator.facs.org/bariatric/?_ga=2.112690692.1282950073.1698781773-393992475.1698781773
According to this one I should be at 78 lbs down for my DS surgery at 6 months. I'm at 80 lbs down. My weight loss has tracked along with this thing pretty steadily, give or take 15 lbs, since surgery, except for my 6 week stall. It puts me at 202 by 12 months out, but DS patients lose for 18-24 months post op, so I should be at 170 sometime in that 12-24 month period!
In the end these are all just estimation tools. Our bodies do what they will and we make the most of it. Still, it is nice to have a loose guideline to follow.

I have yet to see a nutritionist or dietician that truly understands the optimal diet for a SADI or DS patient. Most of the time we just get a modified version of what they give Bypass and Sleeve patients. But as you say, you aren't absorbing as much as they are, therefore to give you their requirements would leave you malnourished.
15 grams of fat is absurd by all medical standards. Most medical studies show we need 60 grams of fat for proper hormone function and even if you ate 60 grams of fat, with an altered digestive tract, you aren't absorbing that much, so you need to eat a little more than that. Even the ASMBS recommends 60 grams of fat by 1 year out!! Your dietician is not following best practices.
Most SADI/DS patients I know follow the vets that have been living with this surgery for 10+ years and maintaining their weight loss. We figure they know more about optimal diet than a surgeon who has never lived with this surgery, or a dietician that has never even researched best diet for bariatric patients of various surgeries. Most patients I know are eating 100-120 grams of protein, less than 50 grams of carbs, and over 60 grams of fat, usually around 100 grams of fat for SADI and 150 grams for DS. You can increase your carbs once you have reached your goal weight, they tend to slow/stop weight loss, so in active weight loss it is important to keep them low so you stay in ketosis.
A calorie range makes dieticians feel better, but it makes no sense for a SADI or DS patient because we malabsorb so much fat we can't even begin to properly calculate our calories. You could eat 1200 calories, but that wouldn't be what your body is absorbing.
I'm sorry this is so complicated. In the end you have to decide what you feel best at. I don't feel good following guidelines like your dietician gave you and when I go over 50 grams of carbs I stop losing weight. So...yeah. I'm going to follow what allows my brain and hormones to function, what makes my skin, hair, and eyes feel best, what gives me the most energy, and what allows me to lose weight steadily. I'm the one that has to live in this body. It is sad these surgeries are so uncommon there are no good studies about optimal nutrition for them. But there is no way I'd go below ASMBS guidelines, they are the closest thing bariatric surgeons have to a standardizing body. Your dietician should be able to give you ASMBS guidelines for your surgery.

One of the biggest adjustments I had to make post op was to eat because I needed to, not because I was hungry. I actually never lost my hunger post op, but in those first few weeks when all you can consume is liquid, it is a struggle to get everything in. As soon as I moved to purees I started eating something every 3 hours when I was awake. Everyone's interval is different. Some can do just 3 times a day, but for me if I got over the 3 hour mark I'd start to get shaky and irritable and completely crash, it was clear I needed food, even if food was just a shake or a Protein yogurt. I'm 6 months post op now and this has eased and I can go a little longer, so I follow my hunger cues more now and mostly eat at normal mealtimes with Snacks if I'm up late or up early. But in the early months I just couldn't do that.

You being able to drink more fluids is not due to your tummy being bigger. You probably are not having as much internal swelling as someone else does. Also, some never lose their ability to gulp a good bit of Water, and you don't list your surgery, some bypass patients also have this happen.
Fluids exit our stomach really quickly, some faster than others. The restriction with fluids early on is because of the internal swelling and how long it takes to get to the stomach through that swollen area. I had a LOT of swelling. Water went down at a trickle. I could literally hear it displace air in my stomach when it finally got there, like a little drain finally clearing. It was hilarious and so strange feeling. For me it took 3 weeks for this weirdness to stop.
I can take a good 3-4 full swallows most days now before I get pressure from my tummy to slow down. I tell you all this because I know for a fact I have a larger sleeved stomach than most, my surgeon made it that way due to reflux. I've seen it empty fluids on imaging, it is fast as lightning! LOL
Your tummy will not lead to bad food choices, even if it were bigger. But your mind will! Trust me, once you add solid Proteins in, you will probably feel your restriction to some degree. Many never feel restriction with purees and fluids.

You being able to drink more fluids is not due to your tummy being bigger. You probably are not having as much internal swelling as someone else does. Also, some never lose their ability to gulp a good bit of Water, and you don't list your surgery, some bypass patients also have this happen.
Fluids exit our stomach really quickly, some faster than others. The restriction with fluids early on is because of the internal swelling and how long it takes to get to the stomach through that swollen area. I had a LOT of swelling. Water went down at a trickle. I could literally hear it displace air in my stomach when it finally got there, like a little drain finally clearing. It was hilarious and so strange feeling. For me it took 3 weeks for this weirdness to stop.
I can take a good 3-4 full swallows most days now before I get pressure from my tummy to slow down. I tell you all this because I know for a fact I have a larger sleeved stomach than most, my surgeon made it that way due to reflux. I've seen it empty fluids on imaging, it is fast as lightning! LOL
Your tummy will not lead to bad food choices, even if it were bigger. But your mind will! Trust me, once you add solid Proteins in, you will probably feel your restriction to some degree. Many never feel restriction with purees and fluids.

