ouroborous

CARBS. You folks need carbs (complex carbs, not sugars or starch). Trust me on this. I think that a lot of folks on here are chronically carb-deprived because of the overall "carbs are evil" mentality. The reality is that without a readily-available source of blood sugar, you'll feel lethargic, blue, and tired. Don't believe me? Low carb and depression/anxiety: A Case of the Re-Emergence of Panic and Anxiety Symptoms After Initiation of a High-Protein, Very Low Carbohydrate Diet -- Ehrenreich 47 (2): 178 -- Psychosomatics Refuting the idea that you "have to be in ketosis" to lose weight with low-carb: Ketogenic low-carbohydrate diets have no metabolic advantage over nonketogenic low-carbohydrate diets -- Johnston et al. 83 (5): 1055 -- American Journal of Clinical Nutrition Ack, I'd post more, but I'm at work. Long story short: don't go crazy with the low-carb thing. Most studies have indicated that the primary benefit of low-carb diets is that they tend to be low calorie, too. So just watch your calories (and of course, follow your doc's guidelines) and you'll be good (and feel so much better if you don't cut out all of the carbs).

Highest wt: 330 lbs Surgery wt: 315 lbs Last Week: 291 lbs This Week: 286 lbs

Maybe one small regret: not being able to eat and drink like I used to. I mean, when I was thirsty, I would just drink before. Now I have to be mindful of when I last ate, how fast I'm drinking, and so on. It's mostly a positive change -- I'm being more mindful of everything I put in my body. But sometimes I have a twinge of wishing I could just gulp down what I need/want when I need/want it. Would I change my decision for this? No way in hell...

It is acid reflux, without doubt. You should be on a PPI and possibly a cytoprotectant like sucralfate.

Thanks for the responses. I'm pondering asking the doc to put me back on a low dose of Wellbutrin. I don't want to; it feels like admitting failure. My depression is mild, and mostly manifests as exhaustion. I had a little anxiety before the surgery; I know this isn't entirely due to the surgery, or I'd just ride it out. It's just gone up quite a bit since the surgery. I'm going to tweak my diet a bit first. I'm taking a chewable Omega 3 supplement (don't know what the ideal dosage is, I'm taking one 250 mg chewable per day). I also consume as much raw flax seed (high in O3FA's) as I can. I just really got started on solid foods, and my girlfriend and I have been grilling steaks and eating tiny steaks and salads, so I'm starting to get more complex carbs in my diet. I'm also a big fan of not ultra-low carb diets, but it's challenging to find carbs that I can eat that don't completely torpedo my weight loss. Tomorrow is my weigh-day. The blue, somewhat depressed side of my mind says I've probably gained weight; it will be interesting to see how that compares to reality.

So, I think I'm hovering riiiight at the edge of this post-sleeve depression. It's weird. Most days, especially days where I take care of my body and mind, I feel pretty good! I'm positive and upbeat about things like exercise and losing weight. I feel like I'm on the right track and things are mostly going well. But I also feel like I have no... reserves? I don't know how to explain it better than that. I feel like I used to be able to weather a day or three of not taking care of myself before I got down in the dumps. But now, it feels like ONE day of not eating properly or not getting enough sleep, and I'm miserable. It's not clinical depression (I know what that is, I've had it before). It's just a low feeling, feeling negative, slightly hopeless/pessimistic about the future. For instance, my girlfriend took some "six weeks post-op pictures" of me yesterday, and instead of seeing the good things -- my face looks much, much thinner, and my belly is sticking out WAY less -- all I saw were the negatives -- I'm STILL a fat, middle-aged man. That plus my mild, ongoing anxiety leads me to believe that I'm suffering from very mild depression. Again, I'm not willing to be medicated for something so mild; self-talk does wonders (for instance with the weight loss, I've lost 40 lbs, but I also had to remind myself that I technically have nearly 100 lbs to go, and it took me nearly 30 years to build up this blubber, I'm not going to lose it all in a day). Also, taking care of my needs (enough sleep, Water, exercise, etc.) really helps, as does simply not allowing myself to dwell on stuff. As I said, I've fought with the grey demon of depression before, and this is NOTHING compared to what I went through in my 20's. That being said, I was wondering if anyone knows of any nutritional (not herbal; I don't want to take St. John's Wort, which is just a poor man's MAOI) ways to improve the body's serotonin/dopamine output? What I figure is happening in my case is that my reserves really ARE low. Instead of my body being able to draw upon copious precursors to these neurotransmitters circulating in my blood from all the food I eat, it's having to work harder. Anyone know of what I can do to help it out? I think I read somewhere that L-tryptophan is a precursor to serotonin. Anyone know if tryptophan helps with mild depression?

