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Is there anyone here that's post op 7+ years having health struggles, what are they?
Lookin4answerspostop11+years replied to Lookin4answerspostop11+years's topic in Gastric Bypass Surgery Forums
I totally agree that it has given me my life back in many ways. and with my aunt 600+ pounds and died early in her mid 60s of stroke and was in a nursing home at 60 after her first stroke. Im very grateful to still be here and have life. Id just like to improve my health significantly so that at 47 with two younger kids (7 and 8 ) and parenting totally solo on my own during covid, I want to be here as long as I can and live a healthy and full life. Hi you asked for a bit more details so here it goes.... possibly related yes, possibly no... just seeking possible ways to become stronger, healthier and live my best life with my kiddos. Im not saying anything against wls surgery at all... its given me so much for quite some time... im just concerned and looking for possible solutions as I think most would if a snow ball multi system deterioration is happening and no specialists have answers and the gastric bypass specialists won't see me. I am sending out a question to see what might fit to help improve my health, that's all. thank you to all for understanding and reading this. Without weight loss surgery I wouldn't probably have been able to have my kids (I was told previously I would never have kids at the weight I was at and with the health issues I was having at the time related to my weight... so no I definitely do not regret it... but I would love to have my health back and improve my and my kids quality of life to an even greater extent. Thanks again! Im 47 female I weigh 180 pounds and at 167 my bones were sticking out and I was receiving a lot of concern as people assumed I was down to 130 on my almost 5'8 frame that's always been very muscular until I gained all the weight in my 20s. Up until then I was very athletic, voted most athletic female at my 1500 student high school, won all possible awards with sports and leadership and invited to try out for the Ontario Provincial Women's soccer team. Im saying that as most BMI charts would have and did conclude I was overweight even while playing for rep soccer, basketball and volleyball teams etc. so the the BMI for me has never been a good indicator of health or fitness. These are my struggles Third Degree Complete Heart Block and flat lined for recorded 22 seconds on a halter monitor. Some may argue it could have been a vasal vagel response (although they usually tap out at 10 seconds)... and if in this line of thought were true, part of the vagus nerve is severed during gastric bypass reux en y surgery, most often not the part that can affect the heart yet any slight injury can occur during surgery especially to nerves. If my vagus nerve was nicked by mistake in the wrong spot, even without surgeons awareness, It could cause a vasal vagel response and shut off my heart temporarily (as its a nerve conduction issue). I developed this complete heart block in 2015 but had symptoms starting in the fall 2009/winter 2010 that could point to the start of the glitches with my hearts electrical circuits. I also developed super ventricular tachacardia (SVT) that did not pre-exist surgery. No arrhythmias did. But I also have heart conduction issues in my family... so it could be genetics or a surgical complication unrecognized during surgery. I have always had stellar bone density. I was tested pre-surgery and they were shocked that someone at my weight (450+) had such strong bones. In 2014/15 I started having back issues and did my bone density test and I was diagnosed mild degenerative disc disease in L4-S1. Three years later its now moderate to severe with a leaking disc, slipped vertebra, and a vacuum affect pulling my spine over to the right. I also now have it in my thoracic and cervical spine all at the mild stage right now. My calcium levels are normal. This may be the cause or one of the causes of widespread ligament/muscle inflammation surrounding my entire spine. Because of no nsaids to reduce the inflammation and because its such deep tissue the anti inflammatory topical creams don't help so much. I have also developed more than 1% bone density loss in my right hip and was told on my report that the Ontario Government recommends bone density repeat testing in one year. I did have a GP at that time but she refused to refer me saying that's not a big enough risk as it is compared to the exposure of the scan. I disagreed but was blocked. Im still in search of a GP (family dr but rural/more northern communities are all in short supply of family drs. People are driving two hours and keeping their family drs when they move because finding one is next to impossible. My hip now is