RickM

Yeah, I never got that thing about how bad breath and BO is supposed to make you lose weight faster ("that's the smell of burning fat!" no, that's the smell of not eating your vegetables.) I get the ketones thing, but I always tested postive for ketones in the lab tests while I was losing (duh - I was using up my stored fat) but I always had a (reasonably) healthy balance in my diet and never agonized over carb counts. I was still having to slow my loss rate at six months without the help of fad diets.

This shows what a great weight loss toll testicles are! Yeah, guys do tend to lose more easily than gals owing to our normally higher muscle mass and metabolisms. Seriously though, this does point up one of the benefits, and downsides, of WLS - that we can lose well that first year with almost any diet. 20-30 years ago patients were often advised to "just eat like always, just less..." and they lost very well. Of course, they didn't keep it off as they didn't learn how to eat for long term health and weight control. The good part is that one doesn't need to go on one of those fad diets that we often see promoted online (keto, paleo, Zone, etc.) and can work to develop or maintain good dietary habits for the long term; the bad part is that one can still eat crap and lose - for now. Likewise, I like the idea that if he can't do it for himself, at least help you out and keep that junk out of the house.

This doc gives a pretty good progression of how your meal volume, on average, will tend to increase over time, and it is pretty consistent with my experience. What I like about this guy is that he is one of the few bariatric surgeons that I have seen that addresses this issue and offers a prescription to mitigate its effects. You may or may not get along with his recommendation (I don't agree with everything he, or anyone else for that matter, says) but it is something to think about in planning your next few years. I have evolved into something akin to his program, as in being fairly veg heavy, but I'm not as grain averse as he is and I do think that his protein recommendations are a bit on the scant side for most.

Sustainability is certainly a key factor in long term success in this game - and I wouldn't be so sure that keto would be any faster, and they often are slower if they do it literally as they tend to run at higher calorie levels (they just lose a bit more water weight at the outset, which they give back at the end when they figure out what they are going to do for the rest of their life,) Likewise, I never did any of those diets but rather maintained a more classical balance of fruits, veg, whole grains, etc. along with the requisite protein, consistent with my caloric budget for weight loss - the same diet that I was on before surgery and now, years post-op, calorically adjusted for maintenance. If I need to drop a bit, dropping the calories around 20% does the trick without any panicky "back to basics" or "reset" diets. Funny thing (not really) is that most of the other post ops in our support group, most of whom are 10-20 years out and maintaining a normal weight range, likewise never got into these extreme low carb diets and seem to be a lot more tolerant of the occasional indulgence or unavoidable junk ingestion than those who did these extreme diets and are always worried about slippery slopes and carb monkeys. A couple of years ago we even had an accidental pizza fest when the restaurant we usually meet at closed without warning and we had to go around the corner to a pizza joint. The doc bought a couple of pizzas, some shared while others ordered sandwiches (heaven forbid!), salads or something else. I ordered a lasagna as that is something that just isn't worth making at home anymore. Yet no one suffered irreperable harm.

Usually it is once the incisions have healed over, which is typically 3 weeks; I still have a bit of weeping from one of them so it was more like 4 weeks for me

Yes, the stomach reconstruction is pretty robust and such things are unlikely, and the musculature isn't really connected in a way that would cause such a problem (likewise, as is a common question at some point, neither will an orgasm create such a problem, as long as how one gets there doesn't cause any discomfort.) What can sometimes result from a cough or sneeze is an incisional hernia, where the cuts were made to access your insides with the laproscopic tools - the fascia of the abdominal wall doesn't heal as quickly as the surrounding musculature, so that can reopen. Many practices supply or recommend using a small pillow to brace your abdomen under such conditions.

It is normal to be able to drink semi-normally right out of the box, but the other end of the "normal" spectrum is to have varying degrees of inflammation in the newly cut stomach which impedes flow and makes it an effort to get enough in initially.

ER sounds like a great idea. Not keeping fluids down implies some sort of blockage, and blood coming out of places it shouldn't be coming out of is never a good thing.

Yes, indeed surgery is the key factor. One of the things that I have recognized over the years of being in this game is how little dietary style influences ones weight loss after surgery. Back in the good ol' days 20-30 years ago WLS patients were often advised to just "eat like you always have, just less...." and that generally worked quite well - for the year or so, give or take, that they were losing. Maintaining that loss was not so successful with that approach, obviously, as they never changed what got them into trouble in the first place, and they often regained just as they did when doing diets in the past, though usually somewhat more slowly owing to the restriction that they had. Back when low fat diets were "in", people did just as well with their WLS as they do today with low carb and keto diets being the big thing. The important thing is developing good long term eating habits that one can maintain forever, and none of the popular fad diets do that for most people, and they tend to regain when they get tired of the diet.

