Well, I slept good last night, and got up early. Went to the hospital to get ready for the surgery. Vitals are done, a lab was drawn for just in case I needed a transfusion. They gave me a blood thinner. Then the doctor comes to see me and notices that my weight went up a couple pounds since my last appt. Then he asks me if I had any carbs this week. I can't lie (except to myself) and admitted I had a little bit. Surgery is cancelled. He explained how all carbs get stored in the liver and swells it up, even if it's only a little bit. I protested as much as I could. He talked to me for a bit and I know he's right. I just had been making excuses for myself. So I put my clothes back on and my coat, and did a walk of shame out of the Surgery Department. I know he is right. I know I screwed up. I am so angry at myself. I have to call his surgery coordinator today to figure it all out. He told me to come back to his office in 2 weeks to weigh in. After that I don't know how it will work. I tried not to cry at the hospital, and now I'm home. I just feel numb.

You are awesome, and very inspirational to me. I wish more people were like you. Everyone makes mistakes. Very few are able to stand up and say " I screwed up. It was my fault. I'll stay positive, take it to heart and move on."

Very refreshing!

I guess I watch too much reality TV but those people always drive me up the wall with their whining, blaming other people and "Everyone is against me".

Lol, I have issues with lying. Even if I tried to lie, I'd be dying to confess it right away. Who needs the guilt? When I first started all this I was whiney and weepy but that doesn't get me anywhere.

You are awesome, and very inspirational to me. I wish more people were like you. Everyone makes mistakes. Very few are able to stand up and say " I screwed up. It was my fault. I'll stay positive, take it to heart and move on."

Very refreshing!

I guess I watch too much reality TV but those people always drive me up the wall with their whining, blaming other people and "Everyone is against me".

As for the cat scan, whose supposed to pay for that? I am sure a scan probably costs $1000 or so - I am not sure OP would have been willing to shell out an additional $1000 for a scan to check the liver, but I may be wrong. CT scans also deliver a respectable amount of radiation -- and all that because someone couldn't keep their hands out of the cookie jar?

. Hi Susanne:

Not being able to keep our hands out of the cookie jar is the reason everyone here is shelling out ten to twenty to thirty times that to get their stomachs permanently altered. If it were that simple, no one would need this surgery at all. At the hospital I'll be getting a chest x-ray and I'll also be put under life-threatening anesthesia, endure the risk of severe pain and complication, need Vitamin supplements and carry scars for the rest of my life not to mention figure out a way to do without any food at all for ten plus days.

All because of that cookie jar.

That said, there are some really excellent reasons to comply with a lowcarb diet prior to surgery. Lowcarb not only depletes the liver of glycogen, it also depletes the rest of your tissues making it far less likely that lymph-related complications will arise. Less Water means less pressure on your heart and circulation which is a good thing when you're undergoing anesthesia. Also people who are carb-laden are in "sugar-burning" mode -- in a surgery like this a ketotic state is optimal since blood sugar is less likely to undergo life-threatening drops. Once you get into a ketotic state, you get anorectic because you don't have insulin and blood sugar driving you to eat. When a person comes out of surgery with most of their stomach removed, it's pretty likely that without that they'll come out starving and weak since fat metabolism hasn't kicked in.

But...again...another way to check to see if a person is in ketosis for surgery is to ask them to pee in a cup.

You are probably sleeved longer than I am and know this better. I believe it is a good procedure to know that a patient can follow some basic instructions before (and then after) a surgery.

Again, it is NOT just about a few carbs!

Who cares about ketosis. It's about a patient being able and willing to take instructions seriously and to follow instructions for just a few weeks. And if those are not followed after surgery, the results can be FATAL.

Don't you remember how it was for you shortly after surgery? Not being able to resist the temptation can be very serious. I have a problem sticking with a diet for life but I sure can restrain myself for a couple of weeks if my life depends on it.

So, I believe the surgeon made the right decision in this situation, and you don't think so. I guess we'll have to agree to disagree - which closes the case for me and I'll stop watching the topic.

You are probably sleeved longer than I am and know this better. I believe it is a good procedure to know that a patient can follow some basic instructions before (and then after) a surgery.

Again, it is NOT just about a few carbs!

Who cares about ketosis. It's about a patient being able and willing to take instructions seriously and to follow instructions for just a few weeks. And if those are not followed after surgery, the results can be FATAL.

Don't you remember how it was for you shortly after surgery? Not being able to resist the temptation can be very serious. I have a problem sticking with a diet for life but I sure can restrain myself for a couple of weeks if my life depends on it.

So, I believe the surgeon made the right decision in this situation, and you don't think so. I guess we'll have to agree to disagree - which closes the case for me and I'll stop watching the topic.

