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It has been a bad day, a really bad day as I deal with a family member that has severe emotional/psychological problems. As I drove away from their home my mind kept ticking through the things that would dull some of the pain I was feeling, and everyone of them revolved around food. Hell, I have a bottle of good Irish Whiskey downstairs in my office, and while I will probably pour myself a stiff drink after the kids are down for the evening, it isn't nearly as attractive in my mind as taking the family out for BBQ and eating until I am so full that it hurts. Is it any wonder diets don't work for us, when food has become a drug that we use to dull the pain that comes with living? Well, the good news is, as my mind ticked through my options I knew that those that dealt with food really weren't an option. After getting stuck last night, I am not willing to piss off Mistress Band two days in a row, and to tell the truth since being banded, I know that using food as a drug will only make me feel worse and I will still have the family matter to deal with with the guilt of having indulged in emotional eating added to it. So, here I sit with my glass of crystal light lemonade, writing a blog entry for those who have helped me on this forum. Thanks for listening.

As some may know, I have been trying for WLS since August of 2005. Finally my time came and I was sleeved. I was a very active member on ObesityHelp until I found this site. Enjoy the info and videos... The word bougie means "candle" in French. "F or FR/Fr" following a bougie size=French Its just a guide that the surgeon uses to butt the stapler up against, when forming your VSG. The closer s/he gets to the guide the 'tighter' /truer to guide the sleeve is. During surgery the bougie is inserted into your mouth down your throat, towards the end of yer stomach where it meets the pylorus via an esophageal dilator. After the new stomach is formed, the bougie/guide is removed out of your mouth, possibly why some VSGrs complain of a sore throat post op. Some surgeons will use an endoscope or other "guide" to size ones new stomach. I read an OH post of a VSGr who's surgeon explained an endoscope is the same size as a 32F bougie...Im not sure. Bougie size determination is between YOU and YOUR surgeon. Discuss size, rationale for size chosen, type bougie and technique used when sizing your new stomach........ PRE-OP!! Some surgeons may "oversew" the staple line giving one a 'tighter' than bougie sized sleeve. In order for an "oversewn" staple line to affect stomach size it MUST be running or continuous oversewn suture line across majority of staple line not intermittent oversewn nor merely at intersected "junctures" where the surgeon has reloaded the staple gun as majority of "oversewn" techniques (to prevent leaks) are done today. Make sure your surgeon explains what his/her "oversewn" technique is. Do not assume because a surgeon "oversews" you have a tighter than bougie sized sleeve. A bougie is 1/3 mm PER french. i.e to calculate ~ inches 40F bougie 1/3 x 40 = 13.33mm convert to inches = ~.52 inches or ~1/2 inch in diameter. Below are diameters of bougie/ "guides" in inches 32F = .40" 34F = .425" 36F = .45" 38F = .476" 40F = .5" 46F = .576" 60F = .75" Video 1 This VSG surgery video shows a 'red' 34F bougie, one technique in sizing stomach, exised stomach, testing for leaks etc .http://www.orlive.co...eight-loss-surg ery-gastric-sleeve Red bougies are older mercury filled ones. FDA is tryin to ban em because of disposal issues (mercury). More surgeons will use SINGLE USE disposable sized bougies Video 2 In this surgical video Dr. Alvarez shows a disposable 32F bougie and use/technique ~9-2012 In another Forum, this member's bougie pix is from hospital she works at 1st: 36F, 2nd: 38F on left, 32F on right General/ crude comparison chart created by another Forum member Standard sized bougies in the US and Mexico are 32F. 32F is the smallest guide a bariatric surgeon in the US may safely use in forming your sleeve. Your surgeon may prefer any size bougie from 32-50F, based on YOU, your height, weight, or perhaps the need for a malabsorptive procedure in the future, inc. 1st step of 2 part DS. Discuss what to expect, rationale for size chosen with your surgeon if this is a concern. LapSF/Dr. Criangle on their routine use of 32F bougies in VSG "Optimal weight loss may require the smallest possible pouch, which may yield the highest leak rate" . Some surgeons will welcome discussion and your input on bougie sizes. After reading a published journal on the higher incidence of VSG surgically induced GERD (acid reflux/heartburn) in use of 28-32F bougies, it may be wise to request a higher bougie size. However, like all surgeries, we will need years of data to support whether or not this claim is actually true. The History of using Bougies In 2000 the use of 50-60F bougies were standard for VSG when it became a stand alone WLS, as they were the standard sizes of DS bougies, which VSG was modeled after. As the years went by, bariatric surgeons thought..smaller bougie, better restriction, less regain. So in ~2005 an adopted 32F bougie became the VSG standard. Rarely, if ever are 28-30F or 50F and over bougies used in the US for VSG as stand alone anymore. Many many VSGrs do EXTREMELY well with 40F-48F bougies as the guide to sizing their new stomach, losing all the weight they need to. In 2008 study (small poll 135 pts) on Bougie Sizes in VSG seems to indicate at 6 mos and 12 mos post VSG .... 40F and 60F bougies with no significant difference in EWL (eventual weight loss) 2008 Bougie Size Comparison In 2009 study (a large poll) on Bougie Sizes in VSG seems to indicate at 5 years post VSG ... 