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The orthostatic hypotension is not unusual with rapid weight loss, and is one of several ramifications of your body still trying to function at your old weight when there is substantially less of you at hand - we often feel cold for the same reason, that the body is still trying to cool what is no longer there. These things do improve over time, though it may be a year or two. In the meantime, as the docs and others suggest, more salt, lots of fluids (non-alcoholic), and also exercise is also a common prescription to "keep things pumping"
On the exercise front - this should improve things, but let your trainer know that you have this problem so they can watch for it. Also, another side effect of the rapid loss is that your heartrate will likely be lower, at rest and in activity, so if the trainer is pushing to achieve some specific heartrate to indicate some level of exertion, (often it is 80+% of a theoretical maximum rate) their measurement scale may be skewed and they may push you harder than they should. When I was 2-3 months out, I noticed that exercise (brisk walking short of a jog) that used to get my heart into that 80% zone (140-150 for me at the time) would barely get me over 100; even today, years later, my resting pulse is low, often 50 or below, and doctors/nurses unfamiliar with me will question it (yes, it's normal) though my BP is normal to a touch high.
So, the exercise should be OK, but let them know and don't let them push you too hard - your cardiac system may have excess capacity, but you may be evertaxed elsewhere.
Your ketone levels have little to do with whether or not you are losing weight. They are in indication that you are burning fat. but that can be ingested fat as well as stored fat. If you want to burn your stored fat, you need a good caloric deficit, and it matters little what style of diet is used to accomplish that - low fat, low carb, Keto, paleo, Atkins, whole 30 or whatever it may be. I used a relatively high carbohydrate diet (by Atkins/keto standards - 100ish g/day) and lost quite rapidly - because of the fairly high caloric deficit; ketones were there in the blood tests because I was burning my fat stores, but those readings weren't a goal.
The high fat/low carb type diets a la keto and paleo are popular these days, but the high calorie levels that often accompany them can sometimes make weightloss difficult. Clinically, high fat/low carbohydrate diets are often prescribed to avoid or minimize weight loss after a non-WLS gastrectomy, so if you are trying to use such a diet for weight loss, you have to keep a close eye on calorie levels.
Being four months out, you should still be fairly restricted in you eating volume so that you should still be losing at a reasonable pace, but if you are ingesting too many calories by "eating around" your wLS - drinking calories or very high calorie foods - then you can see low or no loss at this point.
I was at 400 calories a day but recently, in the past 3 weeks, have been moved up to the 600-700s. My carbs have gone from the 20s to upper 30s. I'll be adding in a piece of fruit so I'll probably be around 800. I've been I a huge calorie deficit. Been meeting my Protein, though. In the 80s typically, daily. Dietitian gets my food logs often and is very happy with my intake... just, nothing is happening. I did Atkins last year and lost the exact same amount of weight and stalled at the exact same weight (I ended up giving up and pigging out and regaining).

I tried adding in a bunch of salt to some Gatorade today but it tasted like the ocean, lmao. I don't really know how much I should add.

I just find it bizarre that this is beginning now when it's been nearly two months since I've lost weight. I lost 68lbs in the first 2 months and nothing since. Figured my body would have gotten dizzy while I was losing weight... not so long during a stall. Anyways it sucks and I get dizzy sitting sometimes, too. My head just starts to feel like there's a lot of pressure, like I am holding my breath.

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I have had issues with this myself. I had pretty low blood pressure even before surgery, but it is really low now. Adding a bit of salt has helped, but I just have to be aware of when I stand up. Sometimes if I feel the dizziness come on, I will bend over for a second and that seems to resolve it. I have had it so badly a few times that all I saw was black and my legs began to give out. That hasn’t happened in a while, but it was still scary.
I'm glad I'm not alone. I thought it was something unrelated to the surgery at first.

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I did go to yoga this morning and got lightheaded a few times, but fortunately it is "flowy" so my body has time to adjust so it isn't severe. And I just stop for a moment if it gets bad. I start with the trainer Monday so def something to discuss.

