RickM

The whole 30g protein limit never made sense to me from an evolutionary perspective. We used to go out and kill an antelope and gorge on it, then not have substantial protein for a few days, maybe grazing on some nuts and seeds along the way. I can buy that we may have a declining absorption with quantity - the first 30g is fully absorbed, the next 30g maybe 85% absorbed, the next 30g maybe 72%, etc.; that would make sense biologically. I can certainly buy into the idea that supplements that hit our system all at once have limits - it's a big difference between a pint of super miracle protein drink hitting all at once, and a pile of antelope that has to be digested and absorbed over time, We have discussed such things in our support group at times, with things like the classic iron/calcium conflict - makes sense when discussing supplements, but considering the number of foods and food combinations that have both iron and calcium in them, the time element for digestion and absorption comes into play.

After a couple of weeks for things like tuna or dark chicken. It's a big YMMV thing for us all. Dark meat poultry usually works better than white meat - the extra fat helps it go down easier. High quality steak like filet often works better than ground beef, which is usually cheaper tougher cuts ground up. Seafood is usually considered easier than beef or poultry and is often considered a 'soft food', though it's not really my thing. Having it in soup or a sauce (aka, 'meat lube') usually makes it go down easier. Good luck, and it does get better, even if one is on the slower side of progress.

You need to look at what your company's policy bulletin specifically says - it should be posted somewhere on their website or you can call them (and hope the rep tells you the right thing!) The policy bulletin is the legal requirement that you and they have to follow. Your surgeon's insurance coordinator may be able to help as they know the lingo and how to read the policies. Typically, these insurance diets are to be medically supervised, which can mean your surgeon, PCP or an RD (dietician), and sometimes a structured program like Weight Watchers is acceptable - you need to see what the policy bulletin states. I used my PCP for my diet and that went through fine.

IIRC, Viactiv is based upon calcium carbonate, which is not as well absorbed as the preferred calcium citrate. Citracal used to have a citrate chew but dropped the product, though I think it got picked up by one of the bariatric vitamin companies (possibly Bariatric Advantage) I think that they also make a chewable tablet as well - I bought too big of a bucket of them and was using them long after I could use the regular horse pill calcium tablet. Some vitamin makers (Celebrate is one, IIRC) produce a petite calcium citrate tablet that's half the dose and size of a normal tablet that works well for many.

Most important thing - can you tolerate them, or preferably, like them? These things don't do any good if they just sit in your garage unused after you choke on the first one. see if you can buy one to try somewhere first (I never got along with any of the RTD drinks; just learned how to make the powdered ones the way I like them.

That is something that they liked to emphasize in our program, that it often works best to offset the lower quantity that we consume with better quality. My wife's doc even gave her a "prescription" for filet when she complained to him that ground beef wasn't settling too well. We still fill that Rx often, even after 13 years, And, it's almost a wash between a half pound of decent ground beef and a quarter pound of filet (almost).

I would want to coordinate between all three - including your bariatric surgeon to get his input. The rheumetologist may know of some other therapies that may help, but the bariatric guy will have the most experience regarding your stomach. Brief rundown on the history of NSAIDs and bariatrics: NSAIDs are a big NO-NO for the RNY as that procedure is predisposed to marginal ulcers and doesn't need any help from any other stomach irritants. Sleeve based procedures are more tolerant than the RNY but still probably somewhat more sensitive than the general population. Surgeons' opinions on this vary widely depending upon their experiences - many are very gunshy about NSAIDs given their experience with the bypass and relatively lesser experience (typically) with the sleeve, so they tend to lump all procedures together with a general "no" recommendation until they get more feedback on the sleeve. Some surgeons who were early adopters of the sleeve (primarily from the DS camp) are much more liberal in their allowance for NSAID use (our doc recommends them as soon post-op as narcotic pain relievers are no longer appropriate; others are somewhere in between.) Most docs are amenable to their use in limited cases, particularly with the sleeve, though I have seen some bypass docs suggest them in some specific cases, so you should get him in the loop on this. From what I have seen, as a none-MD, occasional use is usually OK, but for consistent use as in arthritis or other chronic orthopedic cases, something else is probably preferred. Even for non-WLS peeps, these are serious drugs (even if they are available OTC) and consistent use should be monitored by a physician.

Fullness sensations differ, and my not really be there, for a while after surgery as some nerves have been cut, stomach can be swollen and the normal bit of stretch that is normally detected to start signalling fullness may not be there. And, you often don't really feel "full" on liquidy things as they usually aren't staying in the stomach that long. Things return to semi-normal after a while but in the mean time, it is best to measure what you eat so that you don't overfill things. Your stomach is probably around 2 oz in nominal capacity, so stick with that for more solid foods; liquids and semi-liquids slide on through more easily so more can be consumed, but you have to experiment with it (I was able to sip through a bowl of broth, prob 6-8 oz - and a box of juice in a meal sitting in the hospital, while my wife could barely go through her nominal stomach size of 4 oz - both within normal expectations. Our overall program rule was to try new foods one at a time to test them for tolerance, and if they didn't settle well, then go back to what you know and try that food again in a week or two, then try another new food at the next meal, if desired.