so painful that I cannot lie on it at night. Yes it could be bursitis or it could be due to bone mass loss. This started in my early 40s and has been worsening rapidly. (I had WLS at 36). My teeth also have started to physically crack and crumble, the dentist thinks its somehow related to malabsorption although my tested levels of calcium are normal. I don't know... They aren't sure with the deterioration of my spine if that is causing nerve damage and peripheral neuropathy in my lower extremities as the CT isn't clear enough to see and the referring neurologist who was involved at that time said that all Toronto Hospitals she contacted said no to an MRI until my legs start to give out, as Im too high risk of another complete heart block. Ive also had a lot of cardiac ablation surgery for the SVT and that even in people without previous heart blocks increases the chances of severe heart blocks and death with one spot ablated, I had 7. Yes the heart blocks could be hereditary, yes the svt could be hereditary, the bone density no. The possible way to diagnose this and other neurological issues (which could be ms or my spine deteriorating is possible) cannot now be done due to my heart history that may or may not be related to a vagus nerve injury sustained during surgery and I can't get help to remedy this until its so severe I can no longer do activities of daily living, maintain independence because of risk of falling and loose my lower ability to function. To find other answers to shore up my spine (bones) and make them stronger is imperative to have a good quality of life and function well as a mom of younger kids on my own. I also have since developed very low blood pressure as well now which was never an issue that has now started to have episodic high spikes. This makes medications difficult too low or too high Im in trouble. I had my pacemaker put in in 2015 and another this past October 2020. I have a lot of gas showing to fill and expand my non functioning stomach and I asked the GI when I had one in 2018 why my stomach is so full of air/gas when no opening from the top is there, it only drains downward. I suspect possible infiltration of SIBO somehow or another gas producing organism but he just shrugged and didn't pursue it. My abdomen has now started to severely distend to the point that I look 9mths pregnant, its hard to breathe, and its hard as steel as my 8 year old would tell you and he says its usually mushy lol with all my extra skin. this occurs after I eat especially although its always tender and slightly hard and swollen... just worsens when I eat, not sure if its connected to my cycle and digestive tract, if my stomach that's been severed has issues now that its not functional (just drains gastric bile/stomach acid) and this abnormal non use of my stomach specifically has reacted over time to this, how bacteria migrated upwards while gastric acid flows down and out. I just don't know... possibly totally unrelated for sure... these are just some of the issues... Im just looking to see if any one in this specific community has any similar issues and if they resolved, how. -
I’ve been approved for a revision
YESSYISAWESOME replied to Glorious Release's topic in Gastric Bypass Surgery Forums
hi there question, so you had the sleeve, then they did the REVISION to the BYPASS? -
Is there anyone here that's post op 7+ years having health struggles, what are they?
Lookin4answerspostop11+years replied to Lookin4answerspostop11+years's topic in Gastric Bypass Surgery Forums
I have heard around year 7 from a fellow gastric bypass patient when I first had the surgery as she went for her follow up (it was in the States - Ontario doesn't follow up past 5 years) that the hormones that make you hungry that can be dampened by cutting the vagus nerve near the stomach somehow (Im not a dr, or biologist) start to rev up more than they have since surgery and this can be a period of readjusting to a hunger level that most of us may not have had for several years which makes loosing that last bit and keeping it off a bit more challenging. I think going right back to the basics post surgery and doing a food journal (as painful as that is after awhile lol) could be extremely helpful to find many answers. be sure to include how much water your drinking each day and is it at least 30 minutes after eating, are we all being conscious of taking time to still really chew everything? I think if I found my initial binder of what to do and not to do that may help me again as a fresh reminder, not sure if this may be helpful? It might be for me, thanks for asking this great question! Im interested to see the responses for myself and my own health and weight loss of the last 15/20 pounds, again.... -
Is there anyone here that's post op 7+ years having health struggles, what are they?
