RickM

6-800 is a good range for starters. The online calculators for you TDEE or basil metabolism are a good way to stay fat - they are notoriously optimistic since most only really apply to normal size range people - that extra fat that we are carrying to get us into WLS does virtually nothing toward burning calories. If you were a 300lb body builder the numbers would make some sense, but not as a 300lb WLS candidate. When I was fat, the calculators said that I "needed" anywhere from 3600-4000 calories per day, while my actual stability point based upon food logging was 26-2700 calories per day. When you were on your pre-op diet at 12-1600 calories, how long was that diet and what kind of loss rate did you attain? - that's a better measure of your individual caloric needs than a calculator. If it was a months long diet as often required by insurance, that can give you some insight into your actual metabolic rate, which can guide you to an appropriate calorie level for weight loss and maintenance. When I wsa approaching goal weight, I was consistently losing 10lb per month, which works out to a caloric deficit of around 1000 calories per day (10lb x 3500cal/lb = 35000 cal per month - divide by 30 days = 1166 cal per day) and indeed, I was losing at about 1100 calories per day and maintaining at 2100-2200 per day. Many, particularly the shorter ladies, will be maintaining in the 1200-1600 range, so you need enough caloric deficit to drive your weight loss to goal. Also, note that typically your overall metabolism will drop as you lose weight and approach goal - it simply takes less energy to move 150lb around than it does to move 300 lb, so one needs to account for that decline when settling on a calorie range for effective weight loss.

I think that BigViffer is on the right track here, with some complex carbs that take longer to absorb and not make such a big insulin spike (with the consequent hypoglycemia) but will give you the needed energy boost. P butter and saltines prob aren't that ideal since the saltines are a simple carb that breaks down quickly (though they do work well early on and are easily tolerated,) but perhaps a whole grain cracker may work better. I never had a real hypoglycemia problem when working out - never had diabetes and kept the overal carb levels on the higher side, relatively speaking, during the loss phase, but did run into endurance problems with some workouts. The advice offered by my RD was a pre-workout snack that is high in complex carbs, moderate in Protein and low to moderate in fat. I settled on a small meat and cheese on whole grain bread bread/toast sandwich as being convenient for me and meeting that profile, and it worked well to extend my swimming endurance beyond an hour; a similar Peanut Butter sandwich worked less well, so for me, the bit of extra protein from the meat was important. YMMV Experiment with foods that you tolerate and are on your plan that you can conveniently work into your schedule. My nephew, who is an RD in training, likes some of the CLIF bars as fitting the profile for pre-workout use - not ideal as a high Protein Bar that we typically go for in our weight loss efforts, but check the profiles of the different products to see what fits if the convenience is a big priority (though I prefer making something up at home.)

AFAIK, until your diet improves, which can be a little while early on when we can't get much in, and even longer for those who are seriously into the low carb/keto thing.

How much difference in sleeve size is used between a DS and a stand alone VSG is largely a surgeon's preference and what he perceives to be best for a particular patient - some will cookie cutter things while others will more closely tailor the procedure. Classically, the DS sleeve would be around twice the size of a VSG sleeve - a bougie size of 56-60 is/was common for the DS while the VSG is usually based upon a 32-40 bougie; then there are differences in overall stomach length that will determine what the initial capacity is - taller men tend to have longer stomachs than shorter women. My wife had a DS 11+ years ago and her initial stomach size was about 4 oz. I had a VSG 5+ years ago and my initial stomach size was about 2.5 oz. Initially, she had more apparent inflammation than I did, so she was more restricted in her eating volume, particularly on liquids, than I was, but early on it's still typically a few spoonfuls with either procedure and the variation will be more due to individual differences than the procedure chosen. In maturity, from any practical perspective, our meal sizes are about the same. On an absolute basis a lot less than "normal" pre-op eating but relative to each other about the same. After her DS but before my VSG when I would prepare dinner, I would serve myself about twice as much as I served her - 6oz of steak for me and 3 for her, for instance, or just 2/3 of a combined dish for me and 1/3 for her; now I make less and split it evenly. When we eat out, we get 2-3 meals out of a typical restaurant meal depending on what is ordered.

