RickM

It shouldn't be a problem - I have had orthopedic surgery (shoulders) both before and after my sleeve and they were pretty much the same. The RNY has more limitations on pain meds, NSAIDs in particular, but there are workarounds for that too.

Citracal is one of the popular brands and is widely available, as are house brand analogs from Target and others. They are typically 650mg calcium citrated and 500mg of vit D. Trader Joes has a similar product. It is generally accepted that we can only absorb around 600-650 mg of calcium at a time, hence the need to break it up into multiple doses during the day (and avoid taking it with iron supplements as they conflict). The pill form is widely available, so one shouldn't need to order and ship them, though the chewable ones are more specialized if you need to use them.

Why not give it a try and see how far you can go? Assuming that you are not in a big hurry for surgery healthwise, see what you can do by changing your habits for the long term (as opposed to a quickie weight loss diet)? When I started in this game close to 15 years ago when my wife and I started looking seriously at WLS (she was number 1 on the runway with her higher BMI and comorbidities) I went along for the ride on the 6 month insurance diet, with the intent of following her once she had recovered. We basically worked on learning nutrition and changing our diet toward what we could live with in the long term rather than one of the fad or "book" diets promising miracle weight loss. We joined the Y and I got back into swimming as I had done when younger and learned to kinda like strength training, which I had never done. The key here was to find things that you can stick with in the long term (still going there most every weekday for swimming or a weight circuit), and now have a couple of high energy hunting dogs that need regular running (they run, I hike) The upshot of this all was that I lost about 50lb, or about a third of my excess, in the six months and while it took another couple of years to get my wife on the table (insurance problems) I stuck with it, though was not able to permanently lose much more than that 50, I did keep it off over the years and fell into a WLS maintenance lifestyle with my wife after she got her WLS, though I generally ate about twice as much as she did. The weight remained stable for several more years; when our insurance started covering the sleeve, it seemed to be time to go for it as I was not going to lose more permanently on my own. Nearly seven years later, and things are still maintaining in the 190ish goal range. The dietary adjustment and waiting exercise was well worth it in my case, as it helped to seriously prepare me for the road ahead (not just a quickie pre-op diet and then try to figure out the maintenance thing later). I successfully avoided all of the calls from the various forum "experts" that this, that, or the other fad diet was absolutely essential to WLS success, as I already knew what was working for me. Further, it also gave me better insight as to what procedure would be best for me - had I gained back all (or more, as often happens) of what I had lost, that was a good indicator that I needed something stronger than the VSG, and I would have gone with the DS instead, as that procedure has better regain resistance than the other mainstream WLS like the RNY or VSG. Also, since I was tracking what I was doing, I had a good insight as to what my actual metabolism really was (not just based on some flakey online calculator) so I had a better handle on what type of diet I really needed to use to lose the weight - how many calories gave me the appropriate deficit rather than just guessing or going with what others do (600 calories? 800? 1000? 1200?) In short, while it is a longshot to get to a normal weight without WLS (typically about a 5% success rate) there can be a lot of things to learn by trying, if you put your mind to it, and think long term and not just strictly how much weight can I lose how quickly.

I never used any gummies - that's more of an RNY thing due to the fear of getting something stuck in the stoma, though some surgeons share protocols between the two procedures for the sake of convenience. The only chewables that I used was for calcium as those tend to be real horse pills, but I used them longer than I needed to as I got such a large bucketload of them. One pill at a time with a sip of water worked fine for me, though it took a year or two before I was routinely taking a handful and a time with a swig of water like the old days.

What is your surgeon's recommendation - that is your best guide? Surgeons guidelines vary from a few weeks to never again.

That's great - it really helps to have both in a relationship on board. As an added bonus for both, things fit better in the bedroom - an added incentive for the spousal support unit.

