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I also said “ I will never gain it back” and had a 16 pound gain my third year. (I worked it off) Weight gain can mess with your head. You caught it before it became a major regain. You can get this back down. Some of us can have a piece of cholate and stop. I know myself, I keep temptation out of the house. Maintaining I indulge within reason. Some of us do the pouch reset (liquid progression to real food) It’s a good way to restart healthy habits again. Some of us go back to bariatric basics.( Real food stage, Log food and stay within your weight loss calorie/macros, hydrate and exercise) Others change diet plans. (keto, intermittent fasting, vegan etc) Its finding what works for you. Whatever diet you choose; Logging has been the tool that helped me get the weight off. Here are a few threads that may help: Weight loss group challenge to keep you motivated. https://www.bariatricpal.com/topic/425758-june-2019-challenge/?tab=comments#comment-4781757 If you choose intermittent fasting here is a group of people that can help https://www.bariatricpal.com/topic/419144-intermittent-fasting-daily-menuresultsaccountability/?page=173&tab=comments#comment-4780742 Mental Weight loss battles thread. https://www.bariatricpal.com/topic/425354-the-importance-of-doing-the-head-work/?tab=comments#comment-4776743 Wish you the best. Glad to see you back on the forum.

My homemade cheesecakes are also QUITE low in sugar as we like them to be nice and tart and just put fresh fruit on top. I think if you're trying to eat lower carbs then there are MANY worse "cheats" than a cheesecake, the higher fat and protein to carb content (assuming it's lower sugar of course) make it a much better option than, say, a piece of chocolate cake. If you guys do want to indulge with a cheesecake dessert, it is one of the EASIEST things to make keto. I don't do sugar alcohols though, so mine will also just be .. not AS bad, haha.

The keto diet is very high in fat, and that can be a problem for WLS patients. The poor old liver is already stressed from processing all the body fat breakdown, and adding even more fat can be rough. Fat malabsorption is also a very real issue for some people after surgery and having a lot of extra dietary fat running through the system can have it's own set of issues. I'm not trying to discourage you, but be prepared that your body is going to be in a completely different mode after surgery, and you may not tolerate a lot of fat. Because of the rapid weight loss and caloric restriction, you will automatically be producing lots of ketones. Some folks even end up needing their gall bladders removed after WLS, and I have to wonder if this is related to the poor liver simply not being able to handle the rapid fat breakdown.

Oh yeah Isopure is a good brand i forgot about! I used it when I did Keto. Did your surgery team give you all this good advice or you learned on your own? I'm learning more from you guys and my book than them lol. So Mashed Potatoes is allowed in the pureed stage?? That will be a lifesaver. Glad to hear the shake worked out!

Most of the people here are instructed to do liquids only in the weeks leading up to their surgery, myself included. Also the hallmark of a Keto diet is that it is low carb, high fat. Fat is also something that I was instructed to minimize in my pre-op diet because the liver stores fat as well as carbs. No vegetables for me, I would kill for some steamed broccoli and sliced cucumber.

I have a feeling your story is me in a few months! First off, we're human, we've struggled and we certainly can be our own worst enemy. I get in my own way ALL the friggin' time Be an advocate for yourself and learn all you can. Read, read, read! Just remember, there's no reason to "chug" protein shakes, if you do, only chug the ones with minimal to no sugar and don't go over your daily protein macro set by your doctor. For women especially, just about anything that raises your blood sugar and causes insulin responses can trigger your body to store fat. #1 thing responsible for that is glucose and it comes from several different places, not just what you eat. We are 100% commercial grade, fat storing machines meant to survive and populate the world in all circumstances LOL There is such a thing as too much protein. Protein metabolism, handled by your liver, has a limit. Our bodies make glucose from 2 main sources, #1 the break down of fat in the form of triglycerides in your blood and, you guessed it, #2 proteins...in the form of amino acids. Proteins are strings of amino acids. If you eat too much protein, that protein will become the preferred source of gluconeogenesis...in simpler terms, that's process of your liver converting those aminos to glucose, which in turn can cause blood sugar spikes, which in turn can trigger fat storage, which in turn can lead to dreaded weight loss stalls and gains (like you already experienced). OMG all the science! LOL I haven't had surgery yet, but I'm speaking from the multitudes of knowledge gained while following a keto/LCHFMP diet for nearly 2 years. If you want to put your mind at ease, kill it with knowledge. The more educated you are, the less there's a need to freak out. No matter your diet, bio-science such as protein metabolism is the same for all of us (mostly). Don't forget....YOU GOT THIS!!! 💓

