RickM
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Congratulations, you are in maintenance. At this point your caloric deficit is around zero, or negative a bit if you are gaining regularly. To continue losing you need to get that caloric deficit in the positive again, by reducing your consumption or dramatically increasing your activity levels (exercise); we tend to need more exercise than we expect so this rarely brings about the expected result unless one goes into marathon-training mode. Increasing Protein isn't going to do much nutritionally if you are already consuming what is needed to maintain your lean body mass - excess is just excreted or stored as fat. Likewise, fiddling with carbs may produce some temporary changes due to body Water retention/excretion, but nothing in the long term unless it promotes less overall consumption. Changing these things might alter your hunger or satiety (carbs, particularly the junky ones tend to induce more cravings leading to overeating, Proteins tend to be more satisfying, curbing hunger longer,) but the fundamental change needed is to reduce your overall intake.
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Weaned off Equal, Hello Stevia!
RickM replied to OzRoo's topic in General Weight Loss Surgery Discussions
It might help. All of these artificial/"non-nutritive" sweeteners were the greatest thing when first introduced and everyone went gaga over them, and over time the downsides to them were recognized. There are likely some "gotcha's" with Stevia that will be discovered down the road (there is no free lunch, as they say...) The best thing that I have found to do is to work on reducing my need for sweetness, and mixing up, or diversifying, my sources of sweeteners (including the real thing,) when I do use them. I use them all (other than saccharine) in small amounts in different things when needed. That way I'm not overloading on any of them and when the big news comes out that X sweetener causes whatever horrifying disease, I'm much less impacted by it than if that had been my exclusive sweetener. -
Unflavored protein with jello?
RickM replied to applejenn's topic in Protein, Vitamins, and Supplements
Yes, it works quite well. Another alternative is the Isopure clear liquid Protein drinks of a similar flavor to the Jello. In the amount that you may have at one time it may not be all that much protein, compared to a Protein shake, but it all adds up and that's another 25-40 g protein that you got in over the 2-3 days that it may take you to eat a batch of Jello that you would have had to get somewhere else. -
I'm not a big fan of the Isopure clear stuff, either, but the choices are limited when on a clear diet (which for me, fortunately, has been limited to one day things before surgery or a colonoscopy.) The best thing that I have found to do with it is to mix make Jello with it. The unflavored powders like unjury can be used in the same way, or as suggested, mixed into other drinks or broths They also have a chicken broth flavored Unjury that can be used, though you may not have time to order any unless you are on clear liquids for an extended time for some reason.
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Any tips on shifting the body image to fit the new body?
RickM replied to VDB's topic in General Weight Loss Surgery Discussions
It mostly just takes time. For quite a while you will think 'I can't fit through that narrow space' or 'let's get a table because I can't fit in a booth' (my wife, 11 years out from her WLS, and I often wind up shoving the table back and forth, if it's not nailed to the floor, because it's too far away from either of us). When she was 4-5 out, she told me after an event with people who never knew her before that she was thinking 'these people don't know who I really am.....wait a minute, I'm still me!' So yes, it is a common thing since our body image has been with us for so long (and even those younger experience it for some time - see their reflection in the windows as they walk down the street, thinking 'who is that stranger following me?') As James suggests, as you recognize the positive functional changes that have been made, they start to displace the long ingrained body image. The more things that you realize that you can now do that you couldn't do as "the fat guy" the more that old body image fades, but it does take some time. It mostly just takes time. For quite a while you will think 'I can't fit through that narrow space' or 'let's get a table because I can't fit in a booth' (my wife, 11 years out from her WLS, and I often wind up shoving the table back and forth, if it's not nailed to the floor, because it's too far away from either of us). When she was 4-5 out, she told me after an event with people who never knew her before that she was thinking 'these people don't know who I really am.....wait a minute, I'm still me!' So yes, it is a common thing since our body image has been with us for so long (and even those younger experience it for some time - see their reflection in the windows as they walk down the street, thinking 'who is that stranger following me?') As James suggests, as you recognize the positive functional changes that have been made, they start to displace the long ingrained body image. The more things that you realize that you can now do that you couldn't do as "the fat guy" the more that old body image fades, but it does take some time. -
Nervous and wondering
RickM replied to MyFreshStart's topic in PRE-Operation Weight Loss Surgery Q&A
Absolutely - no pre op diet of any kind other than the semi-usual Clear liquids the day before surgery thing. I was chatting with one of the surgeons (different practice than mine, but same sensibilities) last month at our dinner meeting and he said that the last thing he wants of his patients is to be fasting for weeks before surgery - he wants them as strong as possible going into the procedure. I've never understood the liquid pre-op diet thing and have never heard a viable explanation as to its function. The "liver shrinking" thing is all well and good for those docs who need the extra help, but that is accomplished (to the extent that it can be) by a low carb diet irrespective its composition (liquids, solids, etc.) -
