Long term prognosis

[swizzly 901]

"Over 5 years of follow-up, 77.9% of patients developed Vitamin D deficiency, 41.2% had Iron deficiency, 39.7% had zinc deficiency, 39.7% had a Vitamin B12 deficiency, 25% had a folic acid deficiency, and 10.3% developed anemia.

These deficiencies occurred "despite routine supplementation, in a higher rate than we had expected," the researchers wrote."

That is a little disturbing. I'm wondering how consistent supplementation was? And if they were deficient before surgery or it developed strictly after?

I seriously always question this stuff though -- cos god only knows how many people have deficiencies in the 'normal-stomach-ed' population, they just aren't getting these huge blood panels done all the time. I was very hypothyroid before that was finally discovered (many years ago) cos routine blood draws aren't really a 'thing' that is done. Same for the anemia I had. So really, god only knows what kinds of deficiencies people are walking around with... I think it's a Good Thing that we get this kind of monitoring cos then we can fix it. And also? who knows whether any of it would, absent MAJOR deficiencies a la rickets and scurvy LOL, cause us a bit of harm anyhow? Sometimes what we don't know doesn't hurt us...

Good question! So being re sleeved.

Im looking for information on it...

The only re sleeves I've heard of so far are for ones that are not done "right" the first time..

There's a guy on Thinner Times who's a longtime veteran sleever ("Aviator"), who had a sort of hernia occur in his sleeve, where the top part bulged way out and he could eat a crapton of food again all the sudden, and thus gained like 30lb I think? Anyhow, he had a sleeve revision surgery at the behest of his surgeon, and it went smooth like buttah and he's doing great.

[M2G 1,836]

I'm glad you said this because I found an interesting article about gastric bypass and it says they should wait 1.5-2 hours after a meal before drinking. Then begin sipping for at least an hour. As soon as hunger returns gulp as much Water as possible to totally fill the pouch. It's will prolong hunger by a few minutes. Only after that liquid passes and hunger returns again should they eat. It's called Fluid loading and I tried it for a while. I did lose a few pounds and I did actually increase my Fluid intake. But it's a tough regiment to stick to when you're working in the heat all day.

http://www.gastricby...pouchrules.html

Butter...GREAT article. Wow. Thanks for posting. Even though we don't have a "pouch" and the mechanics are slightly different, I think there are some great takeaways from this really informative article. Thanks for sharing.

I don't know that I need to fluid load to keep hunger at bay (though it's worth trying) but when I wait about a hour (and setting the timer on the phone keeps me accountable, otherwise it's easy to "forget" when you last took a bite, etc.) I notice that the food I eat definitely lasts longer in my sleeve and keeps me full and keeps hunger at bay.

This article makes so much sense to me and I wish I'd read it years ago. I drank litres of fluid (low cal, caffeine free stuff) and huge meals of really healthy foods, primarily veg. And most of the time I was so hungry I could have eaten my own left arm. So I'd drink and eat more "good stuff", and on the cycle went.

I haven't even bothered putting any significant gap between eating and drinking - when i felt i could drink i would, maybe after 10 to 15 mins. Now I get why it's important.

I'm going to print this off and tape it to the bathroom wall, just above the scales. Aim to re-read it once a month.

Thanks Laura.

YES! This IS important and I too had gotten a bit lazy. I still never eat and drink together, (I tackled that problem from day one) but I had gotten sloppy about timing. Did I finish my meal at 12:30. And it's 12:45...okay to drink? Hard to remember with every meal. So I find that keeping myself accountable on this really helps a ton! It's just one of the rules that is easy to not pay close attention to, but it makes a huge difference IMO.

I don't think the results are much different than this study:

http://img2.timg.co....1_151963966.pdf

The abstract for the article,http://www.soard.org/article/S1550-7289(13)00228-1/abstract, states: LSG was effective 5.9 years postoperatively with an excessive BMI loss of almost 60% and a considerable improvement or even remission of co-morbidities.

This study doesn't show much regain later either, EWL was 61% at 1 year and 57% at five years. I know we all want 100% EWL, but the fact is some people are not going to get there. We improve our chances by hanging here and staying accountable.

Lynda

Lynda

Lynda, thanks for sharing this. I will admit at first, seeing all the numbers and charts and jargon were an instant turn-off for me. However, this article is well worth the time it takes to read it. And it DOES address the hunger issue that has been cropping up in this thread. It also does have 2 cases of being resleeved due to "fundus regeneration" so again going back to a physical complication with their sleeve. (The article does a good job explaining this also.)

[clk 3,519]

Thanks for all the great info here.

The stat still seems to be roughly the same to me - 60% EWL maintained at the five year mark. Statistics don't tell a whole story. But I do think this is pretty accurate. I think that it doesn't have to be accurate, but that unfortunately, people just get lazy or tired of doing the work.

