RickM

Some basic questions and points to consider: What is your current weight situation - are you gaining, stable or losing some? Have you been able to lose in the past but regained it, or never been able to lose any substantial amount? Do you know approximately what your current calorie consumption is? How much can you lose at? Have you had any weight control success in the past - lost some and maintained the loss, or does it always come right back? A reversible procedure is very desirable, but comes at a cost - the lap band is removable, but the damage it can do (and often does) to the stomach is usually irreversible, leading to a revision to a sleeve or bypass instead of a simple removal. There is also the aspect that most cannot maintain a lower weight without the long term restriction that is provided by the more permanent procedures (the bypass is theoretically reversible in that all the parts can be surgically put back where they were, but it is rare to do this.) Consider that it will take fewer calories to maintain a lower weight than you consume now (you burn a less moving 140 lbs around all day than 280lb) - assuming that you can lose the weight on your own or with a temporary mechanical device, can you do this on your own? For a ballpark guesstimate. figure on 500 calories or so per day less than your stability point now. The approach that I took to all of this starting about fifteen years ago when my wife and I started getting seriously into WLS thoughts, and started the semi - usual six month insurance mandated diet/exercise program, was to look at what I could do for my diet/lifestyle that was sustainable - what could I do for the rest of my life - rather than what was ideal according to some fad or book diet. Most of us know generally what we should be doing (cut the crap and junk foods, leaner meats, more fruits and veg, whole grains instead of white processed flours, etc.) It wasn't perfect, but it was what I could do and it yielded a loss of about 50lb, or about a third of my excess weight, over six months or so - though that was incidental to the longer term goal of sustainability. Turned out that as my wife went through her WLS, loss and maintenance, I managed to maintain that loss for several years. I learned a lot about myself with that exercise, and that gave me the confidence to go with the VSG once that started getting insurance approval rather than something stronger like the RNY, or with better regain resistance like the DS. Suggestion to think about (if you haven't tried this already...) see if you can lose a moderate amount on your own and maintain it for a year or two - if you can't lose and maintain at, say, 250, how do you expect to maintain at 140 without some kind of recurring physiological help (like a somewhat restricted stomach)? Work on the habits that will help you with long term weight control first before going to a mechanical device to help lose it, and then trying to figure out how to maintain it. Social eating and restaurants do not make weight control easy - but a bit more on that later - I've blithered on enough for now

Here is a good explanation of the early (three or third week typically) stall: https://www.dsfacts.com/weight-loss-stall-or-plateau.php The term "NUT" is a derogatory term, though many on the forums may not appreciate it, derived from the fact that many on the forums find that their RDs or nutritionists aren't prescribing the latest fad diet that can be found on the internet, so they refer to them as being "nuts" for being so "ignorant" about nutrition ("everybody" "knows" that you gotta do Atkins/Paleo/Keto or whatever is hot today, to lose weight.....) Fundamentally, this initial stall is primarily part of your body adapting to the large caloric deficit that you are imposing upon it, and has little, if anything, to do with what dietary stage you are on - liquids, mushes, softs, etc. as even those of us who started out on soft foods experience it. Also, it would not be unexpected for your loss rate to slow some once things pick up again, as once you get through this initial phase of depleting your glycogen reserves and actually start burning that stored fat, things shift a bit as glycogen (stored carbs, basically) burn faster than fats - approximately 2000 calories per pound for glycogen vs. 3500 calories per pound for fats, so you will be burning more calories to lose a pound from now on. I never had a notable stall at this point, but there was a distinct dogleg in my loss curve at right about three weeks.

There is no norm, as programs vary all over the map, but by your doc's schedule, you would start tomorrow, the start of week 4. On our doc's program, we were allowed and served soft foods in the hospital if we could tolerate them, the general rule being to try new foods one at a time to test for tolerance - if it worked, great, if not, try it again in a couple of weeks. And, if something doesn't agree with you, it doesn't necessarily mean that all soft foods are off for you, as it may just be that particular item. For instance, some people have trouble handling eggs in any form for many months, though most don't have that particular issue; others can't handle lettuce or something else for months - YMMV

To know for sure, you need to look at the exact wording of the company's policy bulletin covering WLS requirements, which should be on their website somewhere - that is your bible. Insurance companies, and even different policies sold by the same company in different locations, can vary widely, though I can't see them being so picky that a week one way or the other would make a difference - there has to be some allowance for scheduling. On mine (which was with Aetna, which probably is different now than it was then,) while they implied monthly visits in their "six month physician supervised diet/exercise program" it was not specifically required, and due to scheduling issues between me and my PCP who was my "supervisor", we only wound up doing four visits, and that went through fine. The devil is in the details.