Any husband and wife sleeve teams out there? Topic: Time between surgeries. Discuss! :)
RickM replied to SusanB55's topic in POST-Operation Weight Loss Surgery Q&A
I think that it's one of those "definite maybe" things. If your husband doesn't have any significant complications and recovers fairly quickly as I did, it could be workable, but there is some chance that he will not be up to helping you that soon. Run it by your surgeon and see what he thinks, and also how flexible his scheduling is - can you delay your surgery by a week or two if need be, or does cancelling your slot mean delaying by a month or two because the surgeon is booked up? Always a big concern on recovery and how soon various activities may be (re)started is the need to avoid over-taxing your abs and core - thats presents a real risk of developing an incisional hernia. Most docs impose a ten pound lifting limit for some period of time - is helping your up from a chair or bed equivalent to a ten pound lift? See what the doc thinks (it may not be as obvious as we may think - after my abdominoplasty, things like ab crunches and sit ups were big no-no's, but an ab twist was ok by virtue of how things were stitched together in there.) In short, you may be able to plan on doing your surgeries that close together, but you should have a good plan B in place if things don't work out optimally. -
It's really something that you have to ask your doc's staff about, as there are so many variations. I only had two stages - liquids, mushes and soft proteins progressing as tolerated the first month and then everything else after that.
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Just tried eating egg beaters ? Why so painful?
RickM replied to dawnmac3903's topic in POST-Operation Weight Loss Surgery Q&A
It sounds like you are still having a fair amount of inflammation/swelling in your stomach, restricting the flow of things it. Stick to liquids and sloppier soft things for a while longer and try it again in maybe a week. This is just one of the big variables between different people as they recover from surgery - some may need to stick to liquids (and even those may be fairly restricted for a while for some,) while others will have little inflammation and restriction to liquids. Scrambled (real) eggs and yogurt were no problem for me in the hospital, and even boiled eggs the first week, while my wife had a hard time downing the protein drinks for a while - both are within the normally expected range of results the first few weeks out. -
How to break a long stall?
RickM replied to Packerfan61964's topic in POST-Operation Weight Loss Surgery Q&A
You've made great progress to lose that much in 8 months, but now you are in maintenance rather than a stall. To get things moving again you probably need to drop your intake by 500 calories or so per day to get things moving again, and probably somewhat more than that to take it all the way to your goal (your current stability/maintenance point will drop somewhat as you lose - takes less energy to move 180 lb around than 240). Fiddling around with carbs or salt can help break a stall that is created by Water retention issues and may help cravings if those are your particular weak points, but won't overcome a lack of caloric deficit. Revising to an RNY might help you as you will be starting from scratch again with the stomach restriction and the malabsorption does tend to give a bit of an extra kick to the weightloss, tho that is a temporary effect that lasts a year or two and then you are back to a similar metabolic state as you are in now with the sleeve. That along with its tendency toward reactive hypoglycemia leading to inter-meal hunger often drives regain in bypass patients. Overall, the bypass is very similar in performance to the sleeve, though that temporary malabsorptive kicker might be enough to get you over the hump and into a lower stability point, though you do have to consider the cost of doing so (not just financial, but the different drawbacks and limitations that one gets by moving to the different WLS.) So, look carefully at what your diet is now and where you can make adjustments before leaping to a revision. Also, if you decide that you are stuck enough to consider revision to complete the job, you should also have the DS on your radar as a more powerful tool than either the sleeve or the bypass. It has a somewhat different set of tradeoffs (though not markedly different than the bypass,) but it should be looked into before a revision rather than discovering later that you need a second revision (have seen a couple band - bypass - DS revisions go through our support group in the past couple years.) Good luck on getting things back on track, -
Been Gone A While-Been Stalled Since 6/2015
RickM replied to HaddocksEyes's topic in WLS Veteran's Forum