I'm not sure how much direct help I can be, as our metabolisms are likely quite different (between a 5'10 man and a 5' woman) but I'm stable at around 2000 calories per day, give or take depending upon how routinely active I am, typically split up between about five meals per day. I do about an hour of dedicated exercise per day, usually split between a half hour or so of running the dogs woods or canyon in the morning (they run, I hike) and a half hour or so of swimming or strength training in the afternoon. I don't keep track of the fluids anymore, but it is at or above the typical 64 oz recommendation (I down a 1.5 liter bottle of water per day, plus ice and whatever other incidental fluids I have - iced tea or milk products; more if I am doing something specifically dehydrating during the day. There is a series of videos from one doc that has some relevance - I'm not entirely up with everything in his program, but he is one of the few that I have seen that discusses the increasing meal volume that we typically see over time, and offers a way to handle it. I do something similar in that I have a fairly vegetable rich diet, and do more of his "veg first" approach rather than the traditional protein first that we see in the bariatric world. It does make some sense in that veg is typically high bulk, high nutrition and low calorie, so does a good job of filling that extra capacity that we develop over time in a way that minimizes the caloric load that leads to regain. The more typical low carb (and worse, low carb, high fat) diets that are all the rage today have some weight gain built into them as they are typically higher caloric density which can lead to regain if one doesn't keep on top of the overall caloric load. So, that is something to consider if that can fit with your dietary personality (something that you can stick with long term.) He has some other vids on related topics that may also be useful. He seems fairly down on revisions as a solution, which fits my experience as there seems little that can be done to a bypass that isn't just a short term fix; a revision to a DS seems to offer the best results but is a very complex procedure that few surgeons can perform, so that tends to be a last resort.

This is a tough decision and one that needs a lot of back and forth with the docs - medical care is often a game of compromises and trade offs. WLS is not an ideal thing, either, but it beats the alternative of a remaining life of obesity and its complications. You certainly seem to recognize the conflicts involved and sometimes we end up having to choose the "least worst" case. On dumping, I've see numbers of somewhere around 30% of RNY patients dump, and there are indications that the figure probably improves some over time after surgery. Our luck would usually be that if you want dumping as an aversion therapy, you won't dump! Dumping can hit VSG patients or even non-WLS people, but it is much more rare. Since dumping if basically from the rapid introduction of the sugars (and some fats) into the intestines without things being slowed down by the stomach and pyloric valve, non-RNY people can get it if they introduce simple sugars, particularly liquids, that don't trigger the pyloric valve to close. Early on, if I ate a small piece of chocolate on an empty stomach, I would get a quick "I shouldn't have done that..." feeling, that would pass just as quickly. Call it "dumping lite". With a normal sized stomach, things would be slowed down a bit more than with the small sleeved stomach. A bit of history on the NSAID thing. The bypass has a weakness at the anastomosis between the stomach pouch and the intestines. Unlike the duodenum (the part of the small intestines immediately below the stomach, which gets bypassed along with most of the stomach in the RNY,) the part of the small intestine where the new pouch joins it is not resistant to stomach acid, so that joint is very sensitive and prone to ulcers, so you treat it very gently and stay away from any meds that induce stomach irritation, such as NSAIDs. When the Duodenal Switch came along, one of its big selling points was that it could tolerate NSAIDs better than the RNY. As the DS is based upon the sleeve, the VSG carries this same basic advantage. In parallel, over the past 25 years or so, as NSAIDs came off of prescription and into wider use on the OTC market, some problems have been noted within the general population, regarding stomach upset and liver issues with consistent long term use, so most docs have become more cautious in their use overall. In the bariatric world, which has been dominated by the RNY for much of the past 40 years, NSAID aversion has become pretty standard for bariatrics, despite there being some differences in sensitivity between the different procedures. The DS has been performed by a small minority of surgeons (who also originated the VSG as a stand alone procedure) and the VSG is fairly new on the scene for most surgeons, so the NSAID aversion has remained prominent in the business overall. As more surgeons get more comfortable with the VSG, more are recognizing the differences and are more accepting of at least limited NSAID use where appropriate with their VSG patients. From our online population, you will see people who have been instructed to avoid NSAIDs at all costs for all procedures with others who have been given fairly liberal instructions on their use (our doc is fine with them as soon as narcotic pain relievers are no longer appropriate, but that comes from a primarily DS practice that is experienced with them.) Many docs will be accepting of them after some months of healing, and often advise using a PPI along with them. Best answer - talk it over with your surgeon as he is running your show for you.

It didn't make a huge difference for me, a bit lower not not a lot. With the DS it can make a big difference due to some of its metabolic quirks (my wife's cholesterol is almost below scale, usually under 100 total after her DS.)

Not at all; your weight loss may be lumpy for the first few weeks as your body adjusts to the caloric deficit, but these are common things irrespective the dietary progression. Our program was on soft foods as tolerated along with the liquids and mushies from the hospital on out, and I doubt that my first month's loss would have been any different had I been on strictly liquids, other than from any difference in the calories (I was eating a lot better, and healthier, at a month than most. but was still close to a third of the way to goal at that point. People often/usually have a bit of a stall around 2-3 weeks out and frequently associated that with a change in their dietary progression that usually happens around the same time, but that happens to most everyone even if there was no change in diet - it's just part of the body adapting to living on a lot less. Enjoy the ride - our doc has found that generally patients do better as they move on to real food.

