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I'm 4 years out and have maintained a stable weight for over 2 years. I've taken a lot of cues from the WLS veterans on this forum because I'm acutely aware that a lot of WLS patients experience significant regain, and I live in fear of that because I've gone through a lot to lose 200 pounds and I don't ever want to go back to obesity. I learned early on that one of the keys to long-term maintenance is closely monitoring and tracking weight, and taking action promptly if it starts to creep up. I weigh myself on a daily basis (usually more than once a day). My weight can fluctuate quite a bit, sometimes by 5 pounds within a single day, so I consider my normal weight range to be 135-140 pounds. As long as I'm within that range, I don't give it a second thought. I may be outside of that once in a while, but I don't worry about it too much unless I stay outside that range for more than a couple of days. I've continued to track everything I eat and stay within a calorie limit. Five years ago, I would have been horrified to imagine tracking my food long-term, but I actually think it makes weight maintenance more sustainable. I could probably get away without tracking at this point because I habitually eat healthy, low-calorie meals, but much like having a financial budget, having a calorie budget allows me to prioritize and make conscious decisions about what I want to consume. If I'm tracking my food, I know whether I have room in my budget for a treat today, or if I want a specific treat, I can make sure to leave room in my calorie budget. I think this is really important because I don't have to go off track or have an out-of-control "cheat day" to eat what I want. I eat healthy foods most of the time (with the occasional treat within my calorie budget), and I've completely overhauled my diet. I've gotten the sense that one of the pitfalls that can lead to regain for WLS patients is that we can rely on our restriction for the first year or so to limit our calorie consumption, but if we continue to eat high-calorie foods like fast food and highly processed snack foods, once the restriction is weaker, we can eat enough calories to regain the weight, and/or eat around the restriction by having multiple smaller portions of high-calorie foods. I eat a lot of vegetables and salads, lean protein (chicken, pork loin, seafood), and legumes, and avoid sugar, refined carbs (rice, pasta, bread, crackers), fried foods, and other calorie-dense foods like cheese. I've discovered a lot of healthy foods that I love eating, so I don't feel deprived with delicious low-calorie meals. Initially, I was very strict about weighing and tracking every bite of food, but I've gotten much more relaxed about it and I just eyeball things that are negligible. I still weigh and measure things with higher calorie density like meat or oil, but I don't measure lettuce because even if I underestimate, it will be a 10-15 calorie difference at the most, and I log half a tomato instead of weighing the exact number of grams. This is another reason that weighing myself is key -- I know that if I'm maintaining a stable weight, my guesstimates must be close enough. Exercise wasn't a huge part of my weight loss strategy; I didn't do any exercise at all for the first 75+ pounds, and then I just did YouTube videos at home. Exercise has become a huge part of my lifestyle in maintenance, though. Not only do I do cardio at home on a daily basis and a minimum of 15,000 steps per day, but I also take fitness classes including strength training a few days per week.

Sorry to butt in as I'm only a little over 10 months post GS but I feel I can share a little of what I'm doing to maintain. I reached my initial goal 3 months post op and continued to lose until about 9 months post op, went much below goal weight and stabilized (I think as I've been the same weight with one +- 1KG fluctuation for 1.5 months). I lost weight very rapidly and the weird thing is, during weight loss I never tracked, I would only check my calorie intake once every 2-3 weeks to see where I'm sitting at but the whole theme was barely eating to survive and insane restriction. Now that I've stabilized I track my intake 3-4 times a week to know where I am at and what daily average intake is. There are non hungry days where I don't bother to track (plus weekends) and days where I'm ravenous and I make sure I track to know. I have also picked up the habit of weighing myself at least a few times a week, sometimes daily or twice a day (during weight loss I weighed once a week only), now at maintenance I weigh more often and only because I never did pre WLS and my weight kept creeping up and I refused to face reality (if I didn't know then it didn't happen). I also believe that what gets measured gets managed. I cook most of my food and eat out about twice a week, I prioritize protein 90% of the time and eat fairly well. I get in at least 140 grams of protein a day but I also don't deprive myself of anything. I eat bread, rice, pasta ,dessert and everything else really, just not in substantial portions and usually after I've gotten my protein in. I workout a lot. Always have and always will and I believe this has been a huge factor in my success so far. I built back all the muscle I lost and I believe my muscles are allowing me to eat much more without worrying about weight gain (I eat between 1500-1900 calories a day, depending on how hungry I am). I walk between 8k-10k steps a day too. Lastly, I have worked out a wriggle room for myself, If I do gain a little of weight then it is no big deal, it does not distress me and I will deal with it when/if it happens. I try my best everyday and I accept that I am not perfect nor do I set unrealistic standards for myself. I also believe maintenance is a mindset shift as much as it's a physical adjustment. Portion control, constant check-ins, daily movement are great habits to build, but also liberating ourselves of food fear and relinquishing the all or nothing sentiment.