That sounds harsh. I don't mean it to be. I realize that regain can happen to any of us. But it doesn't happen because our sleeves stretch 600%...it happens because 1) we eat around our sleeve, 2) we choose not to be accountable about our weight or our food intake, 3) we forget we are obese people with the habits and disordered eating that entails.

You'll see the occasional regain due to a huge stress or a medication, too.

As for people not getting to goal? Some people do everything "right" and still can't get there. It's sad but true. Some people have to work twice as hard to maintain. That article FYE posted not too long about about someone with a 20 pound loss having to eat as if they'd had a 40 pound loss is something I believe - we cannot do this work and then just assume we're normal and our bodies will always respond well to the diet that works for everyone else. I have to cut my calories down pretty low to lose. I have more flex with what I can eat (for now) but I can't expect to just lose a pound on 1,200 calories a day. It simply will not happen.

We're not the same as other people. If we were, I truly feel many of us wouldn't have needed surgery. Almost everyone here tried dieting for more than a decade - really tried, really put effort into it - and we all got sleeved anyway.

But I do think just the boards are a little indicative of what happens. We have very few people here over a few years out. People that were the Laura and Butter of their day - people that posted daily, all day long and got to goal...then vanished. I truly believe that regain is a part of that. Oh yeah, we get busy and don't make time for it anymore. But we're not even seeing the "Hey, I'm 5 years out, look at me!" updates. That tells me regain is a part of it for at least some people.

As far as the deficiencies? In my case, I have always been pretty bad about taking mine regularly. They make me horribly sick. I have had issues with deficiencies my entire life, though. I started taking Iron supplements and eating an Iron rich diet at age four, when I had surgery and the doctor told my mom I needed iron. Being forced to eat liver at a young age was traumatizing! The fact that I'm still deficient? No surprise. And hey, let's not forget that lactose intolerance can really affect your levels of D, too. I'm lactose intolerant and fortified dairy is simply not a part of my life anymore. I've chosen, at this point, NOT to replace that dairy with soy or rice or hemp milks that might replace what I'm missing. Quite frankly, I can hardly eat the Protein I need, the carbs I want/need, the shakes I need and still have room for excess food/beverages. I don't. I'm still sipping my Water all the way up to bedtime just to get in my 8 glasses a day, on top of my shakes.

All of this to say what?

Basically that so much of this boils down to perseverance and doing the right things. Hey, a huge portion of people never maintain their losses (or reach goal) with other surgeries or with traditional methods. A huge part of that? Perseverance and doing the right things.

1) Don't avoid your scale

2) Don't eat garbage all the time

3) Even better, check your intake every once in a while to be sure you're not eating more crap than you realize

4) Get your annual labs done

5) Take your supplements

6) Get some damn exercise (this is directed at me, too, I'm terrible about structured exercise and really getting my heart rate up)

How many people have you seen fail to get to goal or regain while doing all of those things?

I promise that they're the tiny minority. I know some people struggle more than others. I know that the hunger doesn't go away for some people. And I know that the hunger returns the farther out you get (or so I hear...mine's not back) but truth? Just because you feel hungry does not mean you need to fill that space with crap. It does boil down to willpower - and I hate that, but it's true. If you can't beat the food addiction and disordered eating with headwork, you're going to have a harder time maintaining. Because sometimes? I go to bed wanting to eat something. Sometimes I cave. But by being sure that I don't do it all the time, I'm making sure I can stay at my goal weight. I still swear that more than 90% of this is the head, not the body.

Studies aside, I still see nothing to show me that we can't maintain 100% EWL if we give it 100% and don't quit. Maybe I'm just feeling optimistic today. I think that the stats are indicative of how few people really have it in them to do this for the long haul. Right around two years out you realize this isn't easy and it's never going to end. I'm sure that's discouraging to a lot of people.

~Cheri

[Georgia 2,908]

If "normal" people maintain weight loss and a healthy lifestyle, now that we have ACHIEVED it, why do we have to accept statistics as to why We Can't do it also? Not me. I'm in it for life. I've regained some. I've worked dang hard to lose it. Did it. Serves to reason if I continue to fight and work it, I can be successful. Simple.

[Fiddleman 4,376]

And when they say "lost 60% of excessive BMI" what does that mean? Does that mean 60% of the difference between presleeve BMI and "normal" BMI? If so I'm way past that. Or did they mean 60% of excess weight?

Typically the doctors talk about 60% of excess weight. I think that statistic is wacko anyways. Everyone I run into is not contributing to the 60%. I think it is all a mind set. If you really want to lose 100% excess, you will. However, it does take work.

[No game 14,436]

Typically the doctors talk about 60% of excess weight. I think that statistic is wacko anyways. Everyone I run into is not contributing to the 60%. I think it is all a mind set. If you really want to lose 100% excess' date=' you will. However, it does take work.[/quote']

It's funny I went to a support meeting last month and everyone there along with the dietician really bought into the sixty percent thing.. And most long timers had achieved it and seemed happy with it.. It wasn't a philosophy I felt like subscribing to...