If you are self pat, you really should have some kind of contract that spells out the costs and obligations on both sides - the insurance companies do that in their network contracts and it is reasonable to do so as a self pay patient. We self paid for my wife's DS and that was under an all inclusive contract that the surgeon had worked out with the hospital - all hospital and surgical fees including anesthesia and incidentals (no lingering bills for $10 Q-Tips, etc. and it seems that everyone down to, seemingly, the floor sweepers are independent contractors wanting to send you a separate bill.) Our contract also included a cost cap in the event of complications, covering additional surgeries and hospital days, if needed. As a self pay, you have the choice of dealing with any surgeon and hospital in the world; the surgeons are often more sensitive to this than hospital administrators, though I would expect in a city like Huntsville they would be more sensitive to competition than an a rural county with only one hospital. Talk to your surgeon about this. They are often on staff at multiple hospitals, and some hospitals are more accommodating than others. Good luck, and hope all works out...

Yep - how many threads have been started by post-ops a couple of weeks out wanting to know when they can start drinking alcohol again (as if their program didn't give them some instructions in that area)? Then it's just "you're a bunch of nannies....)

I would go with what your research and feelings tells you is the best for you in the long term. The surgeries have different "personalities" that make them a better fit for some than others; get the wrong one for you and you can wind up dissatisfied with the results and headed for a revision. If you feel that you need the extra strength and regain resistance of the DS, then the RNY is not a substitute, and revising that to a DS is no simple matter (there are only a handful of surgeons around with the skills and experience to perform those. I have seen a couple of band to RNY to DS patients come through our support group and they obviously wished that they had done the DS in the first place (but didn't really know about it, or were persuaded by their surgeon to do the bypass since they didn't perform the DS. Since you are well aware of the DS and have the option available, you are in a good position to make a well informed choice as to what is likely best for your needs. Note that my wife has a DS (13+ years post op) so I know well it's ups and downs, and it was the right move for her. I went with the VSG as that better fit my needs, so it is an individual situation. If you have already decided on the DS, think about whether your long term needs would be overly compromised by going with what is more convenient in the short term.

Taste is a subjective thing, so one person's favorite may well gag you, and vice versa. If you know of something that you like, and can choke down the cost for a few weeks that you need it, that my be the best approach rather than trying and tossing ones that you don't like. 100% whey isolate is generally the preferred protein as it is the best absorbed, but also the most expensive; many brands use a whey blend or concentrate that is only partially isolate because it is cheaper; but if that is a brand that you like, it is better than the ideal that you won't use. At the moment, my wife and I use, when needed, the Optimum Nutrition (ON) Isolate, usually from Costco. It runs about $50 for 4lb, though sometimes on sale for $30-40 (like this month). Whether it meets your taste needs is up to you. I have never gotten along with any of the RTD drinks.

The bands by themselves on a normal stomach don't work well and tend to be complications in escrow - they go in easily and with minimal complications, but the complications (typically slippage and/or erosion) pile up over time. I haven't seen much about such complications with the BOB (band over bypass) but the overall success rate is fairly poor; likewise with the various stoma tightening procedures. Here is one bariatric surgeon's perspective on the value of various revisions: Check some of this other doc's videos on addressing regain problems - his solution may or may not be something that works for you, but it is something to think about and see if you can craft another approach that is to your liking. Your hunger is not likely to be much affected by the band, as there are no hormonal changes being made to address that issue. There may be some dietary tricks that can be done to reduce hunger (going back to the classic "protein first" bariatric diet is a start.) Have you seen an RD (registered dietician) to see what can be done on that front? That should be a first step before going into a revision. Another surgeon's perspective is that with a BOB, you are taking a failed surgery (your original RNY) and applying a high failure rate device (the band) and expecting great results - disappointment is the most likely result. Sorry.

Some heartburn or reflux is common for a while after the VSG, common enough that many/most surgeons prescribe a PPI such is Prilosec for a while after surgery. As you have seen, Tums only goes so far. An H2 inhibitor such as Zantac or Pepcid is better and works fine for us, and if that does the job for you, it is preferable to the PPIs as they seem to have a more benign history of longer term side effects. If Zantac/Pepcid up to twice a day doesn't do the job, then talk to your doc about a PPI.

While there will always be variations and exceptions, it is not unreasonable that much of the "outside" world has better food, at least from the perspective of being less processed and closer to the ground (as one of the docs on our network puts it, "eat dirt - that which grows in the dirt, or which eats what grows in the dirt, with as little detour through a factory as possible..." Certainly the reduction in white processed/refined flours will be much more agreeable to your DS. OTH, there are places like much of China where KFC and McD's are considered health food, as their supply chains are more reliable than most of the locally based stores where you really don't know what you may be eating. In the states, it is better than it used to be in that with the big natural/organic/local movement, a lot more better foods are available, and becoming more mainstream, but one does need to be choosy and know what you need to look for. Eating out is still a crap shoot, particularly with major chain restaurants which depend on a lot of processed and packaged goods. Our neighborhood Italian place is quite good in that respect, as we often see Vito down at opening of the local farmer's markets and he is out meeting the boats at the wharf for his fish; not everything will be fresh (those &^%&* seasonal foods!) but he tells you what's what - something you don't get at Olive Garden!