My experience on this is that the carbs aren't going to matter if your calories are too high, which they probably still are. I averaged around 100g per day on the carbs when I was losing, and lost the 100+ lb that I needed to lose in about 7 months. But....my caloric deficit averaged about 1000 calories per day towards the end of that effort; it was likely higher earlier on (I averaged 1100 calories per day while losing, and am maintaining at 2000-2200). Your top line metabolic burn (what you are quoting as around 1800 calories) will go down as you lose simply because you have less weight to move around all day long; the exceptions to this are usually those who seriously ramp up their exercise burn as they lose - typically those who get into marathon training or the like as they get closer to goal. So, consider that when setting your caloric goals - at your goal weight, you will probably be stable in the 15-1600 range. Your Protein is likely well in excess of what your body needs to maintain itself, so you really don't need to convert carbs to more protein; better to look into what nutrition your body needs once your protein needs are met and shoot for that, though most of us do overkill on protein to some degree as it tends to provide longer lasting satiety which helps keep the calorie count down while losing. Protein needs best correlate to our lean body mass, and at your height and likely lean mass for a woman, your maintenance needs will likely be in the 60-70g range; mine is around 100-105 to support my 150-ish lb lean mass. If I were inclined to add to my muscle mass, (which I'm not - that's just "fat in escrow" for when I stop,) then I would need to add another 40 or so g per day of protein along with a well-developed program (and all the work that goes with it) to add around 10lb in six months or so (without funny drugs.) For most of us, the best approach is to work to maintain what muscle mass we have while we lose the fat rather than trying to do both at the same time (at least for us seriously obese folks who need WLS,) Some promote the idea that you physically can't build muscle mass while in a caloric deficit consistent with significant weight loss. I say "never say never" but from what I have seen in this WLS world, it is extremely rare. The one case that I can think of in our WLS world is a post op of my doc's practice from several years ago who is retired NFL - he got himself down to about 4% body fat before letting up (and likely a decent muscle mass increase) but he already knew how to do that from years of doing so at the professional level, and working at it 2-3 hours per day, something most of us can't duplicate in our working lives. I would say that if you can get yourself down to around 1000 calories per day, that would leave you with enough margin to get to your goal weight; much higher than that and you will likely fall short. Leave yourself some margin on carb restrictions so that you can make adjustments to fit the nutritional needs of your fitness regimen - I increased my complex carbs strategically (timing relative to workouts) part way through my loss phase in order to maintain my endurance (particularly when swimming, though it didn't seem to make much of a difference to my strength workouts that are similar to yours - alternating muscle groups between sets rather than just standing around doing nothing.) Good luck on getting things back on track, -
3 diet attempts in past 2 years
RickM replied to SarahSleeve's topic in PRE-Operation Weight Loss Surgery Q&A
Is this an insurance or a surgeon's requirement? If it's an insurance requirement, then look up their specific requirements in their policy bulletin regarding WLS (it should be available online) and format things as close to their requirements as possible and hope for the best as they are in charge of the wallet paying for this. If it's a surgeon's requirement, then likewise, format your records as closely to what they want and let them have it. If they don't like it, you are in charge and can go elsewhere - this isn't a universal (or even common) surgical requirement - it is something that can be negotiated with them. I suspect that what you have will be fine, but it is well to keep in mind that it is your decision to have surgery (and with whom,) and not theirs. -
Anyone ever thought:"I can do this on my own, I don't need the sugery"
RickM replied to Killian's topic in PRE-Operation Weight Loss Surgery Q&A
The way I approached this conundrum was to sustainably make the lifestyle changes that I could. We all know generally what we should be doing - cut out the junk, more fruits and veg, whole grains instead of processed/refined grains, limit overall calories and increase activity levels. Rather than following the latest fad or book diet, I worked toward these ideals to the extent that my tastes and lifestyle permitted. Recognizing that the long term success rate for diet/exercise on the seriously obese is about 5%, I decided that rather than following some “diet” that may well get me to a normal-ish weight followed by regaining that lost weight, the best approach was to adopt the lifestyle changes that I could do permanently and see how far that got me – if I could be in that 5% group, that would be great, but I wanted what loss I could achieve to be a permanent loss. I started this almost 13 years ago when my wife and I first got serious about WLS, as part of the insurance mandated 6 month diet/exercise roadblock to approval. I lost about 50 of the 150 lb that I needed to lose in around six months, but that was about as far as I could go with this approach, I kept tweaking and making incremental improvements in my diet, but the main effect was improved nutrition rather than additional sustained weight loss I had lost enough that I felt that the DS (our procedure of choice at the time, as the sleeve was not ordinarily done at the time) was overkill for my needs then, and the bypass was too expensive in side effects and limitations for the performance offered. So I let things ride to see how well I could maintain what I had lost. After 5-6 years of weight stability, the sleeve was being approved by our insurance. As I wasn’t going to lose more sustainably on my own, I proceeded with it; had I regained what I had lost (or more) as often happens, I would have gone with the DS as it offers better regain resistance than the other mainstream procedures. One doesn’t have to wait 5-6 years like I did, but you can learn a lot about yourself by playing with some lifestyle changes before committing to WLS. BTW, I’ve been maintaining my sleeve loss for the past five years, and my wife has been maintaining well with her DS after 11 years - different needs addressed by different solutions. -
Need help choosing my protein shake.
