RickM

It is all quite variable and dependent upon the program that you are on. We were on soft foods (as tolerated) in the hospital while others have to wait a month or more. Likewise, fruit is a variable with some programs seeking to avoid it because of sugar content while others only minimize it behind protein.

As Jazzy, there's a lot of individualism involved. There is a perspective from some docs that assign a BMI score to the different procedures to indicate their relative "power" - a lapband may be "worth" 10 BMI points, while a VSG or RNY are worth 15-20 points and a DS maybe 25. The MGB would be in that same region as the VSG and RNY. This just indicates relative strength, and also indicates that, given the wide variation in results, that most of that variation owe to individual factors - metabolic quirks, diet and exercise compliance and compatibility, etc. One can also say that the different procedures have something of a "personality", such that any particular individual may do better with one procedure vs. another, even if that procedure is statistically less "powerful". Stated another way, particularly with these "middle ground" procedures like the VSG/MGV/RNY, which are overall fairly close together in performance, individual factors will be more important than which procedure is deemed to be "better" overall. Another factor that I see in this is intent - the MGB was originally developed to be a simpler, faster, less expensive variant of the RNY, that was (hopefully} as good as, or at least almost as good as, the RNY. Its' rationale was primarily to be simpler rather than better performing. Contrast with the duodenal switch, when that was first developed some thirty years ago, it was intended to offer better performance than the default RNY rather than be simpler (which it certainly is not!) So, on that basis, I would not look to the MGB as being "better" than the RNY on weight loss performance, unless there is something about it that really seems to "click" with you.

Pasta is generally considered to be "bad" in that it tends to be a lot of calories relative to the nutrition that it provides, so it is something that we like to avoid when we are trying to lose weight, and concentrate on more nutritionally dense foods. While tolerances are quite variable and individual, it isn't something that is going to kill you - just not help your weight loss effort. Sometimes things are unavoidable and we do the best that we can under the circumstances. My wife made a lasagna casserole thing for some group function when I was losing, and I just dished out a portion with as little pasta as I could conveniently avoid and didn't worry about it. Later on, when you are maintaining, it's just a matter of what fits within your calorie/nutrition budget - I made a lasagna for dinner tonight that just came out of the oven (though by making it ourselves, it's pretty rich in meat, cheese and vegetables vs. noodles relative to what one may get at the store which tends to be made more cheaply - more noodle than meat and cheese.)

That's quite common - probably half or so of the docs don't require any extensive pre-op diets. It only seems that way because we see so many complaints from those who do have to do them, particularly the liquid only diets, that it just seems like "everybody" has to do it (it is called "adverse selection" and is quite common in web forums - those with something to complain about post about it, but those with nothing to complain about are silent, so it seems like problems are more common than they really are.) Relax and enjoy the ride - it sounds like you got one of the good docs who really knows what they are doing!

A clarification on the malabsorption is probably in order here. Yes, the villi do tend to grow back and in time, typically 1-2 years, the caloric malabsorption dissipates; however, the nutritional malabsorption persists. Calories can be absorbed most anywhere along the small intestine, but nutrient absorption occurs in more specific regions of the intestine. For instance, mineral absorption primarily occurs in the duodenum (the part of the small intestine immediately below the stomach, which is bypassed along with the stomach in the RNY), and the villi in other parts of the intestine do not change their character to adapt what they absorb to any great degree. So, one's iron or calcium supplement needs won't change significantly, and will likely degrade over time as aging takes its' toll; need for periodic iron infusions is not an overly unusual result in time. As a semi-related aside, the Duodenal Switch, which is overall more malabsorbing, does have long term caloric malaabsorption (which is why it has better overall regain resistance than other procedures) but it's nutritional malabsorption is likewise effectively forever (though of a somewhat different character to that of the RNY).

Not at all unusual, as typically when we start any major weight loss effort, surgical or otherwise, the loss tends to be front-loaded, in that there is usually a fair bit of water weight that is lost initially as the body adjusts to the radically lower intake, particularly from carbohydrates (though not exclusively.) Had you not done a pre-op diet, you would no doubt be losing that 58 lb, and quite possibly a bit more, during your first six weeks post-op. Starting at a much lower level than you, I lost about 32lb the first month (no pre-op diet) followed by 15lb each of the next two months. Similar drops from the first month of weight loss effort to the second is quite normal, and you should probably expect to be losing 15-20 per month the next couple of months, and generally declining in loss rate as you proceed (after all, it takes fewer calories to move 400lb around all day long than 500, and fewer still to move 300, etc.) Good luck, and keep up the good work...

Your best shot at it would be Dr. Keshishian in Glendale. He is one of the handful of docs capable of doing the very complex RNY to DS revision, and while you don't need that level of revision, a good DS oriented surgeon is a good bet for a VSG as the DS is based upon the sleeve, so those docs have been doing sleeves much longer than most bariatric surgeons. When I had my VSG done 7-8 years ago, I went up to SF to have it done as there was no comparable level of experience in LA at the time (Dr. K was still mostly practicing in the Central Valley then.) He will probably advocate that you revise to the DS, as that does generally provide better and more durable long term results, but the decision is yours. If your band failed mechanically rather than on weight loss or regain, and you otherwise lost and maintained well with it, then the VSG should do just as well for you, but without the mechanical issues. If, on the other hand, you did struggle to lose enough with the band, or regained with it, then the DS is well worth considering.