You being able to drink more fluids is not due to your tummy being bigger. You probably are not having as much internal swelling as someone else does. Also, some never lose their ability to gulp a good bit of Water, and you don't list your surgery, some bypass patients also have this happen.
Fluids exit our stomach really quickly, some faster than others. The restriction with fluids early on is because of the internal swelling and how long it takes to get to the stomach through that swollen area. I had a LOT of swelling. Water went down at a trickle. I could literally hear it displace air in my stomach when it finally got there, like a little drain finally clearing. It was hilarious and so strange feeling. For me it took 3 weeks for this weirdness to stop.
I can take a good 3-4 full swallows most days now before I get pressure from my tummy to slow down. I tell you all this because I know for a fact I have a larger sleeved stomach than most, my surgeon made it that way due to reflux. I've seen it empty fluids on imaging, it is fast as lightning! LOL
Your tummy will not lead to bad food choices, even if it were bigger. But your mind will! Trust me, once you add solid Proteins in, you will probably feel your restriction to some degree. Many never feel restriction with purees and fluids.

I find the calculator on the Mexico site to be rather inaccurate for me, but everyone varies. Age and surgery type, as well as co-morbidities all impact weight loss rate. It thinks I should be at 212lbs at 6 months but I'm at 240 with 6 days to go. Not gonna happen. It also thinks I should be at 170 by 12 months, but that's not very likely either.

I've always used the following one as it takes into account the different surgeries and looks just like the one my surgeon uses. They calculate from the highest weight, it is important to include that because if you have a lot of weight loss before surgery your percentages may track differently and your post op weight loss may be slower. I've seen this happen to several people with surgeons calculating it improperly, or applying the bypass trajectory to a DS patient, which is a disaster and very stressful for the patient! This one takes into account much more like your age, ethnicity, and pre-existing conditions:
https://riskcalculator.facs.org/bariatric/?_ga=2.112690692.1282950073.1698781773-393992475.1698781773
According to this one I should be at 78 lbs down for my DS surgery at 6 months. I'm at 80 lbs down. My weight loss has tracked along with this thing pretty steadily, give or take 15 lbs, since surgery, except for my 6 week stall. It puts me at 202 by 12 months out, but DS patients lose for 18-24 months post op, so I should be at 170 sometime in that 12-24 month period!
In the end these are all just estimation tools. Our bodies do what they will and we make the most of it. Still, it is nice to have a loose guideline to follow.

This is totally normal---but freaks you out just the same because what if it stops, right!?! The first 3 months are normally fastest. But the closer you are to your goal weight, the slower it gets. Each surgery has a bit different loss rate, but if you stay the course, even as you slow down, you will get to goal. If you have hit 50% of your excess weight by 6 months you are doing really well according to most surgeons.
I definitely didn't lose 50% in the first 3 months, most people I see lose 50% by month 5 or 6. But it also depends on how much you have to lose and your individual body's pace. Some lose it really rapidly and are at goal by month 7 or 8. Some take 18 months to hit the same goal. My body is a slow poke and likes to have 6 week stalls! So I hit my 50% mark at close to 5 months but have been stalled for a month since and actually regained 6 lbs, lost it, and then just gained 15 lbs in Fluid from surgery again. My weight tracking app looks like an absolute mess. LOL
Working out can seem to cause stalls and slowing down too, because you are trading fat for muscle and muscle weighs more. Plus the act of working out changes the fluid balance and such in your body, so sometimes you appear to gain some weight when you start working out in earnest, but it'll balance out over time.

You being able to drink more fluids is not due to your tummy being bigger. You probably are not having as much internal swelling as someone else does. Also, some never lose their ability to gulp a good bit of Water, and you don't list your surgery, some bypass patients also have this happen.
Fluids exit our stomach really quickly, some faster than others. The restriction with fluids early on is because of the internal swelling and how long it takes to get to the stomach through that swollen area. I had a LOT of swelling. Water went down at a trickle. I could literally hear it displace air in my stomach when it finally got there, like a little drain finally clearing. It was hilarious and so strange feeling. For me it took 3 weeks for this weirdness to stop.
I can take a good 3-4 full swallows most days now before I get pressure from my tummy to slow down. I tell you all this because I know for a fact I have a larger sleeved stomach than most, my surgeon made it that way due to reflux. I've seen it empty fluids on imaging, it is fast as lightning! LOL
Your tummy will not lead to bad food choices, even if it were bigger. But your mind will! Trust me, once you add solid Proteins in, you will probably feel your restriction to some degree. Many never feel restriction with purees and fluids.

One of the biggest adjustments I had to make post op was to eat because I needed to, not because I was hungry. I actually never lost my hunger post op, but in those first few weeks when all you can consume is liquid, it is a struggle to get everything in. As soon as I moved to purees I started eating something every 3 hours when I was awake. Everyone's interval is different. Some can do just 3 times a day, but for me if I got over the 3 hour mark I'd start to get shaky and irritable and completely crash, it was clear I needed food, even if food was just a shake or a Protein yogurt. I'm 6 months post op now and this has eased and I can go a little longer, so I follow my hunger cues more now and mostly eat at normal mealtimes with Snacks if I'm up late or up early. But in the early months I just couldn't do that.