NickelChip

The reason for erratic weigh-ins (and the infamous three-week stall) is that in the early stages of running a sustained calorie deficit, your body does not burn much fat. Your body worked hard to store fat and considers it a precious commodity that it does not want to part with for no reason. For extra energy to make up for a lack of calories in the short term, your body first burns glycogen. 1 gram of glycogen is bound with 3 grams of water, so as you burn it for fuel, you also flush out this water weight. Only when the glycogen reserve is used up does your body turn to burning fat. The first few weeks after surgery, you were probably lucky to get in 600 calories per day. Your body was burning glycogen like crazy. When the numbers first dropped on the scale, that was almost entirely water weight. Now that you're a couple weeks out, you're allowed to have some pureed food, and you can probably get closer to your protein goals with your shakes. With a few extra calories coming in (still nowhere close to what you need every day to power your bodily functions), your body is at least reassured you are not in imminent danger of starvation. It's taking a look at your empty glycogen reserves with horror and doing its best to fill them back up with the calories you are giving it, like a squirrel storing up acorns for winter. For every gram of glycogen your body puts into the storage cupboard, you've got 3 grams of water tagging along for the ride. Meanwhile, you can rest assured that your body is also burning fat to keep your engines running. However, when you step on the scale, it can't really tell you that you've burned 4 pounds of fat and also stored 7 pounds of glycogen and water. It's just going to tell you that you've gained 3 pounds. But you've done nothing wrong. This is your body doing what evolution programmed it to do since humans lived in caves and constantly had to battle short-term food shortages. Once you've restocked that glycogen, you'll start being able to see the fat loss on the scale again, and in your measurements. As long as you keep doing what you're supposed to do, your weight will move in the right direction. But not as a straight line. Weight loss looks a lot more like a staircase with drops and plateaus, and a lot of small fluctuations that have nothing to do with fat. Try not to let it drive you crazy!

The instructions I was given were 48 hours of pre-op liquid, with total fasting beginning the evening before surgery. The longer liquid diet is to promote rapid weight-loss and shrink your liver, but some surgeons don't find this necessary, or only apply it to patients over a certain BMI. The 24-48 hours of liquid-only and/or fasting prior to surgery is just to clear your digestive tract prior to operating. Also, some surgeons don't require a puree stage and go from foods like yogurt and ricotta directly to moist proteins and fully cooked veg that you are instructed to chew for 30 seconds to a minute before swallowing (essentially pureeing them with your teeth).

I would be very hesitant to get the sleeve, to be honest, in your case. If at all possible, I suggest shopping around for a different surgeon, one who feels confident performing the surgery that you want. In the long run, it would be worth a delay to avoid a nightmare.

I mean, I guess fear of prison is ultimately what keeps me from actually slapping stupid people... but the way the world is going, something's bound to make me break eventually. Honestly, why is it so hard for people to just be supportive and kind to other people?

The biggest thing that has helped me with being better (not perfect!) about foods was getting all of the temptations out of my house. I went through every cupboard. When crackers or chips were gone, I did not buy more. I've also started ordering my groceries for curbside pickup. I hadn't realized what a huge help this was until this morning when I had to run in for a few things last minute. It was all I could do to walk past the bakery without buying a loaf of fresh sourdough or to keep myself from throwing a bag of Christmas candy into the cart. Shopping online from a carefully curated list is so much less dangerous! At least for me, removing the opportunity to easily access snacks makes a big difference.

I'm not sure how many months out from surgery you are, but it sounds like the goal you set and the weight your body wants to be right now are at odds. Are you dangerously underweight at this point, or experiencing other serious negative side effects from losing weight? If not, I would suggest riding it out. Continue to eat nutrient dense foods in reasonable portions to the point of feeling satisfied from them, get a healthy amount of exercise, and ignore the numbers on the scale or the reflection in the mirror for a while until your body has a chance to figure itself out on its own time. I think most of the time, it sorts itself out. When my brother had his VSG 15 years ago, he had a period of several months, maybe 12-18 months after his surgery, where he was very skinny, to the point of him being a little concerned (and self-conscious about it since he was used to being a big guy). And then it all kind of fell into place without him having to do anything drastic.

