RickM

Generally, the recommended amount more closely related to your "ideal" weight, or more correctly, your lean body or muscle mass, but those are a little harder to measure so ideal weight and an assumption of a fairly normal body composition is often used instead. Using simple scale weight for a morbidly obese person will overstate the protein need, as all that extra fat doesn't require any protein to support it, while your muscle mass does. This is why we should ignore any of those online calculators that supposedly tell us what our protein requirement, or resting metabolism is based upon scale weight. This is why we typically see recommendations for women to get somewhere around 60-80 g and men to get around 80-100 g, as men usually have more muscle mass than women of equal height, and men are on average taller.

Some programs like to limit things to only 3 meals a day as they feel more gets too close to, or promotes, grazing. OTH, 3 meals a day can promote overeating our WLS in order to get enough nutrition in during the day. Take your pick, lol. Meals, whether there be 3, 5, 6, 7 or whatever, should be discrete feedings of a specified "meal" or amount of food, as distinct from grabbing a bag of chips or nuts and sitting down at your desk or in front of the TV.

It depends upon the surgeon's preference - some use them, some don't. Mine did use one and it wasn't a big deal, and it was a bit of a convenience the first day as I could get out of bed to walk around on my schedule and not my bladder's. Given a choice, I would much rather have a catheter than have them install JP drains (also a surgeon's preference) as those things are a much bigger PITA.

You mean you haven't yet? No, seriously, the usual answer we see from most programs is when you feel like it. As long as you work with positions that aren't stressing anything or making you uncomfortable, it is fine, as there is nothing about the ultimate end game that will cause you (or your surgery) any harm. So, no swinging from the rafters, but otherwise.....

Eat your vegetables, which you probably can't do at this point, but this is a sign that your diet is overly low in carbohydrates. Some relish the bad breath (and often BO as well) as they believe it to be the "smell of burning fat" and have to go through it to burn off their stored fat. That is just fad diet mythology as such is totally unnecessary to reach that end. Short answer is that it will go away as your diet improves. If your diet allows such things as oatmeal or cream of wheat yet, or even some yogurt, that will help. Likewise, the small amount of sugars in milk if you use that in your protein shakes will also help. Others may chime in with their solutions in the mean time, but I can't comment on their effectiveness as I never ran into the problem as we maintained adequate dietary variety to avoid it.

Pre-op diets vary all over the map, from the all liquid things for some number of weeks (typically 2-4 but sometimes months) to no particular restrictions until the day before and everything in between. The usual idea for those programs that impose a diet is for it to be low carb to improve liver condition, so if your chicken cheese steak (whatever that is) isn't overly high in carbohydrates, then it should be OK as you are allowed some chicken and starch on your diet.

I didn't cheat on it as, like many, I didn't have a pre-op diet other than the empty the GI tract thing the day before surgery. It all depends upon your surgeon and how sensitive he is to the need to do such a diet - some are quite specific that they don't think that you did their diet when they get inside that they will close you up and have you try again (though I have never actually seen anyone have this happen,) while others could care less about the diet as they know what they are doing in there irrespective the liver shrinking thing (or whatever rationale they are using.) Some quite specifically don't want their patients fasting for weeks ahead of surgery as they want them as strong and healthy as possible going into surgery - all kinds of different philosophies out there. The best thing is to follow their instructions as you want them as comfortable as possible when they are rooting around in your insides. Note to lurkers and early researchers - it is best to find out about these policies as early as possible - as questions when you go to that first informational seminar rather than find out once you are committed to the practice and it's too late to change.

Dunking or Dexascan are generally better accuracy wise, but typically only used every six months or year, while the scales are good for trend tracking as they can be used daily. It's the classic tradeoff between accuracy and cost or convenience - both have their place when used appropriately. The absolute accuracy of any of these is somewhat impaired for us by the the algorithms used, which typically compare between the test subject and the "normal" population, so they tend not to be quite as good for us fatties/former fatties whose body comp isn't quite normal - think about the excess skin and how that can skew the readings. Dexa is a bit better as it eliminates more variables, but still not quite as good as autopsy - which isn't usually too convenient for us!

