This is likely to be long... and more accurately a vent or a rant than anything else, probably.

I had my (about 3 month) followup with my surgeon today and I am spitting mad! About 5 weeks in I had some nausea, which resulted in me averaging less than 700 cal/day (don't have my charts on hand to give an exact #) for about 3 weeks. For me, that was too low and resulted in an extreme lack of energy, nearly passing out, I thought I was extremely dehydrated, and long story long... I ended up in the ER trying to figure out if something was really wrong. Turned out to be no big deal, and all I needed was stronger anti-nausea meds, fortunately. Unfortunately, as soon as I was able to eat at my prescribed calorie level, I gained 10 pounds within just a few days, and now, 4 1/2 weeks later, my net loss is only about 1/2 a pound.

I've done some reading on what happens when a person is subject to starvation or semi-starvation and then is able to re-feed. In the simplest terms, the body pretty much thinks it better hang onto every bit of energy it can in case there is another "famine" around the corner. One thing I read stated that in a fairly short period of some level of starvation, one can expect the body to take up to 3 weeks to stabilize. Now that I'm at about 4.5 weeks from beginning to eat more appropriately and feel like my body is still not normalizing, I'm looking for more information on exactly what's happening, so I can figure out what to expect and how best to support myself and my system while it adjusts. This is the same kind of thing I always do when I encounter a problem... A big part of my identity (and career, in fact) is in problem solving. Nearly everyone within my sphere of influence comes to me for answers and advice. I encounter a problem, work to understand it, decide what I think is the best course of action, and then implement it and see if or what adjustments need to be made. Not really any different from anyone else, but I work really hard to figure things out and come up with good solutions and I'm pretty well recognized and trusted among my friends (all well-educated professionals) as having a talent for it. So that's the background...

When my surgeon walked in and asked how I was doing, I admitted to being frustrated since getting the nausea worked out a month ago. I explained what had happened with my weight. I told her that I documented over the last 2 weeks (just the duration of the report I ran) that I had been running about a 1200 cal/day deficit and didn't really understand why my body wasn't responding. She stopped me and asked me what that meant (I think now because she didn't think I knew what that meant). I told her that I use a bodybugg (sophisticated body monitor that measures caloric output)... before I even had a chance to finish my first sentence, she cut me off and told me that I couldn't go by the information that a bodybugg gives me, and I can't use it to decide how many calories I should be eating. I tried to explain to her that was not how I use it. That I've been eating an average of 1100 cal/day over the last week (again, just the length of report I ran), which is still 200 cal below what the nutritionist in her office directed me to eat. I told her that I simply compare what I eat to what I burn to get an idea of what I should expect from my body. I explained that I have used this method to great success (115 pounds) within even the last 4 years and my experience with it has been that it was exceptionally accurate and reliable for me in the past (measurements proved to be accurate right up until surgery). So, sometime between right before surgery and now, I went from being able to eat about 2400 calories/day (without any significant exercise) without gaining weight to not being able to lose at less than 1/2 that. That tells me that there has been some significant change very recently and warrants some consideration and perhaps investigation, but did not trigger any reconsideration of her stance, no thought or discussion toward figuring out why my body isn't responding as expected. She got defensive and said "Well it's not working for you now, is it?" That was pretty much where I determined that I would be unlikely to take any further advice from her on this particular topic...(talented surgeon, but this is complete b.s.) She asked me if I was measuring my food. I replied I was. She then tested me, and asked me if I owned a food scale (So, what? I'm lying to her now? I told her I was measuring my food, of course I own a scale! 2, in fact! And GASP! I use them.). She then said that maybe 1100 calories was too much for me. (I'll note here that I'm about 5'9" and have a very large build for a female. I have had a weight loss doctor tell me that I had the largest bone structure any woman he had ever treated. I'm also naturally muscular and athletic. I have never had any trouble burning calories. I have always been successful in losing weight when I was able to maintain an intake lower than my expenditure. My issue seemed to be in the amount of effort it took to do that when I felt like I constantly needed to eat. At some point, I would get tired of it and give up.) She stated that I could drop down to 800 cal/day and still preserve my muscle mass, but I would have to exercise rigorously at the same time, and make sure that I "resisted the temptation to increase my calories with the increase in activity". (I'll note here that an average of under 700 calories with no exercise put me into a state of such low energy that I needed to go to the emergency room. I don't think a hundred or even 200 or 300 more than what put me in the ER would be healthy for me considering it would be combined with an extra burn of approximately 400-600 cal.) Thank you, I will pass. She then went on to say that I can't expect my body to fall in line with "normal people" because I'm a morbidly obese patient and "they" have different metabolisms than "normal people". I bet you're pissed now, too... That's all fine and good. She's right in that there is a lot of research and studies on the metabolic hormone differences in morbidly obese people in comparison to normal weight people. However, she's doing the exact same thing as lots of doctors do that is completely unfair... she's responding to me based on her stereotype of an "obese patient". There are many hormones that have been discovered that play critical roles in metabolic function. They interact with each other and their respective receptors to give the brain the "right" signals. There are about a million places where this system can have a glitch, a breakdown, or simply function sub-optimally so to imply that all obese patients are the same is just as much garbage as saying that all people are the same. That was the "easy" answer, and completely unhelpful.

