RickM

As noted, they generally want you to be off of any narcotics for a day or so before doing any driving. Doing basic errands and around town driving shouldn't be an issue for most, but a multi-hour trip is probably pushing it. At a week out, you may feel like you have been run over by a truck, or you may feel ready to take on Bathurst - it is hard to predict and one day you may feel great and the next feel like crap. I drove a couple hours up to San Francisco for my first post-op appointment at 10 days, I had planned to drive the first hour (my wife doesn't do mornings) and my wife would do the second hour as we got into town and more traffic, but I felt fine and did the entire trip (she drove back in the afternoon.) I would not have attempted it had I not had a relief driver on hand to take over. Similarly, we headed back home in Los Angeles, a 5-6 hour drive, a couple of days later and split the driving chores; but she could have done the whole trip had I not been feeling up to it. In short, a long driving trip should be planned around, and don't depend upon yourself to be able to do the whole thing on your own. I won't get into the prospect of a possibly unreliable GI tract (will you be constipated, or having diarrhea the whole time then? Either (or both) is quite possible with the changes in diet and gut flora that has happened. Good luck in your surgery!

I can't imagine there being a direct link between the two, though it would not be unreasonable for it to be a result, at least in part, of the weight loss and a shifting center of gravity - altered posture as your shape and balance changed. Similar questions occasionally come up in our support group, which is comprised mainly of veterans 10-20 years out - "I'm having this and such problem - is it related to the WLS?" and the usual answer is that while there might be some connection, it isn't common and the overriding factor is that you are fifteen years older, and these things happen as we age... I have known people who have engaged a kinesiologist as they were losing to help them with their balance as their weight shifted with the loss. This might be part of your solution - in addition to any surgical or other medical intervention that the docs may advise - a professional to evaluate your posture and movement to see if that is a factor in your pain,

You will slow down, and even stall - not because you are moving from liquids to mushes, but because your body has burned all the fast burning glycogen that it has and needs to shift gears to burning your stored fat, which burns slower. Most everyone slows and/or stalls at around 2-3 weeks out, even those of us who were on a soft diet from the outset and never had a hard transition from liquids.

I never worried about carbs and fats while losing, as if the calories are low enough to promote the desired weight loss, and the protein is appropriate maintaining your muscle mass (typically somewhere around 60-80 g per day for women, 80-100 g for men), then the carbs and fats will be functionally very low. A good default for calories seems to be in the 600-800 range (some with stronger metabolisms can get away with more, but it's good to start low because it's very hard to cut back once you're used to one level). RDA for fiber is around 25 g per day, and that seems to work well for most on a bariatric diet. Sugar should usually be minimized, particularly added sugar in processed or packaged food; that which is naturally occuring in our fruits and veg are less of an issue, and has a purpose for us (or nature wouldn't have put it there - the added stuff in the packaged foods is just there to sell it to us and make up for the flavor stripped out by the processing.

It's very good - most who lose that much the first month started at a higher weight. Don't worry, though - next month will likely be half that, or maybe less. The first month is almost always a big number as a lot of water weight gets lost at first.

A guy asking if size matters? Oh, sorry... A 1 oz nominal starting size for a pouch is what I have always seen referenced. Does it matter, or the shape that the doc makes it? I don't know, but I suspect that both are minor points of technique, and the more important thing is how does your doc's patients do overall? As to the science of it, I think that this is one of those areas that leans more into artistry than science. In sleeve land, some made a big deal over what bougie size did the surgeon use to form the sleeve, yet that seems to make very little difference overall; indeed, my wife had a relatively huge sleeve done for her DS, about double the initial volume of mine, and yet her meal size after fifteen years is roughly the same as mine - sometimes a bit more, sometimes a bit less. Further, while an RNY pouch may start at about an ounce, a typical VSG sleeve starts at about 2 oz, yet after a few weeks or months, meal size is about the same for either. From what I have seen over the years, with both RNYs and VSGs, the biggest success factor is how one uses the tool that they have been provided with their WLS, rather than which one was done, or what detail size differences there may have been.

It is quite normal for you to be able to eat more now than you could earlier in your post op progression, and for you to be able to eat more in the future. This doc gives a pretty good window on this progression: There is also nothing that says that this progression will be linear - you may feel quite restricted for a while at the outset and as the inflammation subsides, notice that you are eating more than you were not long ago. What I like about this vid is that it teaches us how to live with this fact of increasing meal volume, rather than fight it. This isn't to say that you shouldn't continue to keep your eating volume under control, but to realize that some increase is normal and not to go to the extremes like these reset diets to try to counter it. You may or may not like this doc's prescription for living with this increase (I don't agree with everything he says, either) but to use this as a guide in finding your own path. As we progress, we tend to be able to eat a wider variety of foods - which is a good thing, nutritionally - but also a danger if we get into eating the wrong things consistently. His concept of eating veg first is sound - make sure we get in our protein requirement, but fill in that additional capacity with bulky, low calorie veg. It may not be your thing, but it is a good example of what can be done that you can use in finding your own path to long term success. Good luck...

