GeezerSue

Lisa... We haven't "talked" in so long...are we still friends? Did you come to my "rescue?" (I don't get to the zoo often and I was having too much fun watching "pack" behavior to remember to send for back-up!!! LOL.) How cool that you're here!?! Do be careful, though...in the past twenty-four hours, I have added one plus one and I got one...and then I got someone's name wrong...so probably nothing I say can be trusted. Hey, in all seriousness, on another site, I asked about the difference between "confrontation" and "anger." Most agreed that there can be very happy people who simply take a stand for certain things and won't back down...and there can be people who are truly seething with anger but try to paint a "rainbows and pony" scene to hide the truth and absolutely FREAK when anything threatens that charade. As we all know, the cudmudgeon-y folks seldom grab automatic weapons and blow up groups of people...they ALREADY get their little bitches and moans out during the course of a day, as irritating as it is to the ranibows and pony people. But it's those "artificially happy-happy, nice-guy" people that no one ever expected to go ballistic who make the evening news. So who is REALLY "angry?" Anyway, nice seeing another...what is this group?..."Disgruntled Old Failure!" BTW, as of this morning, I'm down a hundred pounds from my pre-banding weight...and down 80 pounds (the +/- 60 I'd lost and regained with the band and an additional 20) since my DS surgery. My belly is still too big...but my boobs and bottom fit quite well into SIZES...you know, the ones with no letters...the sizes that don't look like lattices...XXXXXXXXXX Hi to Chris...unless I got that name wrong, too, then "Hi" to whoever you see who is cute and looks good on a bike. I was in LV in January...but I was only eight weeks post-op and my esophagus still hadn't healed up...I never left the freakin' Bellagio the whole time. So I didn't try to contact anyone I knew there. See ya... Sue

do you have access to a flexible spending (IRS Section 125) program through work--or spouse's work? If so, you might have A LITTLE help there.

Okay...you win the "creative complication question contest!" I really don't think I've ever heard that one before!?! To the best of my knowledge, though, the dilation--which for some reason the medical dudes thought needed an additional syllable, so they call it "esophageal dilatation" (probably because they were science majors, not English majors)--as we are talking about it here, begins at the bottom of the esophagus, where food stacks up waiting to get into the stomach. It's not an easy thing to find photos of, because "esophageal dilatation" is BOTH a symptom of what banded and other people have when we have inadvertently enlarged our esophaguses (esophagi?)...but it's also a medical procedure performed by gastroenterologists to WIDEN an esophagus narrowed by strictures or disease. So it's a good thing (the procedure) and a bad thing (what we do.) So my guess would be...no...the back of the throat would not be involved. The images I've seen have been of an esophagus that was just wider a the bottom. Like an upside down skinny letter Y. Any chance you've lost enough weight that some of the fatty tissue in that area has just disappeared making a "normal" opening (that you aren't used tohaving) feel "different?"

Jenny, I hope you soon discover that your problems have resolved. Life is too short to spend it in misery!! Good luck, Sue

And high fructose corn syrup...the devil incarnate, honest!!

My only option was "pool walking." Wasn't even up to water aerobics! I just got in the stupid pool and walked back and forth the short way with a bunch of other old people who did the same thing every day. And then it became easier, but it WAS hell at the git-go.

Try to relax...we've either been through this or know someone who has...and MOST OF THEM have no long term problems of any kind. So...chill. Really! Think of a funnel. Made out of leather. (Yeah, weird, but it kind of works.) You can pour in infinite amount of a liquid in there, but solids--just by sitting there and exerting force on the funnel--can start to stretch the darned thing. This does NOT mean is it ripped or thrashed or broken...it's just a little stretched out. If I were a gambling women I'd put my money on "eating too fast." Because we are used to trying to fill up a STOMACH, we have no idea of how little it takes to fill up a FUNNEL. If you give your food time to get there, and send a signal that it's there on up to your brain, your esophagus will not have a reason to stay enlarged and it will reduce itself. Remember, unlike that leather funnel, it is a living organ. It changed by getting bigger and it can change and get smaller. You may need to figure out if YOU are stretching it (best option, because you can stop it). Start there. Exhale, now!!!

