RickM

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.

From the purely gastric surgery perspective, all that's really needed is for the stomach to be empty at time of surgery, so the minimum that we normally see is liquids only, sometimes clear, the day before (and occasionally we see someone reporting just the 'nothing after midnight' thing.) Anything that goes beyond that, as in additional days or weeks of low carb dieting or liquids only is an individual choice of the surgeons to address whatever other concerns they may have.

By what measure(s) is #1 decided? By volume, McDonald's is the #1 restaurant in North America. Are you equating the two? Overall, the sniping between promoters on this thread isn't doing the overall business of medical tourism any good at all.

I fail to be amazed at the variety of pre-op diets anymore, as docs do all kinds of things for all kinds of stated and unstated reasons. Likely, ketosis was far from his intention, as it is hardly a major success factor in WLS, as much as one may read about it in internet forums. For us, ketosis (or at least the objectionable symptoms) was merely an accidental thing that happened because the diet was overly low in carbohydrates for a while, but that didn't make any difference to the weight loss performance of the program. But that does sound a bit scant in protein for something leading up to (any) surgery.

Certainly - programs vary all over the map - though I never used the pre-made ones, just the powdered mixes. We were started on a soft diet, so weren't restricted to just liquids, though they were certainly a big part of things initially.

They will sample anything that looks a bit odd - polyps can happen in the stomach as well as in the colon (which is what they commonly remove and biopsy during a colonoscopy), anyplace where it looks like an ulcer may be forming, there can be localized changes to the lining that can be pre-cancerous. It's generally nothing to worry about, but if there is something going on it's better to know about it early rather than later.

My wife had a DS 12 years ago and I had a VSG 6 years ago. She started out at a mid 60's BMI and I was a near 50. During her pre-op period of trying to get insurance to cooperate (it was still "investigational" then) and we did the semi-typical insurance 6 month diet/exercise program, I lost around 50lb - about 1/3 of my excess weight - and subsequently kept it off for a number of years (settling out around a 40-41 BMI. Once we got her on the table, and into the losing phase, I felt I was too low to go for the DS, and still had some prospect of maybe losing some more on my own. Ultimately, I maintained what I had lost and when our insurance started covering the VSG, I went for it. Had I regained what I had lost, as often/usually happens, I would have gone for the DS as that would have shown me that I needed its better regain resistance. A few things that I have picked up over the years in DS-land: A 2-step DS is a good option for those who are too ill to withstand the longer 1-step procedure. As a "plan B" option in the event of regain it is less satisfactory. Discussing this with our surgeon, his experience has been that the second step works best if it is done before any substantial regain is experienced - the weight loss after revision is usually less than what would have been experienced with a "virgin" DS. There is a general characterization that is sometimes used that "the sleeve loses your weight, while the switch keeps it off." That may not be entirely correct, but it's probably an 80/20 thing. Another consideration is that the DS is usually performed with a larger version of the sleeve than the VSG, so the restriction is a little less than the VSG, offset for weight loss purposes by the malabsorption. This also means that reflux problems that are a not unusual problem with the VSG is less common with the DS. These above considerations really tend to push one toward an either/or decision, rather than a more casual approach of "I'll go with the VSG and the DS is always there if that doesn't work out." We often see threads here about VSG vs. RNY or DS, and it is common for thsoe who decided on the VSG to state that they didn't want their guts rearranged, etc., which is a fair perspective - who does? But we all got comfortable with the idea of removing 80% of our stomach, which many consider a radical step. Fact of the matter is that some people need a malabsorbing procedure to get that job done. In my mind, the more one is inclined toward yo-yo weight patterns and increasing weight over time, the more appropriate the DS becomes over the VSG (and RNY, for that matter.) Indeed, some who fit that pattern do succeed long term with the VSG, but it's more of a long shot; OTOH, I see several 10-15 year DSers every month at our support group who continue to maintain well (and wake up every morning with one!)

It depends upon what your diet requires. For many diets, that wouldn't be a cheat at all, but for others it would be. My guess is that by asking, it isn't on your plan so I wouldn't do it without asking (the doc's staff) first.

I hear you on that - I was/am too. Fortunately we travelled for surgery so I had some good shoreline and forest trails for walking for the first couple of weeks. But yeah, I officially pushed things a bit by going in to the gym at three weeks, but mostly did it as a means of maintaining the habit and took it real easy. I could have walked around the block more as easily as walking on the treadmill. And when I was able to get back in the pool again, it was mostly just paddling around, getting things stretched out again before slowly working up to pace again. I had a much harder time after plastics, which puts you down for a lot longer.

