RickM

As with most anything that you buy from a store, it will have more sodium than if you made it yourself, and might be something to be concerned about if one is on a low sodium diet. However, for most of us that first year, we are eating so little that it is hard to get too much sodium (indeed, some who suffer from orthstatic hypotension will be advised to increase their sodium intake!) so it is very much an individual situation. As to whether chicken is appropriate at this stage for the OP, that too, is very individual and varies from one program to another. If it is on the program's menu at this time, then rotisserie chicken is a classic choice, particularly the dark meat as it tends to be moist and goes down easily.

I wasn't thinking so much about the source, but the amount. At 100mg, that's about three cups of tea, one of which she says will give her problems. Assuming that this isn't an anemia problem (I know mousecat has been through the wringer on a lot of things post-op, so I assume that this would have come out in any labs that have been done in concert with her problems) then it could well be a more basic nutritional problem. Many get into some of these very low carbohydrate diets under the assumption that they will help their weight loss, but they can lead to this kind of energy problem. That simple slice of bread made a big difference to me, and I wasn't doing a particularly low carb diet to begin with.

Usually, such a revision doesn't require the usual bariatric qualifications if it is to address a complication from an earlier (preferably approved or covered) procedure. So, if the reflux problem has been adequately documented, along with whatever efforts were tried to correct it, then it should be approved with minimal hassle. In such situations, one should try to get multiple opinions on the problem and proposed solution - these things tend to be more complicated than the original surgery, both in diagnosing the problem and solving it. Some surgeons who are particularly experienced with sleeve based procedures may be able to correct the problem with a re-shaping of the sleeve while others may not even try and just revise to a bypass without a second thought. Good luck in getting it resolved....

Unfortunately, the ON amino product has a pretty good dose of caffeine in it (looks like a can and a half of Coke's worth) so that may not go over if the OP is sensitive to such stimulants. Not a particular product, but what I had worked out with my RD was a fairly common pre-workout snack profile of something fairly high in complex carbohydrates, moderate in protein and low to moderate in fat; what worked for me convenience-wise (since my gym time is usually after lunch sometime) was a small sandwich of meat and cheese on a slice of good quality whole grain bread. That let me stretch my energy out so that I could swim beyond an hour, where I had previously hit a wall. My nephew, who is an RD in training, tends to use a traditional CLIF bar for that purpose, as they generally hit the same basic profile. I didn't add any more calories to may day, but just reallocated and re-timed what I was already consuming.

As noted by others, progressions vary all over the map; ours started with soft proteins, purees, mushies, etc., along with liquids in the hospital, progressing as we could tolerate - some progress faster while others progress more slowly,

No, it is not too soon to be considering this. This is one of the considerations that I discussed with out surgeon - the prospect of doing the second half of the DS sometime in the future if needed, and his position is that it is best to do it before too much regain is experienced, as the "switch" part of the DS is more effective at helping to resist regain than it is to aid in the loss. IOW, as one informal rule of thumb that they often discussed in meetings is that the sleeve gets the weight off, while the switch keeps it off. That's not completely true - the switch does have some loss component to it, but call it 80% true. Also, most revisions aren't as effective at losing weight than a virgin procedure (you are already used to having reduced capacity, etc., and have worked around it...) so switching early plays into the strength of the DS. The down side of "catching it early" is that insurance may not cover the second half if one hasn't regained to the standard 35/40 BMI level, and also the psych aspect of actually pulling the lever to revise rather than "I know I can do it without, just one more try..." That's a tough choice, but no, it isn't too early for best results.

It sounds like it could be orthostatic hypotension, low blood pressure particularly when changing position or standing up, and is not unusual as we lose weight rapidly - the cardio system has to adjust to there being less body to pump blood through, and could possibly be an offshoot of your transfusions if the numbers aren't quite right yet. It is not unusual to have to cut back on any blood pressure meds that one is on. I had a similar problem years after my WLS as a result of a blood loss, so it could be either, so check with your docs on that to get things back in balance. Worst case is that there may still be a bit of an internal bleed going on (hopefully not after them monitoring you in hospital for a few days before discharge,,,) but best not to hold off on contacting the docs just in case. Good luck....

The patches seem to work OK for some, and not at all for others, so let your labs be the judge as to whether they work for you, and whether you need to supplement with something else. From what I have seen, most in the DS world find that they don't work at all for them, but there may be something about their altered metabolism at work there that doesn't apply to us with the VSG. For some nutrients, deficiencies aren't easy to detect until things are pretty low, and it can be hard to catch up if you fall behind the curve, so I would be cautious about depending upon the patches totally. For instance, I would maybe try them for part my calcium needs, using the patch instead of the extra dose or two per day of calcium that we usually need early out, but still take at least one dose with the pills or chewies. OTOH. the iron numbers measure out pretty easily, and we can usually catch up by doubling the dose if need be (something that the bypass folks have a harder time doing with their malabsorption) so that can be a good indicator as to whether the patches work for you.