At this point, I'm furious. I really couldn't go any further with her and just pretended I was accepting what she was telling me. I redirected her and told her that I really just wanted to understand exactly what was happening with my body right now, and asked her if she could recommend some resources and references for me to read. She suggested "Wheatbelly", and "Fat, Sugar, Salt". Seriously?!?! I ask for some educational information on the function of metabolism and my doctor suggests that I read a couple books on the evils of specific foods and additives in our diets? Sorry, doc. Not. Good. Enough. Pissed really doesn't even begin to explain how I was feeling. My concerns had been dismissed as something I must be at fault for, or lying about, because I must be a non-compliant patient, and when I asked for more information I was directed to dramatized crap, not educational sources. Angry. Hurt. Frustrated. Feeling like I'm still fighting the "Fat person" stereotype in a place where I should feel safe from that.

So... my next steps: Discuss this with my PCP on Monday during my appointment. I think I'm going to look into some metabolic testing to figure out what exactly is going on right now. I may discuss a referral to an endocrinologist to see if some information can be gained by digging a little deeper into my metabolic hormones. And, of course, keep reading articles and looking for books that can give me some understanding (I've got some stuff lined up I found with Google Scholar that I haven't worked my way through yet, and I have a couple college textbooks on metabolism and nutrition that I need to work my way through still). Ultimately, I may have to do what I've always done: figure it out for myself.

Full disclosure: I do recognize that it may be too early to worry. I very well may just still need to wait a little longer for stabilization. This doctor appointment just whipped up every instinct of determination to "solve" this that I have. Nothing like pissing me off to get me to throw everything I have at a problem... While I'm angry, I'm not panicking, nor am I feeling any despair. I know that I will get it figured out and all will be well once I do. I'm really not feeling overly emotional or depressed or anything over this, so fear not, caring VST circle of friends, I'm totally fine.

Thanks all for reading! I think if you made it all the way to the end, you deserve a medal!!! :-) Since I'm fresh out of medals, how about pictures of baby otters instead!

All together now... "AWWWWW..."

http://www.huffingtonpost.com/2012/03/08/painfully-adorable-baby-o_n_1332519.html

Hope you all are having a good night and I wish you all good luck and success!

I feel just like you. I am always doing battle with doctors. Yes, they are the professionals but they are not in my skin, or yours.

Absolutely! We always have to decide how much to trust, which advice we're going to take, what recommendations we can live with, the list goes on and on. At the very base, we have to be willing to learn enough and be confident enough to be our own advocates when we feel like something is off. We should never be made to feel that there is a question we shouldn't ask or a concern that we shouldn't voice.

Thanks!

Mea Culpa.

Sorry, folks. I guess I came across too harshly. <insert guffaws here>. Sometimes I get carried away by my line of thinking and wind up not saying exactly what I meant. It reminds me of a saying by Robert McCloskey:

" I know you think you understand what you thought I said but I'm not sure you realize that what you heard is not what I meant."

What I meant was see if this topic has been previously covered by someone else on this site or another site. I was suggesting just research. The main reason I wrote this is that it seemed (from my perspective) that some people were being harsh and negative. (Something that I clearly cannot relate to. ROFL

The other reason I wrote this ... and I'm sure you can all understand and sympathize ... is that it was Day One of my pre-op diet. Enough said?

Pre op was rough! Thanks for the support.

