RickM

It is normal for weightloss to be done in a stairstep fashion - lose some, then pause, lose some more, pause again (maybe even gain a pound or two).... rather than an straight line x pounds per day or week. Most of the fluctuation can be chalked up to variations in water weight, which so many things influence. If it bothers you, don't weigh daily but rather weekly or monthly.

I never worried about them, and still don't (couldn't afford the side effects of being overly low in carbohydrates anyway). Early on, protein is king and if you are getting enough, you aren't likely going to have room for enough carbs or fat (depending on what diets are "in" at the moment) to worry about - your diet is going to be low carb and low fat by default, so will fit with whatever diet is popular. The most successful people that I have seen in this game, as in maintaining substantial weight loss 10-20 years or more likewise weren't overly concerned about carb counts (sugars and simple carbs, yes, but overall carb levels are irrelevant to long term success.) Follow your doc's program; if he isn't worried about your carb counts at this point, neither should you, even if other people are. And yes, I would put in your vitamins, so that you can get a full accounting of the calories and nutrients that you are getting in.

They could be referring to a stricture, which can happen with malformed sleeve. A good surgeon can correct it and a so-so surgeon will revise it to a bypass because he doesn't know how to correct it. (Always go for a second and preferably third opinion before revising for a defective sleeve, particularly if the first choice is the guy who did the original sleeve.)

Acid reflux with the sleeve is primarily a function of the stomach volume being reduced more than the acid producing potential. The body usually adjusts over time, but not always, hence the need for the acid reducing meds for a time, or sometimes long term. Leave the acid supplements to the miracle diet supplement crowd - they don't address the issue that we have (if they do anything positive at all.) PPIs (protein pump inhibitors) are usually the med of choice to address this problem (Prilosec, Nexium, Protonix and others and their generic equivalents) but have some long term concerns that need to be weighed. There is also another class of drugs - h2 inhibitors - (Zantac, Pepcid, and generic equivalents) that can be used as well and are generally considered to be safer long term though often less effective. A combination of the two is often used as a compromise treatment or when weaning off of the PPI.

Potassium is a tough nut to crack for us, as the legal OTC supplement levels are low (about 3% of RDA) and most of the best food sources are carbohydrates (potatoes, bananas, melons, etc.) which are decidedly unfashionable today (and is one of the reasons that I never went in for any of the low carb fad diets that are "in" these days.) But even eating as balance a diet as we reasonably can we are limited by the volume and calories that we can consume while losing. The best I was able to do then was in the 75-80% RDA range while more typically averaging 60-70%, The good news is that my K levels were fine on the labs and continue to be. My wife is chronically low (it's an idiosyncratic thing rather than a WLS thing for her) and uses an Rx supplement in her high K smoothie (made with tangerine juice, banana, strawberries and whatever else fits in there). Coconut water is good; another good supplement is the low sodium version of V8 juice, which has 900mg per cup, 50 calories and 10g carb, of which 2 are fiber, of it that fits tastewise into your smoothie, that may be worth a try as an alternate. You can also try using the "light" table salts that use KCl rather than NaCl in them, though we typically use so little of it that it probably doesn't make much of a difference., though the ratio of K to Na is as important as the overall level of K in our diet (and typically our diets are the reverse of what they should be - they tend to be closer to 5:1 Na to K rather than the other way around., so anything that pushes things in the right direction is a help.

I've taken regular multivit pills since the first week; the only chewables I used were calcium as those tend to be horsepills, though there are some petite tablets out there.

IIRC, mine were at 10 days, 1,3,6,12,& 18 months, all included in the surgical fee so no extra co-pays. If all is going nominally there is little to do other than evaluation bloodwork on some of them (generally done by our PCP and forwarded to them) along with progress report and advice as needed. If things aren't going as expected (whether you know it or not) who else is going to correct things while adjustments can be made? Most PCPs don't have the experience to do so, and neither do the online amateurs with their months of experience.

currently my numbers in maintenance are: Calories - 2000-2200 for weight maintenance Carbohydrates - whatever isn't fats or protein; no specific goal Fats - 60g minimum Protein - 105-110g, based upon maintenance of lean body mass During loss phase, calories averaged 1100, protein the same 105-110g, fats and carbohydrates wherever they fell while optimizing non-protein nutrition, but typically was calorically split. Fats usually 25-40g, carbohydrates 70-120g.