I posted this elsewhere on the forum but I thought I'd put it here in case you didn't see it. This is what one of my typical days looks like at 4 months post-op. My personal macro goal is 120-150 grams of Protein a day, under 50 total carbs, and 100 grams of fat. Also, I can't tolerate any raw fruit at the moment. And calories are not relevant for DS patients because we malabsorb most fat and a good chunk of our protein... 8 am: Premier Protein Cafe Latte shake 9 am: Ratio Keto vanilla Yogurt with 2 tablespoons of toasted coconut chips, 1 tablespoon of keto nut granola, and 1 tablespoon freeze dried strawberries 12 noon: 1/4 cup roasted Spaghetti Squash, 1/4 cup of ricotta cheese, 1/4 cup of a beef bolognese sauce 2 pm: Cafe Macchiato with espresso and 4 oz Fairlife Protein Milk 3 pm: 2 mozzarella cheese sticks, 2 mini baby cucumbers and 4 cherry tomatoes 6 pm: Roasted chicken leg and thigh quarter, 1/3 cup of vegetable Soup 9 pm: Homemade Keto banana Walnut Dark chocolate Muffin Total Macros: 150 grams of protein (yay!!), 43 grams total carbs, 97 grams of fat, 1634 calories.

I’m looking at dulcolax since it’s 1/2 the price. Gonna hop back on my probiotics. I need to get into a better habit with my pills.... I’m not great at remembering to take them. Alarms don’t help. Oh my favorite cooking blog (40 aprons) has a sushi recipe 😍😍😍 🍣🥢🍣🥢 it’s Whole 30/Paleo/Keto!! Yay!! Can’t wait to try this!! And it’s got 8 grams of protien :) https://40aprons.com/whole30-sushi-low-carb-paleo/#wprm-recipe-container-16015

I'm surprised I didn't get very many responses about this, but I guess if you don't live in the middle of nowhere, a trip to Trader Joe's is not a big event 😀. I found some product recommendations on keto web sites and YouTube videos. Here's my haul: They didn't have several of the items on my list, and there were a few things I didn't buy because they seemed way overpriced, but here's what I got (some of it is just general grocery items just to save me a trip to another store): Meat Individually frozen boneless skinless chicken thighs ($7.99) Ground chicken ($3.79) Ground turkey ($2.99) Pork tenderloin ($4.15) Chile lime chicken burgers ($3.69) Chicken sausage ($3.99) Produce Spaghetti squash ($2.99) Organic romaine bagged salad ($2.69) Heavenly tomatoes ($2.79) Head of garlic ($.49) Organic ginger ($1.79) Frozen Frozen green beans ($1.99) Frozen asparagus ($2.99) Frozen raspberries ($2.49) Pantry Avocado oil ($5.99) Kalamata olive oil ($8.99) Sesame oil ($2.99) Rice vinegar ($1.99) Salsa Autentica ($1.99) Salsa Verde ($1.99) Sundried tomatoes ($1.99) Masala simmer sauce ($2.69) Almond flour ($7.49) Snacks Chomps jerky ($1.69) Quest Hero bar ($1.99) Power Crunch bar ($1.49) Freeze-dried raspberries ($3.99) Refrigerated Plain nonfat Greek yogurt ($.99) Green goddess salad dressing ($3.99) Spicy cashew salad dressing ($3.99) I've only tried a few of these items so far. I love the green goddess salad dressing; it's only 10 calories per tablespoon and surprisingly tasty (I actually licked the bowl when I finished my salad). Sadly, it's perishable and only has about a month shelf-life in the fridge. Haven't tried the spicy cashew dressing yet, but online reviewers love it. I like the chicken burgers, but they'd be better on a nice, fluffy bun. I felt so weird buying all healthy stuff and no junk food! If I had made this trip a year ago, I would have been all over the delicious-looking baked goods and the snacks and desserts stacked above the freezer aisle.

My favorite website ( besides this one) is DietDoctor.com wonderful Keto recipes and educational videos. I think you can search the recipes for free. I love the educational videos, so I pay the $9.00 monthly fee. If you like the site, you can get a free month, binge on the videos, then quit after your free month.

The broad keto would be much better for you. It would be something that could be more easily maintained, and people would less likely fall off that because of less restrictions. The more you restrict yourself, the more likely you are to want to cave in. A lot of people can't process sugary foods, and you'll get sick if you try to eat too much. Once you are post op, your body will adjust to eating healthy things and want healthy things more often, so maybe you can indulge the sugar craving with something healthy, like fruit. Also, I agree with colormehappy. You NEED that fiber to go to the bathroom. Constipation is a BIG deal, and it SUCKS. I can finally eat veggies now with every meal, and my bowels are much happier because of it. (TMI, I know)

I tried weight watchers lost 12lbs then nothing more and I was on for 1 yr. I’ve done Keto and I eat under 1000 calories a day. I track my carbs and I only use a whole wheat, flax and oat bran pita when I have “ bread” I measure everything but my body just likes to be at 220, I work out 6 days a week. I’ve gone to Dr.’s and nutritionist and I’m still stuck here! I won’t give up tho!