Malice, Of any problem to have, a "stretched pouch"--if that is the layman's term the nurse is using for "esophageal dilatation," is one of the easier ones to try to cure. Most of the time, all or most of the saline is removed and the esophagus--in the absense of too much food putting pressure there--cures itself. It takes a while...but it happens. One might want to try to determine WHY the dilatation is occurring--is the patient eating too much or too fast, is there a hernia putting pressure the esophagus from outside, is there esophageal dysmotility keeping the food from moving into the stomach--and resolving the causative problem to prevent a reoccurence. MILD dilatation is pretty common...and, as long as it stays mild, is not the sign of trouble. Perhaps your doctor has told the nurse to disregard MILD dilatation and make sure he knows about severe cases. I think I'd want him to take the time to tell me what I need to do to prevent doing anything that causes any real damage.

What SHE said...

I admit that I've been preoccupied recently with family responsibilities and all, but REALLY...I've found far more posts COMPLAINING that people are discouraging others with the use of this phrase than I have seen posts where people are actually USING the phrase. Again...I have been--and mostly continue to be--up to my ass in alligators right now, and because of that I don't often read and seldom answer the "regular" newbies questions because I figure that others are in a better position to do that. So it is quite possible that I have missed that issue. Do we REALLY have people telling others that the other won't do well once the "honeymoon phase" is over...or are they saying that THEY did well during they felt was like a "honeymoon phase" and then not so well afterward? I'm not being my usual argumentative self...I just see way more complaints about "flag burning" and I haven't noticed any burning flags, if you'll exuse the example.

GAWD...senility is tough...the TOPIC, Sue...the TOPIC. The band can only work when it is adjusted properly. If, anytime after the intial healing period--usually six weeks--the CALENDAR is the determining factor on your adjustments, you are getting follow-up that is easy for the doctor. If it's any consolation, during the FDA trial times with the band, they did the same thing--then they figured out they didn't need to wait so long. More than one FDA trial participant got fed up and went across the border and had adjustments there, because crazy-making is crazy-making. At least one of those 'rebels' is STILL banded and doing well. If she has to have an unfill for a precautionary reason (like for unrelated surgery), she gets it (and gains weight) and then gets refilled (and looses weight.) Literally a spokesperson for the band and you may have even seen her on TV ads! So even those who get frustrated and go off on their own can succeed.

Yeah...mine were about $900 as billed to insurance. But "billed to insurance" is just fantasy...so that their EOB can tell me how much they "saved" me. Crazy overbilling compared to what they COULD charge. (My OR and two-night stay for BR surgery at an uppity hospital where the "stars" hang out was billed as over $47,000. They actually accepted--between insurance and my part--around $2300.) Anyway, that's one reason some of us almost-border-dwellers hooked up with Tijuana doctors for follow up. OTOH, WITH insurance, the $900 adjustment worked out to about $300...which was better than killing an entire day crossing the border to save about $200. But a fill under fluoro is a good idea...and self-fills (there are a couple of banded doctors who unfill themselves for every bariatric conference so they can pig out...yeah, really) are usually the shortcut to problems. RN's--especially RN's with oncology experience--are very good at the adjustments...often better than most doctors because they so more work with the ports...but if they HAVE TO do an adjustment without a band doctor around, they should find a nurse-friend who will help them because problems have happened with the DIY approach. (And they HAVE TO have the RIGHT Huber needle if they don't want to need a port replacement.)