LOL, I got a little... overeager, and slightly strained my left triceps. That'll learn me! I should be healed in a few days. In the mean time, I'm walking over 3 miles a day, at approximately 3.5 mph. VROOOOM!

MlkPas, you said exactly what I was thinking. I've read some of Jillian's posts and I'm very, very concerned for her. You can't just get this surgery and expect that magically nothing else will change, and you'll just get skinny. You can seriously hurt yourself that way. In fact, you can die that way. Jillian, I've been one of the "tough love" posters to you, and I completely agree that you need to completely change your mindset. With the sleeve surgery, you no longer have a choice, you have to start eating tiny, bird-like portions, and eating them very, very slowly. The acid reflux alone can lead to esophageal cancer (not to mention what it's doing to your poor sleeve incision). If you're willing to make the changes and get some counseling, the sleeve can be a great tool for weight loss. But it is not, by itself a magical fix for compulsive eating and bad habits. You have to work with it, not against it, or you're in for a world of hurt (figuratively and literally). Hopefully you've learned and are scared enough to make some necessary changes.

Take it easy and follow all the doctor's orders. You'll do great!

You're right, everyone heals differently. But given the OP's symptoms, I'd be willing to bet that she's eating too much, too fast. Not to be mean, but I suspect that she either didn't get adequate post-op guidance, or isn't being compliant with the post-op guidelines. Oh yes, I COULD eat a Greek yogurt in 10 minutes. But it would make me have reflux (sore throat, some pain in my chest), it might make my stomach hurt, and it would be a bad idea. Could and should are very different, in this case. Before I slowed down on the Water, I could drink way more than 100 oz per day. According to my nutritionist, I should be drinking 60-80 oz tops, and slowly.

Edit: I should reiterate that I'm not a doctor. The meds I recommend are just the ones that have worked for me. Obviously, you should be under the care of a doctor; if you can't access your sleeve surgeon, at LEAST talk to your primary care/family doctor and explain what's going on. You don't want to add prescription med interactions to the mess that's already going on inside your stomach... So, someone's gotta lay some tough love on you here. First, STOP THE NIGHTTIME SNACKING. I strongly doubt you're experiencing real hunger at this point. It's head hunger from bad habits (or it's a symptom of reflux; see below). It is time to break those habits, for good. You should have been ready to change those habits before getting the sleeve, but now it's too late -- you have to change your habits, and you have to do it now. Not only will the late night eating sabotage your weight loss, it will really dial your acid reflux up to 11. Stop eating and drinking an hour before bedtime. If you're super thirsty, you can take a tiny, tiny sip of Water at night. I do this with no problems. But it wasn't until I stopped eating an hour before bedtime that my acid reflux really calmed down, post-op. Second, your reflux sounds out of control. Are you on a PPI (proton pump inhibitor -- acid blocker, like Prilosec or Protonix, or generic equivalents)? If not, WHY THE HECK NOT? At a month or so out, I'd recommend 40 mg of omeprazole (generic Prilosec) per day (20 mg taken twice, once in the morning and once in the early evening) and possibly something like Carafate to prevent damage to your sleeve and esophagus from all the acid. Both are available in very cheap generic formulations, and you can even buy the omeprazole OTC at costco, etc. For the Carafate, get a prescription -- if you can't see the surgeon, talk to your primary care doc, but I recommend it. It's a cytoprotectant that really helps prevent the acid from doing serious damage (or so my surgeon told me). Third, just from everything I've read, you are eating too much and likely too fast. At a month out, it takes me 25-30 minutes to consume one small Greek yogurt, and even then I'm probably going too fast. Also, make sure to separate eating and drinking by at least 15 minutes, probably more like 20-30. Even with water, take small sips -- don't gulp. I know that drinking water is instinctive if your throat is raw and sore from reflux, but drinking too much water too fast can actually make reflux worse (trust me, I went through this... it wasn't until I started drinking less water -- while still making sure I got 64oz+ per day -- that my reflux got under control). Finally, I highly recommend sleeping propped up until your reflux is under control. Acid reflux is serious business. You must control it, and to do that, you need to follow my other guidelines. I am not a doctor, so obviously you should be under the care of a surgeon and nutritionist, if possible, and follow their advice. But even not being a doctor, I'm very worried for you -- it sounds like you're on the road to serious, long-term complications, and you need to course-correct... now.