This is a post I can get on board with. (And, for the record, I agree with just about everything you usually post, but the tone of your post from earlier even bothered me a little bit.) Yes, I am only almost 10 months post-op, but I did embrace a keto way of eating for my entire six month pre-op diet program, so I have been eating this way for 16 months now. And my habits are in fact habits and the way I plan to continue eating long-term. Is my approach "extreme"? Not to me, but I can see how others think so. I have watched my dad (2005), mom (2013), and brother (2014) have the bypass, sleeve, and band respectively. My dad and brother have gained back every pound they lost. My mom has gained about 30 pounds. And even they will admit it is because they immediately went back to eating just like they did before. I have watched them do it (even as I have been on my own journey). Can I predict the future? No, I can't. But, I can tell you this -- I am not going back there. If that means 20 carbs a day for the rest of my life, it will just have to mean that. I have made peace with this way of eating, embraced food as fuel, and learned to manage stress in other ways. One guy called me too serious on a thread earlier this week. Some may call me idealistic or extreme. And, in some eyes, maybe that is true, but I'll be damned if I go back to where I began ever again.

Yay! Same day for my sleeve. Started my pre-op on Nov 22nd. I'm doing my best with my 2 shakes a day but their brand is wearing on me bad. I had to start adding a few drops of water flavoring to them to get them down lol. and Then getting mighty tired of bland chicken and 1 of 5 green veggies a night :(. Had my education class and my per-surgery assessment is on Tuesday and the Wed after its surgery! My surgeons office throws us into keto on the preop and its throwing off my walking bad. But I just keep the thought that I won't have to fight my body any longer.

https://www.oroweat.com/breads/favorites/keto (Living in Texas, I discovered HEB Higher Harvest low carb bread and use that now)

Probably not. 1 tsp of MOM = 425mg of magnesium (from memory). And if you're already on 100g or less for the last 3 months, it shouldn't be a long trip for you. I'd just keep on keepin on, do your bouillon, and drink your water! Most of the keto flu symptoms are really symptoms of dehydration per the keto docs.

Yeah I’m beginning to think f#%* this keto business. Im already restricting enough by keeping to a 1000 cal diet. Beans, sweet potatoes and fruits might help me feel full longer.

Add some mayo to that tuna! LOL *cry face* Your diet makes me sad! I cook a lot and take leftovers most of the time for lunch. I use Kayln's Kitchen for a lot of my cooking inspiration. She has her website broken down by diet type. I try and do Keto mostly. Instead of jello, I would add something with protein. You could do cottage cheese, a low fat cheese stick, Greek yogurt, or even a non starch veggie. I personally eat a lot of edamome, brussle sprouts, and chick peas.

What do you use for a crust keto-style?

I have been low carbing off and on since 2001, so most of my experience is prior to WLS. I would say once you burn off the sugar in your body and get over the sugar withdrawals you start functioning normally. Maybe 6 weeks you notice you are firing on more than all cylinders. It is subjective and I can only go by my experience and the experience of my friends. If you read the stuff by the Bulletproof guy he swears by it, but he is also into a lot of other bio-hacking, some based in science some whacky. The difference with post-op on WLS surgery is takes you a while to be able to eat enough calories to really be clear in your mind. At least 800 calories daily for me, to fuel working and just regular activities. When my calories were below that I was fatigued a lot. I don't have celiac and I don't have a gluten allergy and most people that claim to have gluten allergies have never been tested. I mean think about it, if people were allergic to gluten, most of the population would be sick, it doesn't make sense. Most people are reacting to too much sugar. I don't tolerate sugar more specifically HFCS. HFCS makes me sick. It is too much sugar too fast and it floods your system. People say sugar is sugar and that is kind of true, but how different sugars react in your body is very different. I try to stay at 25 net carbs per day and no more than 75 on a carb day. I only count net carbs because I really need my Fiber and net carbs makes the most sense. Really with just eating meat and veggies, it is pretty hard to break even into 25 carbs. I really have no idea how people end up eating so many carbs. I had ribs yesterday so today I am just eating fish and a lot of veggies so I will post later what my carb count is with all the veggies I eat. If people are seriously just eating meat and green veggies is impossible to have a high carb count, counting net carbs or actual carbs. I think if you seriously low carb for a long period like WLS patients should be doing you are going to have to carb cycle some, or your body just gets used to it and nothing happens. I am still experimenting with this. This day is bad because I had a Fit Crunch Bar I have one day a week that I usually have carbs, I had to add some carb cycling because I was stalling a lot. Saturday I had fish tacos and pizza all day and it was pretty glorious. This is the nutrient break out for that day. This is a high carb day for me and my net carbs are 32.5. I also went to Starbucks in the afternoon and had a Trenta Cold Brew, but I always order it black and add my own half and half. This is a day I didn't really feel like eating much /r/keto has been a really big help to me. I can't eat the fat they eat, but there are lots of good tips there. I use the Keto Calculator to calculate my macros to set in LoseIt. It is awesome because well most people can't handle the huge fat deficits that we can, they would be too hungry, but WLS patients can go on and take the max fat deficit. The weight loss forecast it comes up with there is also really helpful. It tells you at the points you have to increase your calories. I want to add that I am not just coming up with how and what I eat on my own with stuff I have found on the internet. Things I have researched have lead me in this direction but I also am in contact with two University Professors. My biggest issue right now is I don't eat enough calories for my RMR or my activity level. It is pretty hard to up my calories but I am trying to slowly. I don't have a diminished metabolism at all and I want to keep it that way. The best way to do that is to keep adjusting your calories higher as you lose. Leaving them low for a long period, lowers your metabolism. Hey OMI, thanks for this very detailed response. I wasn't able to respond for a few days and just getting around to it now. I'm still way too soon post-op to tailor my macros at this point, but I've bookmarked your post and will come back to it in a few weeks. I really appreciate the level of detail. Interesting point on the carb cycling. Why do you say you can't eat the fats they eat on /r/keto? If you are also trying to up your calories, wouldn't some added fat do that? Anyway thank you again for sharing all of your info. You must be past the 365 day mark at this point so congratulations again on all your hard work and success. Also re: celiac, I got diagnosed during the pre-op process for the sleeve which is why I asked but I'm going to make a separate thread for that.