So onward I go!

Ok in scaring myself today has anyone here seen the Chilean study about the sleeve two years out?

It compares the sleeve at three days and at 24 months out... It basically doubles in size!

Still smaller than before thank the sky's above.

Someone tell me to stop reading this crap!

[Leleboo 104]

It's funny I went to a support meeting last month and everyone there along with the dietician really bought into the sixty percent thing.. And most long timers had achieved it and seemed happy with it.. It wasn't a philosophy I felt like subscribing to...

So onward I go!

Ok in scaring myself today has anyone here seen the Chilean study about the sleeve two years out?

It compares the sleeve at three days and at 24 months out... It basically doubles in size!

Still smaller than before thank the sky's above.

Someone tell me to stop reading this crap!

Laura stop reading and sharing. My sister- in- law had the RNY 10 years ago losing 200lbs, well she has gained it all back plus more. I'm sure she was not eating what she was suppose to and exercise is foreign to her.

[No game 14,436]

Laura stop reading and sharing. My sister- in- law had the RNY 10 years ago losing 200lbs' date=' well she has gained it all back plus more. I'm sure she was not eating what she was suppose to and exercise is foreign to her.[/quote']

Lol... Ok I'm stoping!

I will just sit in a corner for the rest of the night and suck on a frosty cold Protein shake

[Fiddleman 4,376]

Yeah Laura, no scaring the new post ops with your Grimm style bed time stories of sleeve failure. Just pulling your leg. We kiddies want to hear the good stuff. lalala, it is all unicorns and rainbows.

[Supersweetums 1,164]

It's funny I went to a support meeting last month and everyone there along with the dietician really bought into the sixty percent thing.. And most long timers had achieved it and seemed happy with it.. It wasn't a philosophy I felt like subscribing to...

So onward I go!

Ok in scaring myself today has anyone here seen the Chilean study about the sleeve two years out?

It compares the sleeve at three days and at 24 months out... It basically doubles in size!

Still smaller than before thank the sky's above.

Someone tell me to stop reading this crap!

When you think about it, it really makes sense. I don't think any of us would say that we can still only eat what we ate 3 days post op. The good news in my eyes...if capacity was 4 oz 3 days post op, at 2 years out it would be 8 oz. Even if you say 6 oz and 12 oz, that is still a hell of a lot less than the, what, 60 oz that our stomachs normally hold. This stat I am ok with.

And I agree with what everyone is saying. I think long term success has more to do with accountability than surgery. The surgery helps us get there, our heads keep us there.

[No game 14,436]

I think long term success has more to do with accountability than surgery. The surgery helps us get there' date=' our heads keep us there.[/quote']

Thank you sweetums, something about the way you just said that, and my clear head (which doesn't happen often trust me) this morning.

Just made it "click"

"This surgery HELPS us get there, our heads keep us there."

Yes!

When I sit back and think about it? I KNOW we will make it and continue be successful at staying healthy because we have these discussions.

It's nice to have my friends here that "get it".

[Fiddleman 4,376]

Hunger as a post op affects us all. There is no way to avoid it. However, we can make smart decisions about the quality of food we eat and types of food we eat depending on time of day. Reaching for an Ostrim stick or something else that is a lean Protein will satisfy hunger without causing a spike in insulin response. Eating your good carbs in the morning will help create energy for the whole day and not lead to conversion to fat (do not eat carbs after lunch). Try and eat low glycemic index carbs. Eating a small portion of lean protein (100-200 calories) every couple hours will keep your insulin response regulated throughout the day and hunger at a minimum. Do not forget the good fats. A tablespoons of healthy fat (fish oil for example) will help your body minimize inflammation and also help with triggering satiety. Inflammation is directly linked to storage off fat because of increased cortisol levels. I like to have a table spoon of cold fish oil every morning (flavored). Exercise in some form 30 minutes a day. Little tips like these make it easier to go day after day without having to deal with long term hunger and scale creep. This translates into a healthy long term prognosis.

[zenandnow 514]

"This surgery HELPS us get there, our heads keep us there."

Yes!

When I sit back and think about it? I KNOW we will make it and continue be successful at staying healthy because we have these discussions.

It's nice to have my friends here that "get it".