I second (fifth?) all of the recommendations. Attempt to get ahold of Dr. A, but if you can't, and the pain continues, seriously consider going to the ER. Explain in the ER that you are a vertical sleeve gastrectomy patient and when you had your surgery. Today, I would limit anything you consume (if you consume anything at all) to Water and liquids (not solids, not slushy, but liquids only). Consume them very slowly and in moderation (making sure to get enough water). I second Mini-ME: you ate way, way too much, and probably too fast. Hopefully you didn't damage your sleeve. I hope you feel better soon.

Here's how to break your stall: 1. Do the right things: keep your calories in the 600-800/day range. Keep carbs moderate. Make sure you're getting at least 60 g of protein/day. Make sure you're drinking enough Water. Get lots of exercise. Get lots of sleep. 2. Put the scale away. Others have said this, but nothing will drive you crazier than weighing yourself every day. Weigh yourself weekly TOPS.

Interesting, I haven't heard of anyone who was taking regular B12 supplements needing the shot. Great that it's helping you!

Thanks for the reality check, Daisy! I think that the people who will struggle are the folks who thought that the VSG was a magic cure -- they just get the surgery and then they don't ever have to think about it again, they'll be skinny! It just doesn't work that way. What I expected all along was that VSG would be my ally -- it would make it much, much easier to lose the weight and keep it off, but the responsibility would still be mine to "meet it half way."

I'm cleared to go back and hit the gym, and I'm so happy and excited. One nice thing about my genome is that I build muscle like CRAZY (despite being fairly low-testosterone... I shudder to think what I'd be built like if I had normal T levels for a male my age!). It only takes me a couple of weeks to lay on heavy slabs of muscle. Now that I'm losing fat (and I'm also keeping my Protein very high, watching my carbs a little, and tweaking all of the known bodybuilding micronutrients like arginine, carnitine, chromium, and so on), it should be a rocket sled! I have my age working against me, but everything else is in my favor. Right now, I'm DEPRESSINGLY weak and flabby from probably a year plus of almost no real workouts. So, while that's annoying, I know it'll come back quick, and I LOVE that sore muscle "I just worked out" feeling. I'm really excited! It's gonna be a great summer!

But here's the thing. First, as we all know, you can diet and exercise and work your booty off, and STILL not lose much -- if any -- weight. And the instant you slack off, the weight comes back... with friends. Many normal-weight people simply don't understand this; they can often eat and eat and not gain an ounce, or if they DO gain a pound or two, they just "cut back" for a couple of weeks, and they're back at their goal weight. So, they often assume everyone's body works this way, and they assume that the reason we're fat is because we're simply too "undisciplined" to "cut back a little" (or, my favorite, "put down the Twinkie" -- I don't think I've ever eaten a Twinkie!) I'm not claiming victim status, and I'm not abdicating responsibility, but to claim that these two cases are equivalent is simply wrong. It's like telling someone in a wheelchair who's having a problem navigating a not-handicap-friendly workplace that "hey, everyone has the responsibility to go to work." Technically it's true, but the devil is, as they say, in the details. People with a genetic predisposition to obesity, people who are middle-aged or older, people who work sedentary jobs (which means that most of your day is sedentary, compared to people who work in, say, construction) -- we are all at a rather severe disadvantage in fighting the Battle of the Bulge. And many folks like to believe that the only factor in weight loss/gain is "calories in/calories out." It's simply not that simple. Looking at my family -- every single one of whom is obese -- and looking at my friend's family -- every single one of whom is normal weight or skinny, and you just can't escape the conclusion that consumption/exercise is DRAMATICALLY oversimplifying. This other family does, on average, less physical activity than we do, and they eat about what we eat, or even worse. Clearly, genetics play as large of a roll in weight loss and obesity as "personal responsibility" do, and yet "personal responsibility" (which is just a code-word for a moral judgement; IE, you're "irresponsible" if you're fat) is still the only factor considered in society at large. Compounding this is the fact that, of course, most obese people CAN lose significant amounts of weight -- if they essentially dedicate their lives to that pursuit. Who has that much time, and energy? Who wants to live their entire life for fitness? Fitness should be a means to an end -- an enjoyable life -- not an end in itself (in my opinion). I think a lot of us (myself included, at times) have internalized this message that "fat people are bad" (lazy, stupid, slovenly). Just like many double standards, we enjoy it when it works for us -- when WLS leads us to drop 100 pounds, we're happy to soak in the praise and respect from those around us. But that is exactly the same thing as the disparagement of those who are still heavy, just the flip side of the coin. Shaming doesn't make us lose weight, and praise doesn't keep us thin. Unfortunately, for most of us, even diet and exercise don't, on their own, slim us down or keep us thin for significant lengths of time. Ultimately, as my lead-in post said, whether we couch it as "personal responsibility" or "the deadly sin of gluttony," the result is the same: shaming and judging people (including ourselves) for being overweight or obese achieves nothing of value, for society, or for ourselves. If we're willing to let go of that mentality and treat weight as a medical issue, like we treat, say, diabetes (another illness that has a "personal responsibility" component, but one which we don't routinely shame people for suffering from), we'd all be better off. Fat people would be more willing to discuss and work on their weight, and we'd all be healthier -- physically, and emotionally.