I have used the Isopure when I have had to do such things, but likewise can't really take it - I mix it with a compatible flavor of Jello. Fortunately, I've only had to do them for a day before some test or procedure so I could tolerate it that long. There are some chicken broth flavored protein powders out there that would probably work as a change from the overly sweet stuff.

Welcome to the "boringly average" club - those of us who have had no particular post-op issues, where everything goes pretty much as advertised. The problem cases - those with abnormal amounts of pain, nausea, vomiting, etc. - are in the minority; it only seems like that is "normal" because those are the ones that post the most about having problems, while those with no problems have nothing to post about, so we don't see much of that side of the game. Same thing with those who, for whatever reason, have to endure weeks of liquid dieting pre-op - they post a lot about the problems they have and when will it end, etc. while those who aren't put on such diets have nothing to talk about, so it seems "normal" to have to do it.

Odor aside, how is your level of sweating now relative to a year ago - it would normally be much less owing to having that much less body to cool. For me now, sweating is a non-issue and I haven't needed deodorants in years, unlike during the time of being a fattie (but I don't work outside in Houston - So Cal is a "dry" heat, usually.) How far along are you, weight-wise - goal, still getting there, etc? More to the point, what is your diet like? What I am thinking is the possibility of this being part of ketosis - many site the bad breath problem, but bad and odd BO can also be part of it. We all tend to be low carbohydrate to some extent while losing just because we aren't eating much beyond protein, but some take it to extremes and that can lead to problems. Perhaps changing up your diet some, without increasing calories if you are still in a losing mode, can help - more fruits and veg (I know, it TX, that's what food eats...) or some oatmeal can make a difference. Good luck...

Think of it this way - before your WLS, your stomach held between a quart and a half gallon or more, depending upon how much one stuffs it. After your VSG and a few years, your capacity is more on the order of 6-8 oz. If you go for a revision, that will be cut back to the 2-ish oz that you had after your initial surgery, so there isn't nearly the difference as there was with your original surgery. The first thing that you need to do is to address the reason for the regain, as that reason will be back again a few years after your revision if you don't do it now (as they say, you can "eat around" any of these procedures.) The WLS is just a tool that you need to learn how to use, and the RNY is not a better or stronger tool for that than the VSG that you have - it's just a little different. One of the characteristics of our WLS (any of them) is that we can eat more at a meal over time than we could originally after surgery, and we need to learn how to adjust to that reality. This doc describes the problem well and offers his solution to it - you may or may not agree with it, but it is food for thought in working out how you can address the problem. From my experience, over the past fifteen years or so watching others in our support group and online, correcting 30 lb of regain is fairly easy - it takes some dedication to correcting whatever has crept back into your diet and giving it a few months but it can be done; 50lb or so seems to be a lot harder. But if you can't get the majority of this off without surgery, It is unlikely that a revision will be a good long term fix for you - you will be back where you are now in a few years. Good luck...

I think that second opinions are always a good idea, particularly when revisions are involved as both the cause, or need for the revision as well as the surgery itself tend to be more complex than the original virgin procedure, and this is where different perspectives are useful. As with AZhiker above, my real question is why was the hernia a surprise? What kind of evaluation was done to determine that you need a revision, and that the RNY is the most appropriate course of action? Any kind of a problem with the sleeve, whether it be GERD or inadequate weight loss or regain - the most common problems - I would expect that an upper GI or EGD, or both, would be done to evaluate the condition of the sleeve and either would have shown the hernia. With lapband revisons, we often see some patients get two-stepped - remove the band and allow time to heal, then do the revision to VSG or RNY, but just as often it is all done in one procedure. Is the difference specific to the individual patients' situation, or the surgeon's experience and skills? I don't know, but it seems analogous to your situation where it may be that your case is particularly complicated and any surgeon would two-step it, or that the hernia repair combined with the revision is beyond the surgeon's comfort zone and someone else could have done it in one shot. What is the reason for your need for a revision? If it was for GERD, the hernia repair may well correct or improve it. Sometimes a simple resleeve can correct it if there are shaping issues with the sleeve (not uncommon with sleeves from early in the decade) though not all surgeons know how to do that. If it is a regain problem, what has been done to address the issue non-surgically (diet or head games) as overall the RNY isn't really any better at controlling regain than the VSG, and if the fundamental problem isn't addressed, it will happen again. A re-sleeving may do as well, or a revision to the duodenal switch would be a stronger response to that problem. Just more things to consider....(why can't things be easy?) Good luck...