Lookin4answerspostop11+years replied to Lookin4answerspostop11+years's topic in Gastric Bypass Surgery Forums
Hi guys, so here goes... if you are wondering why, if you are thinking this is far reaching this far out from gastric bypass reux en y surgery than this whole message might be of interest to you... if not ... no worries... just responding and hopefully clarifying as best as I can. Not sure what you mean by my question being far reaching, can you let me know what you mean, Im honestly just looking for anyone who might have experienced some health challenges that they are curious if there surgery could have been impacted, worsened or created by the surgery. Im not looking to blame my health on weight loss surgery nor am I saying its a good or bad choice for anyone, that's a personal decision for sure. Im just looking for possible answers in several places (other than bariatric as well) to find answers so I can live my healthiest life that all and if someone else has had complicated health issues or is several years post op and health in many areas has weirdly changed in not so positive ways, what they may be and did they find a specialist or find a solution/decrease in symptoms or cure and what that is. I know its a needle in the hay stack but I am also doing due diligence post surgery as I did presurgery to look for all possible ways to make the most healthy choices for my life. I started to have one thing after another happen starting in roughly 2014 and increasing to the point of 5-6 years later involve multiple systems of my body. The follow up here in Ontario with a gastric surgeon specialist or any gi for that matter, nutritionist, specialized nurse practitioner etc. is not covered by OHIP (our medical coverage in Ontario) past 5 years. I did get a consultation at about year 7/8 when things started to accumulate as far as symptoms, diagnosis's, and medications, specialists etc. But he was just please I kept my weight off and did a general food diary check, supplement check that I was using and just said Im not sure, all these things aren't directly related to gastric bypass and all the best as he said we only follow up for 5 years as a way of gathering data, research, and statistics, once the 5 years are up, its up to your GP (general practitioner) to follow you. In Ontario we have a severe shortage of GPs and mine retired and soon after I moved out of the area and cannot find a gp to even do regular blood work and keep an eye on all the health stuff, let alone gastric bypass related regular check ups, that just now up to walk in clinics that I wait to see whoever and check my own levels online if they will do the test and as they remind me I need a gp and when I ask where would I find one, they go silent. Am I saying its related not necessarily yes and not necessarily no, all I know is our gut is our second brain and controls so many functions in all systems throughout our bodies, even often telling the brain to release or decrease certain hormones, proteins, chemicals throughout our body to attain a delicate balance of homeostasis. So I don't think its a huge leap to say the gut controls a very substantial amount of systems in our body directly and indirectly and when manipulated may effect what seems to be a totally unrelated system. Am I saying this is coincidental or due to life stressors maybe, maybe not... I just don't know and I don't think even most or any gastric surgeons know yet either because to be honest I don't know if that's included in their 5 year max research and stats before your on your own. I know its probably for most gastric surgeons, in there best interest to say no, it can't be connected to gastric surgery and be blown off for many reasons that don't need discussion as far as Im concerned. could it be the accumulation of the perfect storm of gastric bypass surgery, chronic unforeseen life stressors AND heredity, age, all of the above yes I think so.... Im trying my best to seek for answers and do what I can in the area of management of my life stressors, self care, living a healthy life style according to my surgery requirements and and what's best for me, could it be bodily changes just due to aging + all the factors that make aging a more challenging journey than it needs to be, could it be hereditary or just coincidence... I think yes to all of that. Yet if I am willing to seek answers in all areas of my life that could be having an impact on my life, I feel that not seeking answers in this area would be irresponsible to my health and sticking my head in the sand... I think its all important and contributing factors for me. Im just looking to see if others have some commonalities that may give me clues as to what may be part of a complication directly or indirectly related to the surgery or supplement brands/types/ways of administration to provide best deliverance of vital minerals and nutrients. Im sure everyone researched very deeply into surgery just like I did. Does it not make sense than for me to ve researching deeply into possible connections that may be simply modified that could have an amazing cascading positive affect on my health in many areas, may be to something very simple and overlooked by me or specialists yes... because I want to live fully, be healthy, enjoy my life... so searching for every possible way to improve my health is vital... I am worth it. Hope that makes it a little more clear as to my question and why I am seeking some answers here. Even if slim... fit me, every possible help from anyone, is much appreciated as a community of people who have been through this process. We are here because of a common bond, common fears, questions, concerns and victories. I am just coming from a different point in my jouney than most on here... yet I have hope by seeking I will find answers and even though Im post surgery by quite sometime I can also add value to this community of things that have been absolutely changed my life in so many great ways, yet also valued enough to ask the questions... I want answers and my health complications in some or many areas has been somehow caused or contributed to my complex health struggles in any way than that's important information for not just me, for all of us... is it not? -
Anyone have issues with their tongue feeling slightly numb and the tastebuds on the tip of the tongue seem dead? I'm 11 months post op mini gastric bypass and I've had this for the last 8 months and it won't go away. B12 levels are good. All labs are, actually.
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Post op 11 (+) years post op (2009) gastric bypass roux en y. I have had two children post op, 11 months apart, just over two years and three years post op. I have had pretty good success with weight loss. At my highest I weighed 453 pounds,
I lost had lost 100 pre-op years before but couldn't loose weight at all anymore no matter what I tried, my health was deteriorating.
Post op I lost 193 more from August 2009 to June 2011. I had lost my most weight in 2011 and was down pre and post op 293 pounds.