I started playing with small salads at about a month our when our plan opened up to "anything" tolerated. I found that if I cut back my normal meat serving of 3 oz to 2, that I could fit in about another 3 oz of salad as the combination seemed to be somewhat slider-ish. So I would have a couple ounces of leftover chicken, steak or ham along with about 10g each of cheese, chopped spinach (I preferred that to lettuce as it has a somewhat better nutritional profile) tomato, avo, scallion, snow peas, broccoli, pepper, etc. (whatever was in the fridge). My basic guideline was that I was getting enough protein in over the day, and by that time it was fairly predictable for me. I also started having more "combination" meals - stews and stir fries - that were heavily meat at first, but got progressively more veg intense as time and capacity increased. Overall, I sought to achieve at least an "homage" to a normal, balanced diet within the limits of my post-op weight loss needs, and this helped ease the maintenance transition markedly when that came as I didn't have to change diet concepts from "dieting" to "maintenance". This doc promotes a "veg first" approach after a few months, and while I don't quite get on with everything he says, the volume progression that he notes is consistent with my experience, and going more veg heavy over time is a good way to fill out that increasing volume with something that is bulky, low calorie and high nutrition. My overall daily goal (several years out) is for ten servings of fruit and veg which I rarely hit, but am consistently in the 7-8 servings range, and rarely under 5. That's along with 100-120g of protein, so it isn't sacrificing that. Of course, adjustments need to be made for personal protein needs and personal calorie/metabolic limits. Overall, my diet today is not much different than it was while losing post-op, other than the non-protein segment was lower, but philosophically the same.

Nobody here can really say, (without a crystal ball, lol) The costs are quite variable depending upon what procedure you are having done, where, what hospital or clinic, in network or out, etc. Self pay costs, which are a better gauge of actual costs as opposed to what is "charged" and then discounted, are usually somewhere between 10k and 20k for a VSG, somewhat higher for an RNY or DS. Your best bet is to talk to the insurance coordinator in your surgeon's office to get an estimate. Timing and other medical expenses that you and/or your family incur can influence things as well - my surgeon was out of network for Aetna, but by the time they paid off, we had met our policy's max out of pocket limit, so they paid it 100%. It's a big YMMV thing.

In the normal situation, there isn't significant stretch, maybe to double its original post surgical capacity (check it by seeing how much steak or chicken you can eat at a sitting, with nothing else along with it), but there can be more if the sleeve wasn't properly done in the first place (too much of the stretchy fundus left behind, typically at the top or bottom of the sleeve.) I have seen a few resleeves done, though it was usually done as part of a conversion to the duodenal switch (which adds a malabsorptive component) and the original sleeve was poorly made.

Typically, you continue doing what you were before, getting most of your protein from the protein drinks, and add in more of the thicker and more solid foods allowed, but the protein drinks are usually a staple for a while. You can try adding unflavored protein powder into jello, make instant pudding with protein powder added; sloppy oatmeal or cream of wheat are often allowed at this point (check with your doc's plan on what exactly they allow when.) Our program was basically a month long transition into "real" food, with liquids, purees, mushies and soft foods allowed whenever they were tolerated - the basic rule was to try new foods one at a time to test for your tolerance and if they worked ok, then great. If not, go back to known foods and try that one again in a week or two. Then try something else the next meal, etc. Over time, the protein drinks were fully replaced with real food, but given the small amounts that we typically can eat at a time, particularly as things get more solid, the drinks may be there for a while.

The problem with NSAIDs and the RNY is that the anastomis where your pouch joins your intestines is in a location that is not resistant to stomach acid, unlike the duodenum that is located immediately downstream of your stomach, and is bypassed along with the remnant stomach. Consequently that anastomis is very sensitive and subject to marginal ulcers, hence the advice against using any meds that irritate the stomach (such as NSAIDs). Compound that with any meds to further decrease the mucus layers. The sleeve based procedures (VSG and DS) don't have this structural problem, so are more tolerant of NSAIDs, though they can still be nasty drugs and are best only taken under medical supervision.

Welcome to the "three/third week stall" which happens to most everyone no matter what diet phase they may be in. Functionally, it is when your body has burned off all of its short term glycogen stores (basically stored carbohydrate) and starts to shift over to burning your stored fat - which is what you are here for! Also, don't be alarmed if your loss is a bit slower once you resume losing, as it takes more calories to burn the fat than it does the glycogen. https://www.dsfacts.com/weight-loss-stall-or-plateau.php

Yes, it is likely ketosis, which functionally means that your diet very low in carbohydrates and is burning fats, both ingested and stored, to make the glycogen that it needs to function. It will pass as your diet improves, though there are some who like it that way, believing that they lose weight faster that way.