Assuming that you are using one of the body fat/composition scales, then this is an indication that your hydration may be marginal. The scales measure impedance (electrical resistance) between your feet or hands to determine body fat, This makes them sensitive to hydration as that influences your resistance. If you measure yourself first thing in the morning when we are typically somewhat dehydrated from sleeping, the fat measurment is typically higher, often 4-5 points, than it is in the late afternoon when we are better hydrated. First thing to do is the measure yourself at the same time of the day each time, and don't worry about a point or two of difference one way or another, as that is within their normal error band. It is the overall trend over time that is important, rather than any one measurement which can be off some by virtue of you having a bad day hydrationwise. If you want to be sophisticated about it, you can take a moving average to smooth out the bumps and jiggles in the curve. Take, say, the last 10 daily readings, add them up and divide by 10 - that is your average daily reading for the past 10 days. Then the next day, drop the oldest reading and add in the new reading and again, divide by 10. This should give you a smoother curve and a better idea of what's really happening as you average out the minor errors from hydration fluctuations.

Probably not - my doc's practice started testing for D pre-op about ten years ago not because it was important for the surgery, but because they were seeing a fair amount of deficiency post op, and wanted to know how much of that was the surgery and post op diet/supplement protocols and how much was intrinsic to their patient population. Best bet would be to contact your surgeon's team and express your concerns and ask if there is anything that should be done at this time. If necessary, there are OTC D3 supplements at up to 50,000 IU per tablet available that can bring levels up fairly quickly - some take them weekly or several times a week or even daily.

Some patients will have a lot of inflammation in their stomach, so the path through it resembles a pinched soda straw and they will struggle to get enough water in, hence the direction to sip, sip, sip your day away; otherwise it may come back up on you. Others will have little inflammation and their new stomach resembles more of a large soda straw that is not pinched and can drink more normally as the water will pretty much go right on through. The surgeons can't tell who will be significantly inflamed and who will not, so everyone gets the same instruction. Unfortunately, these programs aren't very good at telling patients when they can drink more normally (as that will vary) and how to tell if you can. An no, you won't stretch anything out by drinking too much - if you drink too much, your body will tell you about it; if you aren't feeling any distress, you are fine.

While it may not have yet been proven that it is a scam, it fits the classic profile of a nutrition supplement scam - it is full of weasel words - just what is "equivalent" protein? - it promises miracles - 30 g of protein in only 15g of product, and with fewer calories than 30 g of protein would have - no one really knows what it is, and they aren't telling. If it really was a breakthrough, they could patent it, licence it to others to produce for a fee, and offer their own as the "original" and a higher price. But since they don't......it's just a matter of faith, and marketing. If it walks like a duck and quacks like a duck..... The stuff may be benign, and not particularly harmful (except maybe to your wallet) to their normal target demographic of people on a typical American diet (which is already protein rich) who are convinced that they need more protein, but to us bariatric post-ops who are struggling to get in a minimum functional amount of protein, it can be bad news.

On the pre-op diet front, that depends upon the surgeon - many of us do no diet at all other than the day before to empty the GI tract. If you are talking to the same surgeon who did your original surgery, and he normally imposes such diets then you will likely be told to do it again, though one can make a good case that since you are at a reasonable goal weight you don't need to "shrink the liver", assuming that is the rationale that they use for the diet. All you can do is ask. When contemplating a revision, it is always a good idea to get a second (or even third) opinion, as these surgeries are often more complex and their causes more variable. If the cause is a shaping or other structural issue with your sleeve (which can have a big influence on GERD problems) then it may be better to correct the problem with the sleeve rather than replace it. As the sleeve is still relatively new to most bariatric surgeons, they may not really know how to correct a problem with a sleeve and prefer to stick within their comfort zone by converting it to a bypass, which they tend to know very well. A good starting place to look for second opinions on something like this is in the DS community - look for a surgeon who is experienced with the DS, since as that uses the sleeve as its basis, they tend to be more experienced with them than most, and tend to be more comfortable in correcting them when needed. The practice that did my sleeve had been doing them for around twenty years, and that was seven years ago - most bariatric practices at that time had only been doing them for a year or two at best.

Talk to your surgeon about this. When my wife and I first started looking into WLS about fifteen years ago, having to have the stoma dilated was getting to be so common that it was no longer considered to be a "complication" but almost SOP. I'm not sure how things are today and if the rates have changed much, but it used to be relatively common. If it is indeed dime sized, that should pass most things. How did the doc determine that it was dime sized? Did he do an endoscopy, or otherwise image it, or just tell you that's what it is based upon what he normally does in surgery? If he just told you that without measuring it somehow, then you may just have more inflammation than average that is impeding things, and it will resolve itself, but he should have told you that if that is the case.