Truly, though, my post wasn't intended to ask for advice, though I am always willing to considering something offered in good spirit. I was primarily just throwing my bad experience with my surgeon out into the universe to vent, but I always hope that whatever I share might in some way benefit someone else (if only in that misery loves company...) I have been doing a ton of reading. I actually bought the books my surgeon suggested. The one I didn't list was "Why We Get Fat" (I forgot about it until I went back over my notes from my appointment). Turns out, this one seems like I may find it valuable. However, I found it hilarious that the first couple chapters seem to be dedicated solely to how doctors have been blaming patients for their obesity for decades when there is a significant amount of research that directly contradicts "calories in/calories out" and that most research indicates that neither calorie restriction, nor increased exercise actually works to keep weight off, except rarely. Yet there she was, adamant that I must be doing something wrong if my body wasn't responding the way we expected. I don't know... maybe she was sick the day she read those chapters... Just like I was sick that day in Kindergarten when we learned sharing...

Just my two cents worth, and it's only my opinion, but the lower the calories the better. I couldn't get in 700 until almost 6 months out. I reached my doctor's goal in 5 and mine in 6.

The PhD doctor that speaks at a support group I attend said that unless we are in a POW camp, we aren't going into starvation mode and low calories will not alter our metabolism. You can take that for what it's worth, but I went from who knows how many calories a day to starting out post op at 300, and never more than 800 when I was losing.

I was very cautious about what I ate, that whole honeymoon period thing was forefront in my mind. This has worked for me, like this doctor told us, we had surgery to eat less. I've been maintaining for over 2.5 years. At 1300 I maintain, at 1400 I gain. If i drop back to 900 - 1050, I'll lose. It's a fine line, but I'm finding it easy to do, knock on wood.

Thanks! I appreciate the response. I linked an abstract in a previous response stating that there wasn't any clinical benefit to going below 800 cal. Not likely to be true for every single one of us, but it was true of their test subjects (obese women).

I have heard the "starvation mode is a myth" statement before. This 2013 article from Clinical Science states otherwise, well depending on how you define "starvation mode", but I think of it as the reduction in TEE as described in the paper. It's under Energy Expenditure in "Physiological Adaptations to Weight Loss" http://www.clinsci.org/cs/124/0231/1240231.pdf

Leibel, R. L., Rosenbaum, M. and Hirsch, J. (1995) Changes in energy expenditure resulting from altered body weight. N. Engl. J. Med. 332, 621–628

Sorry, that tiny font was the citation for the article that was used to support their claim. I tried to make it bigger, but the copy and paste just doesn't seem to want to play nice. Now I've got funky font size that seems resistant to change in my regular text, too!

Your statement of your calorie balance actually lends support to my belief that there should be no reason for me to drop any lower in calorie intake than where I am to lose weight. You weigh almost 100 pounds less than me, are 2 inches shorter than me, 18 years older than me, and I can all but guarantee you are built (what... finer than me? Smaller boned? Less stocky? None of that sounds good...) At any rate, I probably have a bigger bone structure, yet you lose at up to 1050. Yet, my doctor believes that I was telling her that I wasn't able to lose at 1100 (not exactly the impression she would have been left with had I been allowed to finish any of my attempts to explain my concern or answer her questions.) Her response was that I should eat less than 1100. I just can't buy that without some proof, because I don't believe that is the problem.

I love this! Why bother to ask experienced people when you can do research until you find what you WANT to hear. I have been a part of these boards for 2+years and I have been sleeved for the same amount of time. I do know MUCH about the sleeve. My sister, niece, best friend and husband are ALL sleeved, so its not just my experience I am basing my comments off of, its that of my entire family! I really think that 1100 calories would be damn near impossible to take in if you are newly sleeved AND its from a good Protein source- besides shakes that is.. I'm talking solid food. All I can advise is to follow the protein first rule and you will be successful, and be patient. Trying to cram in more calories just doesn't make sense to me, I don't care how insane it sounds to only be eating 500 or so. Its not insane for a sleever! Our tummies are tiny! No need to go trying to stretch what you paid good money to make smaller! but,, I digress.

Okay... 2 things.

1 - I hope you are not implying that by looking for information from professionals and published resources, I am somehow searching for the answer I "want" to hear, because I feel that it would be foolish to blindly accept advice on my health decisions from someone on a forum that I have never met or particularly noticed the quality or tone of their posts, just because they say they know what they're talking about. Perhaps that part of your response wasn't directed toward me...