I would be inclined to keep things on the lower end of your range. I did fine at 1100 avg. but that fit my metabolism well. I started about 50 lb lower than you are now, so I only had about 100lb to lose, and was near done at six months (was actually trying to slow things down at that point, and stretch out that last 10 lb loss to avoid excessive overshoot.) Our loss rate tends to decline as we lose, simply because there is less of us to move around all day long - it takes fewer calories to move 300 lb than it does 400 lb, etc.) So, while your loss rate is pretty good now, you still have another 100-150 lb (?) to go, and it is easy to let the intake increase over time as we get used to things (you can likely eat more at a sitting now than three months ago, and that will continue slowly over time) I currently maintain at in the 2000-2200 calorie range. As you have a similar loss rate to what I had, this implies that currently you would likewise maintain in the same range; however, with further loss, your maintenance level will likely be lower, , maybe 500 calories or so lower - all very rough estimates here. But this indicates that you probably shouldn't go any higher than your current 1100 if you want to get down to a normal-ish weight range, and preferably cut it back a bit and go closer to the 800 end of your range. Good luck in your continued success....

We never had a specific puree phase; rather it was just one of the things we could do during the month or so long transition toward "real" foods. The pureed lettuce (ewwwww) that was served up in the hospital kinda put me off the idea of pureeing anything! I got along with straining or mashing up the chunks in heavier soups until I could establish that I could tolerate not doing so.

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 guess that you can say that i have relatively normal hunger at close to eight years out - I get hungry near meal times (getting there now, about an hour away from dinner and that pot roast in the kitchen is smelling awfully good!) and if I get busy and skip a meal a will feel hungry for a while until I get distracted by something else and what do you know it's way past lunchtime. Loss rate can be quite variable, but you have a lot going for you being male and young-ish (in your 30's if I remember other posts?) which tend to help things. With the sleeve, I needed to lose about 100lb, having lost 50 or so a few years before and kept that off, and I was starting to ramp up my intake at six months to slow things down and ease off that last 10 lb. And I wasn't being all that aggressive on trying to lose fast in preference to losing sustainably; there was another guy online around that time with similar stats to mine and he was done in about four months by keeping his calories lower (similar 100lb loss with the sleeve) so it is quite possible. What I would look for as an indication of your loss rate would be your history - how easily have you lost in prior attempts - and that can be a good gauge. Good luck with it, whichever way you go....

That is on the long side of things; more common is two weeks, sometimes less (ours was for most anything soft, pureed or liquid for the first month and then anything else.) Programs have different progressions for different reasons. Some may be longer because they have had patients run into problems with quicker advances, or it may just be that they haven't tried a more rapid progression and don't really know how it works. I wouldn't go ahead of their schedule based upon others, but you could try asking them about it - I have seen patients report that their surgeon advanced them ahead of their published guideline because "we found patients cheating on the diet and not suffering for it, so we accelerated it - we'll update the guideline when we print a new batch..." in short, it doesn't hurt to let them know how you are feeling (otherwise they may never know,) and maybe they were thinking along the same lines. You never know unless you ask.

That's my understanding - that it is typically issued in a time release tablet. That's why my wife went with the liquid form after her DS, which is more malabsorbing than the RNY, but dissolving the pills in liquid has worked just as well for her, so you should be able to work it out one way or another.

The main issue with meds and the RNY isn't so much their strength as whether they are an extended release packaging, and what type of ER it is - whether it is to break down in the stomach or in the intestines, how long they break down, etc. So asking the surgeon or a pharmacist who is familiar with RNY needs is a good start. It may take some experimentation to get things right. My wife is also potassium deficient and for years (since her DS) has used a liquid suspension for her potassium, mixed in with tho orange or tangerine juice (high potassium there) to make it tolerable. After a while her juice morphed into a smoothie (not recommended for weight loss, though!) with the juice, frozen strawberries (more potassium), a banana (more potassium) and sometimes a kiwi (ditto) or something else, along with her calcium supplement. Then as the liquid potassium suspension got prohibitive in price (kooky US pharma industry) tried crushing the pills and dissolving them in the juice/smoothie and that worked fine as far as her labs go. So, you may have to play with things a bit, but should be able to work out a solution.

The consensus of hospital nurses is that you at least wait until you get home. Most docs, like kygirl's, is when you feel up to it, and avoid any positions that may stress the incisions (i.e, the "no swinging from the chandeliers" advice.) The "end result" won't do any damage to you, just be careful how you get there!

It is very difficult to tell from others as the plans are quite variable - some will start with clear liquids for a week or two before progressing to thicker liquids while others will start with soft foods immediately; some will specify/suggest six meals a day while others will say no more than three. So, take these as just examples of what yours might be.

You really don't, though some weight loss is a good sign, it isn't conclusive. We had one gal here last year whose doc did back out and close her up even after several weeks (if not months) of his prescribed diet (presumably followed, but you never know....) The most reliable method is to find a surgeon who knows how to work in there irrespective liver condition and doesn't prescribe any pre-op diet (they're out there, but you have to ask around and look for them.)