I found this abstract that explains some of this: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4743521/ What I read from it and other references that I found with a cursory search is that it doesn't seem to make a big difference what the limb lengths are (within normal standards.) I suspect that your doc is talking of the biliopancreatic limb (which is the one between the remnant stomach and the anastomosis with the roux limb from the pouch., though he could also be referring to the roux limb, as both are part of the "bypass". The main thing that I have seen as a negative to shorter limbs is increased chances of bile reflux, as the distance between the bile ducts (emptying into the duodenum, below the remnant stomach) and the bottom of the pouch. But this seems to be in cases where the limbs are kept very short (as in under 60cm or so) to minimize weight loss in non-WLS surgery patients (such as for cancer or gastroparesis, so it is unlikely to be an issue with what your doc is talking about doing. "Common channel" is not a term usually associated with the RNY, though it would refer to everything below the roux and bilio limbs, and would be however long your small intestine is (quite variable from person to person) minus the roux and bilio limbs. In the more heavily malabsorptive procedures such as the Duodenal Switch or the Distal RNY, that lower intestinal length - common channel - is the key figure and is usually in the 100-200 cm range, with the upper limbs being much longer and determined by initial overall intestinal length.

The protein amount that is usually specified is nothing special (maybe a bit of overkill, but not much) - it represents the amount that we generally need to maintain our lean body, or muscle, mass, and will not change appreciably as we move from weight loss into long term maintenance. What will change over time is the amount of other things that will be consumed with it - fruits, vegetables, grains, legumes, etc. So things won't seem as protein intense over time. It will also become a basic habit (did you worry about your protein intake before you decided on WLS?) As with vitamins, it is something that we will need to make sure we take in some form - some will need more than others - and periodic lab tests will guide us on what and how much we need to take (including protein.) So, do you need to count and monitor it forever? Not really, as it will usually become habit and take care of itself. For instance, protein is only about 20% of my diet, so it isn't something that I think a lot about. Now, if you decide to make major changes to your diet or lifestyle (like going vegan or keto) then you should revisit the subject to make sure that you are getting enough of what you need.

Funny that we were just talking about this last night at our meeting with Dr. Keshishian. While 100cm has been something of the standard for ages (this is with the "traditional" BPD/DS) the common channel is more variable these days, with 150-200 being sited more often. Dr. K's practice is, after measuring the entire small bowel, dividing it up by ratios between the alimentary and biliary limbs and the common channel, with ratios being somewhat variable depending upon a number of factors including age, gender, BMI, metabolic issues, diabetic issues. So guys, and taller ones at that, will tend to get longer CC's than shorter women, particularly if they are not diabetic or have other significant metabolic problems. If you are talking about a SIPS/SADI/ "loop DS", from what I have seen, that does tend to run a longer CC - 2-300 cm - but it is still early on with that procedure so there are a lot more variables in how different docs perform it. With you being of "moderate" weight by WLS standards (did you ever think that you would be "moderate"?) the less extreme approach has merit; it really comes down to your inclinations, as to how much of a "bigger hammer" than a basic VSG do you, personally, need? I started out a few pounds lighter than you and lost about 50 of it on myown when my wife went through her DS, and kept that off for several years until insurance started covering the VSG. With that history, I decided that the DS was overkill for me, though maybe a moderate amount of long term malabsorption would be useful in weight maintenance (so far, so good, though more fluctuations than I would like...)

Have you had any labs done yet (maybe a bit early, but some do them at 3 months,)? One thought is a bit of anemia, either from iron or B12 levels being too low. The other thought is diet - most of us are/were on a low carbohydrate diet by default (low calories, protein emphasis, not much room for other things...) and some take that to greater extremes by following one of the popular diets like Atkins, keto, paleo, etc. under the belief that they will improve weight loss results. When one is being particularly active, low carb diets can yield this kind of result, either overall lethargy, or running out of gas quickly. When on a low carb diet, our glycogen stores (short term energy reserves of carbohydrate) are being kept low, and it takes time to replace it with converting energy from fat - either stored or dietary - so we can wind up running short. It's like only filling your gas tank to half - it may not be a big deal if one is a stay at home sort making few errands, but if one is active and always out and about doing things, then one needs to keep filling up. I never worked to keep carb intake particularly low (or high - I simply ignored it) and never had any particular overall energy issues after the first few weeks. One thing I did run into at about four months was running out of gas after about an hour in the pool (just lap swimming). My RD suggested trying a pre-workout snack/meal that was relatively high in complex carbohydrate, moderate in protein and low to moderate in fat. I played with that and settled on a small sandwich of whole grain bread, meat and cheese, and that did the trick - breaking through that one hour wall. Hypothetically, that provided a bit of a blood sugar rise at about the time that I was otherwise starting to run low (or it was topping up my glycogen supply so that I had enough to go farther.) Note that this made no difference on the days that I did a weight circuit, as I never had any energy problems then, even though those workouts ran upwards of 90 minutes. So different activities can create different demands, so that is something to play with.