And an incorrect paraphrase is just incorrect. YOU might want to reread what I wrote. I was talking about people who "lost" 20 pounds in the first two weeks post op...or some other huge amount. According to your sig, you lost nine pounds in the two weeks post-op. Big difference. Less than half. Nine pounds CAN be lost. To "lose" 20 pounds in 14 days, one would have to underconsume 5000 calories a day. Which would pretty much mean they were 300 plus pounds, eating nothing and jogging at about 8 mph for 20 hours a day. (Okay so I'm exaggerating, but the math doesn't work for a claim of 20 pounds. There has to be a tremendous amount of Water weight involved in that.) And it was Rumbaut who explained that to me. Maybe YOU function well when all you hear is "positive advise and support." That makes you a glass-half-full person, I guess. But half the planet is "glass-half-empty" people and they have their needs, too. Some of us need to hear all the pros and all the cons. I hope we all get the support we need, even the (male or female) curmudgeons. Being married six months...or being banded six months--no matter what other people thought your chances of success at either might be--still does NOT qualify anyone as the source of all wisdom and truth about success at either venture. Not you, not me, not anyone else. One of the most despised banded people I even encountered did a GREAT job with her (relatively short) journey, and at nine months out was at goal and telling people who had been fighting a longer time with far more weight to lose exactly what they were doing wrong. She was eventually chased off of one board by the members and permanently banned on one or two other boards for appointing herself an expert. I don't think MY marriage is drudgery and work...and I feel sorry for anyone who finds themselves in that situation. But my MARRIAGE--the long term, have kids, pay bills, good times, bad times stuff--is VERY DIFFERENT than the first couple of years and there is very little most newlyweds can tell most long-married folks that the latter haven't already been through and accepted or rejected. It isn't an attempt at being patronizing...really. It's just experience. The people who used to tell my husband and me that our marriage would be strong like theirs if we would just join their church or their Amway group (?) are long ago divorced. People who NEVER thought they would consider any wls do. People who got RnY are banded over it. People who got bands change to RnY. People who got DS started drinking and oops. You have no idea how much email I get from previously die-hard bandsters and all of the emails start with "PLEASE keep this just between us..." because they are having to reexamine their position and are embarassed and not up to the fights from people who are going to try to convince them to just try harder. So youthful enthusiasm is cool...but not generally a deciding factor for the old folks. I'm glad to read that. I was starting to worry about the source of your information about marriage...LOL! I hope yours--if you have one--is doing fine. And if the info came from someone else, I hope they get their situation worked out. I don't THINK my husband and I are the exception, because we know others like us...but we are in love, and hold hands, and tickle and giggle and laugh and bicker and look at our daughter and think we did a GREAT job and we suffer when surgery rudely interrupts our sex life and really LIKE to spend time together. (He has 626 days 'til he retires, not that we're counting or anything.) The honeymoon phase (and I don't think I ever use that expression, but anyway) may have used more calories...but the last 25 years or so have been WAY better! Yeah, I know it wasn't all for me, but I'm on Prednisone and wired.

Well, here I am being a double-old-timer! I've been married for just short of 33 years. The committment is stronger than ever...but after the first year or two, it's a different ride. Which is why I chuckled at Susan's refence to how well someone else had been doing at (a whole) six months out. To me, that's like saying, "Look how well their marriage is going, and they've been married six months today!" (Remember, most people also go into the band journey as a "forever" thing.) While that doesn't mean that anyone is going to fail at either their weight loss journey or their marriage, it IS saying that six months out is still a bit early to come to conclusions about what works or what doesn't. I think that at that point, all we can say is, "Well, for me, so far, THIS is what's working...but your mileage may vary." One other thing...I often read about people who are two weeks out thinking they they have lost 20 pounds..forever! Bullshit. They're dehydrated from surgery and insufficient post-op Fluid intake. It happens all the time. And they are probably going to be VERY depressed in a couple of weeks when they start drinking Water and eating food and "regain" all that weight. They didn't lose it...and they didn't regain it. While it doesn't feel "right" taking the wind out of their sails, it MIGHT still be a good idea to mention the possibility of dehydration rather than actual weight loss. First, they might benefit from increasing fluid intake and second, the "letdown" might be less severe...and they might not be tempted to start thinking of themselves as failures...again.

I really DO understand the desire to hold on to the band--whether one is at goal and wants to stay there or wants to give it "one more try." I waited two years to have mine removed. But once someone's band starts hurting them or setting them up for permanent damage or keeps them from having a normal life, IMHO it really is time to stop trying to help them "work with it" and start trying to help them deal with choosing a life-after-banding option. It's only natural to want to help people succeed with the path they have chosen...especially if the approach we are using is working for us...but sometimes it's even wiser to HEAR them when they say it isn't working or it is scaring them. This site is the most notoriously supportive of both pre-banded and un-banded people I think exists. I hope we keep up the good work!

"Being pressured" or being "wisely warned?"