You can try dressings that are yogurt or buttermilk based, rather than oil or mayo based - they are still low in carbohydrates but also naturally moderate in fats to keep the calories in check. They are typically around 2g of carbs and 3-4 on fats, yielding 50ish calories for a couple tablespoon serving. A lot more comfortable than 150 cal servings typical of full fat dressings. Bolthouse Farms has a line of yogurt based dressings in the refrigerator case, and Trader Joes has a few refrigerated dressings that fit in the moderate category, too. I'm carb and fat agnostic, so don't really care about those counts, but do want to get the most nutrition for my caloric buck - I'd rather spend my fat calories on the avocado in the salad than on just a bunch of oil.

Yes, the Costco brand bars are a close second, and are certainly patterned after the Quest bars. Of the Quest bars, I like the Chocolate Brownie the best, and also go after several of the other varieties. The cinnamon roll and lemon pie do have some essence of what they portray, and are good unto themselves. You can buy a sample pack from them which has a variety of flavors, so that is often the best way to find what suits your taste.

Quest bars are generally on the soft and chewy side - depends on their temperature, but many warm them up in the microwave for a few seconds. As they generally are not layered, frosted or crunchy, they take well to being kept in a car or purse (or pocket) and aren't bothered by being warmed some. Read the description of their different varieties, as they seem to have introduced new ones lately that are layered or iced that may not work as well in this regard.

Your post-op progression is not at all unreasonable, and is consistent with what the more experienced sleeve/DS practices do. Both my wife and I were on soft/mushy/puree in the hospital (as tolerated). Some patients may stay on more liquids longer depending upon how much inflammation they have in the stomach. My wife was slower to progress than I was, but within the normal expectations for the program. If your protein requirements are only 40g, which is on the low side (typically 50-60g minimum for smaller women,) I would certainly use something better than Genepro, as that stuff, at best, is substantially overstated in its' protein content.

Yes and no (how's that for a clear answer?) Fatter, moister dark meat poultry is often more tolerable than light meat. Filet, which tends to be pretty lean, is often more tolerable than ground beef. Drier lean ground beef doesn't always work as well as more moderate 85% ground beef. I generally use 85% - ish ground beef for making hamburgers or other dishes where the meat is eaten primarily by itself as it is more moist when cooked than the very low fat grades, which work well for spaghetti sauce or chili (and excess fat can be drained away, anyway.) But then, I'm also usually using the organic or grass fed grades, which alters the equation in yet a different direction. Pot roast, which is usually a pretty fat cut, still doesn't sit as well with me as most leaner or moderate steaks. YMMV. I generally go for the leaner grades, but don't agonize over it either way.

I certainly did, and it didn't bother my weight loss. Some people are heavily into the low carb thing and have a firm belief that they are bad and should be avoided. This is basically a mirror image of the low fat diets of yesteryear. Unless you have a specific morbidity such as diabetes or insulin resistance and have been told to avoid carbohydrates by your medical team, go ahead and have a healthy diet (which includes some carbohydrates...) as long as your calories are still under control. I occasionally used a thin corn tortilla, crisped in the oven, as a mini-pizza crust. After about four months, I needed to specifically add some complex carbohydrates tactically into my diet for energy management purposes.

You would be unusual if you did not stall during your first month: https://www.dsfacts.com/weight-loss-stall-or-plateau.php Don't worry about your calorie levels at this point - lots of people are in that range for a while because that is all that they can get in, and they do well. As long as you are getting in your protein and fluids, you are good to go. Yes, it is ultimately a calorie in/calories out thing, but short term there are all kinds of things that play with your water retention/rejection, so that the loss that we see is more stair steps than a consistent, linear loss day to day or week to week.

There are lots of products on the dietary supplement market that don't do anything except lighten your wallet, but since they don't do anything demonstrably harmful, there is no regulatory reason for them to be pulled off the market. Think of all of the advertised "male enhancement" products that are sold. While Genepro may not be a scam, it checks all of the boxes of being a typical nutritional supplement scam - it's too good to be true (30g of "equivalent" - whatever that is - protein in only 15g of product, and with fewer calories than 30g of real protein!) nobody quite knows what it really is, and they aren't saying, and there is no independent testing of their claims. It may not be harmful - particularly for their target market of normal westerners who already get adequate protein in their diet - but for those who are struggling to get in a minimal amount of protein, it isn't worth the risk. Go with a known quantity that is well documented and accepted - whey isolate, concentrate or blends, pea, soy, egg, etc. It may be legitimate product, but they sure aren't marketing it like it is.