32F and 44F bougies show exactly the same EWL (eventual weight loss) 2009 Bougie Size Comparison In 2012/13 study (a very large poll) on Bougie Sizes in VSG seems to indicate at 3 years post VSG, a LESS than 40F bougie and GREATER than 40F bougie show no difference whatsoever in EWL (excess weight loss) 2012/13 Bougie Size Comparisons VOLUME/GASTRIC CAPACITY in VSG: PRE VSG: Average stomach holds 32-48 oz or 4 to 6 cups per meal POST VSG (~6-8 months out FOR LIFE) ..new stomach holds 8-12 ozs or 1 to 1.5 cups per meal (depending on weight/density of foods you eat! can be much less or much more) The length of an adult stomach is 10-12 inches. DNA affects the length of our stomachs, as well as variations in shape. Tall people, for instance are known to have longer stomachs..so makes sense they have a bit more capacity, short people have shorter stomachs therefore less capacity.... so volume/capacity can be influenced by the length and physical anatomical variations of an individual's stomach. Dr. Alvarez explains in this You Tube video about length of an individual's VSG stomach and how it relates to volume. This limited 2009 study is interesting in looking at gastric capacity in VSG, just 3 days post op (120 ml=~1/2 cup) compared to 2 years post VSG (250 ml=~1 cup) http://www.ncbi.nlm.nih.gov/pubmed/19533260 At the end (8:28 mark) of this LapSF VSG surgical video shows 1 DAY old (pod) sleeve Xray and a sleeve Xray at 4 years out. It is not clear to me if same pt. or solely to impress the new "normal" sleeve size. Note the "new normal" 32F tightly formed sleeve has dilated/stretched naturally to perhaps triple in size...The video also shows one technique of sizing the sleeve, as well as reinforcement of the staple line (to prevent leaks) This VSG video shows the speed with which LIQUIDS/FLUIDS empty from the sleeve. In normal stomachs fluid empty rate is 5 minutes or less due to space creating a reservoir for large volumes of fluids. In VSG stomachs: fluid empty rate looks MUCH faster than that... youdecide! The COTTAGE CHEESE TEST /CCT (link following) may be helpful to VSGrs that are curious about their new stomachs capacity. It was developed for RNY but an effective tool in VSG as well! I'd suggest waiting until you are on a regular diet before checking. When doing this test PLEASE eat to sensation of satiety - no longer hungry, and absolutely not full. A simpler method, following the basic guidelines and time frame in the link provided... is to place 1 level cup (8oz) of small curd cottage cheese in a bowl and eat from that. Using a measured tablespoon to eat any remaining cottage cheese from the original container. Add or subtract any cottage cheese eaten or not finished using the measured tablespoon. 2 TBS=1oz. Total...the amount consumed = your sleeve's capacity. http://www.bsciresourcecenter.com/proddetail.php?prod=A4 STRETCHING in VSG: YOU CANNOT STRETCH/DILATE out your sleeve to anything remotely close to its original size. From LapSF/Dr. Criangle: The removed section of the stomach is actually the portion that stretches the most. The long vertical tube shaped stomach that remains is the portion least likely to expand over time and it creates significant resistance to volumes of food. The fundus (inc. majority of stomachs 'body' up to pyloric canal) of the stomach is ALL but removed with VSG. The fundus is the upper most part of the stomach's greater curvature. The fundus is: 1) the stomach's stretchy/expandable tissue, capable of expanding 2-3xs its resting 'unfilled' size 2) the pre-op 'mass quantities' of food, waiting to be digested, storage section 3) where 70% of the body's grehlin a "hunger hormone" is produced. Stretching, due to overeating is most common in RNY because more of the stretchy fundus part of the stomach is retained to make the 'pouch', and is usually NOT covered by insurance to correct. Re-sleeving or a need for a malabsorptive surgery post VSG may or may NOT be covered by your insurance plan. Anecdotally, Ive read from select OH VSG members, or according to a/their particular surgeon..overeating will cause your sleeve to stretch out. Ive read/found no scientific data, published or otherwise, to date that says this is a TRUE statement. Since food stays in our stomach less than ~ 3 hours after a meal..common sense tells me food doesn't stay in our stomachs long enough to create 'stretching'. Food once ingested, immediately begins to be churned into a liquidy sludge called chyme through peristalsis in the stomach. This liquidy sludge must be small enough to pass through our very small pyloric valve and into the small intestine for further digestion /breakdown and absorption of 'micronutritents' ...so there cannot be enough pressure for long sustained periods of time in our stomachs to cause it to stretch. Post op VSG ... depending upon the amount of swelling/inflammation you have..even a little 'thick/er' dense liquids or pureed foods/mushies may or may not feel restrictive, as you pass through the progression of texture dietary phases ( to promote healing) and onto your regular diet ~2mos post op. ... swelling/inflammation has naturally reduced. Density of meals becomes a key player in restriction. By 1 year out you'll find you can eat more than you could at 2 days post op, at 2 weeks post op, 2 months post op, and 6 months post op. Your sleeve has naturally and fully matured. Depending on the food..you can eat more or less than the 8-12 oz capacity of a fully matured sleeve.......at any particular meal. Toleration of a food, does NOT make it a good choice! "just because I CAN...doesn't mean I DO" --------------------------------------------------------------------------- The bougie size controversy/wars are ridiculous imo.. 'get a smaller one, you can stretch it out, you're not going to have any restriction, that bigger one is all wrong, you'll re-gain easily years out, my surgeon made mine smaller and I got to goal in 6 months' ...all nonsense DO NOT PAY EM NO MIND!! This is YOUR story! YOUR journey! ALWAYS REMEMBER THIS TRUTH: YOUR WEIGHT HAS NOTHING TO DO WITH THE SIZE OF YOUR STOMACH, altered or not! Most important is the quantity and quality of the food choices you ingest post-op

