ouroborous

First, 32 fr bougie to 36 fr bougie is an almost imperceptible difference. Trust me; going from a 32 to a 36 didn't "sabotage" your weight loss. Second, the sensation of hunger is very different for everyone -- both pre-sleeve and post-sleeve. One thing that's really hit me is that I'm hungry a LOT these days, but I just don't eat that much. It's like I've learned to turn it off, or at least down. I have to remind myself to eat, and that's new! I'd recommend that you not worry about it too much. From what I've seen of the sleeve, you WILL lose weight (has there been a single person on here who's had the sleeve who hasn't lost a significant amount of weight?). It will surprise you the rate that it comes off... then plateaus... then comes off again. It will surprise you how much your relationship to food (and yes, you have a relationship to food) will change. Just focus on getting well right now -- follow the doctor's orders to the letter, sip Water whenever you can, walk as much as you can. Try to wean off of the pain meds, and really listen to the new sensations in your body. You will literally have to re-learn how to eat and drink all over again, but the payoff is worth it.

Anyone seen ANY research yet on the M&M (morbidity and mortality) numbers for plication? Also, I'd be interested in seeing EWL (excess weight loss) figures. I would be stunned if plication can approach the sleeve for EWL, since the ghrelin is still present (although it may not be as prevalent without fundus stretching; then again, the plication may also trigger essentially permanent ghrelin secretion; who knows?) and the ghrelin reduction of VSG is posited to be one of the primary mechanisms for EWL from VSG aside from the purely restrictive aspects. I'm sure that initial weight loss in plication is good, but then again it's also good in all WLS -- banding, DS, and so on. It's the long term maintenance that I'm concerned about; that's what drew me to VSG over, say, lap-band (aside from the foreign body issues): VSG has, hands-down, the best 5 year EWL maintenance statistics around. Very interested to see how plication will stack up, but I know that that data is simply not available. Calling plication a "super sleeve" without this kind of data seems to me to be at best misleading, and at worst downright deceptive. But, time will tell; hopefully all the plication patients thrive and do well. The only place I can see plication touching VSG is on the M&M figures, since there's no resection. But even that is hypothetical, as there are a lot of unanswered questions (what are the effects of all that "bundled" tissue long term? can the staples come undone? are there vascularization effects? &c &c)

I wouldn't worry about stretching, but it IS a concern, according to Dr. L. He said that particularly overeating can stretch the sleeve post-surgery. Apparently we're not as much at risk as people with an intact fundus are, but there's still some risk.

New study in the Annals of Internal Medicine (with a very large cohort ~120k participants). Note that it looks like the higher mortality was due to higher animal Protein intake, which is associated with various risk factors. However, it does seem to indicate caution when recommending very low-carb diets as a panacea for health and weight loss. It seems like the best diet recommendations to date ('diet' in its original meaning of 'what you eat,' as opposed to 'how to lose weight quickly') don't restrict carbohydrates, but rather recommend against refined carbohydrates, as well as too much animal protein. Vegetable protein (Beans, beans, the magical fruit...) seems to be fairly safe. Edit: link to study abstract here.

Congratulations, Jane! That's tremendous. How does it feel to realize you're no longer "obese" or even "overweight" anymore... just "normal weight?" That's gotta feel good; I can't wait (weight?)!

Swift, I just wanted to say that you're doing an amazing job. I think we have about the same build and are around the same age, and we're both male -- so I've kind of used you as my yardstick for what's possible. You're beating me by about 25 pounds at this point in your weight loss! That's amazing, and inspiring.

Well there won't be pics of more than my face for a few months since I'm still really shy about my tummy and so forth. But I will say that the changes are amazing and surprising. I was trying to figure out what was different about how my pants fit the other day, and I suddenly realized: I have hipbones. For a non-heavy person, this sounds like "duh," but you fellow travelers on this path probably completely understand how amazed I was to re-discover those bones!

From what I understand, plication doesn't have the ghrelin-reduction benefits of VSG. In short, it is stomach stapling (rebranded). It's probably marginally safer than VSG (although VSG is proving to be very, very safe), but I would wager that the long-term weight loss (3-5 plus years) won't be nearly as good without the suppression of the hunger hormone.

Dr. L told me that crunches weren't a concern, and actually were a good thing. I know this may be counterintuitive, but the fact is that crunches don't cause the "dangerous" kind of pressure on your stomach ("dangerous" is expansive -- making your stomach swell up). If anything, crunches do the opposite, squishing it down flatter. Of course, in the initial healing period, you shouldn't be doing ANY heavy lifting. But -- again, according to my surgeon -- once you're cleared to exercise, "core" exercises like this are actually beneficial.