Had a productive visit with my doctor today, and there's some good news as well as a few adjustments to make. She was happy with my weight loss progress so far, but made it clear that it could be better. Her main concern is the calories I'm consuming, so the goal moving forward is to cut down a bit. One key suggestion was to start considering protein snacks as meal replacements, which makes sense to keep things in check. Since these are my "honeymoon months," she emphasized that it’s essential to get this right now to avoid hitting a stall by the 6-month mark. My workouts, on the other hand, are spot-on, so the primary focus will be on tweaking meals—specifically reducing carbs and being mindful of snack choices. On the health front, I’ve started taking iron supplements and will be getting my vitamin levels checked this Sunday. However, one piece of disappointing news: the counselor is no longer available, so if I need support, I’ll have to look for external options. Overall, I'm feeling a mix of being a little down but also more motivated to fine-tune my food intake and cut back on calories. I’m determined to make the most of these critical months and maximize my progress.

Had a productive visit with my doctor today, and there's some good news as well as a few adjustments to make. She was happy with my weight loss progress so far, but made it clear that it could be better. Her main concern is the calories I'm consuming, so the goal moving forward is to cut down a bit. One key suggestion was to start considering protein snacks as meal replacements, which makes sense to keep things in check. Since these are my "honeymoon months," she emphasized that it’s essential to get this right now to avoid hitting a stall by the 6-month mark. My workouts, on the other hand, are spot-on, so the primary focus will be on tweaking meals—specifically reducing carbs and being mindful of snack choices. On the health front, I’ve started taking iron supplements and will be getting my vitamin levels checked this Sunday. However, one piece of disappointing news: the counselor is no longer available, so if I need support, I’ll have to look for external options. Overall, I'm feeling a mix of being a little down but also more motivated to fine-tune my food intake and cut back on calories. I’m determined to make the most of these critical months and maximize my progress.

Frustrating & upsetting I know but like everything about this experience (including the amount of weight you lose, your rate of loss, your time line for losing, etc.) the three week stall is just an average. Some will stall earlier & some will stall later. They usually last 1-3 weeks but could be more or less. Don’t worry, you will start to lose again. Just give your body time to reset it itself and work out your new needs. You’ll notice the scales dropping again when your body is ready. Can’t force it. You’ll only stress your body & yourself more.

How long was your stall. Sorry I know this post is old. But I’m in that slump now. Eating 1000-1200 calories. Drinking enough water. And getting my protein. Exercising. Still stay the same right now. Almost for 2 weeks now.

I am 3 years out this month. I track my food religiously every day. I try to eat clean and cook almost all of my food. My calories are on average 1500 a day and as this was my first trial number at maintenance, I was lucky. I don't restrict myself to diet foods. I eat full fat versions. It eat good quality food, even chocolate. I weigh myself every few days. My exercise is limited to walking a few miles, a few times a week. Oh and window shopping in town, once a week. I also stay on this site and read it almost every day as it seems to keep my focus.

I've had the exact same thing. Op was on the 7th of October and I lost about 8kg (18lbs) in week one, and then no budging. But that's to be expected. Are you constipated? This can also help with weight retention. So can fluids and gas post op. Just stay the course and it will drop. Taking measurements and seeing your size go down can also help to stay motivated. You can do this!

Welcome to the site! I'm only two weeks post-op (sleeve) so I'm still learning and adjusting as well. Keep us updated!

I had got my sleeve done on Oct 7th. 1 week post op I lost a total of 6.5 pounds (in addition to the 10 I lost on pre-op diet). But since then, I haven't dropped a single ounce! I walk everyday and I'm still on the liquid diet and just so frustrated. If I have to drink another protein shake, I'll gag. Is this part of the whole 3 week stall????