@@OutsideMatchInside are you using a keto calculator app, and if so which one? Thanks for that background/lesson!

Sick of lockdown/quarantine/shelter in place that's for sure. Been doing nothing but walking around neighborhood or riding bike, quick grocery store trips maybe once a week. Been home since March 13th, orders for California where I live are to continue this until May 3rd. 😭 Today is the 3rd anniversary of my mom's passing and I'm suppose to be with my sister. But no traveling, had to cancel my flights to see her. I physically can't eat more than about 3 1/2 ounces of food which is super helpful because I think I would totally be gaining weight if I could eat more. I've been doing "very well" with my hydration as I track like I'm on crack every ounce of fluid going into my body and usually hitting about 70 ounces. I was on a keto diet prior to doing WLS and have pretty much continued that but more protein then fat diet, but not very many veggies. How do people fit in veggies when protein is your main objective? The struggle is real. Also how to get in so much protein besides drinking it when we have to wait 15-20 minutes before and after eating to drink again and we need so much liquid. It's like there are not enough hours in the day. I know I'm crazy spiraling sorry. As for weight loss, gosh I feel like I should weigh less by now. I mean I exercise regularly and I eat/drink less than 800 calories a day and my active calories per day are anywhere from 800-1200. Total calories burned daily like 3000-4600. The math just doesn't seem to add up to me 🤷🏼‍♀️ I miss hugs 🤗 I am an extrovert and this being cooped up is killing me.