Anyone else notice how weird of a sensation this is? Now that I'm wearing clothes that are closer to my "real size" (according to my bone structure, this is somewhere between a loose XL and a tight L in the shirt, and probably about a 36 waistband normal cut pants), the cloth actually touches my body. It's taking a real mental shift for me to start thinking this is OK. I think it's a self-confidence thing; it's improving as my mind makes the shift from "I'm a fat disgusting slob who has to hide his body at all costs" to "I'm a normal looking guy with a decent body" -- I'm making progress, but it's slow! I've noticing that the cut of clothes is different; I used to be 2XLT shirt -- the "T" (for Tall) was because I needed the extra length to cover my belly. Now I don't, and it's an adjustment to realize that my size is "just" XL. With my jeans, I wore Levi's 550's -- Relaxed Fits, aka "fat man jeans." Now, not only has my size (waistband) gone way down, but I'm finding that even jeans that fit appropriately in the waist and length are far too baggy in the butt and thighs. I have a butt (unlike a lot of white guys! :confused1:) so it's not just "disappearing ass syndrome" -- the fact is that I really shouldn't be wearing the baggy "fat guy cut" jeans anymore. It can be a confusing journey, but it's fun to see all the changes in my shape and health! Oh, I also just realized -- I'm more than halfway done with my weight loss. WOOHOO!

Your arse hasn't fallen off, it's just that the old baggy clothes are now way too big and swallow it like a python eating a deer! I'm in the same boat. I wore Levi's 550 "Relaxed Fit" jeans, and now even though the waistband fits me, the butt and legs are incredibly baggy. So it's not just the size of the clothes, it's the cut that changes. I'm probably going to go try on some new "normal cut" (IE, not relaxed fit, aka not fat man jeans) jeans this weekend.

I've been losing about a pound a week or so, and I figured that I was just out of the "initial rush." But then, all of a sudden, I've lost 3 pounds per week for two weeks running. Without changing my diet or exercise habits or anything. It's so utterly weird how the body will hold on to weight for as long as possible before finally letting go and burning up the fat! Oh well, I'll enjoy the losses :thumbup: My next mini-goal is 250 pounds. Then, after that, my BIG goal is to reach a BMI of under 30, and finally be out of the "obese" category for good. But that will be a long way off! Patience is a virtue. An insanely rare, hard-to-practice one, but still...

I seriously wish people would worry less about fats and carbs and so forth and focus more on: Getting enough Water (this is, without a doubt, your number one concern, especially post-op) Getting your Vitamins (again, this is a safety concern) Getting enough Protein (this is a long-term concern) Eating the right total calories Exercise If you do all of those, I abso-frickin-lutely guarantee you'll lose weight. You know how I know this? Because if you're consuming 600-800 calories a day and burning 100-200 in exercise, you can't NOT lose weight. It may be slower than you'd prefer, but it WILL happen. The body can only live off of circulating blood sugar for so long before it starts to burn fat reserves -- which is what you want. So: Focus on HEALTH, not "should I eat that or not that." Once you've focused on health, the "what should I eat" sorts itself out naturally. Don't obsess too much about your weight. You WILL have stalls and you WON'T lose as fast as you think you should. This is normal. Enjoy the ride; you'll arrive at the destination soon enough. And if you focus on getting there in a sustainable, healthy, happy way, you'll be able to keep the weight off -- which is more important than losing it!

Well I'm not exactly going to keep you updated. Let's just say that I'm very pleased with the results, and leave it at that. Fellow XY chromosome folks: this alone is reason to lose the lard!

My nutritionist said 600-800, but she also said to adjust for exercise. Be honest about the calories you're burning (if you're burning 100 calories and pretend you're burning 300, that won't work), but still, she said to adjust for calories burned. So when I'm being a good boy and working out hard every day, I'm usually eating about 1000-1100 calories.

Honestly, I'm kinda turned off to booze since the surgery. I really can't drink enough to get much of a buzz (from a volume perspective). I can't drink much beer at all. And I find that the after effects are much stronger -- 2 or 3 drinks and even though I don't get very intoxicated, the next day I feel hung over. It's to the point where it doesn't really seem worth it. I guess that's for the best, health-wise, but still it's a little sad to say goodbye to all the fun crazy times...

Thanks! Anyone else notice that it feels hard to be honest about your achievements? On some levels I'm really proud of myself and excited to feel good and look good for the first time in... well, ever. But on some levels, I feel like I'm bragging! I wonder how many of us deal with this same issue. I wonder, does "self confidence" just mean being honest and unashamed of your strengths? I wouldn't know since I've never been terribly self-confident. But I have a feeling that that may be changing!