I didn't die, and was having small salads, including tomato and avo (don't get along with the cukes, though!) after about the first month. Yes, protein is priority but once you are reliably getting that in, it's great to widen the variety into other nutritious foods. My doc was putting me onto veg after 10 days as my protein intake was already more than adequate. YMMV.

I am also from the class of 2011, and my surgeon is 3-400 miles away (he was then, too.) Can your surgeon's practice do any remote consults - phone or email? Mine does, as they were used to many of their patients being non-local travelers. I have my annual labs faxed to them and they provide any comments as needed. They also have a semi-local support group, which is now shared with a local surgeon, but they welcome patients from all surgeons. By far the majority of my care is through our PCP with just an occasional consult with the surgeon if there are any issues that the PCP is uncertain of. There really hasn't been much change in the care of the VSG - most of the changes that we see in articles are the result of the influx of RNY based bariatric surgeons getting into the VSG business and bringing their RNY practices with them - there are a lot more of them than there are old time VSG and/or DS surgeons who know the sleeve best. Most of these things like NSAIDs and NG tubes are things that are well to be cautious about, though we don't have nearly the sensitivity to them as the bypass folks do. As to finding a new local(ish) surgeon, look into local surgeons' support groups and see if they welcome outside patients (many do,) and that can be an entry to a more involved relationship when needed; ask questions if you have any problems or concerns and that may spark an interest in your case. My preference is to look for an established DS surgeon if possible, as the DS is based upon the VSG and they tend to know the most details about its care and feeding, and from what I have seen, may be more welcoming of patients who have moved. (a very incomplete list can be found at https://www.dsfacts.com/duodenal-switch-surgeons.php, or check with those in one of the DS forums about surgeons near you.) Good luck in your continued health....

Good for your nutritionist! I don't know why some docs still do these liquid pre-op diets - personally, I would avoid those docs if I could (which I did, as our doc doesn't do any pre-op diets.) To answer the OP's question, no, we didn't have a choice, nor did we have to do a diet. However, if we did, I would choose to keep my diet as close to your long term post-op ideals as possible, to avoid the continual changing up of the diet as one progresses through to one's ultimate maintenance lifestyle. Make the concessions that are needed to accommodate the post-op steps toward "real" food, but keep the vision long term. Unnecessary liquid dieting simply distracts from the long term goal of learning to eat a healthy diet that aids in weight control over your lifetime.

Your loss rate will generally decline over time as you lose weight - you simply need fewer calories to move you 200ish lb body around all day than it took when you were 300ish lb. There are also some water weight effects that happen early on, in the first couple of weeks that skew the impressions as well. If you are losing 10+ lb per month at this point, 35-40lb from your goal, you are doing great. Within a couple of months, you will likely be worrying about overshooting the mark and losing too much - cross that bridge when you get there!

You lost fairly quickly, which implies that you still have a relatively strong metabolism, so you have some work to do. As a very rough approximation of where you should be, take the average of your last couple months' loss; for every 5 lb (2.3-ish kg), that's about a 500 calorie per day deficit that you need to make up. For instance, I was losing at 10lb per month the last three months of serious weight loss, which works out to around 1000 calories per day deficit; I was averaging 1100 calories per day, and am now maintaining (for the past 6-7 years) in the 2100-2200 range. This will at least give you an idea of how large the steps up that you should be making to ease into your maintenance range. I started working toward maintenance at the six month mark when I was 10 lb from my goal (or about a month away) so I started increasing things then to slow things down; as this was early November, I in part just let the holidays happen and it took another two months to lose that final 10 lb, and I had minimal overshoot; I still needed to fine tune things from there, but I was pretty close by then.

It makes some, but not a lot - the majority is made in the bypassed remnant stomach as most of the protein pump ports (those buggers that inject the acid, which the protein pump inhibitors, PPI's, inhibit,) are clustered around the pyloric valve which is part of the bypassed stomach. This is also why the sleeve is more prone to acid reflux, as there is more stomach is removed than acid production capacity, so in some cases the patient's body doesn't fully adapt. RNY folks are also subject to acid reflux and GERD, but not as often as the VSG. The downside of this for the RNY is that the part of the small intestine where the pouch is attached is not resistant to stomach acid as the duodenum is (that's the part of the small intestine immediately downstream of the stomach, where the bile is introduced to neutralize the acid before things proceed downstream.) This means that the anastomosis is easily irritated by what acid is there and subject to ulcers, which is why stomach irritating medications such as NSAIDs are a big NO-NO with the RNY, but are better tolerated by the sleeve based procedures like the VSG and DS.