Both my wife (11+ years post-op) and I (5+ years) keep in touch at least with annual labs and feedback, sometimes in between if issues or concerns that his local program director can't handle.

I've never heard of the product. Sounds chemically. Lol. Nonetheless, I'll look it up. Sent from my iPhone using the BariatricPal App It's a sugar alcohol, like most anything that has -itol in its name (maltitol, xylitol, etc.) that has some fraction of the calories of regular sugar relative to sweetness (not zero calorie, but less than normal sugar.) It's not unreasonable to go without the fake or zero-calorie sweeteners, but it does help to track your intake long term to keep your accounting straight. As others have noted, particularly later on toward maintenance when one can eat more, be aware of cravings that can come with sugar consumption (and some of the artificial ones too) so pay attention to keep your weight under control long term.

With sleeve patients, my surgeon takes it out if he feels gallstones in there, otherwise he leaves it alone. With his DS patients he takes it out as a matter of routine as he doesn't want another surgeon going in and getting lost in the altered anatomy should it need to be removed later.

A good diet and adequate hydration is essential for overall health, including your skin, but don't expect any miracles from it. The problem is with figuring out what might be helpful on this problem is that there are so many variables involved, not least of which is genetics, that is't difficult if not impossible to devise a proper test or study to evaluate how a particular product may work. It may provide some benefit for one person but not another. Someone may chime in online saying that they did x,y,and z and had little loose skin, but no one (not least of which is the person making the suggestion) can say whether they would have gotten the same result from doing nothing. Various exercises, again, are good for overall health and may provide some benefit on the skin issue; your age and relative youth plays in your favor on this. Building musculature to replace the lost fat is useful in some places - think upper arms and thighs; building the pectorals can be useful particularly for the guys with manboobs, but unfortunately for the ladies, breasts are full of fat and they will probably need to be tightened or filled up. These things only work to some degree - people who are only moderately obese by WLS standards may get away with it while those in a more extreme starting state will still have more excess than can be filled with muscle. Also, think of the abdomin, how the "ideal" six-pack abs compare to the typical obese person's belly - there's no way that musculature is going to fill in the difference there! As Bufflehead indicates, if if feels good that you are doing something proactive and it isn't inordinately upsetting your finances, they won't do any harm and they might help. Much like some of the diets that you may see people doing - there may not be any indication that they do anything beyond what the basic caloric restriction is doing, but people feel good doing something beyond the basics.

Dehydration and hypoglycemia as mentioned are two possibilities; the other common malady that fits the description is orthostatic hypotension - low blood pressure when you stand or sit up quickly. It is not uncommon as we lose weight rapidly and particularly if we are on BP meds. If you are on BP medication, call your doctor and explain the situation and he may well cut your meds over the phone and then have you come in for a check. If you have a BP monitor at home, check it yourself and give him the numbers.

EGD is correct - EsophagoGastroDuodenoscopy. Hopefully the path reports are clean, as they usually are, but better to find anything early rather than later, just as with colon polyps that can be found during a colonoscopy. It may mean that things will have to be looked at again in few years' time to make sure things are behaving (a good reason to be getting a sleeve over a bypass in this case.) If your surgeon has any concerns about the results I'm sure he will discuss them with you.

I have yet to find a good explanation of why some docs impose a liquid pre-op diet. The notion that it helps shrink the liver, to the extent that such can actually happen in a couple of weeks - a debatable point amongst the surgeons - only requires a low carb diet like meat and veg, but not a liquid fast. The counterpoint to it that some docs site is that they want their patients as strong and healthy as possible going into surgery, and fasting for a couple weeks doesn't do it. Personally, I would avoid any of the programs that impose such requirements, unless they can site specifically what it does that a more patient friendly meat and veg diet doesn't do.