Susanne, I haven't been sleeved yet. And I think what I was trying to express wasn't whether the "surgeon was right or wrong" -- really how would I know? I'm not a surgeon. What I am trying to say is that it seems like the American healthcare system is really fuqed. And when I say that I mean the whole attitude we've become accustomed to -- wait six months for this evaluation. Wait another four weeks for that approval. The doctor makes his pronouncements about these things and as consumers we really aren't free to argue; even though I have to tell you in that situation I might.

The way I came to my decision about whether I would have surgery in the country ( knowing I sure as Christmas was not going to get covered for this even if I waited til Hell froze over) or out of the country finally had to do with how long I was going to have to wait and how much crap I have to put up with just to get to the freakin *point*. In my *opinion* making people dance on the head of a pin to prove to a doctor they deserve surgery is pointless since the *actual surgery* and post-op is such a massive pain. I truly doubt anyone considering this surgery does not know that their lives are riding on that fork. If you are suicidal or stupid, you are going to go home from the hospital and order a pizza. Otherwise there has to be a clue included somewhere in the fact that your stomach is gone.

What I've gleaned from my research is that the huge variation in pre-op instructions has to do entirely with what is comfortable for the surgeon. There seem to be unique instructions and methods with every guy. If there was an industry or medical standard regarding these things, both you and I would know about it. So what I was trying to say -- respectfully, Susanne -- was that it's possible to separate these issues out without feeling like you ruined your life by eating a cookie. *After* the surgery that might be true for a while. But forever before, with surgeons who insist people have to lose fifty pounds before they can even * get* to the "pre-op diet", and insurance companies denying these procedures at the last minute for some "actuarial" reason -- the way all this goes it seems like you might just die of natural causes or *stress* before you lose pound one.

That's all, just my 2

Oh Heather , I am heartsick for you! I know how much I long for my surgery and to think you got so close and were sent home really hurts. <<<HUGS!>>>

BTW, be mindful you have had a blood thinner- if you cut yourself you will need to be extra careful about stopping the bleeding. Don';t shave ;-P

It's great that you all look after each other , but using a blood thinner will not run you the risk of bleeding from simple cuts. Our body is simply incredible...when it comes to capillary tears, we are all good!!

Best,

Dr. JSA

Don't beat yourself up. I am going to say what no other person said...your surgeon in a CREEP!!! There is not hard fact evidence of the liver shrinking...NONE..Just a belief. My doctor doesn't even require a pre-op diet for this reason and he is a very cautious doctor. just no large meals 3 days before surgery.

I am sorry you had to go through this horrific experience. I can imagine the planning and mental preparation you had to go through. Don't beat yourself up, folloow the plans and get your surgery. I am speechless at your story.

I am going to second you on this comment my friend...I can tell you that I have found nothing to support this idea. Although it is true that patients should stick to their pre-surgical diet, a 'slip' like this one, should not have prevented you from having your surgery. This is my way of thinking, but I am sure your doctor had his/her reasons.

In my surgical team, we have found that being on a low-calorie liquid diet actually allows us to visualize the stomach with NO distensibility. This allows us to make the cuts on the stomach with a more 'realistic' view of the stomach's actual dimensions. Think about this for a second...when you eat large meals, your stomach stretches out quite a bit. If you do this constantly before a surgery, what 'we' see in the OR is not the 'actual' size of the organ. Thus we run the risk of maybe leaving you with a smaller stomach than we intended.

At least this is how we view this subject. We are actually gathering data to support this and submit it to some journals. I will keep you guys posted!!

Best,

Dr. JSA

It's great that you all look after each other , but using a blood thinner will not run you the risk of bleeding from simple cuts. Our body is simply incredible...when it comes to capillary tears, we are all good!!

Best,

Dr. JSA

Really? I guess it is different if you take one regularly. Our good friend was just at a music convention he had been looking forward to forever. He takes coumadin right now. He cut himself shaving and was literally in his room for 24 hours trying to stop the bleeding. Yep- he should have gone to an er, as you never know...

He has grown a beard ;-P

Edited since it is coumadin instead of warfarin and to add my MIL also has ssues with having trouble getting a small cut to heal and ended up in the ER.

Really? I guess it is different if you take one regularly. Our good friend was just at a music convention he had been looking forward to forever. He takes coumadin right now. He cut himself shaving and was literally in his room for 24 hours trying to stop the bleeding. Yep- he should have gone to an er, as you never know...

He has grown a beard ;-P

Edited since it is coumadin instead of warfarin and to add my MIL also has ssues with having trouble getting a small cut to heal and ended up in the ER.

