RickM

You are right on schedule. We usually experience a very rapid loss whenever we start a major weight loss effort (surgical or otherwise,) as our bodies will first burn off our short term energy supplies of glycogen (basically stored carbs.) After that is exhausted, the body usually rests while it gets the idea that you are serious about this caloric deficit thing and gets into its longer term fat burning mode. This is what creates the typical three (or third) week stall that we hear so much about - the loss pauses as the body works to restore some of its lost glycogen reserves and moves to burning more fat. The other consequence of this shift is that fat burns a lot more slowly than glycogen (around 3500 calories pre pound lost vs. around 2000 calories per pound) so it takes more lost calories to lose a pound now than it did at first. The good part about this is that you are now doing what you really want to do - burn off that excess fat! Note that you may or may not experience an actual stall here - no weight loss for several days or weeks - though most do, but you will certainly experience a slow down in your loss rate. I never had any measurable stall here, but there was a distinct change in the loss rate chart. Also note that this shift to "fat burning" mode has nothing to do with what style of diet one may be on (some promoters of fad diets like Atkins or keto talk their diet putting one in "fat burning" mode as a means of keeping one buying their products despite some unpleasant side effects,) as it is the continued caloric deficit that keeps you burning that excess fat. The same pattern happened when people were caught up in the low fat fad. It is also good to keep in mind that long term, our loss rate will generally decline as we get lighter - it simply takes fewer calories to move ourselves around 24/7 than it did when we were heavier, so unless one seriously ramps up their exercise/activity levels, the loss rate will slowly taper off over time.

It may be that as leaks have become increasingly less common, that they have decided that the leak test isn't necessary any more (just a guess, but many things change in their processes as they learn more and develop new tools.) As for your Water drinking, the typical advice from the docs is to sip, sip, sip your water these first few weeks as inflammation in the stomach can impede your drinking and make normal drinks or gulps uncomfortable (or worse, back up again.) I am a big drinker, too, but we have to put up with the sipping until swelling goes down in there and fluids flow through more normally.

Much of the program protocols that we see in the WLS world are based upon RNY practices, as that has been the default procedure for the past couple of decades, and carried over to newer procedures such as the VSG as much for the convenience of the surgeons' staff as for an abundance of caution with a new or unfamiliar (to them) procedure. We see variations based upon the experience that different surgeons bring to the table from their varied backgrounds. For instance most of the DS programs that I have seen have a more rapid progression than we typically see in the majority of bypass oriented programs - I was on scrambled eggs and yogurt, along with liquids, in the hospital, and we progressed into most pureed and soft Proteins including most seafood as tolerated from there, with everything else added after the first month. Their general finding has been that patients seem to do better as the move to real food from supplements and shakes only. I'm not sure what a "lasagna roll up" is, but such a thing is conceivably tolerated at a couple weeks, particularly if it's primarily cheese and sauce. Given what I have seen from the DS world, it seems like the sleeve is somewhat more robust than most bypass oriented surgeons give it credit for, and many are slowly recognizing this as programs are slowly moving to more rapid progressions. Things like saltine crackers and mashed potatoes (particularly laced with Protein powder), while not necessarily ideal weight loss foods, are easily digested early on and can have a place in the progression as one moves toward more nutritionally dense foods for the longer term. Looking at how these procedures, and similar non-WLS gastric procedures are structured, it seems that the common thread is what type of tissues are being grafted together and how quickly those connections heal. The VSG is only stomach tissue connected to other stomach tissue (same with the DS, which is a sleeve plus intestinal rerouting, which adds intestine to intestine connections). Contrast with the bypass, which connects stomach tissue in the pouch directly to intestinal tissue - that's a tougher healing process (and indeed is the root of the bypass's much greater NSAID sensitivity relative to the VSG/DS) Looking at non-WLS gastric procedures, there are some straighforward partial gastric resections to remove ulcerated or other diseased areas, but are confined to just the stomach tissues (sort of a "partial" VSG), while there are some partial gastrectomies that remove the lower part of the stomach and leave a pouch that connects to an intestinal loop - the origins of the RNY gastric bypass. Getting more radical, a total gastrectomy typically removes the stomach end to end, connecting the esophagus directly with an intestinal loop (often with a pouch formed from intestinal tissue). This is an even "tougher" heal than the partial or bypass gastrectomies, and often uses a feeding tube for several weeks to maintain nutrition while allowing for the connection to heal.