Hunger as a post op affects us all. There is no way to avoid it. However, we can make smart decisions about the quality of food we eat and types of food we eat depending on time of day. Reaching for an Ostrim stick or something else that is a lean Protein will satisfy hunger without causing a spike in insulin response. Eating your good carbs in the morning will help create energy for the whole day and not lead to conversion to fat (do not eat carbs after lunch). Try and eat low glycemic index carbs. Eating a small portion of lean Protein (100-200 calories) every couple hours will keep your insulin response regulated throughout the day and hunger at a minimum. Do not forget the good fats. A tablespoons of healthy fat (fish oil for example) will help your body minimize inflammation and also help with triggering satiety. Inflammation is directly linked to storage off fat because of increased cortisol levels. I like to have a table spoon of cold fish oil every morning (flavored). Exercise in some form 30 minutes a day. Little tips like these make it easier to go day after day without having to deal with long term hunger and scale creep. This translates into a healthy long term prognosis.

I'm no where near a vet (think I can only post here because of the number of posts I have), but I wanted to say thank you for this thread & these articles. There's a lot of - how shall I say - angst on the boards here; panic about stalls, small gains, the myriad challenges one experiences early on. There's also a lot of 'I lost 100 lbs in 3 months!' type of stuff. These are valid topics and serve a purpose, but they tend to dominate the boards and I find I have to drill down a little - often to the fitness or vet forums - to get to the 'meaty' stuff....the info or discussions that I can really learn from. I am so grateful to the vets who take the time to keep posting so that those of us just starting out can learn from you and get a preview of what it will be like for us when we get to that point. Thanks for the valuable insight & for sharing your knowledge - it is greatly appreciated!!

(Even the scary stuff, Laura-ven!)

[No game 14,436]

You know fiddle, I think the path to scaring myself this week with long term results started with reading that stupid comment from the doctor saying that people need a second surgery five years out...

I started looking at my eating habits as of late...

First I must say I eat well, Protein is my friend.

But as I was telling butter yesterday.

I will eat low calorie but.... I will make a LARGE volume a factor too. I will eat plain meat with plain veggies as not to add more calories with sauces and dressing so I can have MORE!

Taste is not top factor for me, it was always about filling the hole.

I am not opposed to pain. As a binger I would eat till pain then wait for it to subside then eat some more...

So do you see where I was tripping about stretching?

I've thought out loud here the last two days (sorry guys) with this thread. I really thought about what adjustments need to be made right now... Volume I need to be ok with not feeling pain as my full. And small thing but I noticed that I was drinking perhaps to soon after meals (barely 30 minutes) so I pushed it to an hour yesterday. It felt better and the food stayed with me a lot longer.

So that's Laura's crazy thoughts for the day

If you read this far, thank you.

[feedyoureye 3,087]

Aaaand I posted in the vets forum again, dang it! Sorry guys not easy to see on the app

You alway contribute mature thinking to the vets forum! You are a medical professional?

"Over 5 years of follow-up, 77.9% of patients developed Vitamin D deficiency, 41.2% had Iron deficiency, 39.7% had zinc deficiency, 39.7% had a Vitamin B12 deficiency, 25% had a folic acid deficiency, and 10.3% developed anemia. These deficiencies occurred "despite routine supplementation, in a higher rate than we had expected," the researchers wrote." That is a little disturbing. I'm wondering how consistent supplementation was? And if they were deficient before surgery or it developed strictly after? Bah, not loving the article I must say. But, LV, I didn't read anything about hunger level. Did I miss something?

This is the most interesting part of this study to me... Sunblock contributes to a lot of our Vit D def. I was low on VitD, and Vit B12 (Im a vegetarian) but not much else. My doc said it was because I ate so many damn organic veggies and if not raw cooked them in an Iron pan!

Ole Louise? Ouch. The hunger thing was in response to the comment in the OP about the hunger coming back to pre sleeve levels. Don't want to go off topic, but is my lack of hunger really that unusual?

I think it is. Mine is reduced, but not gone from early on. I can say its not MORE than it was at around 6 months out.....yet.

Typically the doctors talk about 60% of excess weight. I think that statistic is wacko anyways. Everyone I run into is not contributing to the 60%. I think it is all a mind set. If you really want to lose 100% excess, you will. However, it does take work.

Even though I think so much of what you say here is correct... "I think it is all a mind set" is a little simplifying. Emotions, physical craving, triggers, chemistry, genetics (edited to add: support!)... are so powerful, and not that easy to understand and to catch hold of. Its a little like saying, "If those poor people would just work, they wouldn't be poor!" Poor people=lazy people, not that easy. That being said, getting your mind set in the right place is a tremendous help in the weight loss/maintenance Quest. Is it "all"? I look at people who try and try again to lose and maintain, and slide back, and I think there but by the grace of god go I... went I, I may go again, and again.... I hope not! So far my mindset along with some other tools, are keeping me on track. I just know that not that long ago I gained 22 pounds... in what seemed like a blink of an eye! Realizing this frailty (along with my personal strength) allowed me to come back here and get back into the game with support... and not be so afraid that I would be seen a having a weak mindset or really, a failure, but as a person that is not giving up when the numbers go up...(not really a rant Fiddle, just a perspective)