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thank you though for everyone sharing that they experience this too. i feel better. i hope it improves for us soon!

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just ordered some sodium chloride tablets.

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I have this issue even pre-op at 245 pounds. I’ve dealt with it since I was 10. It’s an annoying thing my body does. I can’t say if it improves as your weight stabilizes, but I can tell you that most remedies have been useless for me. Increasing sodium, taking atenolol, wearing compression stockings, chugging Gatorade, it was for naught. I know now to just manage the symptoms as they come. I try to avoid triggers like doing anything too exerting first thing in the morning, exercising too intensely, standing stationary too long, especially in stuffy/hot environments. If I feel an “episode” coming on, I try to lie down if possible, and if not I sit down and try to ensure I won’t fall if I faint. Good luck!

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Yeah my normal BP has always been in the low 100s over the low 70s. Now it's in the 80s over the 40s. My braaaiiinn.

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Cripes that's low!

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I had this problem too! It started 2-3 weeks out and has gotten much better now (I'm 2.5 months out). The nurse at my surgeon's clinic told me to drink broth once every day or two, and weirdly that has helped a lot. There's drinkable broth powder that you can buy here at the grocery store (I live in Amsterdam) and it actually tastes good and warming and gives me a bit of extra salt. If I were more on my game I would be making Bone Broth for myself. When I don't feel like drinking the broth or if I'm a bit hungry I drink V8 and sometimes spice it up to make a virgin bloody mary.

My doctor also advised me to be vigilant about taking my Vitamins (I wasn't because the Iron in my multi made me throw up and I've since switched to chewable multis without iron) and also to make sure I'm getting all of my Water in, which I wasn't. She said I have to make sure I have enough water in me in the first place, and then have the right salts and minerals to make sure my body keeps it in. So I went from where you are--on the verge of passing out every time I stood up--to now rarely having problems and just being a bit more cautious with standing. Good luck, I'm sure that you'll find something that works for you.

Also, regarding regretting the surgery: the only way is forward. I know you're trying to come to terms with this huge change, but maybe consider whether regret is a helpful emotion right now. Things will get better--hang in there!

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12 hours ago, ummyasmin said:

Cripes that's low!

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I knowwww. I get so confused! I'll stand up and someone will be talking to me and it's like I barely comprehend what they are saying for about a minute until my blood comes back to my head. lol!

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So, this resolved for a month and a half but has now returned with a vengeance! aaaaaaaa!!!! When I stand up, my vision just goes black and I have to just stand super still while everything.. flushes back to normal.

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OMG Mousecat, some days you just can't win for trying!

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Try tensing leg muscles before standing. The higher muscle mass the better it is for me. BP is low - 100/55 or so. Just has been that way for me even pre WLS. Try to be as focused on the good as possible as you wade through muck.

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Unf. The last 2 weeks I have been losing my vision nearly every single time I stand up. I also get very confused for a moment, occasionally. It's affecting my ability to exercise at the intensity I am at (and otherwise ready for). I stand up from the sofa, slowly, to walk to the kitchen, lose my vision and stand totally still, then as it's coming back slowly edge my way towards the counter to hold on for a moment until the blood rushes back to where it's supposed to be. lol. I messaged my doctor about this and he's just like "hopefully it will eventually get better".

O__O OKAY

Edited by mousecat88

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Your internal barometer has gone a little wookey and it is a MISERABLE THING! More deluberate, move sliw, right now you can't set any Land Speed Records!

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Your internal barometer has gone a little wookey and it is a MISERABLE THING! More deluberate, move sliw, right now you can't set any Land Speed Records!
Tell me about it! I think I'm going to see my primary care about Midodrine. I have GOT to raise my BP! Salt doesn't help. It's really scary feeling so woozy and losing vision so often. My trainer is concerned because I'll be doing something and then get like this thousand yard stare and confusion for a moment and then I'm fine again.

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