Smoothies are typically a red flag item in the bariatric world due to their implied high calorie content, but you seem recognize that with your 80 cal statement. You can make a smoothie/protein shake or drink with unflavored or vanilla protein powder and add whatever extra flavors or fruits/veg that are consistent with your caloric limits. My wife makes one every day with vanilla protein powder (Optimal Nutrition from Costco is her choice) with tangerine juice as the basis and a bucketload of frozen strawberries and a banana. It is by no stretch of the imagination a low calorie or weight loss drink (she makes it more like soft serve ice cream consistency) but she doesn't need that at 13+ years post op, and it does hide a bunch of her needed supplements. Do the accounting with MFP or whatever tracking app you like to ensure that it fits your program needs, and have fun playing with it. Enjoy.

No surgeon or program specified pre-op diet here, other than the semi-normal day before GI surgery thing of clear liquids only.

It makes some sense, as there has been a genetic test available for a while to check is one is predisposed to diabetes, insulin resistance and a genuine carb sensitivity (many who claim a carb sensitivity are just noting the normal effect of carbohydrates causing some water weight gain when one is on a low carb diet.) My wife is a bit of a bread-o-holic but it doesn't bother me - I can take it or leave it, and used it for specific added nutrition part way through my loss phase. My loss trend actually improved with it added.

As far as I know, the acid reducing medications do not control hunger per se, but rather excess acid can mimic hunger, which can in turn be controlled with these meds. So, if you aren't really having an excess acid problem, then that isn't the cause of your returning hunger, and the meds shouldn't be a significant factor in that regard. On cutting out those meds, yes, as above, go ahead and refill them and then go from there. Typically, PPIs like pantoprozole need to be tapered off, or else they can create a rebound reflux reaction. Cutting the dose in half is a good start, or replacing is with an H2 inhibitor such as Zantac or Pepcid (which is what famotidine is) as an intermediate step is often used, so either replacing the pantoprozole with another famotidine for a week or two is a good start, then dropping one of the famotidine for another week or two before dropping the last one - checking for any reflux symptoms along the way, of course. The PPIs have been showing signs of some long term side effects that aren't too pleasant, so they are good to get off of if one can, while the H2 inhibitors are generally considered friendlier to us, though somewhat less effective and not as enduring. The returning hunger may be a revival of your grehlin (a big YMMV thing) but can also come from increasing dietary variety, particularly if some of the junkier foods are creeping back into your diet, as some of those are known in induce hunger. Good luck, and keep up the good work....

There is no reason to do any of those fad diets that you hear about online (Atkins/keto, etc.) and generally long term most do better without getting involved in those. Your sleeve works just fine on most any diet that you may choose, but the important part is what will you stick with long term that will allow you to eat sensibly and control your weight. I second the motion to discuss this with a dietician, particularly if you are new to vegan/vegetarian as there are nutritional issues that one needs to address - plant vs. animal proteins, iron, etc. It is difficult to do early on owing to the low protein density of plant proteins, but after a few months is quite workable. A couple of specific references to look for is Dr. Alvarez on Youtube and other social media, who is a Mexico based sleeve surgeon and is also vegan and helps many of his patients take that approach if they are so inclined, and Dr. Matthew Weiner, also on Youtube, who, while not stictly vegetarian, does advocate a veg first approach to his WLS and weight control patients. Both are useful in helping take a non-traditional WLS approach

It mostly comes down to how much inflammation you have in your stomach post op, and how quickly it resolves. Normally, in best case, your new sleeve or pouch will be like a soda straw and water and thin fluids will flow through fairly easily, though somewhat slowly. If there is much inflammation, then it's like a pinched soda straw and things will flow, or drip, through more slowly, and if you sip or drink too fast, it will come back up. I was on the easy side, and could sip through a bowl of broth (6-8 oz?) and a juice box in one sitting in the hospital, so 10-12 oz in maybe a half hour. My wife could maybe get through her nominal stomach size of 4 oz in a sitting, so she had more inflammation; both cases were within our doc's normally expected results. The not drinking before eating only really applies early on when there may be some inflammation present, and you want to make sure that all of the liquid is through the system before eating, so that the liquid isn't competing for space with the meal. Once things are flowing through fairly normally, there is no reason to avoid drinking before eating as the liquid passed through the stomach in just a couple of minutes, though some programs don't bother mentioning this or removing that restriction from their instructions; drinking after the meal is still a good thing to avoid in the long term.