It is so good to hear an update from you. I am so frustrated for you that you had to go through a stall because of conflicting information but at least you’re on track now. I am on a pretty similar plan my breakfast every morning is a proffee which is a caramel shake with iced coffee on top. Then I eat every three hours so luncheon dinner with two high protein snacks. this actually works well for me to remember all of my vitamins too because I have to take vitamins at five different times a day. that’s so exciting to hear about the clothes fitting and you were so lucky but you have someone to borrow. I think for me my most exciting moment was clearing out some of the things that are way too big for me now. I was actually thinking of asking my team if we could do a clothing exchange at the support group meeting. for the wheats, if you don’t have any look on marketplace consider discount stores as well. I checked several thrift stores for mine, and apparently they sell them separately because I found them in several stores but only one. I ended up finding some at a discount store for 599 for the set. Alternatively, check your library, city, and county websites for classes that use weights. Mine has all the weights there for you to use. And the group classes are really fun, Inexpensive and there’s no commitment. At mine it’s a really cool environment too. It’s nothing like a gym. The women are just average women that are there to get healthy. Nothing competitive whatsoever everyone choose each other on to beat their own personal best or just totally mines their own business. They even gave me my first class free to see if I liked it. I’m sure I mentioned that I started with yoga. I never in 1 million years would’ve considered myself someone who would survive one yoga class never mind love it. Of course I’m horrible and can’t do half of but it’s still a workout and I am getting more flexible and my balance is getting a bit better because of it anyways, congratulations on your loss and finding your groove. Keep doing what you’re doing and keep us posted.

Hello everyone!! I know I did a bit of a vanishing act, but I have things to report in. First of all - I hit a really frustrating plateau that lasted about 3.5 weeks from around weeks 7-10. That had me feeling pretty bummed, as it was post-two month check in and I had been feeling great about my progress before switching from purees to solids. I had last posted about hearing somewhat contradicting information from the nurse and Nutritionist. I had been told that I didn't need to really worry about staying on keto because I wasn't eating much as long as I hit my protein goal and by the nurse to try to stay Keto because eventually I'd get this great burst of energy from going into ketosis. WELL -- After doing some research I found out that the thing your brain tells you would be the worst thing to do - EAT MORE - was actually the solution. I started bringing in more vegetables and an occasional grains while sticking to mostly lean meats, plus using a protein shake for breakfast to keep me on track with my protein goals. I was already using Genepro; and I since picked up one of the Whey protein powders in a chocolate plus some of the PB2. That did the trick! I have started allowing myself an occasional 'cheat' type meal on days that I'm locked in on my protein, and find myself often meeting my protein goal and then some - more like 70g of protein per day rather than the minimum of 60g/day. The result of spreading my meals out - breakfast, three hours later lunch, three hours later 'dinner' and three hours later 'protein snack' if I'm still hungry - DID IT. My energy is up now that I've been walking more and giving my body more fuel. I am seeing the weight loss finally, and even when the scale doesn't show it right away I'm seeing my measurements shift and the way my clothing fits feeling different. I had purchased a cute pair of jeans about a week before my surgery and a button down short sleeve gingham shirt. At the time I couldn't get the jeans all the way up over my thigh; and now they fit loosely. My bras don't fit properly and I already had to buy one in a smaller size. I'm turning down plus sizes clothes I like that I find at the thrift store for pretty much the first time because - they're too big. I'm borrowing shirts from my Mom that I handed down to her previously and other friends handed down to her rather than me because she was a 2x/3x for a long time (mostly due to her chest) and I was a 4x+. I can feel where my arms have gotten smaller in the way shirts don't feel snug in the arms, shoulder, and chest area. I've gone down 2.5 ring sizes! All in all, I've found that portion control is still a big deal, but so is listening to your body and remembering that if it sends you a message about hunger, there is a reason. I DO have to focus on making sure I drink enough water, but the Baritastic app has helped me keep my sugar low. Even if I do hit over 30g of carbs in a day it's rare and because of something like beans, rice, or vegetables. I'm feeling more comfortable loosening the reins a bit on how strictly I adhere to my diet - although I still don't do anything carbonated, do minimal caffeine, and keep sugar very low. The idea to bring your own tupperware to restaurants along with a cooler is really smart. I'm not in an organized group exercise of any kind yet but I do have personal goals like trying to get in over 10k steps three times per week. I'm working my way up and have gotten to an average of around 5k steps each day, which I'm very proud of. My calorie deficit is usually 800+ calories less taken in than what I'm burning via exercise per day, and this week I have lost almost 6 lbs due to exercise and losing the bloat from my first period post surgery. I wanted to mention that - I did miss my first month's period and my second month's was late. As to exercise - I feel the activity in my back and as a low ache across my lower abdomen mainly, which I think is a result of using those core muscles and the way my figure is redistributing the weight on my joints. I'm shopping Marketplace to add weights to my exercise and still use my exercise bike when the weather isn't nice enough to walk. OH! And Old Navy has an amazing 50% off sale on their website right now and I just finally ordered myself some pants in two sizes below my pre-surgery size! I'm so excited for them to get here. Best wishes all, keep up the amazing work and be kind to yourselves!