Yes, definitely. The height loss is an important clue, and it's good that you picked up on that. I think ALL sleevers should take a Calcium citrate supplement (osteoporosis or not), but I would definitely get the bone density scan as soon as you can. Only two things can happen -- either you'll find out you're not at risk (hooray!) or you'll find out you are, in which case you can work to correct it. Both are positive outcomes compared to not knowing and getting a fracture, or with going off the PPI's "just because" and developing Barrett's esophagus/esophageal cancer. (Note to the medical geeks out there: how prevalent are Barrett's and e. cancer in WLS patients? Anyone know the numbers? I'd like to know if this is a real risk or a "hit by a meteorite" risk.)

Even carbs? But carbs are EEEEVILLLL! Actually I'm hoping to get back into this groove again too. At 40 I may be a tad too old, but I'm going to give it the old college try.

Congratulations! Now remember: 1) It really does get better every day, by leaps and bounds. 2) Sip, sip, sip. Your number one goal right now is to stay hydrated! 3) Walk when you can manage it, as much as you can manage without burning out. 4) Don't be afraid to take your pain meds, but if you don't need them, don't take them. 5) Do EVERYTHING the doctor tells you to do, even if it seems weird or stupid. You'll be shedding the pounds like crazy in no time flat! :biggrin0:

Congratulations! This is tremendous progress! :biggrin0:

Just to be pedantic, if you don't have osteoporosis or osteopenia, don't worry about the PPI's. They are not generically dangerous, and many people take them for life without any problems. If you don't know if you have osteoporosis/osteopenia, especially if you're in one of the at-risk groups (particularly low-testosterone men and post-menopausal women), ask your doc for a bone density scan. It's pretty simple and painless and will put your mind at rest.

Great to hear that you're doing better! Just rest, sip Water, and follow the doctor's orders. You'll be up and about and racing around the block in no time!

I know that plenty of people lose enough weight with VSG to kick the CPAP (for the non-apnea folks, that stands for continuous positive airway pressure, it's the blower machine thingy that we have to use at night to breathe properly). The question I have is, when does that happen? Anyone have a ballpark pressure range for when to see the sleep doc and get that (hopefully final) sleep study done? My girlfriend and I both have apnea and are both sleevers. She's gone from a pressure of 13 (I think) down to 9 (and that's still too high). I've gone from BiPAP of 16/12 down to CPAP of 10.5-11 (and again, that may still be too high). Obviously, we know how to set our own pressures, but without a sleep study (which insurance won't pay for more than yearly, and which still costs us about a grand out of pocket due to coinsurance), we're just guessing. Any folks who've had the experience of going through this have any tips on when they went to see the sleep doc again?

To each his/her own. My girlfriend just bought a brand new, high-tech, large capacity washer/dryer set, and I swear she was as giddy about that as I am about the bike!