I gave birth to my first child and had a healthy baby at the end of May in 2012, and gave birth again to my second and last child to a healthy baby very first of May 2013. My weight fluctuated a lot. I had some major stressors occurring, I was married in 2011 and was told years ago Id probably never have kids due to my health issues and obesity. (at this point I was 38 and early menopause was a.family thing) lol
They were very wrong lol. I had two healthy babies in less than one year roughly 3 years post op. It was a challenging time. I was married post op to a life long acquaintance who became more and was married for my first time in 2011, then gave birth in 2012 and 2013. My dad had a stroke three months after my second child was born and passed away in late 2013. I separated from my husband 5 months later with two children under two.
My biggest fears while pregnant was around whether or not my developing babies were getting the nourishment they needed with what my body was absorbing and with the supplements post surgery. So honestly, it was ummm Im going to eat everything I can (do not recommend AT ALL, not so fun if I ate too much, or had a little too much carbs or fat!!!! but think of the old mentality of "IM eating for two ... on steroids with Im eating for two using a shot glass to eat at a time... so eating around the clock became a habit once the food went through (I still if Im paying attention and in the present moment feel the food and drink exit my pouch - not sure if others experience this? Or its another just another thing that makes me special
....
I live In Ontario and was covered to go to a hospital in Rochester NY for surgery because of my health deterioration and at that point severe back log and health complications. My brother has also had the surgery and he is post op 7 years (approximately) and we have very different outcomes some better some not. Unique just like us
. He has been physically healthier and has regained all his weight. I have kept most of my weight off yet am struggling with complex heath issues. Whether or not this is connected to our differences as people and circumstances, or if it has something to do with surgery and/or post op changes... Im not sure and Im not sure that can in all cases be even answered.
Post operatively, even years later the benefits and blessings that Im so grateful that are part of my life has been absolutely astounding AND the health complications and complication have also been scary and dumbfounding. So both are possible even at the same time, but alas such is life for everybody.
right now post up Feb 2021 I weigh 187 pounds and my lowest weight and target weight is 170 because that's weight I feel the most healthy and confident at and (Im big boned and always been muscular) people aren't on my case about being too thin ... (That part Never Gets Old LOL)... actually it does when they start asking if I have now developed the opposite (but of often the same or similar general origins in my experience). eating disorder of anorexia (at 170 pounds - because no one weight is ideal or healthy for everyone... we are all incredibly and wonderfully unique with a spectrum of healthy weight ranges that are as individual as each of us are). Going below 170 when I dipped below did not create in me a feeling of health, energy, and confidence. So each of us have a healthy weight that's different. Dversity is awesome in weight as well as long as we are healthy and confident.
I hope this message finds you well, confident, excited, healthy, vibrant, living your best life and going for the moon.
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Ugh that's really frustrating! I can totally feel how that would be disappointing. That said, you must have lost a bunch pre-op; that slows your progress. I'm not sure what you mean by water? Unlike the sleevers, we bypassers don't have a high-pressure pouch. It shouldn't be that hard to drink for you after 5+ weeks. Maybe some RNYers can chime in? Are you otherwise sticking to the plan?
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Setting a goal weight?
ms.sss replied to Sleeved_in_MN's topic in PRE-Operation Weight Loss Surgery Q&A
My surgeon didn't have a goal weight for me, only that he said he would consider me a "success" if I lost 60lbs in the first year (This was calculated as 60% of excess weight, based on BMI 25 ideal weight). I had different ideas: I aimed for 120, which was just about the mid-range of "healthy" BMI for my height, AND was the weight I was when I met Mr. back in my 20's. I later changed this to 127 as I felt it was enough at the time. Anyhoo...I got to surgeon's goal at 3 months. I got to my revised goal at 7, then to my original goal anyway at 8. -
Hi, I am 20 years post op and my stomach still makes a lot of noise especially at night. I'm happy that I came across this website because I was really starting to get concern. I guess I'm noticing it a lot more now. The gastric bypass was worth it. I used to be 250 and I am 140 and holding. I wish you all the best with the surgery.
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Hi! I had a question regarding weight loss.