By most accounts, protein drinks count toward your liquid goal, so you can do both at the same time. It is rare for a program to require 2-3 protein drinks and a half gallon of water. It is typically 64+ oz total.

Very common. The thicker liquids may not go down quite as well if you still have notable inflammation in your stomach - some do, some don't. Tired is also normal - recovering from the stress of the surgery takes energy, and most aren't getting many carbohydrates in their diet at this point, which is where our short term energy comes from.

The Genepro stuff is too good to be true, so I wouldn't depend on that to do anything other than make expensive urine. The claim that some, even professionals, make about there being some protein limit per meal is somewhat dubious, and goes against our evolutionary biology - in the good old days we might gorge on an antelope and then have little protein for a few days - so there is some conflict between these "modern" hypotheses and how we actually developed. (A diminishing absorption with increased amount would be consistent with our biology, but not some magical cutoff point.) That said, I generally do space out protein, along with other nutrients, across the day, under the premise that there are many nutrients that work well together, and we have also evolved to graze (hunting and gathering...) and it is generally better not to overwhelm our systems, particularly with a reduced stomach. As long as we have to sip liquids all day to stay hydrated (until our drinking returns to semi-normal), why not just sip on another protein drink?

This is really up to your surgeon and your individual situation. There was one person posting recently on one of these forums who had a sleeve done instead of a bypass due to the extent of their fatty liver, despite being compliant with their pre-op diet (which somewhat reinforces the point that I have heard from several sources that there is only so much that a couple weeks of dieting can do for this problem.) Some docs are more sensitive to this than others - my doc doesn't do any pre-op dieting other than the typical day before surgery thing and doesn't have any issue with working around fatty livers (it's what he does for a living); other docs may be more troubled with it. YMMV. All you can do is to follow his directions as best that you can - let him know that you had some problems and why, and let him be the judge on it.

Loss rate generally doesn't pick up over time - it usually declines over time as one has less weight to move around, one burns somewhat fewer calories in their everyday life. We generally see a big drop the first 2-3 weeks of a weight loss program (starting at surgery, or a pre-op diet) due primarily to water weight loss before the actual burning of our fat stores begins and things slow down a bit (fat burns more slowly than the carbohydrate based glycogen that we burn off at first.) Those who maintain a more consistent loss rate over their journey are typically those who get seriously into an exercise program (as in marathon training, rather than an extra couple blocks of walking) to counter the declining caloric deficit. They are the outliers of this world (as in the "*results not typical" fine print in the weight loss ads.) You can certainly meet your goals if you keep at it. As you are about half way there, figure that it may take about twice as long as you have already been at it to get that second half of weight loss done, but it can be done if you stick with it and don't let a lot of crap back into your diet.

If you are having a bypass, NSAIDs are generally prohibited due to specific problems associated with that procedure; I have seen references to a few surgeons who approve NSAID use with a bypass under limited circumstances, though they are few and far between. The sleeve based procedures don't have the same problem as the bypass, so those patients are more tolerant of NSAID use, closer to a "normal" or non-WLS person - who should still be careful with these meds as they can do unpleasant things to even normal people. Many bariatric surgeons lump all the procedures together on this matter owing to their extensive bypass experience relative to their sleeve experience; those with greater sleeve experience tend to be more amenable to NSAID use, but it still shouldn't be a routine or everyday thing. Here is one prominent sleeve surgeon's view on the matter:

It does happen, with any of the WLS procedures, though with somewhat differing rates. Revising from the bypass to the sleeve is possible (talk to your surgeon!) though the results are unlikely to be all that good as they are both similar in their overall power. As with most revisions, the second surgery tends to yield less, and slower, loss. The key to any of them is to understand why the weight has come back and get a handle on that, as one can eat around any of these procedures. There are some bypass specific procedures that are sometimes done in an attempt to correct some problems - band over bypass or different stoma tightening techniques, but they overall don't seem to have a very good success record. The best approach that I have seen is to revise it to a duodenal switch, as that procedure offers better regain resistance than the others, but that's a very complex procedure for which only a very few surgeons are qualified (like maybe half a dozen or so). From what I have seen over the years, is that 30 lb or so regain is fairly easily lost again over some months by getting back to dietary basics and cutting out whatever junk has crept back into the diet. 50lb regain or so seems to be more of a 50/50 thing as to whether one can pull it back with diet or have to revise.