I went to my surgeon's office yesterday for my final pre-op appointment. The person working at the counter who makes his appointments and takes the insurance cards etc (I don't know if this person is a nurse or not) looked awful. She told me she had been sleeved one year and 3 months ago and still doesn't eat very much. In fact, she's so thin that her facial bones are sticking through her face and her eyes look like they are bugged out. She said the docs are trying to get her to GAIN weight. Has anyone ever heard of this happening? Can't a person die from malnutrition? I was kinda freaked out!

Yes, and the only time I've heard about it is when the person is not following the advice of their medical team, not taking the prescribed vitamins/supplements, and overall not monitoring their intake properly.

In my opinion, if she is still having problems, and being malnourished yet it wasn't addressed early on, then that is on her and her medical team. I am not saying it's her doctor's fault, or lack of care, but this should have been addressed long before her reaching 1 year post-op.

I can tell you my surgeon suggested I start adding in more calories and carbs at around 4-5 months out because I had dropped weight so rapidly. I was monitored closely, not only medically, but nutritionally as well. My labs were pulled every couple of months.

If she can't physically eat a lot, then something is going on mechanically with her sleeve. If she is choosing to not eat enough, or has mentally switched gears and is not feeding her body properly, that's something entirely different.

I know a couple of RNY'ers that switched mentally to more anorexic behaviors. They ate minimal amounts, and simply drank their calories (via slimfast shakes, and/or ensure drinks) so their labs would not be off when they went in for follow ups.

There's probably a lot more to the story that is contributing to this woman's physical condition, and I wouldn't base your decision, or let this fear consume you.

Yes, and the only time I've heard about it is when the person is not following the advice of their medical team, not taking the prescribed vitamins/supplements, and overall not monitoring their intake properly.

In my opinion, if she is still having problems, and being malnourished yet it wasn't addressed early on, then that is on her and her medical team. I am not saying it's her doctor's fault, or lack of care, but this should have been addressed long before her reaching 1 year post-op.

I can tell you my surgeon suggested I start adding in more calories and carbs at around 4-5 months out because I had dropped weight so rapidly. I was monitored closely, not only medically, but nutritionally as well. My labs were pulled every couple of months.

If she can't physically eat a lot, then something is going on mechanically with her sleeve. If she is choosing to not eat enough, or has mentally switched gears and is not feeding her body properly, that's something entirely different.

I know a couple of RNY'ers that switched mentally to more anorexic behaviors. They ate minimal amounts, and simply drank their calories (via slimfast shakes, and/or ensure drinks) so their labs would not be off when they went in for follow ups.

There's probably a lot more to the story that is contributing to this woman's physical condition, and I wouldn't base your decision, or let this fear consume you.

Thanks Tiffykins! Your reply made me feel better. Perhaps there is something mentally going on with her. I weigh a whopping 275lbs. so there are not many things that can deter me from going through with this surgery. Only the fear of dying so eventhough I can't imagine whiddling away to nothing, seeing this person really freaked me out.

I know one person who went through a "too skinny" stage, but has since been able to get to a healthy weight.

A lot of people exceed their target weight, but we tend to set high target weights anyway.

This is one of the things I worry about. I'm on month 3 of my pre op diet and I'm weighing around 228 at 5'3. I'm afraid of losing way too much between these next 3 months and after surgery...I don't have ANY health problems at all, besides being obese...Im scared of doing more damage to my body in the long run with what could happen after surgery... what can u do to slow or stop ur weight loss if u feel you're getting too thin post op?

This is one of the things I worry about. I'm on month 3 of my pre op diet and I'm weighing around 228 at 5'3. I'm afraid of losing way too much between these next 3 months and after surgery...I don't have ANY health problems at all, besides being obese...Im scared of doing more damage to my body in the long run with what could happen after surgery... what can u do to slow or stop ur weight loss if u feel you're getting too thin post op?

Increase your carbs will slow your weight loss. You will have to find what calories and protein/carb/fat ratios you will need when you get to maintenence stage which may take a couple of months to figure out. Usually increasing your carbs will slow your weight loss.

I agree with everything Tiffy said. I have seen people turn it into kind of a mental illness, where they claim they can't eat anything so they don't. Part of the reason they are supposed to get a psych consult. If for some reason they couldn't, the doctors can do a procedure to open up the sleeve a bit.

Huh? How can you open up the sleeve? The stomach is gone!

[\I think she means do a dilatation. Sort of stretch the opening to the stomach or the stomach itself by inserting a balloon type instrument and blowing it up. This is done all the time in the elderly who have a narrowing in their esophagus not allowing them to swallow properly.

That's exactly what I meant. Thanks

Yes, her problem is most definitely psychological rather then physical. There are thousands who have full bypasses and can maintain their weight despite the fat that in the case of an RNY they have a MUCH smaller "stomach" (actually a pouch made up of part of the intestinal tract). Quite a few people have had to have their stomach completely removed due to cancer or the threat of cancer and can survive and thrive.

I'm going on 8 months out and have slowed to 1 or 2 pounds a week weight loss which means I am eating close to what I need to maintain my weight. I can easily add a few calories and keep my weight right where it's at.

Just as they had issues with eating too much food they now have issues with eating to little.

Rootman you're probably right. I'm glad you're doing so well 8 months out. I hope I do that well. I have about 130 pounds to lose and I'm afraid it's going to come off very slowly. Congrats to you though because it seems you're doing really really well