Another band-to-DS'er here ever-so-slightly tweaking some definitions. The RnY is a primarily restrictive but somewhat malabsorptive procedure. The DS is a primarily malabsorptive but somewhat restrictive procedure. They both "bypass" stuff, but they work very differently. (The band, of course, is purely restrictive.) However, while the band and RnY people DO have to make more "intelligent" food choices...what constitutes intelligent for the DS person is changed, right along with the anatomy. For example, EVERY MORNING, I eat an egg (sometimes two), and some cheese (usually in an omelette, but if not, I melt it on the toast), and bacon or ham, and toast with Peanut Butter or cheese (on non-omelette days.) My cholesterol is 119, my triglicerides are 117, my HDL is 64, my LDL is 32, and my VLDL is 23. (And all my other stuff is pretty good, too.) The REALLY intelligent choices that Rachele and I have to make involve taking our supplements and not going ape-shit on carbs. (And shit is the appropriate word, given what MOST DSer's bowels DO with a carb overdose.) And, in an attempt to not blame the victims, some DS people make all the right choices and STILL have deficiencies. But a few. Just like a few banded people have stomach necrosis, where the band kills the stomach. Back to the topic...if you had/are thinking about wls without knowing all about what the various procedures are then you CAN NOT HAVE MADE AN INTELLIGENT CHOICE ABOUT WHICH IS RIGHT FOR YOU. Even if you do know, it can be a crap-shoot...but at least you can hit the ground running when you find yourself in difficulty. So anyone who had RnY because Carnie did--or the band because Sharon Osborne did--had better be someone with outrageously good luck. Back to the topic at hand... Vanhos, given your history and the choices available, the band may be your only option other than dieting. And, if the band is not causing you any problems, then it would seem worth it to regroup and try again. If you ARE having complication, your next step would be a REALLY experienced DS guy...one who has done revisons from band and RnY--or flying solo. good luck to you!

Thank you, thank you! I didn't want you--or anyone--to think I was "advertising" for the DS. This surgery really IS a worrisome thing, for me, because it has had such negative press. I have an idea of what can go wrong. So I HAVE been religious about the supplements. (I might as well be religious about SOMETHING.) I try to convince myself that one reason that so many surgeons don't like to do this surgery is that patient compliance isn't what it should be and that invites disasterous complications. And I know of peope who have had obstructions or hernias farther out than I am...so I'm not done obsessing. (And even if I were, I'd find something else to obsess about.) And then the whole back problem thing...I've had two steroid injections and I'm on Prednisone for 12 days...can we say "hungry," boys and girls? Can we say "eat everything that isn't tied down?" I hate needing this drug. I was once on it for MONTHS...mycoplasma pneumonia...and gained 40 pounds! Oh well, I see my DS surgeon for my six-month check-up on Tuesday. At least now I can handle being in the car several hours in each direction!