I think that it depends upon what your particular needs are. Most things marketed as Meal Replacements trade higher Protein levels for broader, more complete nutrition, which isn't a bad thing - if the product makes sense in your daily diet, allowing you to make your protein goals. I had little problem with protein even early out (doc was adding veg to my diet at day 10 since my protein intake was good, 90+ g per day.) I usually used a blend of Instant Breakfast and Protein powder with milk which worked well for me. Others struggle to get in enough protein, so they need to concentrate on the higher protein density products, at least until such time as the protein intake problem is solved. If my protein was running low for the day, then I may have used the straight Protein Drink, or doubled up on the blended drink and had two of them that day. Some people continue using the Protein shakes long term as a convenient breakfast or snack - they would be a good candidate for using of a Meal Replacement as many skimp on their nutrition while continuing nutritionally limited diets.

There should be some kind of booklet/binder that they give you the lays it all out, and often one or more classes that say the same things. In any event, you should have a fair idea of what your post op protocols are ahead of time so you can do some preparation for when you get home. Coming on here and asking then is next to useless as the programs can vary widely - some will be having steak at the same time that others are sipping Soup. Also, by now you should also be up on whatever pre-op procedures they use - some by now will have already started some sort of pre-op diet regimen while others have nothing until the day before surgery

Lethargy, brain fade and occasional hypoglycemia are common side effects of low carb diets that are often used when pre-op diets imposed (which is why I avoided going to such extremes in my post op regimen - recovery from major surgery is hard enough without the added stress.)

I have been on Singulair for years, and likewise, it's not been a problem. Even the NSAIDs aren't nearly as big a deal for us with the sleeve as it is for those with the bypass, for whom they are a big no-no.

It is something that your Dr. will provide you if he wants you do anything. There will always be some pre-op instructions for the day before and morning of surgery, but some docs impose some kind of diet for a week or two (or more) before surgery. These diets can vary widely depending upon the surgeons' philosophy on such things.

That is certainly one of the saner pre-op diets that I have seen (of those programs that use them) and seems to hit all of the high points of what such a diet is supposed to do. Some programs do an all liquid (or even clear liquid) diet for a couple weeks or more, for which I have never seen a rational explanation. Good luck on your upcoming adventure.

The first month or two we do tend to lose rapidly for several reasons, and then it settles down to a more sustainable rate. Guys in particular tend to lose faster, so it's no surprise that you are running ahead of their normal expectations. My doc gets concerned, too, with overly rapid loss, but they are a DS oriented practice, and those guys can be hard to catch if they lose too fast, but that is rarely a problem with the sleeve. It looks like you will be a six monther, give or take, so keep an eye on your monthly loss rate and you can always start adding calories as you approach your goal. I was within about 10 lb of goal at the six month mark and the RN was wanting me to cut back the exercise (which wasn't going to happen, I was only doing the maintenance level of exercise that I had been doing for the past several years,) but I did ease up on the calories and sort of let the holidays happen (that was November at the six month mark), had been losing consistently 10 lb per month the past three months and that stretched that last 10 lb loss out a couple of months and had no significant overshooting of the mark. It did drift down a bit more over the succeeding months as I worked into a stable dietary routine, but that is also a good time (or at that six month mark) to re-evaluate your goals and see if you want to make any adjustments - get a body composition analysis done (fat mass, lean mass, etc.) and see if you want to tweak things. Good luck, and have fun with this!

About a month out, though I usually used chopped spinach for salads rather than lettuce due to its somewhat better nutritional profile, but both settled well with me. However, some people do have a bad reaction to lettuce for a long time, so best to try it first at home rather than at a restaurant!

Yes, PPIs like omeprazole need to be stepped off of on their dosing, or else rebound reflux or heartburn can occur. Try cutting the dose in half for a week or two, or alternate doses with an H2 inhibitor like Zantac or Pepcid.

As little as possible, most particularly that which has been added (as opposed to naturally occurring in a particular food.) Some are effectively allergic to it (diabetics and the insulin resistant) and should more aggressively avoid it than others, but given that most have gotten to the point of needing WLS these days by the excessive amount of sugar and sugar analogs (like highly processed flours, etc.) in their diet, we should all be working to minimize them.