I'm kinda split on this issue as I have seen good and bad with both, so it really seems to depend upon the players in a patient's network. Our surgeons preached to ignore most RD's, as their practice was centered around the DS which is beyond their experience and training - if one was into bariatrics, that meant the bypass which is a very different animal, nutritionally speaking. They had developed their own program based upon their (and others in the DS world) long experience and patient feedback over the years, and it worked well. Their insight transferred to the sleeve as well as we are much closer to a "normal" person so it isn't difficult to back out the unique DS quirks from their recommendations. Contrasting that, as noted above, docs can be as subject to fad diets as anyone else, maybe more so if they feel the need to be seen as being "up" with the "latest" science. MDs have been at the center of most of the popular fad diets past and present, so their advice should be taken with a few grains of salt. OTOH, I did work with an RD associated with our PCP who did quite well in interpreting the surgeon's plan and tailoring it to my needs. She is a private practice RD with a fitness orientation and all of the Diabetic Educator certifications that are offered in the field, This meant that she fully understood the merits of low carb dieting when therapeutically necessary, but wasn't going to promote it for my use as such is contraindicated with my lifestyle and fitness needs. Many on these forums talk down RD's because they don't put out a blanket promotion of the latest fad diet promoted by some YouTube diet guru. As a profession they have seen these diets come and go, so they tend to wait for the science to catch up with them. I also have a nephew who is studying to be an RD, and he got into it by way of his dietary sensitivities and allergies showing him how important diet can be to our overall health and well being, in areas where doctors usually have little insight (and instead would just be pushing more pills.) As with most things, these RDs and MDs can vary widely in how they work, depending on their background, interests and practice structure. You can have an MD who has his hands in every part of the practice from end to end while others may be just the cutter in a large hospital program, with little input or insight in the total program. Likewise an RD may be just a cog in a large machine, dispensing diet sheets and conducting canned classes to which they had little input, or they may be integrally involved in the research and patient treatment of the practice. It's a big YMMV thing that we have to figure out with the practice(s) that we are using, and how best to use them. So, it's hard to make a blanket pronouncement to follow the surgeon's or the RD's recommendation when they conflict.

What is LCLR? Low carb most likely as those are "in" these days. Liver Reduction, perhaps? If so, what does it entail, as docs use all kinds of different diets to notionally shrink the liver. Some are more tolerable than others for what they do.

With the couple of plastics procedures and an orthopedic job that I have had since WLS, I cut my calorie load back about 20% to account for the lowered activity levels, and for the plastics boosted protein levels by 40-50% to promote healing after that much trauma (which for me was around 140-150g - the doc's standard recommendation is 100+g, which would be appropriate for an average sized woman. Otherwise, my diet was similar to my normal maintenance diet, just with the protein/non-protein ratio adjusted accordingly.

I never cared, and still don't Sugars and other simple carbohydrates were limited and still are to some extent, but there is a lot of value provided by complex carbohydrates in the diet. With our protein minimums and a suitable caloric deficit for weight loss, both carbohydrates and fats are going to be at a functionally low level. As people found during the low fat fad, the quality of the fats consumed were a lot more important than the overall level, and the same applies to today's low carb fad. One can report notably low counts by accounting tricks - loading up with artificial sweeteners (which behave like "zero carb" carbs) and other frankenfoods, but to what end - is one trying to lose weight and be healthier or report a low number? Go for quality rather than quantity, and don't get wrapped up in math games.