What's wrong with fresh fruit and veg - I'm guessing that your program feels that it's too early for them, rather than not at all forever? Likewise, check with your surgical team on such things, as programs vary all over the map. Pickled stuff isn't my cup of tea, but I wouldn't go overboard on them as pickled veg seems to carry some cancer risk (doesn't everything?) but specific to gastric cancer.

Initially, it is the typical bariatric diet that's protein first and then whatever else fits and fits with whatever specific diet a patient may be on or prefer. Many do one of the popular commercial type diets like Atkins, paleo or keto, but that's a preference for them rather than a physiological necessity. I'm 7-8 years out and just eat a fairly basic balanced diet - some meat and dairy, whole grains, lots of fruits and veggies and the occasional junky no-no; in short, a little bit of everything, not too much of anything. My wife is fairly similar being 13-14 years out on a DS, though she also puts in a daily smoothie that incorporates a lot of her supplementary potassium and calcium.

I've had one, but it was several years after surgery so fluid intake wasn't a problem like it can be in the first few months. Have you talked to the gastro, or whomever is doing the colonoscopy, about the problem to see if they have any alternate preps - things have changed over the years and there are several approaches to the clean out, some needing less fluid than others.

The 50k is not that unusual in the DS and RNY worlds and is available OTC. Some may even take it daily for a while if they are trying to build their D levels back up, and then back off the frequency or dosage to maintain it. But it shows that the timing is not critical and we have some limited, at least, storage to work with. D (along with A, E and K) being an oil soluble tends to hang around in bodies longer than the other water soluble vitamins that tend to get flushed through more quickly.

Once a day is fine for D3, as as noted, many/most calcium supplements include D as well (and some even the preferred D3). My wife takes 50,000iu D3 once or twice a week (or sometimes every other week, depending upon how the labs go) so it isn't as fussy on timing as the calcium and iron is.

Most certainly - many surgeons don't bother with pre-op diets (other than the normal day or evening before surgery thing); our doc doesn't do them for any BMI level, while others like yours varies it by BMI. One surgeon I know quite specifically doesn't want his patients fasting for weeks before surgery, as he wants them as strong and healthy as possible going into surgery. Cutting down on the calories may not be needed, but it isn't a bad idea to get used to protein drinks as they are one of the early post-op staples, and just generally work on a long term healthy post-op diet that you can sustain. Good luck on this new venture!

While that is an extreme example, it is not unusual for restaurant entree salads to be calorie heavy, usually over 1000; As with a basic potato which is fundamentally a healthy food and low/moderate calories, commercially the seem to feel the neeg=d to load them up with a lot of calorie rich extras to make them sellable. The dressings alone can easily add 3-500+ calories with the amount that gets glopped on. You can probably do a similar salad at home with 1/3 the calories - and that would still be much more than we could normally eat.

As you can gather from others here, eggs are one of those foods that some can tolerate fine while others have problems for an extended period of time (lettuce seems to be another one of them). We had scramled eggs served up to us in the hospital and tolerated hard(ish) boiled eggs the first week out. It's a big YMMV thing.

It can be either, though refined sugary crap seems to be the most common. https://www.webmd.com/digestive-disorders/dumping-syndrome-causes-foods-treatments#1 Might it also be lactose intolerance that you developed after surgery, from the (presumed) buttermilk in the dip?

I'm certain that I had some in that time frame - it was just another meat protein. When my wife was going through this and commented to the doc that she was having some problem tolerating ground beef, he told her that such was not unusual, and to try good quality steak like a filet, and that many find that to be better tolerated. He was right. Some of the differences are just individual tolerance differences, and some may be program related, and how the dietary progression proceeds. Our program has us on semi-real foods (soft stuff, at least - eggs, yogurt, oatmeal, fish, and purees - from the hospital on out, so we may, on average, better able to handle steak at 4-8 weeks than those who are on liquids for the first month. There was also no liquid or fasting diet pre-op, either, so the stomach had less time to forget what it was supposed to do.

Plain ice water is my drink of choice - I always have a bottle with me. I got a couple of boxes of Crystal light packets before surgery and never used them.

That's something that I never bothered with - if your protein is where it needs to be to maintain your muscle mass and your calories are low enough to promote weight loss (courtesy of our WLS) then the other macros really don;t matter - your diet will by default low carb and low fat. I just aimed to get the best overall nutrition that I could within that remaining non-protein portion of my diet, and ignored the software targets (most of which don't make a lot of sense with the minimal amounts that we are eating at this time, anyway.) In retrospect, my diet then was a rough caloric split between fats and carbohydrates, but that was just how things shook out, not a target. If you are inclined to follow one of the popular diets out there - Atkins, keto, paleo, South Beach, etc., they may have specific macro targets that apply to them, but they have nothing to do with your weight loss over the next year or so - that is dictated primarily by your average caloric intake. Personally, you may feel better being a little higher in carbohydrates than fats, or vice versa (carbs provide better short term energy, fats are longer term) so you can make adjustments based on how you feel.