Note that when an article refers to "bariatric surgery" or "weight loss surgery" in the general sense - not specifying any particular procedure, they are typically referring to the RNY gastric bypass, as that is, or has been, the most common procedure over the past 20-30 years (and particularly in Canada and other countries that may have been slower to adopt newer procedures). If you have a different procedure, the article may or may not apply to you. The warning may still be valid - changes in diet after surgery may result in deficiencies even of the procedure that you have doesn't have any inherent relevant malabsorption - and the advice may still be sound - keep up with labs and maintain appropriate supplements, even if they may be different from what is anticipated in the article.

I have never thrown up in the seven years since surgery. I don't know what "slimies" or "foamies" are from any personal experience, only what others report.

I's so sorry that you have gone through all of that, but I'm really surprised that they had such a problem finding it, as that is the classic place for ulcers to form on an RNY, and that should be the first place they look. With the Prilosec, was that indeed a capsule, as opposed to the little oblong pills that they often provide (I have mostly used the OTC generic version, so that's what I'm mostly familiar with). I can understand a capsule may not dissolve properly within the pouch, but don't most regular pills work normally (other than possibly time release meds)? I would think that the medication form (pill, capsule, liquid, etc.) would be specified on the Rx if it were critical. (Note to all of us - get friendly with your pharmacist and ask questions!) Bit confused and concerned on the treatment you have been getting, but best of luck in getting everything resolved...

All you can do is to try them - maybe mash or chop them finely at first, or make them sloppy and liquidy at first. I had scrambled eggs in the hospital and normal boiled ones later the first week. Our general rule was to try new foods, whatever they may be, one at a time to test for tolerance - if it worked, great, if not then try it again in a week or two. Our tolerance for different things is so varied that it's hard to go by others' experiences.

Yes, it can take some time for it to resolve, though many with either the sleeve, bypass or DS will walk out of the hospital free of meds and insulin - it's a big YMMV thing. There does seem to be some correlation with the length of time that one has been on medication and/or insulin and the time it takes to go into remission. My wife had been on medication, just short of being insulin dependent, for about twenty years when she had her WLS and it took the better part of a year for her to be fully off all of her meds - and that is with the stronger DS (remission rates typically 98-99% vs.85ish% for the RNY and VSG.) So, while you may be amongst the unlucky 15 % or so for whom the bypass doesn't work, there is still a lot of hope that it will. Good luck,

Looking back at my records, it looks like I was off of them as a regular thing at a little over a month or so out. The shakes were there only occasionally after that (and still are for special use, mostly for exercise recovery after some workouts, but those are a different composition now, for a different purpose.)

It is likely orthostatic hypotension (as in low blood pressure) and as you see above, is fairly common with rapid weight loss and the body needing to adjust to having much less of it there to maintain. If you are on any blood pressure meds, they need to be reduced or eliminated (see your doctor first!) If you are not on any BP meds, check with your doctor on other methods to counter the problem (other than "don't do that"!) Some suggest increasing sodium intake (the opposite of common advice for controlling high BP). Eventually, your body will usually adjust to its new normal and you won't notice this anymore. Related issues that you may encounter is a low resting heart rate, which again is the result of having cardiovascular capacity in excess of the body's normal need (many athletes run into this, too.) This can sometimes cause an apparent arrhythmia as the body has secondary back up pacemakers that kick in when it decides that the primary isn't going to do its job. Again, check with your doc if you experience any of these "common" things to ensure that they are indeed just the benign result of your weight loss and nothing more serious. Good luck and congrats on your success!

Yes, this is quite normal, frequently along with some bad breath. As noted, it's a sign of being in ketosis, which is a result of a diet that is overly low on carbohydrates, and will go away once your diet improves. Note that some fad diet promoters tell their followers that this is the "smell of burning fat", to keep them buying their diet products in the face of the unpleasant side effects, More accurately, it is the smell of not eating your vegetables.

We were on soft foods, along with liquids and purees/mushes from the hospital on out, so yes, at least the softer "real" foods is not unreasonable. That was seven years ago, though my wife was on a similar program around six years before that, so it isn't really new, but more programs are catching on that they don't need to be on liquids as long as they used to be and that patients tend to do better as they move toward real food (at least that is one of our doc's findings.)

Your stomach is in charge, so follow its' lead. That's why our program had the 'test for tolerance' advice admonition. We all progress at somewhat different rates within a normally expected band of results, inflammation within the new stomach can be highly variable. Some programs will hold all patients back to the progression of the slowest expectations while others will try to hit an average progression. There will always be questions as some will be concerned that they aren't progressing as quickly as others or the program guidelines while others will wonder if something is wrong that they aren't having the problems of others. You can't win in producing these guidelines!