I thought I would post up my entire experience with ALM in Tijuana while the details are still fresh in my mind. This will be a bit of a long read, but hopefully someone who is investigating the possibilities will find some useful information, answers to some questions and some reassurances! Here goes: I was introduced to the idea of bariatric surgery about 6 months ago during a conversation with a friend, who has been struggling for a few years with a significant (100lbs+) weight gain. I, too, had been gaining weight steadily since losing 100lbs four years ago. She said that if she couldn't lose the weight in the next year, she was "gonna get the gastric surgery" and be done of it. Of course, I had heard about gastric bypasses and lap bands, but I always associated it with Hollywood stars (ie, the very wealthy) or people who were much larger than 250lbs. I walked away from that conversation with a seed planted, and over the next few days I began doing some preliminary online research. This was one of the sites I came across at that time. I learned about the different procedures, and researched some of the worst case scenarios associated with each. I researched long term consequences, health outcomes, the effects on women of childbearing age who want to become pregnant, etc. I tried not to get bogged down by only reading positive stories or looking at #vsgbeforeandafter pictures and imagining my weight disappearing effortlessly overnight. I decided that this was something that really piqued my interest. I went to my provincial health authority's website (I live in Nova Scotia) and saw that the wait times here for an insurance covered procedure were more than 5 years, as there is only 1 bariatric surgeon in the province. Dismayed, I googled some bariatric centres close to where my above mentioned friend lives (Houston) and saw the procedures ranged from $12,000 USD up to $20,000 USD. There was simply no way I could afford that, even though I travelled to Houston on a weekly basis for work and could stay with my friend free of charge. I put the idea out of my head. I thought, "this really IS for rich folks, $28,000 (Canadian dollars) isn't feasible for a normal working person." But I kept coming back to pages like this, and others and on one of my google searches a sponsored ad result for ALM popped up at the top of the screen. "Affordable bariatric surgery at a top hospital in Tijuana, Mexico" or something to that effect. Intrigued, I clicked through the ad and read the entire content of the page. All the procedures were available, starting in the low $4000s (about $5500 CAD). I'm not naive (in fact, cynical would be a much more appropriate adjective), so I thought "what's the catch?" I took note of the doctor's names from ALM's website. I checked them on linked in, I read forums like this one, I entered search terms like "Dr So-So Tijuana deaths" and read well beyond the first page of Google results. I read about ALM, again entering morbid search terms, digging through online forums and basically trying to find that one piece of information where I would say "AHA! Gotcha! Of course that's a terrible idea!" I didn't find much. The company seemed legit, plenty of online posts dating back a few years to a few days about people who used their services and had successful operations with the surgeons they work with. This was around June. So I sent an email to a link on their page. I explained my personal experiences with weight loss and gain, my concerns about some members of my family and their onset health problems, and asking if I would be a candidate for the procedure at 5'8", fairly muscular and 250lbs. I don't wear plus sized clothing, but I'm at the point where if I gained another 15-20 lbs I would have to. I clicked send, and wondered if/when I would hear back and went on with my life. To my surprise, I heard back only an hour later. My coordinator, Crystal, answered my questions thoroughly (I was surprised it wasn't a generic "form" email, thank you for contacting us, don't call us - we'll call you blah blah blah). We opened a line of communication back and forth, and I felt pretty confident with the answers I was getting. So now I was getting excited. Possibilities. What seemed unattainable just a few weeks earlier was now suddenly in reach. It was time to discuss my findings with my wife. I chewed this over in my head, how to bring it up, was I ready to answer her questions, should I nerd out with all the info I had learned, or should I nonchalantly just throw it out there? I brought it up, and she was surprised but open minded. I explained all the options I had looked into, and what, exactly, a vertical sleeve gastrecromy is and isn't. She listened to my spiel, and said "Okay. Would I qualify for the procedure?". She is not fat, but has lost and gained 60lbs in the past few years and has an obese parent with diabetes. Her BMI was 32 when we had this conversation, and she wears size 12 jeans. We emailed Crystal with her concerns and questions, and again, she got right back to us. She emailed us forms and questionnaires for the doctor's review and we set to filling them out. We were on holidays for most of July, and when we returned we set a date, Oct 27 and paid our $500 each deposit to hold that date. In early August, it seemed like an eternity but since we both travel for work and work 70 hours a week, we knew the time would surely pass. We talked about little else but how excited we were. How we were going to do everything right, get back to the gym, change our lives and how this would help us when we start our family in a few years. We booked plane tickets. We changed companies in September, which was a welcome distraction from all the VSG this and VSG that. Starting about 3 weeks prior to our travel dates, we started receiving emails from Cindy Rios, an RN who works with (for?) ALM regarding diet, lifestyle changes, phases of the surgery recovery and suggestions for streamlining and making the most of our pending surgeries. We had quit caffeine and carbonated drinks in August, in a bid to make it easier down the road. We went to Costco and loaded up on Premier Protein (like a shopping cart full) because we are on the road with work and didn't want to be short on supplies and maybe tempted to cheat. We didn't do "food funerals" in the same way I wouldn't attend the funeral of a nemesis or adversary who had stolen some of my life and made me unhappy with who I was. We bought enough salad to get us through the work week when we were home each week. The pre-op diet was easy, for the most part. Not wanting to risk enlarging our livers with excess carbs and losing our hard earned money if the surgery couldn't be completed made it easier. We had a supply of Keto-strips from previous ketogenic dieting and made sure we were staying in ketosis throughout the entire time. We flew out of Nova Scotia at 5am on the 26th. We arrived at the San Diego airport before noon (4 hour time difference) after changing planes in Toronto. We had a text message waiting for us when we landed from our driver, asking what our schedule looked like. We told him we were on the ground, and just waiting to deplane and on our way. We received a call immediately saying they would pick us up at the cab stand at Terminal 1 in about an hour. We carried on our luggage (not wanting to risk the airline losing our luggage with multiple connections) so we strolled from Terminal 2 down to Terminal 1. We received a text message with a picture of the driver's license, Rafael and his personal information. When an hour came and went, I sent a text asking where he was and got a call right back. He was stuck in