RickM replied to Taltyana's topic in Protein, Vitamins, and Supplements
The first priority is to find the one that you will drink - the one with the greatest specs is useless if you can't stand to drink it. Then look for one that is 100% whey isolate, as that is better absorbed than whey concentrates or blends (which are cheaper.) A whey blend that you will drink is better than a whey isolate that you won't drink. Generally for our use, go for the one that has the most Protein per calorie that you can find and tolerate. Of the three that you posted, the Isopure looks best, and is whey isolate rather than a cheaper blend or concentrate as in the other products. As a bonus, it has a decent amount of potassium in it, which is something that we don't get much of (particularly on the low carb diets that are popular these days) and isn't supplemented well with the normal OTC supplements. -
1 day post-op... am I drinking too much?
RickM replied to FeelingFancy's topic in Gastric Sleeve Surgery Forums
You pretty much cannot drink too much (unless you are drinking lots of calories!) You simply have less inflammation in your stomach than some will have, so liquids go on through unrestricted, as they should. Some will have enough swelling in their stomach to significantly impede the flow of liquids for a while, which is why we start out sip, sip, sipping our liquids until things settle down. -
Differences in Plan of Care
RickM replied to Ruth1ess's topic in POST-Operation Weight Loss Surgery Q&A
I was on purees and soft Proteins (yogurt, scrambled eggs, etc) along with liquids in the hospital and on out. The surgeon's practice had been doing sleeves for about twenty years at that time, so I wasn't going to argue with their experience on what a sleeved stomach could handle. A cup of Water per hour is not unreasonable (our standard was an ounce per five minutes though that wasn't a mandatory thing) but that can vary some with the amount of inflammation in the stomach that one has post-op. I can understand their requirement that you be able to handle a cup an hour as dehydration is not uncommon and is probably the most common reason for readmission to the hospital. -
There is a fad diet floating around the internet ("I read it on the internet, so it must be true!") that goes by names such as the "3 day (or 5 day) pouch test" that some use to try to "reset" their eating habits. It usually involves going back to a liquid diet and working back up to yogurt and cottage cheese. It doesn't test anything (particularly a pouch, as with the VSG, we don't have one,) and there are any number of ways people can cut back on their calories again, or reset their cravings after a binge of no-no's. If one actually wants to check the capacity of their sleeved stomach, one needs to eat something that will close the pyloric valve at the base of the stomach - typically a piece of chicken or steak - and not a liquid or sliderish glop that flows through with minimal restriction as is done with these "pouch test" diets.
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Sleeve to DS Insurance question
RickM replied to Samantha Hunt's topic in Duodenal Switch Surgery Forum
This topic came up last month in our support group meeting, and the surgeon said that in this woman's case, like yours, it is usually considered to be treating a complication of the original surgery, so the BMI requirements don't apply. Like always, its a YMMV thing between companies, but that is how it is generally handled. -
Bariatric Realities – Medical Professionals’ Guidelines about Alcohol Use & WLS
RickM replied to Connie Stapleton PhD's topic in Weight Loss Surgery Magazine
My doc's perspective on the subject is that ideally alcohol should be a never again thing, but realistically, people being human, his real absolute is for none at all during the weight loss phase (something we sign up for during the psych evaluation). His biggest concern, beyond the long term transfer addiction issue that is the centerpiece of this article, is liver health. Or livers are usually in marginal, at best, condition from our obesity, and it is further taxed by its role in metabolizing all the fat that we are rapidly losing; it doesn't need any more stress from metabolizing alcohol (which beyond being a toxic as noted, is specifically a liver toxin. His perspective is somewhat colored by his background as a biliopancreactic (liver/pancreas) transplant surgeon before he got into bariatrics and continuing along side that practice. Addressing the obesity problem can significantly reduce the demand for transplants; alcoholism is another significant source of such demand. He does not want to see any of his bariatric patients coming back on his transplant table. -
RNY VS Sleeve for a type 2 diabetic?