This doc will give you an idea of what to expect regarding your eating capacity as the months and years pile on: This is entirely consistent with my experience, and I have no problem getting in a good balanced diet, and I am not very short of his ideal of a pound of fruits and veg per day. Whether one is into the specifics of his plan, it does have merit, most particularly the aspect of how our capacity will grow over time and that one should be prepared for it and a relatively veg heavy diet is a good way to address that issue - and get in a lot of good nutrition to boot. I started figuring this out early, as I found that if I cut back my nominal meat capacity of about 3 oz to a serving of 2 oz, then I could fit in about 3 oz of salad veg along with it. Such salads have been a staple of mine since about a month out., though now with a much larger fruit/veg proportion (and still 2 oz of meat.) We often see references on these forums to "slider" foods, which most people identify as junky carbs - chips, twinkies, etc.; however, many very high nutrition/low calorie foods also have a sliderish character which can be used to our advantage. My basic practice has been to ensure adequate protein intake for the day, mostly by pre-planning, and then filling in the remainder of my intake with as good of a nutritional balance as would fit, without regard to trendy diets - no counting carbs, fats, or whatever is the fad of the day. Dinners were/are often meat/veg combinations - stews, stir fries, salads, etc. I can have quite a bit of such combined foods, as this doc suggests, though my sleeve is still working properly - if all I have is a chunk or meat, then 4-5 oz is all there is room for. So the composition of what we eat is very important (and is something we don't think much about pre-op since we can eat more than enough to get ourselves quite fat,) though this is a factor that we can use to our benefit, but can also get us into trouble if we eat the wrong things.

Yep - it's a doctor's preference. Mine just did a clear liquid diet the day before, others do a couple weeks or more of low carb liquid and solids while others go the liquid only route for a couple weeks or more.

What you wear does affect the reading that you get - the professional series of Tanita (and I assume, other brands) have an offset that they can program in to account for an average clothing weight, typically around 2 lb. So, wearing your heavy clothes and purse will give you a higher reading. The impedance measurements for fat mass, muscle mass, etc. depends upon the resistance to current run between the foot pads or handles on the hand held devices. Either can provide some error depending upon where on holds their fat - a pear shaped person carrying most of their fat around their hips and thighs will read "fatter" when measured between their feet than between their hands, and the opposite occurs with an apple shaped person that keeps more of their fat around their abdomen. The better scales, in both professional and home models, will have both foot pads and handles to measure both and average them. Either way, impedance is only a so-so way of measuring body composition as it is highly dependent upon hydration - they will typically read a few points "fatter" first thing in the morning when we are dehydrated from sleeping than in the late afternoon when we are more normally hydrated, and can vary some day to day with hydration changes. Dexascan, water displacement or BodPods are somewhat more accurate, but less convenient than a home impedance scale that can be used daily to track trends.

If this original procedure was insured, you can also contact the insurance company that paid for it - they love doctors who commit insurance fraud.

Yep, it is likely ketosis, which is from your diet being overly low in carbohydrates at the moment - not an uncommon thing this early out when our diets are little more than protein. It will resolve as your diet improves over time.

There are a few minor tweaks that are commonly done to bypasses to try to improve things, like band over bypass or stoma tightening procedures, but they overall don't seem to have a great success record. The best results revisionwise is to revise to the DS (duodenal switch) but that's a complex procedure for which maybe a half dozen or so surgeons around the country are qualified - you are in luck if you are in California or the NY/NJ area as that's where most of them are, otherwise count on travelling for that solution.

There isn't a whole lot one can do other than suck it up for the day or two you have to do it (and be glad your doc isn't one to prescribe these things for weeks pre-op!) At least Dr. Burch has one of the saner pre-op programs. I'm not a big fan of the Isopure, but it is one of the few clear proteins out there. When I have to do these things (like for colonoscopies or other such GI tests) I usually mix the Isopure into JellO so there is at least some consistency to play with. SF popsicles are another staple for these diets as well. Good luck, and see you on the other side....

Treated as a convenience food for grab and go, they are quite good. They have a variety of flavors to try, so something should fit your tastes somewhere. Compared to many such products, they don't have any coatings, icings or layerings that melt, so they hold up well to keeping in the car or gymbag for when needed - some people like to nuke them a few seconds to warm them up. There are some other brands that have similar numbers that one can try as well, though they often have a lot more sugar alcohols that some are sensitive to., but Quest have minimal amounts or none of them.