Hi meggiep! Glad you mention it's coumadin...whole different animal. When it comes to razor cuts, there is no way to assess how superficial the cut is until we see the patient in the ER. If I were you I would tell your friend to go to his PCP and have his PT/PTT times checked (coagulation times). There is a possibility that he may have to have his dose adjusted.

Just a thought. Remember...preventive medicine always beats reactive medicine!!!

Best,

I want to thank you for your post I am new to this and was looking for some answer to the many questions i have. I am sorry what happen but you should not be ashamed that you could not have your operation. But everything happens for a reason that is what I say. I want you to think about it this way, I finally was honest about myself and that is the first step to accepting this life change. I now know it is going to get better and follow instructions because I know my health counts. And if I don't take care of myself who will. But my thanks I really want to let you know because I am excited and scared about this. I feel that the requirements in the states is hard to deal with when you are doing alot of things and no one person is clear why you need to do this. I started this in Oct 2010 and though that i had to wait 6 months because of insurance but found out that my insurances does not require it so I have one my cleareance appt and support group to go to and then I will have my second doctors visit. Counting the days myself. Question what type of exercise were you doing and what type of diet were you required to follow?

Good Luck that day will be here sooner than you know

Heather,

There really isn't anything I can add that hasn't been said by others better, but I'll throw in my ha'penny. Your surgeon is a colossal tool. Yanking the rug out from somebody the day of surgery after you have seriously made arrangements in your life for it is kinda like sending out a pornographic sympathy card when someone's grandmother passes. It's just cruel and low class. If he had some pre-op instructions that were dealbreakers for him, than you should have been told explicitly, "Show up here having done X (or not done Y) and I'm not operating on you."

My experience was kind of the exact opposite of yours. I was alarmed at my surgeon's lack of instruction and convinced that what happened to you would happen to me. Instead, he tells me 3 days before surgery to *try* to eat low-fat the next couple of days. Mostly was concerned that I follow the "nothing to eat or drink after midnight the day before" instruction. His exact words, were, "Nothing to eat or drink after midnight doesn't mean eating the biggest meal of your life at Outback at 11:59." That kind of shocked me, as he usually has the sense of humour of a death-row sniper.

Oh well, carry on, and always remember the dying words of the Duke's uncle.

Tom

Wow, news to me... do you have anything to back that up? Just curious. I've seen many WLS television shows and they've showed the difference between having the surgery with a fatty liver and a healthy one. From what I've seen it's clearly easier to work around a non fatty liver.

I understand the point of this diet plan, but I have to wonder if it has to do with the expertise of the Dr. - how confident they are in their surgical skills perhaps? I too, have not been placed on any type of pre-op diet. Just a cleanse the day before. Or, perhaps from the ultrasound done on me last week they could tell my liver isn't going to be a prob? I certainly don't know either, just a curiosity. Nonetheless, GOOD LUCK INFERNORED! You can SO do this!

Hi meggiep! Glad you mention it's coumadin...whole different animal. When it comes to razor cuts, there is no way to assess how superficial the cut is until we see the patient in the ER. If I were you I would tell your friend to go to his PCP and have his PT/PTT times checked (coagulation times). There is a possibility that he may have to have his dose adjusted.

Just a thought. Remember...preventive medicine always beats reactive medicine!!!

Best,

I jut saw this- thank you! I will indeed tell him to do that.

First, so sorry about your experience. I think your Surgeon should have weighed you before you got prepped or perhaps even the day before if that was his policy. I honestly think he stopped to teach you a lesson. Second, the lady across the hall from me in Mexico almost had her surgery canceled. She said she followed the low carb diet to a T and her liver was still very fatty. In medicine or anything really there are no absolutes. To assume that the reason Drs do something is because they have science to back them up is silly. I can think of many (controversial) places where they do indeed cause harm because they just wanted it done their way without any science to back it up.

Wow!!! Am so glad I read this... I got no pre-op diet instructions from my doctor.. Just to show up for the tests the day before the surgery.

So I just emailed him... This was his reply:

______

"That is a good question.

At least pre-operative 2 weeks, you have to keep high Protein diet with 1200Kcal/day.

However, you lost lots of weight within the last year.

So I recommend to you keep your lifestyle until then.

That is enough to prepare for surgery.

_______

Anyway, it is good to know about the liver shrinkage. Last year when I was 66 pounds heavier I had emergency gall-bladder surgery and afterwards my doctor said I have the healthiest liver he's ever seen in an adult. That was cool to hear. Anyway, I'm going to take the advice of everyone on here who said that not eating carbs will shrink my liver... Any advantage I can get right?!