Almost 5.5yrs post sleeve and also have maintained below goal. I try to eat regularly & to a schedule. Helps me avoid unnecessary snacking and making poor choices because I’m overly hungry. I try to meet protein & fluid goals every day. I don’t track but check ingredients & nutritional content of new foods & recipes where I can and do random checks to ensure I’m not overestimating portions or calories, etc. I try to ensure I eat meat (yep I’m a carnivore), vegetables, fruit, dairy, and complex multi/whole grain carbs everyday. Add beans or lentils to various meals at times. I adopted a way of eating (not a diet) that is working for me & is sustainable. It doesn't stop me socialising or make it a challenge to make food choices. I do some sort of exercise almost every day (about 20 minutes a day total & not traditional ‘exercise’ but stretches & resistance bands). I weigh myself at least a couple of times a week. I can’t control every aspect of my life every day so I don’t beat myself up if I go off piste or decide to treat myself or can’t follow my regular schedule or can’t meet my goals or whatever. As long as it’s not the norm and a regular occurrence, I’ll be okay. And if something changes (ill health, the crap life throws at us, etc.), I’ll look at my options, make changes where I can or just work with my new reality.

I was supposed to have my surgery Dec 28 last year. I had the option of taking a last-minute cancelation the Monday of Thanksgiving week, but when I told my mom (whose help I needed with my kids), she was totally against it. Said I would ruin everyone's holidays if I had a terrible recovery and kinda made it all about everyone else. So I gave up the date, even though it pained me to do it, because I didn't want to be selfish. A couple weeks later, my hospital discontinued their surgical program and canceled my date. I was devastated. I had to rebook with a different program, which was still affiliated with the parent organization of my hospital, but unfamiliar to me. I didn't end up getting my surgery until February. It was very stressful and I was pretty angry with myself for not choosing what I wanted instead of what other people wanted me to do. Having said that, it did all work out for the best in some ways. Apparently, the November surgery date would have been right after the doctors at my old program were told the center was closing, so maybe that would have meant the surgeon wasn't as focused going into my surgery, which could have been dangerous for me. And I would have had to do all my follow up with a different program, which would've been awkward. And I appreciate that I knocked out my deductible in February so have had full coverage of all my tests and appointments all year. I actually have a biopsy I have to get done next month (not related to bariatric surgery) and that won't have any out of pocket costs, so yay for that. On the other hand, my recovery was pretty much text book, so all my mom's worries over me ruining the holidays with a terrible recovery were baseless. I was pretty self sufficient and back to about 80% functioning by the end of the first week. And 8 months post-surgery, the holidays are rolling around again and guess what? I still can't eat more than a tiny plate of turkey breast, a few green beans, and a bite of pumpkin pie. I still won't be baking a million cookies or drinking a pint of egg nog. So, whether it happens this year or next, your family will have to figure out how to navigate around your new normal. If it were me, I would decide based on what makes financial sense (your deductible, etc.), what works for you with time off work, and would probably avoid the two weeks right before Christmas just because you will need some time to recover in peace without holidays adding to your stress. In retrospect, waiting until February wasn't such a big deal, though, so if you do have to wait, it will be okay. Just make sure you do it for yourself and not for everyone else.