This is a good example of how differently people respond to different foods. I had no problem at all with saltines (they were suggested in the program as a good means for soaking up excess stomach acid if one feels a bit queasy,) and occasionally had a couple with a bit of Peanut Butter early on; they don't really need to be soaked as they are mush by the time they hit the esophagus. Some people find themselves intolerant to lettuce for a long time while others have no problem at all. You can find similar disparities with most any food you can think of - most have no problems but some while some will react violently. Lessons - try new foods one at a time to isolate any adverse reaction, and don't try new things on public.

Liquids pretty much go right on through us with little restriction. We will have some inflammation in the stomach after surgery, but that is a big variable - some will have a lot and it will be like trying to move the liquids through a pinched soda straw, while others will have little inflammation and can sip things through fairly normally. I was able to have a bowl of broth (6-8 oz?) and a half cup of juice in a sitting in the hospital while my wife could barely move anything through her stomach initially - both completely normal results from my doc's experience.

I wouldn't go too far with such things until checking to see what your surgeon does - one only needs to do a clear diet, at most, for the day before surgery, though some docs may do so for longer, or post op - though most do not. It is certainly worthwhile to experiment with protein shakes to find ones that you like (or at least tolerate) but as tastes can change post op (not guaranteed either way...) you don't want to load up on whatever you find that you do like in case your tastes do change.

This is something that you need to ask your surgical team, as there are no standards when it comes to pre-op dieting - they vary from nothing at all to several weeks of liquids and everything in between. It would really come down to what the intent of the diet is (and after all the years of reading these forums, I still haven't figured out what the liquid diets do.)

Three basic answers to this question - 1 - ask your surgical team, as this is medical advice and doctors have different advice and opinions on this varying from a few weeks out to never again. 2 - do a search on this site for "alcohol" as this comes up frequently (like yesterday) and you will get as many answers as you like. Yesterday's thread was actually more civil and less nannying than usual. 3 - ask yourself why is it important that you have "X" (beer, wine, liquor, pizza, cake, pie, whatever) to celebrate some occasion, and how does this relate to the problem that led you to WLS in the first place? Is it possible to celebrate without "X" one year?

Protein is what is needed if you are looking to build muscle mass; carbohydrates provide our short term energy needs and are often needed to fuel our workouts - it's one of those big YMMV things that depends upon what you are doing and your specific physiolgical needs. Carbs are not going to turn into fat unless you are consuming excess calories, in which case it doesn't matter whether that excess is from carbs, fats or Proteins - it's the excess calories. When I was part way through my loss phase, I strategically added some complex carbs to improve my endurance during the workouts (a common bit of nutritional advice is to have a meal/snack that is relatively high in complex carbs, moderate in protein and low to moderate in fats an hour or so before a workout - I found that a small meat and cheese on whole grain sandwich did the trick for me.) This worked very well in extending my endurance while swimming beyond an hour, while made little difference in my strength workouts that averaged 75-90 minutes, so you may or may not need that added boost depending upon what you are doing - experiment with it some to see what works for you. Your fears are real, and this is a common problem amongst those who get into these trendy diets - they may help keep you away from those foods that caused problems, but they don't help you learn how to get the nutrition that you need on a sustainable basis - they cut out the good along with the bad (much like what happened during the low fat fad.) Now your challenge is to learn how to include the good foods that you need in your diet without triggering the cravings for the junk that probably got you into trouble in the first place. Another little caution about setting your workout and muscle building goals - most all of us want to get rid of the excess flab that we are left with after massive weight loss, and want to build muscle to feel and look better. However, added muscle needs maintenance - you have to keep it up to keep that added muscle from turning into fat when you lose interest, get injured or ill and can't keep up the workouts. Aim to do what you think that you can keep doing over the long term. The exercise in general is a good habit to develop and provides many health benefits, but it's also easy to overdo it. I realized early on that I wasn't going to get a Schwartzeneggar body (not to mention maintaining it...) but settled into what I could do to improve and maintain decent strength endurance consistent with my lifestyle goals. My routine has evolved over time, but I still consistently do an hour or so of work each day between swimming, strength training and hiking - this is after 12-13 years, so I guess you can say that it is an established habit. It may not be perfect, but it's what I can keep up in the long term, and it allows me to do most anything that comes along with little problem of excess fatigue or sore muscles including things I rarely do like digging out a tree or kayaking across the bay.