NovaLuna replied to ComradeOrwell's topic in Gastric Sleeve Surgery Forums
Hi Kai. To answer your question... it's possible, but the statistical average of gastric sleeve says it's unlikely. There are many people who have gone above an beyond statistical average though. It depends a lot on 1. how your body takes to the surgery, 2. whether you follow the nutritional guidelines, and 3. how determined and motivated you are to work with the surgery and make it work better for you. Personally, since you're at a higher weight I'd suggest gastric bypass or DS or Loop DS. If you have any acid issues I'd definitely say the gastric bypass. But, it's very much your choice. If you feel like you can work for it and keep yourself motivated and are more comfortable with the sleeve then go with the sleeve. So yes, it's possible, but it'll be hard. I wish you the best on your journey! -
Day 6 super super irritable doubting my sanity
Recidivist replied to WafflingWafa's topic in Gastric Sleeve Surgery Forums
I had surgery a couple of times before bypass, so the people around me already knew that I'm not terribly pleasant when I'm recovering and basically steered clear of me in the first couple of weeks. This surgery is more major than many of us realize, and it's understandable that you are not yourself. I'd recommend a conversation with your family to express what you need (and don't need from them)--and apologize in advance for any future crankiness. -
Hi everyone. I am one year and six months post op gastric bypass surgery. I originally had a sleeve but got a revision due to bile reflux and a hiatal hernia. It seems like I am constantly nauseous off and one. Some days nothing and other days it's terrible. I have had a lot of testing done and I was told some can just have this post op. I have tried a ton of different medications and no luck. Any advice or suggestions would be greatly helpful and appreciated. Thank you! Sent from my LM-Q730 using BariatricPal mobile app
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Can you have pasta after surgery?
Recidivist replied to Circus321's topic in Gastric Sleeve Surgery Forums
I'm celiac as well and have had no trouble (after bypass) with gluten-free pasta. As you said, however, we need to watch the quantity due to the carb content. Your homemade pasta sounds yummy! -
Looking to go from sleeve to either bypass or DS
RickM replied to Megxelizabeth91's topic in Revision Weight Loss Surgery Forums (NEW!)
For treating a regain problem, I prefer the DS as it is stronger metabolically than either the VSG or RNY - the RNY is too close to the VSG in strength to reliably offer a significant improvement in weight loss, from what I have seen over the years. Figure maybe 20lb loss on average - about what one would expect from going through all the intense dieting associated with going through surgery again. (There are some who do significantly better, bit it seems to be more a function of their determination to "make this work" or "not screw it up again" than the actual surgery itself. Call it something like a surgical placebo, lol.) By your surgeons not finding the codes for the DS implies that they are talking about the newer SIPS/SADI/"loop DS" which is a single anastomosis adaptation of the traditional BPD/DS (biliopancreatic diversion) which has been routinely covered by US insurance and Medicare for the past 14-15 years, but is a more complex procedure that relatively few bariatric surgeons perform. Some practices that do the SIPS/SADI use the BPD/DS billing codes which is technically insurance fraud, but if they're comfortable doing it, that's their concern. Revising the VSG to a DS, of either flavor, is straightforward as each use the VSG as its basis (some don't even consider it a revision, more a "completion" of the ultimate configuration.) The strong point of the BPD/DS is its regain resistance - regain is possible as it is with any of these procedures, but it is harder. I know many with the DS who are 10-20 years out (my wife included) who are still maintaining a healthy weight; some are up a bit more and working on losing their "Covid 19" - just like "normal" people but major regains are relatively uncommon. The SIPS/SADI type of DS seems to fall somewhere in between the VSG/RNY and the BPD/DS - I have seen a few in the various forums who have had it and seem to be doing well with it, but it doesn't have as long a history. Any of these procedures - the RNY, DS or SIPS - will be somewhat fussier and less care-free than your VSG when it comes to supplements and follow up; the RNY is maybe a bit less so, but one can get into some serious trouble with any of them if one slacks off. If keeping up with supplements and annual labs is not an issue with you, then any of them should be fine. -
Any teachers out there?
Bronxcutie replied to Jnfinney's topic in PRE-Operation Weight Loss Surgery Q&A
I’m a Pre-K teacher. I had gastric bypass surgery on Dec 23, the last day of school before winter break. I just returned to work on January 25. Timing was perfect since I would have had two weeks off anyway. I made the right choice by taking off an additional two weeks. I tend to feel a bit tired at times probably due to the restricted food intake. It did give me a chance to rest and prepare mentally and physically to return to work. I honestly felt and looked refreshed! I was cleared by my surgeon pretty early to do cardio and light weights so I did use my elliptical, recumbent bike and weights at home. It also helped that I was able to try foods at home to see what I could tolerate. I would definitely recommend taking off at least three weeks if possible. -
Can I clarify whether you have had bypass surgery yet? Your profile says that you are pre-op.