Walking immediately and some cardio in 3-4 weeks and lifting beyond 10lb after 6 is fairly typical advice; my doc didn't want any ab or core work for 12 weeks, which arguably is not conservative enough. I started back to some basic resistance exercise at 3 weeks since the pool was out for another week for me (still had a weeping incision to close) but kept it light, about half of what I had been doing and only with the machines to isolate the core. It was mostly just a range of motion thing to keep everything moving some. One of the things that I have picked up from the physical therapists going through orthopedics is that the connective tissues - the tendons and ligaments holding the muscles together, and would also include the fascias like the abdominal wall, don't get the blood supply that the muscles get, so they don't heal as quickly. This means that we may feel strong enough to lift more than we really can, so caution is the watchword. Incisional hernias are fairly common after abdominal surgery, even lap, and even something like a sharp sneeze or cough can open one (this is why we are often advised to hole a small pillow against our abdomen when we cough post op.) The good news is that such hernias can be a way to subsidize the cost of plastics later on! An abdominal binder might be useful for a while when you start - talk to your surgeon about your plans and what his experience has been.

It could well be the low carb count - such lethargy is a hallmark of low carb dieting (one of the reasons that I never went that direction - I couldn't afford the side effects.) The keto enthusiasts insist that you are supposed to be able to burn fat to get that energy, unfortunately, our bodies don't read those diet books so don't always know what they are "supposed" to do. Talk to your surgeon about your needs and what can be changed if his program isn't working out for you - you may be doing more work than your surgeon was anticipating in providing those instructions. Timing can be an important consideration if you have specific workout times when you do your walking and run into your problem. A small snack an hour or so ahead of time, composed of something relatively high in complex carbohydrates, moderate in protein and low to moderate in fat can provide the longer enduring energy needed to extend things some - this is what I worked out with my RD when I was running into a wall about an hour into my swimming at about 4 months out and hit the spot just right. I did not increase my calories for the energy, but just reallocated what I was already consuming. If your walking is more spread out during the day, it may take a more generalized increase in complex carbohydrates or fats, or a bit more of both, during the day to meet those needs. Another thought is that it could be a bit of anemia - have you had labs checked lately. Iron is the traditional problem but B12 is sometimes a problem - some programs recommend B12 supplements as a matter of course and some don't, and some people are more sensitive to it than others as well. Also, double check your hydration, as you may think that you have been well hydrated, but if you just increased your exercise levels a month ago and didn't increase your hydration to compensate, you may not be doing as well as you think.

It sounds like the RD you were working with was just dispensing the standard diet sheet handed down from upon high by the surgeon or hospital, much as pharmacists spend much of their time simply counting pills per a computer order rather than getting to dispense the advice that they have the education and training to do. A good RD given a bit of freedom will work with the patient to affect the desired result within the tastes and tolerances of the patient. You are right though, that it seems that many pre-op programs seem to be devised to test a patient's tolerance and compliance. Another thought is whether "liver shrinking" was a major intent of the diet, or some other rationale. A lot of surgeons aren't overly concerned with that.

There are an awful lot of "may"s and "could"s in there. The problem that we have is that the science that we currently see comes from the same sources that also told us how essential low fat and low dietary cholesterol was. The science then was just as good as it is today, but ultimately what we see are small elements of a much larger whole - there was nothing fundamentally wrong with the science on fats and cholesterol in the limited cases that were studied, but it ultimately didn't translate as a big a deal in the general case. Likewise, as the pendulum has swung back to the low carb regime (as it has done several times over the past century - lather, rinse, repeat...) there is a lot of work that applies to similarly limited cases - particularly diabetics and the insulin resistent who have always benefited from such diets even when they weren't "in" - that has questionable application in the general case. Looking from the top down of how these diets work in the long term - 1 year, 2 years, 5 years, etc., they don't show any better success rate than any other diet over the years - about 5% success in the absence of WLS. With WLS, there isn't much objective work out there to suggest that one diet works better than any other. Go with whatever diet one likes - if one has a specific morbidity that requires specific limitations, then go with them, whether they be limits on carbohydrates in general or sugars specifically, fats, dietary cholesterol, gluten, fiber, protein, nuts, dairy, etc. - there is a lot to be gained from good dietary science (see your local RD!) but if one is looking for a one-size-fits-all magic bullet, keep looking - or keep jumping on whatever is trendy. You need to find something that you can stick with for the rest of your life that will help you control your weight and hopefully provide adequate nutrition to minimize the need for pills.

Yes. There are legions of people out there who have tried and failed at Atkins diets over the years who need to be convinced that there is something new to spend their money on. Plus, there's a new generation of dieters to whom Atkins is just too "old school", so a new name and a new scientific gloss and you get a new diet. That's marketing at its' best. Much like some restaurants that will inject steam into their day old dinner rolls to make them "fresh baked". Same thing.