traffic at the border, but wouldn't be much longer. We got a description of the van he was driving so we knew who to watch for. He arrived not much longer, and we picked up 2 other people on the way. We made our introductions and were off on I5 towards Mexico. Rafael informed us that because we had landed quite early, we would head straight to Mi Doctor hospital and do our preoperarion check ups instead of waiting for surgery day. The hospital is literally 5 mins from the border. Rafael took us from place to place in the hospital, and stayed with us the entire time. First we had blood taken for a full work up. Next, we went for an EKG to monitor heart function. I then met with Dr Elias Ortiz in his office, as I was the first surgery of the day the next morning. My wife filled out paperwork upstairs, and after my meeting with Dr Ortiz, I filled out the same paperwork. All the paperwork is in English and Spanish, so you'll sign everything twice. I was the only patient to meet Dr Ortiz that afternoon, as he would meet with the others during the day between surgeries. I asked him to visually inspect my gallbladder, as I have a family history of gall bladder disease and he said he couldn't see if there stones, but the general health would be evident. I asked him about taking Advil (i take a HUGE dose of Advil once a month for period cramps) and he assured me that NSAIDs would not be an issue once the sleeve was healed. I have an alternative medication, but I don't take it because it causes drowsiness and he assured me that it was fine until I can handle NSAIDs again. He was friendly, knowledgable, and overall seemed like a really friendly fellow. I felt like I was in good hands. Rafael was waiting for us when everything was signed, and we piled into the van to head to the hotel. We stayed at the Grand Hotel Tijuana, which was about 10 mins by van from the hospital. Rafael ushered us through the lobby and into the elevators to the 11th floor. He collected our IDs and did the check in process on the medical floor while we lounged and admired the view. Rafael told us what time we would each be picked up the next morning, 5:40am for my wife and I. One by one, we got our rooms and he passed us off the concierges to take us to our rooms. The medical rooms were nice - spacious bathroom and shower, we had a king size bed and several pillows each. ALM provides each patient with 3 room service orders of broth, - sugar free popsicle and a glass of apple juice. We ordered twice and it arrived promptly. I skipped the juice, because I had worked so hard at cutting all the sugar out of my diet and I wasn't going to reindulge the night before the surgery. We were pretty tired from the flying, and even though it was only 6pm in Tijuana, it was 10pm at home and we had been at the airport for 3am. So we enjoyed our broth, watched some Netflix on the iPad and went to sleep. We had to bring our luggage to the hospital the next morning, as we weren't returning to the same room after the procedure and would be staying 2 nights at Mi Doctor. We got up at 4, had a shower and packed up our things. We met Rafael downstairs in the lobby and headed over to the hospital. We were greeted there by a nurse who gave us compression socks and gowns and told us to change into them. We changed, and the nurse came back in to put in the IV. She said it would be a little while before doctors were ready for us, so we puttered around the room and waited. A series of doctors from the surgical team came in, we shook hands, saw pictures of their kids and talked a little about how the day would progress. I was first up, and my wife was second on the lineup. They explained that after surgery, I would be wheeled into a recovery room right beside the OR and would be waking up just as my wife was coming out of her surgery before we were both moved into our room upstairs. After what seemed like eternity (maybe 4 hours, from the time we arrived) a knock came at the door. A nurse sat me in a wheelchair and I was brought upstairs to the OR. My wife was lead shortly after I left to our room upstairs. While in the room, nurses were in and out to hang some signs over our hospital beds and get it ready for us. They moved our luggage in for us, and she waited for her knock on the door. When I was wheeled into the OR, I was given a hairnet and booties and told to untie my gown from the back and hop up on the OR table. I was wearing underwear, but no bra and nothing was said (many people seem to have concerns about this). I was never asked to remove them or asked if I was on my period. The doctors I had met that morning were all there in their scrubs, and we had a grand chat about my work, including lots of questions from them. The anesthesiologist was busy hooking this and that up, and he said I would feel a bit woozy as he injected something into my IV. I felt elated, ecstatic and silly all at the same time. I was still chatting animatedly with all the guys when the anesthesiologist put a mask over my mouth and nose. I do not remember anything after that point. I awoke in the room outside the OR (although I didn't know that at the time) and immediately tried to sit up. I had some pains under my collar bones, and looking down I could see the row of incisions on my belly. I remember asking for wife, was she ok? Yes, they said, she is fine and right beside me. I looked over at her, and then asked "did you do the surgery?" (As if the incisions weren't proof enough) and they said "yes, you did great and your wife too!" Then I went back to sleep. When I was brought out of the OR and still under, my wife was summoned from our room to the OR. She sat with Dr Ortiz who informed her that my surgery had gone just fine, and that I was still in the OR preparing to be moved to recovery. They chatted about what would happen after her surgery, and she was brought into the other OR to be anesthetitized. While laying on the table, the anesethesiologist said "you look nervous, I'm going to give you something to relax and then we'll chat about what comes next." That's the last thing she remembers. I vaguely remember being bumped around off one bed and on to another. This was in our room. It was still light outside, and I immediately went to sleep. I awoke shortly after when they brought my wife to our room, and I was very relieved to see her sleeping soundly in the next bed. We both slept for what I can only assume is a few hours. I awoke suddenly and was incredibly nauseated. I tried to take a deep breath, but my shoulders were hurting and I couldn't breathe deeply. I vomited in my mouth, and threw myself out of bed to the bathroom and spit it in the toilet. It was dark coloured blood, which would have been alarming if I hadn't been so medicated. Feeling better, I went back to bed. A nurse woke us up to check our vitals, and change the IV bags of medication. I asked about the bloody vomit and was told it's completely normal. They gave us an IV shot for nausea and we drifted off to sleep again. This process was repeated every few hours (not the vomiting) until the next day. They brought some warm bags to place on my shoulders, the left of which was developing a very sharp pain. I had some pain in my stomache, like a hunger pain right before your stomache rumbles when it's empty, except it would not rumble. Just a twisting, painful sensation. I didn't have my watch or phone and had no idea what time of the day or night it was. The time difference made it impossible to guess, but I was feeling wide awake. I could sit up in bed, albeit with some pain, and took stock of my surroundings. It was a good sized room, there was some free space to walk around the side