2 - You seem to indicate here that you believe I must be gorging or stuffing myself when I eat. You stated in your previous post that you often were so full you felt sick after you would eat. I admit to having made some mistakes on tolerable volumes and the appropriate speed which I can eat without discomfort during the learning process, but I currently rarely feel ill or any discomfort when I eat and am especially careful when eating any dense protein because I am still adjusting to that. Perhaps you assume I am doing the same thing you did?

Okay, maybe 3 things... I actually do take offense to the implication that I am somehow trying to "cram" in calories. I am eating under my nutritionists guidelines. If you think it's silly to follow that recommendation, so be it. I would recommend that you don't follow it. Let me be very clear here. I understand that you believe you are right. And since you have been very successful, you clearly are right for you. However, I've never me you. To me, you are "a random". I'm unlikely to take your advice over someone I know to have a degree in nutrition, and that I found to be reasonable after lengthy discussion.

I am 5'9" as well, have a large build, and my doctor's nutrition program has lifetime caloric intake at 800-1000 cal/day. No changes for height. Your body probably can't handle more than that, and 700 cal/day should not cause you to go into starvation mode. Have you seen the dietician? The therapist? They'll probably give you a better insight that the MD.

Thank you, I agree that the dietician would likely give me better insight than the surgeon, however, she's already given me her recommendations, so I'm sticking with them. I think I indicated in my post (if not, I did in one of these responses) that I didn't believe that I actually need a change in diet. I believe it's some combination of increased hydration and my body's reaction to the calorie normalization. But, at any rate, the post was about the interaction with the surgeon, not any "failure" to lose weight. The entire issue was that I was angry at being marginalized. I saw a therapist for a few months before surgery, but we determined that there wasn't really a need for me to continue seeing her unless I ran into something I felt I needed to work out. All of my closest friends are therapists and social workers. I talk to them about everything. It will be pretty easy for me to identify when/if I need to see a therapist. So far, I haven't had the emotional sh*tstorm I expected. No tears, no increase in depression, no sense of loss or grief. Short tempered at times, but that's pretty much my baseline. I used the clinic therapist for my psych eval. I would not consider seeing her for therapy. She was very nice, but her idea of a psych eval was a 25 minute telephone conversation. Thank you very much, $275, please! I didn't know that was what I was in for until she didn't make it to the scheduled appointment and rescheduled me for a phone "interview". I would have used my regular therapist, but she couldn't do it, so I just used the one at the clinic because I figured it would be less hassle. That part was definitely true... All of that is neither here nor there. At any rate, a therapist isn't going to tell me all the deep dark secrets of how the metabolism works, and I'm not stressing over weight loss. I'm just angry about my interaction with my surgeon during this appointment.

To be blunt and to not waste anyones time.. Asking a surgeon for a detailed response about the effects of bariatric surgery on an individuals metabolic rate (particularly as we're all different) is like asking a baker to fix a rare sports car. In short, you need an endocrinologist.

As for the impeded weight loss. You sadly had a bit of a rough trot of it immediately after your surgery - so this would definitely have short-circuited the system - giving much credence to the points made by our learned friends on this site, that you may have to wait it out and see how your body normalises.

As far as references for current academic research go, please see below. As you'll know, academic research is normally very narrow in its focus, so you'll have to go through quite a few of them in order to assimilate a potential 'ground truth' for yourself. However, there are some articles which offer the generic information you seek which might at least allay your current fears. Naturally, this comes with the caveat that without full knowledge of the endless subtleties and nuances the endocrine system plays on our bodies, it might appear attractive to propose one hypothesis for your current predicament, for it to then be incorrect because of a previously unidentified and unevaluated interaction.

Consequently, if you want your rare sports car fixed? Go see a specialist mechanic

Hope this helps. Any questions or queries, please do not hesitate to ask. Best of luck, Daydra x

Bariatric surgery in obesity: Changes of glucose and lipid metabolism correlate with changes of fat mass Original Research Article

Nutrition, Metabolism and Cardiovascular Diseases, Volume 19, Issue 3, March 2009, Pages 198-204

F. Frige', M. Laneri, A. Veronelli, F. Folli, M. Paganelli, P. Vedani, M. Marchi, D. Noe', P. Ventura, E. Opocher, A.E. Pontiroli

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2 Effect of bariatric surgery on liver glucose metabolism in morbidly obese diabetic and non-diabetic patients Original Research Article