Carbs, and fats too, really, are pretty much irrelevant to us at this early stage. If your calories are low enough to promote the desired weight loss, courtesy of your WLS, and your protein is high enough to maintain your lean body mass, you will by default be on a low carb and low calorie diet. This is one reason why WLS has been the most successful weight loss therapy for the past few decades, irrespective what diet fads are "in"with the weight loss industry. At this point, you really shouldn't be looking at how to get in more fats or carbs, but how to get better overall nutrition within the limited diet. My basic plan was to get the best nutrition that I could in the non-protein segment of my diet within my tastes and caloric budget. On average, it worked out to be a rough split between fats and carbohydrates, but that wasn't a specific goal, but just how things worked out. If you get into being more active as you progress, then a specific concentration on adding specific carbs may be appropriate is you find yourself running into energy limits - the body can only convert fat to the needed glycogen so quickly, so the balance may have to be shifted if that occurs. At around 4 months, I found myself running out of gas when I was swimming beyond an hour, so I shifted the meal balance some before the workout to favor complex carbohydrates and problem solved. By feeding my body appropriately, my loss rate kept stable rather than continuing to decline as typically happens - so much for those silly diet myths that "carbs make your weight loss slow or stop" or "carbs make you gain weight".

Frustr8, it is best to travel some if you have to in order to get what you need; even if you wait until your local guys start doing what you need, do you really want to be their guinea pig? A frequent recommendation is that your chosen surgeon should have several hundred of whatever procedure you choose under their belt to ensure that they are well up the learning curve. I, likewise, traveled to get my VSG as it was still pretty new when I had it done seven years ago, so I went up to SF from LA to get it done by one of the established DS practices that had been doing them for twenty years or so. Paraphrasing one of the surgeons in our network when looking at images of a wonky VSG, "twenty years of doing bypasses and they think they know how to do a sleeve...." It may be a simpler and more straightforward procedure, but it still has its subtleties and nuances that one only really understands after doing a lot of them. Likewise, though the bypass has been done for some forty years as a WLS, and relatives of it for some 140 years for other maladies, it still takes practice to get it right.

The mini bypass has been around for at least 15-20 years, as it was being touted by a few back when my wife and I first started seriously getting into this about 15 years ago. Since then, both the duodenal switch and the sleeve gastrectomy have made the jump to general acceptance by both the ASMBS and the US insurance industry and Medicare systems, while the mini bypass remains as an "experimental/investigational" procedure and has never gained traction in the US. This indicates that so far, the overall results have not shown to be as good, Recent years have shown some increase in its popularity in the medical tourism trade where cost is a major consideration. Another consideration is how familiar is it where you live? Consider the situation where some years down the road you have some serious medical problem, related to your WLS or not. If you have had a common, mainstream procedure such as the RNY or VSG that is well known to your local medical community, the ramifications of your WLS can more readily be considered in treating your new problem; if you have had an unusual WLS that is not well known, that can complicate the diagnosis and treatment of your new problem. For me, if I were to consider a procedure that is not mainstream, it would have to have demonstrably better results overall than what is common. This certainly applies to the DS, which while still a niche procedure owing to its greater complexity, typically yields better results in return; the marketplace and regulatory authorities don't seem to be finding a similar rationale for the MGB.

I don't see why not - I used to mix in some of the unflavored whey isolate as it cooled. I never tried mixing in the yogurt but that sounds like a good alternative/addition if one isn't restricted to clear liquids at the time.

As noted, some programs do low carb as a pre-op diet to improve liver condition prior to surgery. Low carb can help you lose a bit quicker initially as it promotes some additional water weight loss, so if you are trying to game the system to make a certain weight by a certain time, it's a good way to do that. But, as Fallingfast has found, since it's mostly water weight, it comes back as soon as you stop. And, if you are doing true keto as in high fat, low carb, moderate protein, it's not so good as a long term weight loss diet owing to its high caloric density. Indeed, the clinical use for such high fat, low carb diets is to avoid or minimize weight loss after a non-WLS stomach surgery.

This jello stuff is more debatable. The major source of protein is collagen which doesn't do us much good; there is some whey isolate in there which is the preferred source, but it is way down the ingredient list with the preservatives and other additives. For protein jello, I make regular sugar free jello with either unflavored whey isolate protein powder or Isopure clear liquid protein mixed in (it's the only way I can tolerate that Isopure clear stuff when I need to do a clear diet). It's a lot cheaper and you can play with the flavors and concentrations to fit your taste.

I haven't tried them, but they don't look terrible. Their protein is whey isolate, which is what we want (as opposed to the great unknown that's in that Genepro scam), though the low carb crowd will certainly find that they have "too many carbs", but if that doesn't bother you, go for it. They do seem to have a fair amount of sugar alcohols (erythritol, sorbitol) which bother some people with GI distress, but not others. Like protein bars and such, I wouldn't have more than one of these per day, both from the perspective of diversification (don't get all of your protein or other nutrition from just one place) and with all the sugar alcohols in it you may find yourself stuck on the toilet all day until you find out how sensitive you are to them.