OK!!!! I just created a new surgery ticker and I realized I am only 3 weeks and 5 days away from getting sleeved! Holy crap! I better get moving! I have made lists of all of the things that I will need post surgery. While I have purchased many things, there are still a few things that I need to pick up. I need to go and get these this weekend. ASAP! Scheduling an extended timed trip to WalMart and GNC. I have also promised myself that I would start toning pre-surgery. I want to start pumping those muscles up now! I have to find my hand weights and schedule some time in my week to start my circuit again at Planet Fitness. I have already begun my vitamins including my Biotin. So, I have to schedule in extra time to shave my legs because the hair is growing back 3 times as fast! UGH! (The hair on my head better grow like this! For goodness sake!) I want to take pictures and measurements of myself so I can chart my progress. This is going to be a depressing harsh dose of reality. (I better add a bottle of rum to my list in celebration of my Bye-Bye To Fat Measurement Pity Party.) I also have to schedule time to take these measurements and pics! My surgeon is not requiring a pre-op diet because I am a lap-band to sleeve revision. However, I feel that if everyone else has to do a special diet well, then I should too! Now, don't get me wrong! I am not thinking about 2 weeks of liquids. NOOOOO!!! More along the lines of a week of 2 protein shakes a day and one light meal followed by two days of liquids immediately prior to surgery. (See. I have some discipline!) I better pencil the diet starting date into my planner. Now....... having said all that, I have just one thought. Being a teacher, and having all of the end of the year stuff to manage and complete, I have a "full plate" with this WLS. And... WLS and full plates do not go hand in hand! I think I need to hire an assistant. I need someone to make sure that I am keeping to all of these schedules! My husband already has said that he does not want the job no matter how high the pay! Geez! I guess I better start taking applications! Only serious inquiries need to apply! LOL