of the bed and to foot with a private bathroom and shower in the room. A nurse came in and told us to take a shower, and they would change the dressing on our incisions and we would get dressed in our own clothes. For the rest of that day (day 2), we walked a little inside the hospital, took a few walks outside and wandered around the parking lot (dragging an IV tree) and I tried to walk off the pain in my shoulder. The other shoulder felt fine, but the pain on the left side was making it difficult to draw breaths. We relaxed in our room, played on our phones and chatted. Shoulder pain aside, we were feeling pretty good and mobile. My IV stopped working (unfortunately after they injected a nauseau shot into it, which swelled my hand up a bit). They switched hands for the IV, but my blood kept clotting inside the port and they had to keep cleaning it out to get the IV working. Finally, they asked me if I was feeling ok and just took the IV out, so I was pain med free. The doctor came in to remove the drains the night before we were to be discharged. It was mildly uncomfortable coming out, but my shoulder pain disappeared immediately. We were bandaged up, and told that we would meet at 7:30am the next day to meet for aftercare instructions. We were both brought downstairs for an X-ray leak test with the radiologist, which both showed no leaks. Dr Ortiz came in and told us that our organs looked great and healthy when he did the surgery, and that we had obviously followed the preop diet closely and that he appreciated it, as it makes his job easier. We thanked him and shook hands, and did not see him again. About 20 mins after, I noticed a bloodstain on my inner left arm, but I was wearing a dark coloured t-shirt and could not see that my drain wound had bled through the bandages. A nurse came in right then, and I lifted up my shirt to look for the bleeding. She immediately changed the bandages, but about 5 minutes later it bled through again. This happened 5 times, using a variety of pressure banding and trying to close the drain with bandages before a call was made to a doctor. A doctor in scrubs appeared shortly after, and she lifted off the bandages to check me out. She was surprised that the drain hole was still bleeding and decided to stitch it up. She put in 3 stitches, which immediately stopped the bleeding and bandaged me back up. I told her that I suspected the drain wasn't working properly, since the drain balloon was full of large clots and my IV had been clotting, and told her about the intense pain in my shoulder that had dissipated as soon as the drain was removed. She agreed that it had probably gotten blocked and caused some buildup and pressure, but there was nothing to worry about. We walked, talked, napped through the night and arose at 6:30 for our morning meeting. We showered, had our bandages changed and packed our bags to head downstairs. During the meeting, we all received a little purple reusable shopping bag with some medications, copies of our blood work and leak test paperwork, as well as some ALM goodies, like a tshirt, button, pen and bumper sticker. We were all shuttled over the Grand, and has a debrief while waiting for our new room assignments. It was about 9am, and we had a tour of TJ lined up at noon. We weren't sure if we would go, as the time change was really messing with our sleep schedule and we had been up most of the night. We got to our room, and decided we'd set the alarm for 2 hours and if we felt well, we'd go. Sure enough, a 2 hour solid nap did the trick and we headed out for the tour. Rafael drove the bus with about a dozen patients and friends of patients. We went to a place with tasty ice cream (I was a bit nervous, since ice cream isn't exactly "clear liquids", but I ate a few mouthfuls anyway). I ordered the tiniest child size and couldn't get through half of it. Next they took us to a pharmacy where the pharmacist gave a very entertaining presentation of all the medications they recommend for bariatric patients. B12 shots, pain killers, half a dozen kinds of antibiotics, anti diarreah, medicine for nauseau, and a whole host of others. He wrote prescriptions for whichever medecines you were choosing, so as to not cause problems crossing the border back into the USA. Everyone was filling up baskets, and even getting some of their medications from home unrelated to the surgery like Ritalin, Valium and Viagara. We then went to the "main drag", where lots of tourists buy trinkets, get pictures with brightly coloured backgrounds set up and eat tacos (if they haven't just had surgery, of course). We were supposed to go to a restaurant that serves excellent broth afterwards, but there was a mixup with times and they were closed so we went back to the hotel. We were pretty tired, and basically just lounged around the room and had some broth and went to bed. The next day, we had nothing lined up through ALM so we found our own action. We got dressed, changed our bandages and headed out into the sunshine. There is a restaurant across th street, Fonda Argentine that we had read online serves excellent broth. The door was open, and we stood inside at the maitre'd stand for about 10 minutes. Employees were sitting at a table, looked at us and turned their backs and refused to acknowledge us so we left. All together, we walked about 2 miles around the neighbourhood, checked out the little ice cream stand again, and stopped by a little grocery store on the way to the hotel. We purchased a few of those "3 minute lunch" cups, where you just add water to ramen noodles. We got some spicy beef and chicken ones, and microwaved them at the hotel in the medical floor lobby. We strained the broth out, and it was a welcome and delicious change from the bland chicken broth at the hotel. The next day was our travel day, and we met Jack at 11am in front the Grand. There were 2 others who were there with their daughter heading to San Diego with us. Their flight was at 3pm, ours was at 6pm. It took about an hour and a half to get to the airport, which was much faster than we had expected. We printed our boarding passes for the 3 flights home, and left the airport to take a trolley tour of San Diego. It was about $40 each, and took 2 hours. You could hop on and off at any of the stops, but we were anxious to get back in time in case security was busy. There is an excellent little restaurant past security at terminal 2 called Saffron that sells delicious chicken broth. We got a cup of broth to go each, and boarded our first flight home. LAX had absolutely nothing that could pass as "clear liquids", it was all burger joints and pubs and none even had soup on the menu, so we just walked the entire 2 hour layover. We did stop and have a glass of cranberry juice. We clocked about 3 miles of walking that day, and that included carrying our backpacks everywhere (remember, we carried on our luggage) and we were feeling great. We had the same problem with lack of hot food options in Newark, the only place that serves soup didn't have any soup ready at 7:30am. So we wandered around the tiny terminal, just getting some walking in. On our way home from the airport yesterday, we ran errands in a few stores, stocking up on broths and soups we can strain for the next phase of our diet, starting tomorrow. I was in the kitchen all afternoon making a huge pot of butternut squash soup and a spinach dip with soup like consistency to portion up for work later this week. Tomorrow we are back to our regular schedule! If you're still with me, I hope this will help someone who is thirsty for the details on how this all works! Ask me anything, I'll do my best to answer it!