It is very common for people regain after an injury, prolonged illness or surgery that puts them down for and extended period of time. I have had several surgeries since my VSG (plastics and orthopedics) and in each case I prophylactically dropped my intake by about 20% to accommodate the reduced calorie burn until my activity levels normalized again. 20% was just a guess on my part (called a SWAG - scientific wild assed guess - in the tech world) but it was fairly easy to do and could be adjusted up or down as needed to keep my weight stable. It was better than reacting later to a gain. Be careful about online calculators for things like BMR or calorie burn for different activities, Beyond often being optimistic, if they only use scale weight rather than lean body mass or "ideal" weight, they can be wildly inaccurate for us fatties and former fatties. The extra fat that we carry does little to alter basil metabolism (active, yes, as we have to haul around that extra weigth 24/7), and they don't account for the metabolic problems that often accompany our obesity or former obesity - it is not unusual for someone who has a theoretical BMR of say, 1600 calories to gain weight at 12-1400 or even less.

In our case, the fundus is the stretchy part that makes up most of the greater, or outer, curvature of the stomach, and is what is removed when a sleeve gastrectomy is done, or is folded up and tied back in a sleeve plication. It looks like with the endoscopic procedure, they suture it up internally to make the fundus inaccessible, leaving the reduced "sleeve" like path open for restricted food flow. Being a fairly new procedure, one is fighting the learning curve - both for the individual surgeon and for the industry as a whole. The guys that did the first heart transplant were the best in the business, but the patient still only survived a short time; it takes time, practice and experience - both individual and collective - for a procedure to mature into a routine, everyday therapy, so your doc may well be exceptional, but they are all still working out the kinks in a new procedure. Where to go from here? A bypass was suggested, and this is very common, as most bariatric surgeons were raised on them, so to speak, know them well and tend to be very comfortable with them when things get complicated as they can with some revisions. You note that a SADI has been suggested - was this by the same surgeon, or someone else? If the SADI is a possible, then a regular sleeve gastrectomy should also be workable, as the SADI normally uses the sleeve as its basis, and presumably that would be most attractive to you as that is what is most similar to your originally chosen endo sleeve. Whether you need the malabsorptive component of the bypass or SADI is an individual decision. When things get complicated like this, it is usually best if one can get a second (or even third) opinion on the problem and possible solutions. There are often several different alternatives available, but individual doctors will prefer, or have more experience, with one over another, while another doc may have different experiences and preferences as to how to approach this problem. Good luck in working this out...

I found this edamame based pasta at Costco - 24 g protein per the typical 2 oz serving at 200 cal; 1 oz is plenty for me at 7 years out, and I usually cut that back some as it expands a bit more when cooked than regular pasta. http://www.seapointfarms.com/products/edamame-pasta.html Another regular dish is chicken cacciatore - saute some chicken breast, add a can or two of diced tomatoes (or fresh ones in you have them) Italian seasoning to taste, bit of garlic, and load it with veg of choice - peppers, onions, broccoli, snap peas, squash, etc. Rotelli or similar pasta added in if desired. Turkey bacon from Trader Joe's if you have one in the area - 6 g protein for 30 cal per strip. Great for fleshing out a breakfast, maybe a small Kodiak cakes protein pancake (I make up a bunch on the weekend with milk or buttermilk for extra protein and freeze them; ditto the bacon or sausages)

I went with the same practice that we found when my wife was getting into WLS about fifteen years ago. They were one of the few that offered both the DS that she was most interested in along with the standard RNY, so it was one place where we could get a reasonably honest opinion as to which procedure best fit her (most surgeons will only recommend a procedure that they perform, whether it fits or not), and they were a well regarded practice that attracted patients nationwide (and beyond.) An added consideration was that though we were travelling up to SF for the surgery (from LA) they still had a semi-local office and support group. When it came time for my VSG about seven years ago, they were one of the most experienced at doing sleeves (owing to the sleeve being a part of the DS) - an important factor when considering a procedure that was fairly new at the time; one should always look for a surgeon who has several hundred of whatever procedure one is interested in under their belt, irrespective how long they have been in bariatrics. Given the newness of the sleeve then, it was still worth going up to SF for the surgery as no one local had their kind of experience. And, considering that we had already been doing business with them and going to their support group on and off for several years, I knew the program, they weren't into the latest fad diets - just what has worked (and worked very well, indeed) for the past twenty years or so. It still is working seven years later.