If you can swing it, my recommendation is to save your pennies and try to stay local for plastics if you possibly can. This has nothing at all to do with doctors in Mexico, Costa Rica or other countries vs. US, but rather the nature of the procedures and the relative risk for minor to moderate complications that may need some form of continued attention from the surgeon. Our WLS is fairly straightforward with a fairly small chance of some complication during the first couple of months and tapering off from there - most things that may happen will keep you in the hospital a few extra days. With plastics, there are a number of minor to moderate things that can happen during the healing phase in the first couple of months and possibly thereafter - incisions that don't quite heal properly or open again somewhere along the suture line, lingering drainage or seromas that form. A lot of things can be handled by selfies and email but others require a hands on approach with an office visit. These are things that happen more often when you have more extensive cutting. Most of these things fall into the inconvenience category but are usually handled as part of the basic surgical fee stateside. If you are hours away from the surgeon, you need to arrange for such treatment locally which can cut into your savings. I had drainage into my scrotum (not an overly unusual complication of hernia repairs, which was part of my package, or other abdominal surgeries - those channels that our testicles dropped through when we were wee ones are still there and make a great passage for excess fluids, irrespective all the JP drains they install) which took months to resolve as it slowly drained, evolved into a hematoma which got tapped and drained a few times before finally getting fully absorbed. Yeah, had had triplets for a while - and I don't even own a pawn shop! Had I travelled for this, beyond the normal discomfort of flying a couple weeks after that extensive surgery, adding in carrying a grapefruit down there through all of that is not something I care to contemplate. Basically it's a risk/reward decision that favors staying local more than the original WLS does, but the savings can still be worth the risk - something to factor into your calculus.

I had a TT and a moob reduction done. Both were marginal in necessity in my case, but since i had a couple of hernias to repair, went ahead and combined the procedures. But you are right that there isn't a lot out there given that women are still the majority demographic for bariatric surgery and are probably an even bigger majority for plastics.

Yes, it is normal to be able to drink that readily. It is also normal to have problems getting enough in if on has a lot of inflammation in the stomach from the surgery. These are two ends of the "normal" spectrum of expectations. i, too, had no problem sipping vast quantities of liquid early on, while my wife struggled, the doc was not concerned with either situation.

It's just a personal preference of the surgeon based upon his experiences, just as some do pre-op diets and some don't, and some progress their patients more rapidly post-op than others. Mine didn't do any drains but did use a catheter, which actually was somewhat more comfortable the first day post op as it relieved (so to speak) any urgency in having to get up to go to the bathroom, I suspect that my doc's use of them (if he still does,) is based upon his normal practice of doing much longer and more involved bariatric procedures than the sleeve, and it just carried over to his sleeve patients. Based upon the variance in practices on the drains, it seems like this surgery is marginal in its need for it as they usually aren't doing that much cutting in there, When you get into plastics you will get drains all over as there is a lot more trauma produced. Personally, I would be more inclined to avoid docs who do multi-week liquid pre-op diets than those who use drains or catheters.

Surgeons vary widely on what they do pre-op. Based on what I see on these various forums, I would guess that maybe 20% of the practices do EGDs pre-op (doesn't seem like it's anywhere near 50%) and maybe a similar number do pre-op ultrasounds to look at the liver and gallbladder. Some may do a specific H. Pylori test. Some do pre-op diets of some description while others don't. My doc didn't do any specific GI imaging ahead of time, but would have removed the gallbladder had he felt any stones when he was in there. Likewise, I expect that he would have taken some liver samples for biopsy had he seen anything of concern (and he gets very concerned about such things as liver transplants is other major practice.) I guess that you can say that some docs don't want to be surprised when they go inside of you and want to have as much planned out as possible, while others are perfectly comfortable working more on the fly, as it were. There may also be scheduling concerns - if a doc packs his surgical schedule, then he would want to know ahead of time if he needs to schedule more time for a particular patient; others may keep a more relaxed schedule that can accommodate the typical added tasks.