From what I have seen, dinner plates are generally in the same size range. I think that the basic lesson here is that long term you will be able to eat about half in a meal of what you did before surgery, so don't count on only being able to eat 100g forever. Dr. Weiner's basic rule of thumb of eating about half the volume as previously is still restrictive enough to maintain good weight control if you develop the right habits, but leaves plenty of room for regain if you choose poorly. I think that this is part of the basis of his philosophy of eating a vegetable heavy diet, which is fairly bulky but also fairly low calorie, It's not the only way to go, but is a good approach.

The diets are all over the map, from just the day or night before surgery up to six months (yep, six months of liquids....for what reason is anybody's guess!) 1-2 weeks is typical for those who prescribe such diets.

I also notice that you mention sauce in your meals, which some will refer to as being "meat lube" as in it helps you eat more by making it moister and more slippery. This is neither good nor bad - it just is. While it can be an aid to overeating over time (or eating around your pouch), it can also be very helpful in getting you to eat more normally, aiding in nutrition and recovery. Like many things, a double edged sword; use it wisely, but consider it if you have concerns about eating too much as time moves on.

I don't think so, as the variations can be particularly pronounced early on with differences in initial healing and inflammation. My wife could barely down her nominal stomach size of about 4 oz (typical DS stomach) in protein drink for quite a while, whereas I could drink almost any amount of liquid (sip, sip, sip, of course) those first few weeks, both within the normally expected spectrum of results. Unless things are totally not moving, it's hard to tell how well the surgery was performed by the first few weeks experience, as there is quite a bit of variation in what is "normal",

This doc lays out a pretty good progression timeline of what to expect, and is consistent with my experience. Variations will occur due to the amount of initial inflammation one may have, and in how big the stomach is initially (which can vary by one's height with the VSG and by surgeon's technique and preferences with any procedure.) Amount will also vary markedly by the composition of the food or meal, with one being able to consume more foods that are softer/slippier (so-called ":sliders") and less of firmer and more fibrous meats or vegetables.

It's a good thing that your surgeon is very positive about being able to work with this, as the weight loss is the major treatment for the problem. You may have to jump through a few more hoops to get to surgery but it still looks reasonable. If, after investigating things further with the liver guy, your surgeon has reservations about surgery, look further afield for a surgeon who has more specific skills or experience - for instance, the surgeon that I used is also a liver guy (does transplants in his "spare" time) so dealing with heavily diseased livers is routine for him. Good luck, may this just be a bump in the road.

For pizza while I was losing, I usually used a thin corn tortilla crisped in the oven as a crust, then added the various toppings, usually a bit heavy on the meat side to keep the protein balance up.

http://ir.kroger.com/ Scroll down toward the bottom of the page and they have a listing of all the different store names that they operate under - it's hard to be far from one if you're in the USA. Albertsons is a different company and now owns all of the Safeway brands.

Pushing seven years out here. Are you involved in a bariatric program yet? If so, they should be able to hook you up with some long term post ops, and there may be some who hang around their support group meetings (if they hold them.) Beyond that, ask away, and good luck on this venture.

The consensus of hospital nurses is to wait at least until you get home.

It's the liver thing is why some docs are real strict on alcohol consumption during the post-op losing phase - the liver doesn't need the added stress (I think that drinking alcohol was the biggest Cardinal sin in our program, above most any other cheat that one could do).

Not a particular expert on the subject (who is on here?) but in addition to the generally poor liver condition that goes with severe obesity, the rapid weight loss and metabolizing all that fat that we are losing additionally taxes the liver, so that is likely the reason to see higher than normal numbers. Whether your numbers are higher than expected under these conditions is for your docs to say (though likely it will be a wait and see type of thing.)