@BigViffer Yeah, I track all my food in Metric. I wish we would just the rest of the scientific world. Also I notice that even on the packaging the grams in parenthesis are off from ounces/tablespoons, with the grams/ml being more accurate. It doesn't seem like much at one time, but over a month or a year, it adds up. @2-Liter I am really glad you like Keto. I think the key to doing it long term, is liking it. Really enjoying and understanding how it works. It makes it easy to make the right choices in various situations and you don't feel deprived. I also had a lot of bad habits that got me to almost 400 pounds. I am going the opposite now and trying to cement them as habits for life. Like weighing and tracking my food. The further out I get the more lax I want to get with it, but any time I slack off, even for half a day I suffer for it, so it just isn't worth it. If I hadn't been really serious about it in the beginning when it was fresh and I was really dedicated I am sure I would have quit by now. Also being serious about it in the beginning helped me learn that it really works and see the benefits so that also makes it easier to continue. I don't know if you use IG, but this guy https://www.instagram.com/vsg_kingtut_77 started large, he is still a big dude, but he built and fine as $%^&. If I was a big guy starting out, he would be motivation. Anyway, good luck and keep up the good work!

I struggled with the tell or don't tell issue, and finally decided to be honest with family and friends. I didn't want the stress of making up some "I'm doing keto" story or something like that. And after a lot of thought, I decided that I really don't give a flyin' flip what anybody thinks about my surgery. If they don't like it, I couldn't care less. And as it turns out, I haven't gotten any negative reactions. People have really been supportive. If they disapprove, they haven't told me to my face, so I at least haven't had to listen to negative garbage. But to each his own. I can totally understand wanting to keep it under wraps. When I was younger, I probably wouldn't have been so open about it, but I'm now at an age where I don't give a hoot what anybody thinks about me! 😉