Do your research, make the decision that is right for you, and tell them they can either support you or not, but that your medical decisions are yours alone to make in consultation with your doctor. End of discussion. I suggest you speak about it in declarative sentences. Don't say, "I'm thinking about having surgery, so what are your thoughts about that?" Instead, say, "I will be having surgery in x number of months, and if you have questions or concerns about this, I am happy to have you talk with my doctor about why this is the right choice for me and how you can support me on this journey." You are the only person who lives in your body. That makes you the only person who gets to decide how best to take care of it. Your mother and partner are basing their opinions on incorrect information, emotions, and horror stories. You can try to give them the correct information, but don't let their fears sway you. As was mentioned above, it is probably more about the fear of change than anything else.

I've personally been on both Saxenda and Wegovy. With Saxenda, I lost 20 pounds and my blood sugar and cholesterol improved, but high blood pressure was unchanged. I stopped because the insurance price went from $50 a month to over $200, and my weight loss plateaued so $2400 a year to keep off 20 lbs seemed a bit steep. As soon as I stopped, the weight came back, the A1Cs went up, and the cholesterol went higher than before I started. With Wegovy, I was only ever able to get the first two months of doses before shortages made it impossible. After that, I switched insurance and lost coverage of Wegovy completely, meaning over $1k per month out of pocket if I wanted to continue. I wasn't on it long enough to see how my labs would have been. From everything I've seen, surgery is the only durable option. In my case, the copay is less than a single month of Wegovy, with the possibility of it lasting a lifetime, and the ability to add the GLP-1 drugs down the road if needed. Only you can decide what is right for you, but I think for most people who are at the point of qualifying for surgery, the drugs alone will not be enough, and if you lose access to them, you will most likely go back to square one with weight. Or in my case, square one plus 10 pounds.

Love this new podcast! Dr. Weiner is one of my favorite sources of information.

Even with all the bandages you look tiny! I hope your recovery goes well. It sounds like you're getting great care.

The most likely way I can think to lose 8 lbs in 18 days would be to stick with a very low calorie diet of protein shakes and steamed or raw vegetables from now until after your appointment. Not the easiest thing to do with the holidays, and not a very healthy way of eating, though.

Oh for heaven's sake... It's like you keep buying the winning ticket in the medical maladies lottery. I really hope you're back to feeling better soon, and that this is the last time you have a scare like this!

I got to the photo with the little monkeys and burst out laughing. That made my day! Your weight loss is stunning and such a remarkable achievement. You look great, but I know you must be so eager to be rid of the excess skin. This surgery is going to be so amazing for you, and you absolutely deserve it. I hope the recovery goes really well and as pain-free as possible. It sounds like you're pretty much getting everything lifted and tucked as you possibly can! Would you mind sharing a ballpark figure of what that costs by going to Tijuana to have it done? All I know about costs in the US is it makes my eyes water thinking about it. Good luck to you!

I'm so happy to report that I have an appointment January 2 with the director of the new practice. When I spoke with the administrative person to make the appointment, she did make it sound likely that I would not have a lot of extra stuff to do since I was right at the end of the process before it got cancelled, just needing the routine pre-surgery tests and my insurance approval. I'm so sorry your insurance is being a pain about your in-network coverage. The whole in or out of network coverage is total BS. If they're a licensed doctor, they should be covered. Period. I have to say, the relief I felt when the HR person sent over the insurance benefit packet and I saw the logo of a very widely accepted insurance that is known to have good coverage is almost impossible to describe. This is sort of a long-term consulting gig for my husband, and I had nightmares that the consulting firm would be using crappy companies I'd never heard of to save some cash. Financially, I may end up coming out of this a little bit ahead, maybe $1500 less out of pocket. But I swear I'll spend that on hair dye to cover all the gray hair this ordeal is giving me! And I'm self-employed, so I can't just request a few weeks of vacation when the time comes. I'll need to do some major reworking of my schedule to accommodate the new date. As you said, is the head of the old hospital losing sleep over this? No, he is not. But it will work out, and this time next year I will be looking back on it and laughing. In that awkward way you laugh over things that are so not funny.

Oh no! I hope they get to the bottom of this and you're on your way back to surgery soon. I know how frustrating it is to get your hopes up and have it not happen. My surgery was supposed to be the 27th but it was abruptly cancelled last week because the surgery program at the hospital is closing down. I just got a new patient appointment at an affiliated program at a different hospital but not until Jan 2, so I know it will be at least mid-Jan or later for me now (probably later, realistically). Don't lose hope! It's hard not to be frustrated and angry, but try to stay positive!

Hoping it's all gone well and you're recovering quickly!