4 days to go and op cancelled again for the 3rd time, date now 30th may, really fed up, but trusting in God, dont understand but He is in control so who am i to grumble, in His time, praise the Lord,xx

I've finally broken my stall after almost 2 weeks, and have lost a lb. a day for the past 3 days! I knew it had to end eventually, and tried not to stress about it, but it was hard! I'm now 224, 50 lbs from my top weight of 274. So excited!

Look at it, doesn't it look disgusting?? doesn't the thought of consuming such a thing just put you off? well guess what it's actually delicious! i know i was surprised too. Low calorie, full of vitamins/minerals, filling, delicious can it get any better than that? well i first heard of the green smoothie from this book forgot the name of it, but the recipe the lady gave me tasted despicable >.<. Ok so rule of thumb, the smoothie should be half greens half fruit so it's sweet, also make sure to blend until smooth so its not chunky and gross. I use half spinach and half strawberry/apple, banannas dont have enough flavor for me :/. It tasted just like apple juice! breakfast anyone

Just put some masking tape over the number part of the scale. On the tape write down your goal weight. Now EVERY time you step on you will ONLY see your goal weight and are forced to either wait until you see the Dr. or bend over and remove the tape (which you KNOW will be wrong)

I don’t wanna go to work tomorrow! Only because I know I have 2 week’s worth of work I need to do. Job 2 I get to see my day care kids and I will get 2 weeks of hugs from the kids. Since the Midwest is starting to have a spring I think I will take the day care kids on a Nature Walk tomorrow. Tomorrow I start week 3 post op and I start adding soft foods. I already packed my breakfast and lunch for work tomorrow. Also, I added a snack just in case I get hungry. So what is on tomorrow menu? Breakfast 2 hardboiled eggs (seasoned with garlic powder) ½ serving of cottage cheese Lunch Mashed Potatoes 430pm Snack 12 Special K Crackers and a low fat cheese stick. (24 crackers is 120 so I decided to do a half portion) Dinner Soup What do you think? I know I will have to add some more protein but I will get better with time. I noticed lately I’ve been getting hungry either around 4pm or 8pm. I don’t know why. I read that having snacks on the band is not good. I hope I am doing this right. Anyway my momentum is still strong and I am starting to look good in the mirror now. :wub: Thanks for reading.

Went for a fill appointment this morning, talked over my hunger levels and loss history over he last month and the nurse suggested a .2 tweak, bringing me up to 4.9. So, liquids today, and mushies tomorrow. And I don't have to go back for a month.

My initial loss with my band was amazing (and a little scary), but the joy of seeing pounds dropping off on a daily basis was truly fantastic. As I was looking at my weight this morning, I noticed that I had only lost 5 pounds during the month of April and was tempted toward the negative by comparing my loss with what I did when I was first banded. Then I started to think about my bike ride on Sunday, 28 miles, 23 miles two days before, Both at speeds that it took me 5 months of work up to last year to be able to sustain for 15 miles. I thought about my spin class and the progress I have made during it, where I had to stop and rest halfway through when I first started. I thought about the fact that it is time to go shopping for clothes again because my pants are starting to bunch at the waist when I tighten my belt enough to hold them up. I thought about the fact that I am down to one belt because I haven't punched holes in the other two. I thought about the fact that the fat percentage on my scale hit a new low number this morning. I thought about all the weight that I lost on WW, and how 5 pounds in a month would have been a cause for celebration. Yup, the low hanging fruit of my band journey is all gone, but that's ok I burn more calories when I have to climb the branches to reach the higher fruit. Father God, please help me to remain thankful for all that you have given me instead of focusing on what I don't have...