I had a three month post-op blood draw, and the doc said I'm in excellent health. All signs of my fatty liver have disappeared; the doc said my liver looks like the liver of a 20 year old (again what he mentioned after my surgery; I'm starting to think he has some weird liver fetish!). My kidneys are in excellent shape. My HDL/LDL are still a TINY bit off, but my overall cholesterol number (158) is excellent and improving, and my triglycerides are great. All the other numbers were excellent, which is a great improvement over the beginning of all the obesity co-morbidities that I was showing. And one real bonus, in three months, my total testosterone has gone from 352 (borderline low, reference is 350-850, I think) to 575. This is due to removing fat, which converts (aromatizes, technically) testosterone (good for men) to estrogen (bad for men). Thumbnail guess is that by the time I hit my target weight, my testosterone should be around 650-700, which will put me in the high range (although not dangerously or riskily so). This is excellent since men's testosterone starts decreasing in their 40's, leading to osteoporosis, heart problems, and depression. Stacking the deck by starting high is a good thing. Also the added "oomph" that higher testosterone will give to building and maintaining muscle mass is a good thing, and one thing that I've noticed already is that sex drive is way, way up (which may necessitate changes in my relationship, but all in all I'd rather be healthy!) So, all things considered, very positive stuff!

EDIT: don't read if you don't want to read borderline self-aggrandizement. But if you like to hear about NSV's and how losing weight can make you feel better, read on... Well, I'm still losing relatively rapidly, so I didn't want to buy a LOT of clothes for fall, but since my old clothes are rapidly becoming tent-like, I needed some basics. I used to wear 2XLT (double-x large tall). The "T" was necessary because my gut would hang over the waistband of my jeans and the T-shirts weren't long enough to cover it (I'm only 6'1" so I don't really need super "tall man" clothes). I was thinking that maybe I could go down to a 2XL or maybe an XLT. Well, imagine my surprise to discover that XL fits me perfectly, and I actually might end up a snug "Large." I won't be any smaller than that because that's simply my build (shoulders and chest), and actually if I bulk up my muscles I may still need an XL, but I'm excited to essentially have lost two shirt sizes in three months. Also my jeans have dropped from a snug 48 inch waistband to a loose 44 moving towards a 42. By the end of the year, it's even odds that I'll be in 38's for the first time in a LONG time. My smallest adult size was 36 waist (which, again, is where you start to get limited not by fat but rather the muscle and bone of my hips and thighs). Lastly, my underwear have dropped from a snug XL to a form-fitting L, and may eventually get down to a medium. And I look good in them :biggrin2: I've always had fairly muscular thighs and glutes, and now that the fat is melting away, it's looking good down there. I feel like I'm bragging, but it's true -- I'm looking good in my biker briefs, and it's a nice change! Oh, I almost forgot. Instead of needing an 11 wide shoe, now I just need an 11. That isn't a huge morale builder or anything, but it DOES make finding shoes that fit much easier. My New Balance exercise shoes I just bought fit like a glove! All of this is tremendous for me. One downside is that the snugger fitting XL t-shirts actually touch my body. It's strange, but I think a lot of us heavier people are not used to clothes touching our bodies. Anyway, that shows where I definitely need to get back to the gym and keep my stomach and chest from sagging. Fortunately, I have excellent genetics and lots of determination, so I think I can pull everything back where it's supposed to be. So, I'm more determined than discouraged if I see that I'm not quite as ripped as I want to be. All in all, it's pretty exciting developments!

Without going into too much detail, now that I'm about 3 months and 60 lbs out, I'll just quote from Blazing Saddles: it's twoo! Oh, it's twoo, it's twoo!

Actually, since my post, I've had a glass of beer at a company event, and as long as I drank it really slow and burped almost every sip, it was fine.

First, I reached a minor milestone today -- I broke the 270 lbs barrier. 269.6, but still, I'll take it! Second, I've really started noticing that people are treating me differently. All of my life -- literally -- I've been heavy. I've sort of resigned myself to being the "fat friend;" I'm treated as comic relief by the men, and as the platonic "shoulder to cry on" by the ladies. It may not be cruel, and it's probably not always intentional, but basically I was never taken seriously as a man. If there's one phrase I would use to describe how people treated me, it would be "non-threatening" -- not that I want to be threatening, but I want men to realize that yes, I'm a man too. And I really want that from the ladies -- even if I'm not going to act upon it, it's SUPER hard on the self-esteem to be treated as an essentially asexual "buddy" by women that you're attracted to. That is changing. I'm noting real changes in how people react to me. Men seem to take me more seriously now, listening carefully to what I have to say before talking (or talking over me). And women, well that's a pleasant surprise. I was out working on my motorcycle in the garage the other day and a neighbor stopped by to explain why her car was parked in front of our house. After a moment some part of my brain was thinking "why is this explanation, which should be taking all of 5 seconds, going on so long?" And then I noticed that she was smiling at me and adjusting her hair. Finally, she said "hi, I'm so-and-so" (we hadn't met) and then surprisingly, gave me a hug. I thought nothing of it and went about my business, but it was tickling at the back of my brain. Finally, about 70 miles out on my ride, it hit me: she was flirting with me. Now, she was an attractive younger lady -- the kind I would never think was "in my league." I'm not shopping around -- I have a girlfriend -- but still, it was pleasant and surprising to realize that an attractive woman possibly 15 years my junior was really trying hard to flirt with me. So yeah, people are really treating me differently. I have to say... I like it :thumbup1:

So, nobody should take my posting as a recommendation to avoid meds. I am not anti-meds -- not at all. Better living through chemistry, baby (I mean, come on, I paid 20 grand out of pocket to have my stomach sliced up instead of "just" dieting and exercising; would someone who is anti-medicine do that?) I thought I was really clear about that, but I'll say it again: you really need to talk to your doctor about depression, and if you need meds take them. That being said, the point of my post was that, for me, taking meds has never been as effective as remembering to take care of my physical needs. I don't know how many people are like me, but I don't always "remember" to take care of myself, but I always, always always pay the price. So I have to consciously remember to get enough sleep, eat enough healthy food, drink enough Water, etc. And one of the prices I pay if I don't do those things is depression and/or anxiety. I suspect that for a lot of us, depression worsens after surgery. Not because of fear of mortality or anything deep and psychological like that, but simply because our brains are part of our bodies, and if we're not taking care of our bodies, we're not taking care of our brains! It's amazing how many people forget that they are a "part of" their physical selves and think that they can neglect their basic health and still keep firing on all cylinders, mentally and emotionally. I don't know about you guys, but I just don't work that way -- especially since the surgery. So, if you need meds, TAKE THEM. But also, try to take better care of yourself -- do all the things you know you're "supposed to" be doing -- and see if that doesn't help at least a little.

Look, what counts for grams of Protein is weight -- period. Volume is affected by density. Take a giant bag of popcorn, and you can lift it and throw it around easily. Take a giant bag of rocks -- same size, or volume -- and you can barely lift it. That's because there's a great deal more mass -- weight -- in the same volume. That means it's more dense. Weight -- or mass -- is a constant. There's a trick physics question which says "which is heavier, a pound of bricks or a pound of air?" It's a trick question because they both weigh a pound. Sure, a pound of air might fill a 55 gallon drum, whereas a pound of bricks might mean a half a brick, but they're still both a pound. That's why when measuring things like protein quantity, weight is everything. If you want to know how many grams of protein you're eating, the only reliable way to figure that out is to take the weight of the chicken (or whatever) you're eating, and multiply it by something (that "something" is the coefficient of chicken mass to protein mass). I'll say it again, when you're trying to figure out how many grams of protein that you're eating, mass (weight) is all that matters. Now, just because that's too simple, volume DOES matter, but for a different reason: we have tiny stomachs! Most of us can't eat more than 1/2 to 1/3 of a cup (a cup is a measure of volume, not weight) at a time. So we have to look at that 1/2 chicken breast, which maybe weighs 2 oz. cooked (56 grams, for about 15-20 grams of protein I'd guess), and see if it's more than 1/2 cup of volume. If it is, we may have to cut it into two meals, or get more protein in a different way (some Beans, maybe?) But if you really want to accurately measure your protein intake, you must use weight. That's because all of the measures are in weights, and if you start confusing weights and volumes, you'll get your numbers all wrong. I highly recommend you get an accurate (gram accurate) kitchen scale and weigh all your portions. Then use something like Livestrong (or whatever) to get your nutrition info from your portions (1 gram of chicken is not 1 gram of protein; you need a nutrition database to figure it out). I also recommend using metric measures :biggrin0: As you're already seeing, "Imperial" or standard weights and measures are needlessly complex. Almost all nutrition information is already in metric on most sites, so why not make the switch? Even if you don't have any conception of what a "gram" (a unit of weight) is, your scale will, and you won't be tempted to get it confused with say a cubic centimeter (cc, a unit of volume). I don't mean to be harsh to those replying otherwise, but this is basic physics -- basic weights and measures, really. Volume matters to sleevers because we have tiny stomachs. But if you're calculating nutrition, weight is king, baby. Edit: all this being said, it's probably a tempest in a teapot. I don't measure ANYTHING anymore, I just try to get "a lot" of protein and a fair amount of carbs, and I eyeball portion size. I think that honestly the payoff isn't worth the effort of religiously weighing portions. And yes, to avoid overeating, you should pay attention to volume, since that's what will plug you up, not weight. But still, I just wanted to point out that if you want to measure your nutrition, you must use weight. If you just want to eyeball it, then volume is probably fine.

Sounds like a little bit of dumping, mixed with some anxiety. Just chalk it up to experience; you'll be having a LOT of those "oops" experiences as you learn what you can and can't eat, going forward...