Journal of Hepatology, In Press, Accepted Manuscript, Available online 20 September 2013

Heidi Immonen, Jarna C. Hannukainen, Patricia Iozzo, Minna Soinio, Paulina Salminen, Virva Lepomäki, Ronald Borra, Riitta Parkkola, Andrea Mari, Terho Lehtimäki, Tam Pham, Jukka Laine, Vesa Kärjä, Jussi Pihlajamäki, Lassi Nelimarkka, Pirjo Nuutila

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3 Dramatic Reversal of Derangements in Muscle Metabolism and Left Ventricular Function After Bariatric Surgery Original Research Article

The American Journal of Medicine, Volume 121, Issue 11, November 2008, Pages 966-973

Joshua G. Leichman, Erik B. Wilson, Terry Scarborough, David Aguilar, Charles C. Miller III, Sherman Yu, Mohamed F. Algahim, Manuel Reyes, Frank G. Moody, Heinrich Taegtmeyer

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4 Bariatric surgery and its impact on sleep architecture, sleep-disordered breathing, and metabolism Review Article

Best Practice & Research Clinical Endocrinology & Metabolism, Volume 24, Issue 5, October 2010, Pages 745-761

Silvana Pannain, Babak Mokhlesi

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5 Progressive Regression of Left Ventricular Hypertrophy Two Years after Bariatric Surgery Original Research Article

The American Journal of Medicine, Volume 123, Issue 6, June 2010, Pages 549-555

Mohamed F. Algahim, Thomas R. Lux, Joshua G. Leichman, Anthony F. Boyer, Charles C. Miller III, Susan T. Laing, Erik B. Wilson, Terry Scarborough, Sherman Yu, Brad Snyder, Carol Wolin-Riklin, Ursula G. Kyle, Heinrich Taegtmeyer

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6 ESR1 gene and insulin resistance remission are associated with serum uric acid decline for severely obese patients undergoing bariatric surgery Original Research Article

Surgery for Obesity and Related Diseases, In Press, Corrected Proof, Available online 14 November 2012

Weu Wang, Tsan-Hon Liou, Wei-Jei Lee, Chung-Tan Hsu, Ming-Fen Lee, Hsin-Hung Chen

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7 American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery Medical Guidelines for Clinical Practice for the Perioperative Nutritional, Metabolic, and Nonsurgical Support of the Bariatric Surgery Patient Review Article

Surgery for Obesity and Related Diseases, Volume 4, Issue 5, Supplement, September–October 2008, Pages S109-S184

Jeffrey I. Mechanick, Robert F. Kushner, Harvey J. Sugerman, J. Michael Gonzalez-Campoy, Maria L. Collazo-Clavell, Safak Guven, Adam F. Spitz, Caroline M. Apovian, Edward H. Livingston, Robert Brolin, David B. Sarwer, Wendy A. Anderson, John Dixon

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8 Clinical Practice Guidelines for the Perioperative Nutritional, Metabolic, and Nonsurgical Support of the Bariatric Surgery Patient—2013 Update: Cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery Review Article

Surgery for Obesity and Related Diseases, Volume 9, Issue 2, March–April 2013, Pages 159-191

Jeffrey I. Mechanick, Adrienne Youdim, Daniel B. Jones, W. Timothy Garvey, Daniel L. Hurley, M. Molly McMahon, Leslie J. Heinberg, Robert Kushner, Ted D. Adams, Scott Shikora, John B. Dixon, Stacy Brethauer

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9 Bariatric surgery and the gut-brain communication—The state of the art three years later Review Article

Nutrition, Volume 26, Issue 10, October 2010, Pages 925-931

Maria de Fátima Haueisen S. Diniz, Valéria M. Azeredo Passos, Marco Túlio C. Diniz

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10 Postoperative Metabolic and Nutritional Complications of Bariatric Surgery Review Article

Gastroenterology Clinics of North America, Volume 39, Issue 1, March 2010, Pages 109-124

Timothy R. Koch, Frederick C. Finelli

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425]

Bariatric surgery

has become an increasingly important method for management of medically complicated obesity. In patients who have undergone

bariatric surgery

, up to 87% with type 2 diabetes mellitus develop improvement or resolution of their disease postoperatively.