Do I get to play, or is the revision surgery "cheating?" Remember, I went up to my pre-banding weight PLUS three pounds when I went for the revision...so I was starting at the top...again. My BMI was 49-ish...it's now 35-ish. My weight loss has been stalled for a couple of weeks (couldn't move, on pain killers and/or steriod inections), and I'm probably going to experience a slight gain...as I'm starting (f'ing) Prednisone tomorrow for a back injury. When stressing about my mother and my back, I did the only normal thing...for me. I ate all of the chocolate in my zipcode. I knew it made no sense when I bought it and made LESS sense when I ate it, but--at those moments--I apparently trusted the chocolate more than I trusted reason or logic, to solve my problems. I have learned NOTHING from being banded. I think I made the right decision in going with malabsorption. And I got my 6-month labs back today. Penni--and other medical types--if there's anything I'm supposed to worry here about will you let me know? I've been really anxious about these! * = near either end of the "Reference Values" ** = outside the "Reference Values" ~~HEMATOPATHOLOGY WBC--7.6--(REFERENCE 4.3-10.0) HGB--12.0--(REFERENCE 11.5-15.0) HCT--35.6--(REFERENCE 35.0-47.0) *MCV--80--(REFERENCE 80-99) RBC--4.45--(REFERENCE 3.90-5.20) *MCH--27--(REFERENCE 27-34) MCHC--33.8--(REFERENCE 32.-36.0) **RDW--15.6--(REFERENCE 0.0--15.5) PLATELET--416--(REFERENCE150-450) **TRANSFERRIN--397--(REFERENCE 200-360) IRON--49--(REFERENCE 37-145) Vitamin B-12--804--(REFERENCE 211-911) FOLATE-- >20.0 ~~COAGULATION APTT--34.9--(REFERENCE 24.0-36.0) PROTIME PT--14.3--(10.0-15.7) INR--1.06--(REFERENCE 0.70-1.19) ~~URINALYSIS WAS FINE ~~CHEMICAL PATHOLOGY GLUCOSE--93--(REFERENCE 65-99) NA--138--(REFERENCE136-147) K--4.1--(REFERENCE 3.5-5.5) CL--104--(REFERENCE 96-108) CO2--25--(REFERENCE 22-29) ANION GAP--9--(REFERENCE 5-14) BUN--10--(REFERENCE 6-20) CREA--0.5--(REFERENCE 0.4-1.1) UREA/CREA--20--(REFERENCE 10-22) OSMO CALC--274--(REFERENCE 268-292) TOT PROTEIN--6.7--(REFERENCE 6.3-8.3) ALBUMIN--4.3--(REFERENCE 3.6-5.0) *GLOBULIN--2.4--(REFERENCE 2.4-4.4) A/G RATIO--1.8--(REFERENCE 0.7-2.5) FERRITIN--19--(REFERENCE 15-417) ~~PROTEIN ANALYSIS *PREALBUMIN--20.4--(REFERENCE 20.0-40.0) ~~CARDIAC RISK INDICATORS TRIG--117--(REFERENCE 0-149) CHOL--119--(REFERENCE 0-199) HDL CHOL--64 CHOL/HDL-- 1.9 LDL CALC--32--(REFERENCE 0-99) VLDL CALC--23 (REFERENCE 0-30) ~~THYROID FUNCTION T3U--36--(REFERENCE 24-37) HS/TSH--1.04--(REFERENCE 0.35-5.50) FREE T4--1.2--(REFERENCE 0.8-1.Cool PTH INTACT--48--(REFERENCE 14-72) ~~MISCELLANEOUS TESTS Vitamin A @--0.37--(REFERENCE 0.30-1.20) RET PALM @--0.02--(REFERENCE 0.00-0.10) VIT A INTERP @--NORMAL **VIT D, 25 OH @--15--(REFERENCE 20-57) VITAMIN B6, PLASMA--PENDING My PCP says I need a little sunshine and an occasional Protein drink as my prealbumin is at the low end of normal. Is there anything else I should be concerned about? Thanks, Sue

A couple of things, the first may be nitpicky. I didn't "lose" my band; I "got rid of it." And it wasn't a surprise for me either...I was a notion I'd been harboring for months...maybe even a year or so, I don't know for sure. Anyway, because it wasn't a surprise and I had plenty of time to think about it, I was DELIGHTED to get rid of something that was making my life miserable. That's an important distinction only because I didn't have to waste any time mourning about not having the band anymore. And, one of the things MOST of us do when we're in mourning is eat like there is no tomorrow. So, for those of you still mourning...a novel I recently read mentioned that grief is like a huge wave behind the boat you're piloting. If you don't keep moving forward, that wave can overtake and drown you. But if you DO keep moving, the waves generally become smaller and less threatening. Your only defense is to NOT stop. ~~~ Then, Penni, and others who us who are in that place, I have a book here called '"It's Not About food," that was written for women with under- and over-eating issues. One of the first things they ask us to do is to just PAY ATTENTION to our eating...NOT to try to change anything about it, just to PAY ATTENTION to when we eat and what we eat and to STOP being judgmental and to become observant. And then later, they ask us to ask ourselves questions about our eating. So, eat lunch with John and go home and think about what to eat next but DO NOT judge that behavior as "sick." That book also tells us that our relationship with food is NOT a sign of weakness, but a sign of strength. At some point you developed that behavior to get through something bad. And it WORKED! But now, that bad thing is gone and you need to go through a process to learn that nothing bad will happen if you stop using that technique. ~~~ My mom is driving me nuts. She deserves her own thread and I may post it, but right now, the issue seems to be that I seem to think that chocolate is going to cure something. I have had the DS surgery and 80% of the fat I eat and 20% of the carbs I eat don't even "register" in my body. IN SPITE OF THAT HELP, the combination of a sedentary existence (because of a back injury related to this), and sleeping all day thanks to the pain meds I'm taking for this, and being able to do nothing but get horizontal in a place I know I can't get up from or sit at this keyboard all day, and the water-retention from all the salty prepared and delivered meals we've been eating...I have managed to slow or even "stall" my weight loss. Now I know that if I want to change that, I can cut down on the carbs (and salt) and I'll lose a ton of weight in no time. But right now, the bags--yes...I'm back to BAGS--of chocolate candy (and probably the 21 ounce can of Deluxe Mixed Nuts, too) seem more essential to my psyche than the continued weight loss. So, I keep telling me I'm not "bad" or "sick" or anything other than "currently in need of chocolate/nut therapy" and that this time will pass. I can only trust that it will and that MY wls-tool will get me goiing again. Hugs to all... Sue