While some people will wind up leaving the hospital free of diabetes medications, more typically the longer one has been under treatment for it the longer it can take to fully get off the meds. My wife had been on diabetes meds for close to twenty years at time of surgery, and was just short of needing insulin in addition to meds, and it took her the better part of a year to be fully off of the meds (and that's with the DS, which is a stronger treatment for it.) The really good news about it is that she hasn't seen any diabetes meds or test strips for over ten years.

As usual, check with your doctor, but in general if it doesn't cause you any discomfort then it isn't hurting anything, and if you don't feel right when doing it, don't do it again for a while. "Doctor, it hurts when I do this..." "Well, then don't do that!"

I basically used a week without loss as that was when I formally logged my weight (though it was usually checked most every day for other reasons,) and only had one week when I didn't log a loss up to the point that I was within sight of goal and started ramping up the calories to slow things down and ease into maintenance.

We were not given any specific carb numbers, but were told to minimize sugars and simple carbs. I couldn't afford the side effects of the very low carb diets that are promoted in some places and haven't seen any particular benefit to them from a weight loss perspective (however they are useful therapeutically for those with diabetes or insulin resisitance) particularly over the long term. I averaged 70-100 g per day the first four months post op and then increased my complex carb intake some in certain meals to improve exercise endurance, taking the average into the 100-120 range. I wouldn't want the weight to have come off any faster than it did.

As a part of the DS (duodenal switch) WLS procedure, the sleeve has been used for around thirty years Sometimes the DS was done in two steps for patients too heavy or weak to tolerate the longer total procedure (the sleeve first, then the intestinal rerouting later after some weight had come off and the patient was stronger.) It was found that some patients did well enough on just the sleeve alone to consider adapting to a stand alone procedure, which has been done for the past 10-15 years in increasing numbers. My wife is 11+ years out on her DS without any problems from the sleeve.

A few random thoughts in no particular order - Does your insurance cover the SADI - many consider it to be experimental/investigational and don't cover it, while others do, Many insurance policies provide, one way or another, for covering out of network doctors as in network when there is no in network coverage for a specific treatment in your area. It may just be extra paperwork to get an exemption or filing an appeal for an initial decision. Depending upon when during the year your surgery occurs and what other insured expenses that you have had during the year, you may run into the max out of pocket threshold of the policy, where they start paying 100%. My surgeon is out of network but was paid 100% because by the time Aetna stopped dragging their feet and paid him we had hit that threshold. There are a number of good surgeons who take advantage of the lower cost structure of working in Mexico to offer a good product at an attractive price. Within that cohort you may find some that advertise a sleeve for $4000 while others charge 6000 or more - do you want to go with the cut rate surgeon or the more experienced one with a good reputation. Consider that when comparing costs with your at home co-pays. If you are interested in the SADI, I would certainly bias myself toward staying at home. This is a newer procedure where the long term effects have not been fully characterized. Long term follow ups with your surgeon would be a good idea as they may find certain deficiencies crop up over time within their patient population so they may change their lab protocols, adding or deleting tests as experience dictates. My wife is 11+ years out on her traditional DS (I'm 5+ out on a VSG,) and still gets annual lab follow ups from the surgeon - it helps them in understanding how things evolve as their patients age as well as helps us keep things in balance with the altered anatomy. That's a valuable benefit of keeping things local if you choose a more complex or less well known procedure.

It sounds like ketosis, which simply is a matter of your diet being overly low in carbohydrates and will go away as your diet improves. There are some diet gurus who promote the idea that this is a good thing (it's the smell of burning fat!) in order to keep people buying their diet products in the face of the unpleasant side effects. More accurately, it is the smell of not eating your vegetables - while the ketones are a natural result of the fat burning process, the implication that one needs to suffer through these side effects and offend others with bad breath and BO is untrue; one can burn fat just fine on a more balanced diet that avoids the problem, and people have been doing so for decades, long before the current low carb fad.

Mine was a month, but it was combined with the liquids and soft proteins so we could move around as needed since individual tolerances can vary so much. I don't think that I actually pureed anything (the pureed lettuce in the hospital is a bit off-putting!) but did some straining and mashing of chunks in the chunkier soups initially until i found that it wasn't necessary.