That's a tough one, as medically the most that one needs to do such things is a day or so to clean things out (beyond that it's one of those "what are they thinking..." things. When I have had to do them for things like colonoscopies, I have used some of the clear protein drinks (Isopure, Premier) to provide some protein satiety, and I generally make Jello with them (if that is allowed) so that there is something solid-ish to have. One can also alternate with some unflavored or chicken flavored protein powder in broth to counter the over-sweetness of other protein drinks and Jellos. Good luck! (what are they having you do post-op if they put you through this pre-op?)

I have never heard of weight gain being a side effect of omeprazole, but I expect that if one looks into all of the fine print that accompanies the Rx instructions that there is some fraction of a percent of people in some study that did, and that has to be included in the data sheet. People have been taking it post op for years and losing weight as expected for their surgery, so don't worry about that. Zantac is a completely different class of drug from omeprazole, so whatever problem it is having at the moment doesn't apply to omeprazole, which along with all PPIs have their own potential issues (as indeed, do all drugs...) and they apply to long term (years) use rather than short or intermediate term. As for not losing weight at the moment, do a search here for three (or third) week stall - it is entirely normal to have a weight stall around this time.

Did you just stop, or taper off of it? The PPI's are well known to have a rebound reflux reaction to stopping them, so the usual advice is to taper off of them - as AZ did, cut the dose in half for a while and them eliminate it. Sometimes it may take a few steps of dosage reduction and/or substitution of H2I acid reducers (like Pepcid or Zantac) to get completely off of them.

I would be inclined to go to the ER as things continually coming back up is not a good thing. Doesn't your surgeon have 24 hr emergency coverage for these types of cases (he should...there should be someone on call 24/7 in these practices)? I would call to get their opinion - it may be a 'go to the ER' or it may be one of those 'it will settle down and pass in time' things.

The cups are merely a convenience - if you can sip one of those every five minutes, that's 12 oz in an hour, or 64 in a little over 5 hours during the day. If it is more convenient to sip from a 12 oz or other sized bottle, go for it. I think that some programs prefer the small cups as it may reduce the temptation to guzzle more too soon, though from what I have seen, most who attempt that won't do it again! The main problem that I have seen is that most programs don't tell you how long you need to do that sip, sip, sip thing until you can drink more normally (as it is a big variable between people,) but in time - anywhere between a couple of weeks and a couple of months - you should be able to drink more or less normally.

Good luck - what problem(S) are you hoping to address with a revision?

This has me somewhat baffled - and same as catwoman, I've never heard of this being done as a normal pre-op test. I would be interested in hearing what their rationale is, as my understanding of it all is that stomach emptying in a normal person is largely a function of the pyloric valve, which is being bypassed along with the remnant stomach in your RNY. I can understand that if you were having a sleeve or DS done, which preserves the pyloric valve, then faster than normal emptying could imply a higher risk of post-op dumping or reactive hypoglycemia, which are rare with the sleeve based procedures but relatively common with the bypass (owing to the existence or non-existence of that pyloric valve.) Maybe a tendency toward rapid empyting implies that the surgeon should give you a tighter stoma to slow things down post-op? Call me confused - but curious!

I would expect that they would have told you if they wanted you to do anything special. When I have had an EGD that involved particularly aggressive sampling - somewhat similar to ulcer damage, though mechanically induced - they sent me home on a low fiber diet (usually liquid or soft stuff the first day) for a week or so. No whole grains, seedy or unpeeled fruit, fibrous veg (as my BIL put it when he was on one - a Wonder Bread diet - all the things that you should avoid for a normal, healthy diet are good, all the things you should load up on - fresh fruits, veg, seeds, grains, etc, - are bad; donuts and cinnamon rolls were on their "recommended" list. Yeah, right, lol! In the absence of anything specific, I would just take it easy on overly aggressive foods, either overly fibrous or acidic, until they tell you otherwise.

Normally, our protein goals should not change markedly between when we are losing and when we are maintaining weight, as the goal in each case is to maintain our lean body (or muscle) mass, which (hopefully) won't change much as we lose the fat (there will inevitably be some loss, but we should try to minimize that with the typical protein recommendations and some strength oriented exercise.) Once reaching goal weight, then one can evaluate their body composition (fat and lean mass amounts) and make adjustments accordingly, or if one wants to go into a muscle building program, then an increase may be in order.