The hospital administration continues to prove they have handled this in the worst possible way. I went to see my endocrinologist at the weight management center on Monday. She was fighting back tears as she explained the way news of the closure was handed down, along with a timeline to wrap up the practice by early February that frankly puts profits before patient well-being at every turn. I have left 2 messages and filled out a contact form with the new center but have yet to hear back from anyone. There has been no official letter from the hospital to explain their decision to disrupt my treatment only 3 weeks before surgery, no apology for having to learn of this through an automated cancelation notice, no indication they care at all about what this is doing to any of us who have been caught in this mess. Still not sleeping well, experiencing high anxiety, and very worried about how I will have to rearrange my work schedule to accommodate a new surgery date, but of course having no clue when that will happen makes planning impossible. On the bright side, I have confirmed my new insurance coverage that starts Jan 2, 2024 does cover bariatric surgery and the out of pocket for me will be comparable to my current plan, so I'm no longer worrying about that, at least. For now, all I can do is focus on healthy eating and exercise. My doctor offered to restart me on weight loss medication in the meantime, but I just think it's one more thing to have to juggle and I'd rather not complicate my life more than needed.

You might try some of the walking videos on YouTube. They're only 15-20 minutes and you can do them in your living room. I also find wearing my Fitbit can be a motivation because it's a visual reminder of my goal. If you aren't doing any exercising right now, don't plan to suddenly do an hour a day at the gym. Add one thing that is small and feels easy to do and focus on that first. You can add something to it next month, and keep doing that little by little over time.

I don't think there's anything wrong with writing letters to your loved ones for your own peace of mind. If the prospect of sudden, unexpected death frightens you (and I don't blame you because it's terrifying!) having letters for your family that you put aside in case that happens is probably a good idea. If your surgery is the thing that makes you realize you want to do that, you should definitely do that and no one should tell you not to because that's very rude and insensitive of them. If you are significantly more terrified of having your surgery than you are of getting into a car to drive yourself to the hospital for it, I also think it's important to recognize that the odds of dying as a result of bariatric surgery are slightly higher than the odds of dying if you fall down the stairs, about 2-3x more common as dying in childbirth (in the US), and about 10x less likely than dying in a car accident. If you are about 2-3x as nervous about dying as you were when you went into labor, and just a bit more nervous than the last time you started to slip on a staircase, that's probably about the right level of mortal fear, statistically speaking. It's probably safe to say none of us are as respectful of how dangerous driving is as we should be. I would put your letters somewhere safe and plan to revisit them every so often and keep them up to date over the years because tomorrow is never a given. It would probably be a healthy thing if we all realized that every day. But try not to let that fear with regard to your surgery become overwhelming.

Just an update on my situation: On Wednesday evening, I emailed my primary care physician and asked her if she could look into things because I still had heard nothing. Yesterday, I heard back from her, confirming she had reached out on my behalf and the center was indeed closing. She was shocked I had received no information. This morning, I got a call first from the office of the doctor I had seen at the weight management center up until July, when I moved from the medical to surgical side. She wants me to come in Monday so she can walk me through things, and I think just to see how I am doing with all this because she's really nice and had been my doctor for 6+ years. A few hours later, I finally heard from the manager who was supposed to be contacting me. He told me the center is officially closing in February, so all remaining surgeries were cancelled, and he told me of three options for centers within the same hospital group (Beth Israel Lahey) that had agreed to help absorb the affected patients. He is supposed to be sending my information to the one I chose, Winchester Hospital, and I also left them a message this afternoon (their office closes early on Fridays so I just missed them). Praying that I'll have a better idea on Monday how big a delay this will cause and how many new flaming hoops I will have to jump through. Bottom line, reaching out to my primary care doctor seemed to get the wheels turning, so never be afraid to be the squeaky wheel! Also, I managed to keep my temper in check with the manager because I'm positive this is not his doing, but I would welcome the chance to express my displeasure to the hospital administration. A troop of poorly trained chimpanzees could have handled this with more compassion and competency, and I think that reflects directly on the upper management (upon whom I have been wishing many unpleasant afflictions this week).