Bariatric surgery

can reduce the number of absorbed calories through performance of either a restrictive or a malabsorptive procedure. Patients who have undergone

bariatric surgery

require indefinite, regular follow-up care by physicians who need to follow laboratory parameters of macronutrient as well as micronutrient malnutrition. Physicians who care for patients after

bariatric surgery

need to be familiar with common postoperative syndromes that result from specific nutrient deficiencies.

11 Update: Metabolic and Cardiovascular Consequences of Bariatric Surgery Review Article

Endocrinology and Metabolism Clinics of North America, Volume 40, Issue 1, March 2011, Pages 81-96

Donald W. Richardson, Mary Elizabeth Mason, Aaron I. Vinik

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425]

Obesity is a disease state with polygenic inheritance, the phenotypic penetrance of which has been greatly expanded by the attributes of modern civilization. More than two-thirds of obese persons have comorbidities, many of which are characteristic of cardiometabolic risk syndrome (CMRS) in addition to other life-quality–reducing complaints. The CMRS is associated with increased cardiovascular events and mortality. Individuals with a body mass index greater than 35 infrequently achieve or maintain weight loss adequate to resolve these metabolic and anatomic issues by lifestyle or pharmacologic strategies. Data suggest that some of these patients may be better served by

bariatric surgery

.

12 Secretion and Function of Gastrointestinal Hormones after Bariatric Surgery: Their Role in Type 2 Diabetes Review Article

Canadian Journal of Diabetes, Volume 35, Issue 2, 2011, Pages 115-122

Alpana Shukla, Francesco Rubino

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13 Cirurgia bariátrica: como e por que suplementar Review Article

Revista da Associação Médica Brasileira, Volume 57, Issue 1, January–February 2011, Pages 113-120

Livia Azevedo Bordalo, Tatiana Fiche Sales Teixeira, Josefina Bressan, Denise Machado Mourão

Jeez I read that whole thing. Whatever else you do' date=' get your BMR tested. That's the one thing you mentioned that makes sense. With that information you do not have to guess any longer. Your BMR test results will tell you exactly how many calories you're burning. The problem with the fit bit/body bug devices is they estimate your calorie burn based in non sleever information. Everything changed the day you got sleeved. It has been well documented the metabolic "reset" that VSG causes....and they are still not 100% sure how and why. But such things as diabetics being able to go off meds immediately even before they lose the weight...these instances happen frequently. Point is what worked before sleeve doesn't necessarily work the same way now. Also, curious about your hospitalization. Was it lack of calories or lack of hydration? Cause most people suffer from dehydration immediately after surgery, but lack of calories does not usually cause problems. Our bodies will happily burn fat at that point. But even drinking the 64 oz of Water maynot be enough for someone like you with a large athletic frame. It's not for me. I drink double that. It's always a shock to people how much of our daily water needs are obtained through food prior to surgery. After surgery, that's no longer the case which is why they push us to drink so much.[/quote']

Yes. I agree.

Okay... 2 things.

1 - I hope you are not implying that by looking for information from professionals and published resources' date=' I am somehow searching for the answer I "want" to hear, because I feel that it would be foolish to blindly accept advice on my health decisions from someone on a forum that I have never met or particularly noticed the quality or tone of their posts, just because they say they know what they're talking about. Perhaps that part of your response wasn't directed toward me...

2 - You seem to indicate here that you believe I must be gorging or stuffing myself when I eat. You stated in your previous post that you often were so full you felt sick after you would eat. I admit to having made some mistakes on tolerable volumes and the appropriate speed which I can eat without discomfort during the learning process, but I currently rarely feel ill or any discomfort when I eat and am especially careful when eating any dense Protein because I am still adjusting to that. Perhaps you assume I am doing the same thing you did?

Okay, maybe 3 things... I actually do take offense to the implication that I am somehow trying to "cram" in calories. I am eating under my nutritionists guidelines. If you think it's silly to follow that recommendation, so be it. I would recommend that you don't follow it. Let me be very clear here. I understand that you believe you are right. And since you have been very successful, you clearly are right for you. However, I've never me you. To me, you are "a random". I'm unlikely to take your advice over someone I know to have a degree in nutrition, and that I found to be reasonable after lengthy discussion.[/quote']

You are absolutely right. You shouldn't take my advice or any other successful sleever for that matter. You seem like you already know everything and have it all figured out. I should have picked up on that when in your original post you were mad at your surgeon and took no responsibility for your weight gain. I will refrain from ever commenting on a post from you or one that you added your thoughts to previously. I don't have that kind of time to spend online arguing with a person who asked for advice but already knows it all. Good luck to you. I'm sure you will be a success however you define the term.