You certainly want to keep an eye on your calories as you move on from losing into maintenance and beyond. We often see people come through these forums who proudly proclaim that they do "full fat everything", which works well early on when capacity is minimal but then the struggle with regain later if they let their calories get away from them. From a practical perspective, the clinical use for a high fat/low carbohydrate diet is for non-WLS gastrectomy patients (from cancer or gastroparesis, typically) who need to minimize their weight loss and ultimately gain back lost weight, so there is weight gain built into the diet that you need to counter.

It is hard to tell from the vernacular - traditional/modified/etc. - what exactly you had as surgeons can use such general terms rather loosely. If indeed you had a BPD/DS, that is quite distinct from the SIPS/SADI/"loop DS" which is a very different procedure where some use a DS label for marketing purposes. The "traditional" BPD/DS can be "modified" in different ways - primarily in varying limb lengths and proportions, and the common channel length, but still be a BPD/DS as defined by the CPT codes that insurance companies and Medicare use for billing purposes. The SIPS/SADI is a different structure that resembles a DS in that it uses a sleeve gastrectomy and alters the intestinal tract, but to a different fundamental configuration. It is neither better nor worse than the traditional DS (time will tell on that, given its' newness) but it will have different characteristics in its nutritional absorption and potential side effects. Calling it a DS is somewhat deceptive (that's marketing for you!) and is akin to calling a RNY gastric bypass a "DS with a pouch instead of a sleeve." My suggestion would be to have the surgeon explain exactly what he did and how it differs from a "traditional" DS, and to get a copy of the surgical report from him or the hospital. This last point is very important for all with these intestine altering procedures (or any bariatric, for that matter) so that if any problems crop up later in life - including an accident putting you in the ER for emergency surgery - the responsible surgeon at that time can have some idea of what your altered anatomy looks like. Some patients I know keep a reduced and laminated copy in their purse for just such an eventuality.

Either way, really - whatever is most convenient for you. If you consider that in these early mushy and soft phases most foods are close to the density of water (which scientifically is the measurement standard as 1oz volume = 1 oz weight) then it doesn't really matter. I find weighing to be much more convenient as one isn't continually cleaning measuring cups and spoons; even when cooking I rarely use measuring cups as the European method of weighing things is a lot easier.

They wouldn't be here on a WLS forum if they lost it on such a diet and didn't have surgery. Many people try those diets (and every other kind) as a "one last try", fail at it and have the surgery, as all of those diets have a 95% failure rate in the absence of WLS. With the help of WLS, such diets are more successful, but most any diet works the first 6-12 months post op; the important factor is learning how to control one's weight in the long term, which most of those diets don't help. Those who I know who have been most successful at this (as in maintaining substantial weight loss for 10, 15, 20 or more years didn't do it by succumbing to quickie fad diets, but by taking advantage of that year or so long window post-op to establish the healthy dietary habits that work forever.

First and foremost is to not get fat in the first place, and second would be to get better parents - it's primarily a genetic thing. There are lots of potions and creams out there that purport to tighten loose skin, and some might actually do something in minor cases. The problem is, beyond the nature of the industry for cosmetics, nutritional supplements and other miracle cures, is that it is very difficult to validate the claims with any kind of double blind control testing. With all the personal variables involved, it's virtually impossible to get two groups of effectively identical people together to test the value of these products (assuming the manufacturers were so inclined, which they rarely are.) So, yes, we will find people who used this or that product and report a certain result. The problem is that they have no idea whether that product did anything at all versus having done nothing. Give it your best shot, use what seems to be the best product, and see how it goes. Losing more slowly has some merit, though the major difference would be in losing your weight over five years versus six months. The difference between getting to goal in ten months versus eight months would be insignificant. Some are naturally slower losers than others due to their metabolism; however, the danger in trying to lose more slowly by consuming more while losing is that you may never get all the weight off that you want to get off. Our overall metabolism (resting plus activities) will trend lower as we lose since we have progressively less weight to move around (the main exception being those who seriously ramp up their exercise as they progress - as in marathon training levels,) We go into weight maintenance when our consumption meets that declining metabolic burn, so we can end up short on our loss if we consume too much.

With a VSG? Probably nothing as B12 concerns are mostly an RNY thing that many docs carry over to their VSG patients; it isn't even in my doc's protocol for VSG or DS patients. If you aren't feeling overly lethargic, you are probably fine as the main upshot of low B12 is a form of anemia. Go ahead and start taking it until you get your first round of labs done and see what your levels are.

You're also hanging on to more muscle mass than most, and working it too. But, yeah, 150 isn't overly excessive if the calories are in line with one's weight loss needs (that's 600 calories so well within most weight loss needs), though some with kidney problems may complain (particulary their doctors!) but those limitations should be from MD instructions as appropriate. I target 105-110g to maintain my 150ish lb of lean mass; 140-150 if I was inclined to be building muscle mass, or for heavy duty surgical recoverly (like from plastics.)