I wish I knew what they have planned. They are supposed to call me to explain, but so far the only person I've spoken with is the guy who answers the phone, and he probably wasn't supposed to tell me anything. He just said, "unfortunately, the center is closing, so..." The worst part is, I've been a patient there for almost 7 years, doing nutritional and medical weight loss. I love my endocrinologist there, and the nutritionists, the staff. If they are losing their jobs, I will cry. And they are always so busy I don't see how they can afford to close. I am so mad because I had a chance to move my surgery to right before Thanksgiving, but I had to pass because it was too last minute for figuring out the childcare. Now I'm kicking myself. Literally, my insurance approval is in and everything. I have a pantry of protein powders and a bookcase of bariatric cookbooks. I have watched every video on the planet. I just needed my final pre-test, which was supposed to be next week. My mom had booked a hotel in Harvard Square to be close by the night of the surgery and take me home the next day. The kids would be off school for winter break. Now I have no idea where anything stands. I will still have my insurance for January because my husband's job doesn't start until a few days into the month so we'll have paid the premium for January, but as of February it'll have to be the new insurance, and I don't yet know what they cover, or even which insurance company it is. Plus, my deductible starts over on Jan 1, naturally.

I called again this morning and the person who answered let slip that the entire weight management center at the hospital is closing. So, I am not the only person impacted by far. He said that a manager is supposed to call everyone to explain, but still nothing has happened. Maybe tomorrow? As for what happens next, I'm not sure. The hospital was recently acquired by another big Boston hospital, which has a bariatric department of its own. I assume they are trying to integrate all of the departments across the system to eliminate redundancies, but their communication so far has been appalling. Why they wouldn't have planned for this by shutting down the pipeline of patients months ago so that all surgeries were completed before the closure is a mystery. I attended my full day immersion class in August and completed all my requirements on October 6. At that point, they were booking 10+ weeks out and there was no indication anything was changing. This isn't an independent bariatric practice where I could see there being management or money issues, but a center that is part of a Harvard Medical School teaching hospital. I find it shocking to say the least. I've spent most of the day wishing whichever faceless bureaucratic suit responsible for this trips and falls into a fiery pit. Clearly emotional intelligence was not a job requirement.

I'm supposed to have my surgery on Dec 27th at Mt Auburn Hospital in Cambridge, MA, with pre-op tests scheduled for next week. Today, I get an automated message from my hospital to check MyChart. I did, and it showed my pre-test appointment as canceled. My surgery date is also gone from my upcoming visits. No explanation. Meanwhile, my insurance approval appears to have gone through. I called the weight management center's office and the receptionist mumbled something about surgeries being canceled and someone would call to explain. No one has called all day. I emailed, too, but nothing. Now the office is closed for the day and I'm so worked up over this, I won't get a wink of sleep. It wouldn't be such a big deal if it had to be delayed, except I am currently on an insurance plan through the healthcare marketplace as I am self-employed and my husband has been unemployed for a bit. But he starts a new job in January and I have no idea what the health insurance situation is going to be in terms of coverage. I am so stressed right now I could cry.

Being on solid foods for 3 weeks tracks relatively closely to what my plan will be. My hospital only does a 2 day pre-op liquid diet, and then you are on liquid/soft dairy (yogurt, pudding) for about 10 days. They generally do the surgeries on a Monday and you go to a class the following Thursday, although I will have mine on a Wednesday, and I think I will still go to the Thursday class, so it's only just over a week for me. After the class, we're advanced to stage 4 for about 4 weeks, which includes soft/moist meats like chicken thigh, fish, and eggs, along with soft cooked veg and fruits. The only thing that doesn't match up with my plan is the cucumbers because raw veg isn't allowed until stage 5, which is at roughly 6 weeks post-op. But frankly, cucumber is almost all water once you chew it, so the volume is minimal despite looking large. My program doesn't bother with purees. We're just told to chew thoroughly. As others have said, you may not feel full this early because of nerves not being fully healed, so just watch your portions. If you've lost 25lbs in 4 weeks, I hardly would call that doomed! I would double check with your nutritionist about portions, make sure you chew thoroughly, and keep making healthy food choices like you're doing. You may just not have as much swelling as some do, which would explain the ability to eat closer to a normal post-surgery capacity right away. Just because you can eat a couple of eggs doesn't mean you'll soon be able to eat a 24oz steak and sides!

Do you have any of the protein drinks or powders that are more like the clear/juice variety? I bought Wicked Protein powder in their Ice Pop flavor and froze them in popsicle molds as an experiment to see how they would work for after surgery, and they ended up tasting so good one of my daughters has wiped me out of the batch I made. Maybe having it in a different shape/texture would relieve the monotony?