You are absolutely right. You shouldn't take my advice or any other successful sleever for that matter. You seem like you already know everything and have it all figured out. I should have picked up on that when in your original post you were mad at your surgeon and took no responsibility for your weight gain. I will refrain from ever commenting on a post from you or one that you added your thoughts to previously. I don't have that kind of time to spend online arguing with a person who asked for advice but already knows it all. Good luck to you. I'm sure you will be a success however you define the term.

Um, do I detect a facetious undertone here?

Um' date=' do I detect a facetious undertone here? [/quote']

I've grown tired of this whole subject. I tried to help by saying what made me successful but alas my suggestions of Protein first and not overeating the sleeve were unwanted and unwelcome so I just wished her well. It's obvious she knows the secret to success and is not really here seeking advice from those who have already done it. It's seems that she merely wants to argue her point of view and I'm not going to engage in that further. It's a fruitless endeavour. I do genuinely wish her well. I am not a mean spirited person. I know when my thoughts are not welcome and that's fine. Sometimes in these posts you can't tell a person's intent and I was only trying to give advice that I was given. No harm meant but No use in beating a dead jackass. See you on another thread! I'm out! :-)

Daydra I read your whole post and I can so relate. You don't know how hard I have been working to NOT do exactly what you are doing, which is exactly what I used to do before the surgery: try to find my own answers.

I'm a problem solver. I'm well-educated. I know more about my body than any doctor who doesn't take time to understand me. Only I can help myself.

And then I hit 230 lbs by trying to solve my own problems my own way.

When I decided to have the surgery, I didn't worry about food funerals, not being able to eat, social life, etc etc. I worried that I wouldn't follow the plan. That I would continue to to think I could educate myself and customize and tweak things for myself.

For me, getting mentally ready wasn't about food. It was about giving up control. About subjugating myself to a plan, not overthinking it, and just DOING it. Super hard for people like us! But there is a plan here.

In broad strokes, it's to eat between 600-800 calories, get at least 60 gms of Protein and drink at least 64 oz of Water. That's it. Don't question it. Try it.

Your doc is right, our metabolism isn't like that of people who have not yo yo'ed. Some studies suggest our metabolism is up to 40% slower! But there I go again--using my knowledge and science to justify something.

I don't need to. For once, I don't need to know. I don't need to be the expert. I just need to follow orders. As much as I HATE following orders, that's what I need to do. I don't even need to understand why, even though half my posts are all about why why why.

Your admission to the ER was due to a stricture and dehydration. Don't relate it to calories. Eat your protein, drink your water and keep your calories between 600-800 while losing. Just do it for a few months.

FYI, my husband is 6 tall, big burly man, was 298 at his highest, 278 DOS and is 225 now. Very muscular. And he follows the same plan as I do. Eat between 600-800 calories, get at least 60 gms of protein and drink at least 64 oz of water.

I hope I didn't sound harsh because I say this to you with love. Let go my dear, and let the plan take over.

Aaand I probably should have read the other pages before I posted because I read you weren't asking for help or advice but rather sharing your frustration with the surgeon.oops. I can delete my post if you'd like?im kinda half man so I always look for solutions even when people are just venting.

I will say the reason I didn't automatically delete my post is because I do think for people like us, letting go IS part of the issue. It's also part of your issue with your surgeon thinking she knew better what was good for you and ignoring your input. I would respectfully like to suggest that while her bedside manner may have sucked, maybe she does know better. Maybe.

Aaand I probably should have read the other pages before I posted because I read you weren't asking for help or advice but rather sharing your frustration with the surgeon.oops. I can delete my post if you'd like?im kinda half man so I always look for solutions even when people are just venting.

I will say the reason I didn't automatically delete my post is because I do think for people like us' date=' letting go IS part of the issue. It's also part of your issue with your surgeon thinking she knew better what was good for you and ignoring your input. I would respectfully like to suggest that while her bedside manner may have sucked, maybe she does know better. Maybe.[/quote']

Don't delete....it's a good post. It indeed may ring true to others....even if not the OP.

Show off.

<shakes her tail feathers>

Ppppbbbbbtttttt.