No thanks would be ideal hut if your family and friends are like mine and just won’t let up sometimes a little white lie Iis in order. What i did with my sleeve at Thanksgiving and Christmas was just to take the food, eat my tiny portion say it was delicious and tell them I will be hungry in another hour and I plan to finish it at home. (I tossed whatever my hubby wouldn’t eat but it spared them feeling as if I didn’t enjoy it). There was WAY too much food so it would’ve ended up getting tossed anyways. Even after leftover week. If you haven’t told anyone about your surgery you can just say that it’s delicious but your stomach just feels a bit off and again take a plate with you to eat later and give it to someone who can have it. If it will tempt you though, just say no thanks and be persistent. I was actually thinking about a holiday dilemna too. I am always invited to an annual cookie day. Everyone brings their supplies for a recipe and makes like 2 dozen cookies and the host makes tons of sugar cookies the night before for the kids to decorate while the cookies are baking. It’s a while day of eating junk, drinking and smelling cookies. I don’t think I can do it this year, I’m too early out. I think I’m just gonna be honest since they do know about my surgery. Tell her I will pop by and say hello but I am not gonna stay.

I'd suggest taking a look at The National Weight Control Registry at http://www.nwcr.ws/. This is a long term list of over 10,000 successful "losers" that have lost weight and kept the weight off for long periods of time. If we dig into the data a bit, a few things seem to come to light as keys to successfully maintaining weight loss: 78% eat breakfast every day. 75% weigh themselves at least once a week. 62% watch less than 10 hours of TV per week. 90% exercise, on average, about 1 hour per day Of course, another thing you'll see in the data is that there really is no one size fits all model for success. While the trends above are helpful for most people, there are people that are successful that don't exercise, that never weigh themselves, and don't eat breakfast. The point is that ultimately you have to find out what works for you.

for me: (1) continuing to track my food intake (via MFP) and weighing myself daily...and making adjustments when a moving weight trend shows up in either direction i dont really want. also, (2) regular exercise (which morphed into a love for exercise) and (3) striving to maintain an angst-free existence: understanding that i am not perfect, that nothing is forever, that i believe i can and will adapt, accept OR change, whatever the circumstances. i am 6 years post op next week and have maintained below goal weight this entire time, following my own advice above. i know that my M.O. is not for everyone...but i also know that each one of us can figure out what works for us (and what doesn't) and act accordingly, if we choose to.

Good idea. I think it’s pretty standard to require all the labs at three months but my surgeon did require me to go to my PCP a couple weeks after my surgery also. I think it was more of a cookie cutter thing for people that were on medication’s and things that may need them adjusted, but it was in the paperwork so I just did it. it couldn’t hurt. I bet they could answer most questions. Perhaps email your teams office and ask them exactly what labs they suggest.

Today’s win for me is finally starting to feel like I have found a bit of a balance with my life. For the past two months everything has been on hold and life has been 100% about my recovery, nutrition and fitness but I finally able to juggle my crocheting and make time for my hubby to hang out and do things. I was really not making time for crochet very often so I joined a second group so at least I am working on it twice a week but I have been working on it more than that this week. I did decide no handmade Christmas gifts this year though. I make chemo caps for the local cancer center and they are more important than my family getting new towel toppers if I have to pick one.

I just watched a video on the procare website that you might enjoy. I get my Bariatric vitamins from procare and they always have very informative doctors etc come on. A few key points made 1. everybody loses weight after bariatric surgery. 2. not everybody maintains weight loss. 3. after gastric sleeve 7 to 50% will gain weight after the seventh year Mark . he goes on to state that success is not about fault, but about physiology he goes onto state that surgery does not change your genetics. he goes on to state that those of us who gain weight have a calorie balance issue our body is not balancing it like it should. versus a person who does not gain weight. he goes on to state that movement at least five times a week is very important and that determining physical hunger versus emotional hunger is very important. Etc give it a look

I was finally able to get in over 10k steps yesterday. I'm still two weeks post op so no strenuous activity or lifting so I have to walk to work instead of cycling. At first I was annoyed because I love cycling, but I think having to walk will kick-start the weight loss. I've lost 8.5kg (18.7lbs) in the two weeks since surgery and walking helps.

I'm only two weeks post op and it doesn't hurt to eat unless you eat too much. I've learned pretty quickly what "too much" is so it's not painful to eat. Just eat slowly and your restriction will stop you from.being in pain. My mother had bypass in 2008 back whe it was standard to do an open procedure. She was able to eat almost anything and she wasn't in pain when she ate 15 years later. If they are 3+ years post op and still in pain when eating, they are probably either not eating correctly or they should speak to their surgical team.