That may be your doc's program, but not necessarily the OP's or anyone else's. Your program may call for liquids exclusively for two weeks, while others may do it for three or four weeks, or just one week or none at all - it depends upon the doc's experiences and sometimes individual patient needs and tolerances. For instance, my program was for purees and soft Proteins like eggs, yogurt, some seafoods along with liquids from the outset, with the caveat being that if something wasn't tolerated then back up a step to other foods that are tolerated and try again in a couple of weeks. Some wind up being more liquid intense than others for a while depending upon their individual needs. From what I have seen, more programs are heading this direction as more surgeons get more sleeve experience. This is what makes it difficult to give much specific advice to people on these forums beyond coordinating with their surgical team, who they (or their insurance) paid to provide such advice and support. To the OP, no it's not normal to have stomach pain while eating, tho some foods may cause some discomfort which is a warning sign to back off and take things a little slower. Try new things one at a time and in small quantity to test your tolerance for them, If they go through well then fine, add that to your menu; if not then try it again in a few weeks and go with something known for the moment.

Do they not cover the sleeve itself, but do cover other WLS such as the bypass or DS, or do they exclude all WLS? If they exclude WLS in general, then there isnt much that can be done and you are doing the right thing by going self pay. If they do cover other WLS procedures but exclude the sleeve, then that is something that can be appealed, usually successfully; it just takes a bit more work.

Absolutely run this by your surgeon, as they vary widely on their advice based upon their experiences. The NSAID thing is a big NO-NO for the bypass as that procedure has specific problems with those meds that don't necessarily apply to other procedures, but surgeons often carry over their advice from one procedure to another despite the differences. The sleeve and DS are a lot more tolerant to NSAIDS than the bypass, though even non-WLS people should be cautious with consistent use of them. OTOH, Tylenol has relatively low toxicity levels, so care must be taken when using it in place of stronger pain relievers. My doc has no problem with using NSAIDs as soon as narcotic pain relievers are no longer appropriate, but with some 25 years of DS/sleeve experience behind him, and relatively little with the RNY beyond revisions, he has a different background than most bariatric surgeons. In short, if you have a bypass, Advil is typically a big red NO-NO, but if you have a sleeve or sleeve based procedure like the DS or SIPS/SADI, then it is a maybe - consult your surgeon.

Yes; my doc has the contract to do the DS for norcal Kaiser since they don't do it in house. We usually have a few Kaiser people in the monthly support group.

Yep, stay the course as this has absolutely nothing to do with what diet phase you are in or are changing between - those of us who never did a liquid diet phase go through the same thing. Overall, your loss rate will decline as you progress (so don't get too excited by initial loss and think that you can pork out and still make it to goal!) Long term, there is simply the matter that it takes fewer calories to move your body around when you weigh half what you did before, so those last pounds to goal can be slow ones. Early on, the first 2-3 weeks sees us burning up our quick energy reserves of glycogen, which are basically stored up carbohydrates and burn fairly quickly (around 2000 calories per pound lost). After the glycogen is depleted and your body gets the idea that you still aren't going to feed it like before, it starts drawing on its long term energy stores of fat (which is what we are here for!) but fat burns more slowly,(around 3500 calories per pound) so the loss rate that we experience will now be slower, but it's doing what we want it to do - burn off the fat.

The SIPS/SADI/"Loop DS" is a newer procedure that is hoped to provide results similar to (or at least "close enough" to the traditional BPD/DS, but in a simpler procedure that would be accessible to more surgeons. The traditional DS is a technically challenging procedure such that few surgeons find it worthwhile to develop, and most particularly, maintain the skills to perform it, so it is hoped that more surgeons can offer the simpler procedure, and that the procedure give better results than the current mainstream RNY and VSG. Time will tell if it works out as proposed, as it is still generally considered to be experimental/investigational without a lot of long term data supporting it. Its only relation to the traditional DS is the use of the sleeve gastrectomy as its restrictive basis, though being fairly new, it is very much on the ascent and shows good promise, unlike some of the older procedures such as the mini bypass or sleeve plication that never gained much traction due to inherent limitations.