Perhaps you can go back to the surgeon who did the exploratory (is he Kaiser, too?) and see if he has any pull, Were you satisfied with his work and would you want to go back to him? Unfortunately, this is often how Kaiser is - they do things their own way. In CA, the Dept. of Managed Healthcare is the regulating agency and is who one appeals to when one has exhausted the appeals process within the healthcare company, though I'm not sure if they will do anything yet (they aren't refusing you care, just what you want...) That said, people who want or need the DS instead of an RNY or VSG have to go through the DMH to force Kaiser to provide it from an outside surgeon since they don't do it in house, so it is worth touching base with them to see what your options are from their side. As for "going after" the original surgeon, after this much time it would be hard to determine if there was anything wrong or defective with the original surgery vs. the way something evolved in your body. It might be worth going out of network and paying out of pocket (if you can) to see an outside bariatric surgeon for a second opinion, and use that (assuming it goes your way) as part of filing an appeal through DMH. Longer term, given your history, both physically and with Kaiser, it may be worth exploring switching to another health plan like a PPO that gives you more flexibility in choosing specialists - it's these tight restraints that Kaiser imposes that keeps their rates lower. Good luck...

It's not our opinion that counts, but your surgeon's and staff. That would have been fine on our program (it was specifically on their recommended list for the first month) but may not be for other programs, so it's best to check with them if it wasn't specified in your handouts.

Yes, mine too, no pre-op diet other than the day before. We do see various pre-op protocols specified, and there seems to be some debate within the bariatric community as to how much good a couple weeks of dieting can do on liver condition, and we do see the threat of not doing surgery if the liver isn't shrunk enough, though I can't recall anyone having that actually happen to them. For the OP, if you have had liver indications in the past (not unusual for the obese community) and it is in your medical records, I would expect that if your surgeon was really that concerned about it, she would order another ultrasound to check on its condition now, so that she could prescribe a more intense pre-op regimen if needed.

I never had a problem with cold drinks and generally prefer them, though some do have a problem with cold or hot for a while after surgery. I don't think I could get by on cool or room temp protein drinks and always blended ice into the mix along with milk to make the shake. It's another of those big YMMV things.

I never figured that it was impossible - that seems to be one of those WLS/dieting myths that you physically can't gain muscle mass while undergoing major weight loss, but I know of at least a couple of retired pro athletes who went through this and most likely did gain lean mass as they already knew how to do it from their previous life; much more common to see some who think that they will gain some by walking a couple of extra blocks. Keep up the good work.

Quite correct - this also why we usually end up with some loose skin even when working out during loss - the musculature takes up less space than the fat that it replaced. That said, it is also very difficult to actually build muscle mass while maintaining the caloric deficit required for weight loss (some will say it's impossible, but I say, "never say never" - it's would be very rare to see overall muscle mass gain during loss mode). The best that we typically shoot for is to minimize the loss of lean mass during rapid weight loss.

I suspect that it is probably hydration related, either not compensating enough for the workout with increased water intake, and/or some water retention revolving around the exercise and muscle repair. It seems to be fairly common for people to stall some when they begin an exercise program (causing no end of frustration - "I'm doing all the right things!" Probably more important than day to day weight changes, which can be variable anyway, are the week to week or month to month changes - that will give a better indication of what the workouts are doing for you (and probably not as much change in weight loss as one may expect, but you will feel better and be healthier as a result.)

It is certainly worth looking into, though it doesn't seem that there is much that is special, as there are other single incision type lap techniques that are touted, and extensive pre-op diets, liquid or otherwise, are not a standard thing - I never did anything other than the usual day before thing. VSGs are sometimes done outpatient with the standard techniques - it's more of a concern of verifying that all of the inside part is working correctly than the incisions healing, and the endoscopic aspect is a normal part of a VSG procedure as that is where they insert the bougie that they use for guiding the stomach cut. It overall sounds like they are applying a proprietary name to some fairly routine techniques as a means of setting themselves apart from the crowd. There is another guy in TX that promotes a "special" sleeve (inverted, maybe?) that is little more than an oversewn staple line that is, or was, a fairly standard procedure. It mostly sounds like marketing more than anything overly innovative; I would really verify results and complication rates as results matter a lot more than what techniques are used to get them.

Yes, it can be done for the "wrong" reasons (such as to get down to a size "x" for that reunion next year, or for bikini season...) but I think that you are headed in the right direction. Going through this out of concern for your ability to be their for your family is a good part of "doing it for yourself". That is a good part of the motivation to see it through to a successful conclusion. More worrisome would be if you were doing it because your family was concerned about your health and were coercing you to have it done because they thought it would be best for you- your mind isn't in the game in the same way. I have a brother in law (a couple times removed) who went through a bypass some years ago, primarily at the instigation of his wife (out of her concern for his health), but it really wasn't his idea. He was never really all that committed to it or compliant, and of course it didn't work all that well as a result. But if you are committed to it out of your concern for your family, that's a great start.