Ok...not to be a downer, but just so you know. I had the panniculectomy (apron removal) along with the rectus muscle repair (tummy tuck part) about a year and a half ago. I was MO at the time. Surgery went well, but I developed an infection that would NOT resolve and about about a week post-op was readmitted to the hospital for ANOTHER TEN DAYS of IV antibiotic therapy. THEN it resolved. However...it was a teaching hospital. And the supervising PS (from UC Irvine in California) was having a discussion with the "fellow" (he had finished his internship and residency) who actually performed my surgery. It went something like: Supervisor: So, Kev. Do you know the complication rate on an abdominoplasty (essentially what I had) on a morbidly obese patient? Fellow: Uh...75%? Supervisor: No. 100%. If you perform an abdominoplasty on a morbidly obese patient there WILL BE a complication. Me: You guys might have MENTIONED this in advance. Fellow: Now that I know, I WILL mention it in advance. Want another tummy tuck? So, I do NOT want to rain on your parade and I have had surgery in Monterrey and I LOVED my surgeon and the hospital was great and all that...and those are US stats, not Mexican stats...but, just so you know that it is apparently NOT as simple before we lose the weight. That said, Dr. Fobi (of the "Fobi Pouch") routinely performs the panniculectomy at the time of the bypass procedure and I have a friend who went to him and had it done with him and I don't recall what--if any--complications SHE had. Good luck...and it IS easier to move without that mess. And I will need it tweaked when I finish with my DS-related weight loss, but I don't care. Sue

Just PM me when you're in the mood, Cindy. I'm in CA and my surgeon was Ara Keshishian in Delano, CA.

Is this for me? I don't recommend ANY surgery for anyone else! I had the band and developed complications. The majority of people do NOT have that problem. So that's a plus...for most people. And the surgery itself is safer and the recovery is a piece of cake for most people. But I hated the eating restrictions--many of which were undoubtedly caused by my complications--and I felt "deprived" or like I was "missing out on something." (Well, I was...I was missing out on chewing and eating stuff like salads.) I knew I'd have those issues with the RnY eating restrictions, too. I'm MORE delighted with the surgery I just had...the DS. But it is HUGE step and it isn't for everyone. You can't have the RnY or DS and then go back and only get the band...because you are already rearranged. You can do it the other way. Just study ALL of the offerings. Be brutally honest with yourself. When you read about problems that DS or RnY or banded people are having, do you pretend that those could never happen to you? Are you harboring the notion that you will lose 100% of your excess weight, keep it off with no problem, never have issues getting the right amount of saline in the band, be able to eat exactly what you eat now but in smaller quantities? If so, you may be disappointed with the band. But if you have a realistic view of what to expect INCLUDING KNOWING THAT IT DOESN'T WORK FOR EVERYONE AND IT IS NOT "ALWAYS ADJUSTABLE," AND THAT SOMETIMES, REAL WISDOM IS KNOWING WHEN TO CUT YOUR LOSSES AND MOVE ON, then you're off to a good start.

The way I read your post is that you are underweight, can't eat a healthy diet and the band is making you sick. OF COURSE, you want it out! I had mine out, but not under those circumstances. I wish I could help beyond saying that I certainly understand your concern and hope it all goes smoothly.

Comment about comparing LapBand to RnY: For those who were not at or near goal two years post-op, the RnY person usually lost and regained and the LapBand person never lost much...and they both ended up at the same place. For those who were at or near goal two years post-op, the RnY person had 18-24 months "free time" but then had to learn how to MAINTAIN that loss. The LapBand person had to learn from the beginning or the loss would not have happened. In both cases it's about learning...it's the sequence that varies. From what I understand, the DS is less about learning because there is more malabsorption, which is why I went to that. You CAN regain after losing with the DS...I know of people who have. But the malabsorption (and related problems) are ongoing, so the learning SEEMS TO BE more about eating Protein first and taking supplements galore!