Yes, take it up with your doctor, as if anything bad happens, you get the blame if you were going against advice. That said, I never pureed anything, but that was within program instructions that had us on liquids, purees/mushes and soft foods as tolerated from the hospital on out. The thought of pureeing anything after being served pureed lettuce (eeewww...) in the hospital was rather stomach turning. Let your doctor know and let him advance you if he is comfortable with it - I have seen a couple guys come through here reporting that their surgeon advanced them ahead of their published schedule saying that they have found patients cheating on the schedule and not suffering from it, so they changed the schedule. Most docs don't really know how quickly or slowly we can advance without feedback, so let them know. Also, your doc may make is sleeves differently than my doc or someone else's that requires a slower progression than others - there are few standards with this procedure.

Count me in - I was 292 at surgery time, hit goal of 190 at about seven and a half months (after slowing things down at six months to keep from over shooting the mark too far) and eventually hit 185 before correcting it to 190ish. I could have taken it lower but that would have meant losing too much muscle mass rather than fat,

As Creek noted, official diets are all over the map, but most have the common element of a certain protein minimum (typically 60 or more, depending upon the patient's need - smaller women need less, taller men need more,) and minimizing sugars or otherwise simple carbohydrates. Relatively few programs promote a keto type diet - those are typically adopted by patients on their own - and there is little general need for such diets but if one is into them, it won't do much harm (at least in the short term.)

No pre-op diet here, but that was our standard program protocol (not that unusual, though these diets seem more common than they are due to all the complaints that we hear about them). If your surgeon requires one, it's best to follow their directions as only they know why they require the diet and you want the surgeon as happy and comfortable when he is rooting around in your insides.

The alcohol is a much bigger deal than the burger, as that goes straight to the liver, which is what they are trying to improve prior to surgery (for those surgeons who care about such things and impose these diets.) Bigger concern is whether this is an indicator that one can stay away from the alcohol long enough to get through the weight loss period without damaging the liver more than the rapid weight loss is already doing, or doing the addiction transfer thing and dropping into full blown alcoholism.

Industry standard is 40 BMI or above with no co-morbidities or 35 BMI with co-morbidities (though companies vary about which and how many co-morbidities are required.) Some companies will reserve some procedures for higher BMI's but anything outside of the industry standards are ripe for appeal, both within the company and to state regulators. I didn't lose anything on Aetna's 6 month diet requirement and that was no problem, though that was seven years ago so policy details may have changed in the interim.

Certainly - I had pureed stuff along with other soft things like yogurt and scrambled eggs in the hospital (pureed lettuce put me off the idea of pureeing anything) and there are quite a few programs that are similar in their progressions. The basic rule, however, is to follow your doc's or program instructions as we can't know what reasoning they have for their protocols.

Crystal light is a fairly typical recommendation and is generally benign, if one doesn't mind artificial sweeteners. V8, particularly the low sodium variety, is great if you need to do liquids and want to maintain some semblance of nutrition in the diet. I'm not a fan of liquid diets for reset or back on track as they don't really get to the meat of the problem (so to speak) and often have a lot of artificial sweeteners that emulate the sugars and junk carbs that one is trying to eliminate. I find that basic meat and green veg does the job better as that provides most of what one needs nutritionally and satisfies hunger so that one can wean off the junk that has crept back in.

I;m not so sure about the stretching your sleeve and what omeprazole has to do with that, but I do respect much of what Dr. Roslin says, so there may be something there. It may also be the general concern about using PPI's such as omeprazole long term, which is something that we would like to avoid. As an alternative, try one of the over the counter H2 inhibitors such as Zantac or Pepcid, which are generally friendlier to us than PPIs though not as strong or long lasting. They are, however, reputedly better for overnight reflux, so may just be what you need.

Pretty much everyone has this issue - do a search on here for the three (or third) week stall. A pound a day is not unusual for the first couple of weeks or so, as you are mostly losing water weight at that time. After the first couple of months, 5-10 lb per month will be the norm for most people. Also, most lose in stair steps rather than a straight, even loss per day or week, so weekly (or monthly) weigh ins are good if the variations bother you. https://www.dsfacts.com/weight-loss-stall-or-plateau.php