A recent article posted here on this subject - maybe a bit nannying but covers most of the issues. http://www.bariatricpal.com/page/articles.html/_/healthy-living/bariatric-realities-%e2%80%93-medical-professionals%e2%80%99-guidelines-about-alcohol-use-wls-r601 There are several reasons for avoiding alcohol post op for varying lengths of time, and different surgeons are attuned to different reasons - Allowing the stomach to heal for some period of time (usually a few weeks or months) before subjecting it to irritants such as alcohol is the first and most common reason. That alcohol is basically empty calories that doesn't help your weight loss is another common reason (so a sip of wine here and there after healing wouldn't be a big deal, beyond one sip leading to another...) The prospect of transfer addiction is another reason given - we no longer have food to feed whatever addictive behavior we may have, so it can be easy for a casual drinking habit to turn into full blown alcoholism. Being obese, our livers tend not to be in the best of shape to begin with (hence the "liver shrinking" pre-op diets that some surgeons impose) and metabolizing all the fat that we are losing adds another stress on it. The last thing that the liver needs is more stress on it from metabolizing a liver toxin such as alcohol. The length of time before alcohol is permissible varies from one surgeon to another, from a few weeks to never again. My doc has us agree to not consume any as long as we are in weight loss mode.

Yes - in (variable) time. Quick story - when my wife and I were first looking into this WLS thing and going to support groups pre-op (she had a DS 11 years ago, I had a VSG 5 years ago) one of the post op guys was telling how he got into the DS, after going to other surgeons' groups, being told that dumping was the RNY's "gift" to you, etc. he showed up at our doc's group and saw someone eating an In'N'Out burger. "Have you had this procedure?" "Yes." "And you can eat that?" "Yes." "Great, this is the place for me!" We do occasionally have a small hamburger out someplace, usually with just half the bun - either open faced or "extruding" the contents out between the halves. At home, they are on our normal meal rotation, usually about 1/4 pound split into two patties with cheese on a slider bun (am still looking for a whole grain slider bun....sometime settle for a half of a whole grain sandwich/hot dog roll.)

Basically, the DS is the same as the sleeve from a medication perspective - the bypass has specific structural problems that contraindicate some medications (NSAIDs being the biggie) that doesn't apply to sleeve based procedures. The DS has problems absorbing some time release medications depending upon the time release mechanism used. That's something to discuss with the surgeon and to research the specific medication. IIRC, those that are activated in the stomach work fine while those depending upon transit time through the active intestine don't work so well.

SIPS/SADI/"Loop DS" (three names for the same thing) is a simplified DS-like procedure using a VSG (like the DS) but a simpler intestinal rerouting that is hoped to provide results similar to (or "close enough") the DS but in a procedure that can be done by more surgeons (the DS is a technically challenging procedure, such that many surgeons can't, or don't want to, develop and, most particularly, maintain the skills to perform.) At this point it is still generally considered to be "investigational" meaning that insurance rarely covers it. As for the OP, I would expect that it would be similar to the bypass or DS, with 2-4 days in the hospital and 2-4 weeks at home depending upon how physical ones' work is.

As noted above, check with your surgeon's team to see what their specific requirements are. Some crackers, like saltines, are basically mush by the time they get to your stomach and should be ok. They were recommended by my team for settling any minor stomach queasiness early on, but then we didn't have discrete liquid, puree, and soft stages - they were all grouped together and we progressed as we could tolerate things, so check with your team to make sure.

The 500 in your multi isn't doing anything as you have little, if any, of the intrinsic factor in your pouch to absorb it. Beyond that, you need as much as you need to keep your levels up and you are doing more than well there (IIRC, 1000 is the top end of the "normal" range, depending on which test is done.) The papers provided by your surgeon will be an initial catch-all recommendation for all, which should then be tailored by your lab results, which certainly indicates that you can cut back. The once a week that your surgeon suggests is probably good advice until your next round of labs indicates otherwise, or you start feeling anemic/lethargic.