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Looking to go from sleeve to either bypass or DS
Megxelizabeth91 posted a topic in Revision Weight Loss Surgery Forums (NEW!)
I got the sleeve in 2011 and I lost about 100 lbs after.. since then I have gained about 60 back. I had a many complications with the surgery and had my staples pop and had to have follow up surgeries. Since then I have found an amazing doctor who I trust and he spoke to me about a revision surgery for weightloss. He recommended the DS but apparently their was not a surgery code to bill it yet * this was last January 2020 * . He then recommended the bypass. I agreed and started everything with hopes of getting the surgery by June 2020 before he retired. Due to covid my surgery got pushed indefinitely and he retired. In august when they started to do elective surgeries again a Doctor from his group reached and said that my original doctor asked this new Dr. to take me on as a patient moving forward with the surgery. I had decided that I did not know him that well and would not proceed at that time. Well I am still struggling with weight loss. A huge amount it is effecting my daily life I work in trauma and psych in the hospital and I am in nursing school and having issues keeping up due to my energy and weight. I have recently made the decision to continue with the pre op tests and get my chest xray and labwork redone to see if I can fast forward this surgery and get it by end of march beginning of april. I was just wondering for people who have had the revision surgery --- sleeve to bypass or sleeve to ds - how it ended up for them. I doubt I will be able to get the DS even though that is what I want due to the insurance issues so bypass is the way it looks. Also recovering times and everything else please. I am doing this one solo only 1-2 friends will know I am having the revision due to so much stress and people giving me their opinions about the situation the first time I do not feel like dealing with again. -
I had gastric bypass surgery yesterday morning and believe it or not,a day later and I am feeling pretty good. Very bloated from the air they pumped into me but no nausea or severe pain. I see I have gained about 9 pounds from the IV fluids they were giving me in the hospital but I am sure they will come off soon enough. Has anyone else experienced this? Has anyone else had the experience of feeling better than you thought you would? Reading some of the forums before my procedure had me really scared. Sent from my SM-G965U using BariatricPal mobile app
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I had a revision on 1/11 and I am going back on 2/1 , so 3 weeks with no lifting required job. I wanted 2 but Md said no, and I'm glad because I still get tired. Sent from my SM-G965U using BariatricPal mobile app
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I had the (Robotic RNY) gastric bypass
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I announced on Facebook today that I am planning on having gastric bypass. I am an honest person, and transparent as far as my thoughts and feelings, so I wanted everyone to know what was happening before I started losing massive amounts of weight. Everyone has been very supportive in their responses thus far but it has left me feeling exposed and vulnerable. Bring on the anxiety. On a positive note, I've lost 2 more pounds and have gone down 2 pant sizes since starting this journey. [emoji1373]
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Today is officially my 1 month post bypass, and I've only lost 16lbs. I had a gnarly 2.5 week stall, but I barely eat anything- I feel like I should be losing more. 16 lbs. in a month is nothing to sneeze at, but I thought It'd be a little more. Are my expectations too high? I've been struggling to get in enough fluids too. Just feeling a bit disheartened.
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So i got my authorization for an appointment with the Biatric team. Its next week. I just really hope they approve me for my REVISION.
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Can I see some before and after pics?
Starwarsandcupcakes replied to Hopefulin2021's topic in Gastric Bypass Surgery Forums
This is the most recent comparison that I have. SW (5/1/19) 327, VSG (12/17/19)- 264, RNY revision (8/11/20)- 211, Thanksgiving weight- 185 I had emergency surgery 12/26/20 so I haven’t taken a current photo lately but my current weight is 157, so 7lbs from goal. -
I started my weight loss journey of August 1, 2019 it has been a year I was losing weight for a while now all of a sudden I stopped I don't if it is because I stopped the slim fast at breakfast and lunch metancil 3 times a day with a 8 oz glass water 3 teaspoons of metancil I went from a big plate and a big bowl to a small bowl and I cut my portions I may have 3 snacks day any suggestions let me know The pictures of me now with a blue shirt the one silky black white was a year ago Sent from my moto e6 using BariatricPal mobile app