I had sleeve revision to SADI (just the bypass portion) and I am really happy with my decision. My surgery was August 7th so I am about 2.5 months out and including my preop loss I have lost 55 pounds. I am over halfway to my goal. I have been eating 100% on plan though and exercising a pretty great amount (2.5-3 hours a day). The revision surgery gave me the metabolic Hca Hes tk actually do Al of that though. I never exercised or prepared fresh homemade food with my sleeve. Didn’t have the motivation. It made a pretty huge difference for me. Did your Dr do a endoscopy, barium swallow and gastric emptying study? Mine did those tree before deciding I was a candidate for SADI or Bypass. If the sleeve didn’t work for you long term then I would probably lean away from a ReSleeve. Just thinking why repeat history. Try something different but that’s just me. The research does say that the loss is more durable witb the SADI revision than the Bypass. Not certain about the ReSleeve but my guess is that too since the Virgin Sleeve doesn’t have the best statistics for durability. Also, resleeve is kinda risky. My Dr said he wouldn’t touch the sleeve with the SADI not because of my BMI but just because he doesn’t think it gives that much more benefit to justify the risks so that’s something to look into as well. Ooh and if you do have coverage for the GLP-1 and you can tolerate them, they do work. They don’t have to be long term for everyone either. If you take the time on then ti make real lifestyle changes you may be able to go off of them and maintain. Ibvuously If you just eat a few French fries for your meal you will lose, but will obviously eat more when you don’t have the meds but if you genuinely change your habits then people do maintain the loss. I have a friend that is almost to goal and she has been asking me for advice of what foods to choose to be sure to get her protein in. Kinda odd because she is smaller than me but I have heard a couple success stories with them. My friend has to force herself to eat. It’s a chore. If you do go that route, talk to your doctor about staying on the lowest dose that works for you. That’s the thing that many bariatric doctors usually recommend and it makes sense to try to avoid the side effects. . And some people go onto a maintenance dose after they reach their goal if they need it. Also, see about a three month supply when you do get to the dose that works because for my friend it’s cheaper that way. I strongly considered them but I didn’t have adequate coverage. I even considered postponing to see if things would change but my family Dr advised against waiting since these things can take a long time. There are pros and cons of each option but do your research. This is a good start but make anothet appointment with you surgeon if you have more questions. I did several before I decided. You probably only have this one more shot at this. Not a lot of surgeons will do a second revision ooh and that is one thing to consider if you do go with SADI, it’s newer so ask your surgeon if you had a complication god forbid what you would do. Mine actually brought it up that he would send me to another hospital to someone with more experience with the surgery. I mean obviously he would stabilize me but if I needed a revision because of malnourishment or something he would send me elsewhere. I kinda respected the fact that he would admit what his limits were and appreciated it but maybe you feel differently about that. Or maybe your surgeon is fine with revising if necessary but I would for sure ask.

I appreciate your taking your time to reply ❤️ I feel like I'm not communicating my feelings as efficiently as I can. My thoughts about dieting are similar to that of surgery. I feel as though its a punishment because "normal" people don't need to do this. My downfall is comparison- The line of thought is if I were just an average person, I wouldn't be so big in the first place, I could eat what I want and actually not go overboard. I could do so many things differently, in my head. Realistically I know obesity is on the rise so everyone eating what they want is no longer realistic for many. It's more or less wishful thinking at this point. I've been dieting since I was 5, and believe me that does feel like a punishment lol. I see my counselor once a week, because I, like so many, have a lot of trauma in my past. Late last year I checked myself into an outpatient eating disorder program for binge eating, because I was sure that is my problem. After 4 weeks of doing multiple hours long sessions, I was told my issue is not eating enough when I start my day, and then that trigger major hunger later. Truth be told I don't know about all that, I do know I need to heal my relationship with food and I am working on that. All in all, I know I will make it through, I've been working towards surgery since January of this year. It's given me a lot of time for thinking and reflecting. Too much time sometimes, lol. Thanks for hearing me out and all the great insight. I truly do appreciate it ❤️

My pre-surgery Vitamin A was 43. It had dropped to 27 at 4.5 months and was up to 34 at 7 months, but "normal" is 38 or above, so the doctor is having me take 10,000 IU of Vitamin A daily for two weeks (which is the same as 3,000 mcg) just to bolster my levels. I will retest before my 1 year surgery follow up. You can get Vitamin A supplements over the counter, no prescription needed.