RickM replied to MissMerc's topic in General Weight Loss Surgery Discussions
Overall, it's a coin toss, and which procedure is best suited to your personality - both the sleeve and bypass show diabetes remission rates of around 85% - some practices will show marginally better results with one procedure than the other and vice versa. One thing to consider is that most bariatric surgeons are most experienced and comfortable doing bypasses, as the sleeve is relatively new to them, and they tend to recommend what is most comfortable for them to perform. Look at the positives and negatives of both procedures, if possible talk to surgeons who specialize in each, then decide which fits you best, and choose a surgeon who is most experienced with that procedure. An additional note - if diabetes is your primary concern (as it usually should be,) then also take a look at the Duodenal Switch, which typically shows diabetes remission rates of around 98-99%. It is a more complex procedure, which is why most bariatric surgeons don't offer it (it takes time and resources to develop, and most particularly maintain, the necessary skills,) but it is the best available for addressing the diabetes problem, and should at least be on the radar of any diabetic looking at WLS. -
How much you lose is largely up to you, though surgeons' programs vary widely on their expectations, which can strongly influence your outcome - some expect and settle for the quoted average of 60% excess weight loss while others expect their patients to lose 100% - which practice do you expect has better overall results? Even if you are in one of the more pessimistic programs, you can still go beyond their recommendations and exceed their average results. Also, being young(er) and a guy tilts things in your favor on both amount of loss and speed. After losing 50 lb around 12 years ago and maintaining the loss for several years, I lost the remaining 100ish lb that I needed to lose with the sleeve in about 7 months; I could have done it somewhat quicker had I been interested in doing so. Quite variable, depending upon age, genetics, weight history, how you hold your fat, and who know what other factors. Another big variable. The sleeve has some predisposition towards this, like most any medical procedure or medication that will have some predisposition towards a negative side effect. The bypass generally considered to avoid this particular problem but at the cost of its own problems and limitations. We look at all the potential risks of the different options that we have (including doing nothing...) and make a choice. As with other aspects of complex procedures such as this, the skill and experience of the surgeon can be a big factor - a poorly shaped sleeve as one may see from a surgeon new to the sleeve can exacerbate the problem. I can't say that I have noticed much of this, but then, being a guy, I'm probably less sensitive to such things (more clueless?) than the ladies are on average. Not really, though the fat pad around it shrinks, so more of your gentleman will be hanging around outside now (better locker room image...) which also means that there is more of him available to explore more deeply whatever he is inclined to explore. There's no right or wrong reason for improving your health; overall, you are interested in improving your life as a whole. As we get older, mortality grabs more of our attention as we can see the significance of our health issues and see more of our peers leaving this world. It's never too early to get a handle on blood pressure, diabetes and other chronic diseases that come along with our weight. and the sleep apnea can sure get in the way of overnight dating! Good luck on this venture,
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Pre-Surgery Diet
RickM replied to BariatricBoundBlondie's topic in PRE-Operation Weight Loss Surgery Q&A
Clear liquids and a clean out the day before surgery for the surgeon; 6 months of monitored diet and exercise for insurance. -
Total weight loss confusion...
RickM replied to haleymarie's topic in PRE-Operation Weight Loss Surgery Q&A
It sounds like the psych is telling you more about them than you - that this is what you can expect from their program. Many of these WLS programs are geared for 50-60% excess weight loss as their goal (it's a lot easier to be "successful" with moderate goals,) while other programs push for 100% EWL. Some do get down to normal-ish weights with these moderate programs by exceeding their recommendations - many of these programs target 1200-1500 calories per day during their losing phase - and the psych is telling you their results - while the more aggressive programs target 6-800 calories per day - overkill for some, but necessary for many/most to achieve the more challenging goal. The docs in these moderate programs are often "amazed" at how well these patients did (by ignoring their advice.) -
Question regarding the first week and drinking liquids
RickM replied to Goplay_sf's topic in POST-Operation Weight Loss Surgery Q&A
It is probably more correct to say that it can be difficult to handle liquids early on, but it not necessarily will be difficult - there can be quite a variation in results, primarily due to how much inflammation one may experience in the newly reworked stomach. It may be significant, impeding flow through the stomach, or it may be minimal allowing relatively normal drinking. I, too, had little problem with liquids even in the hospital, while my wife could barely down her nominal stomach size in a sitting - both are within the range of normal expectations according to our doc. -
Pre op diet...3 weeks, WHAT?
RickM replied to tina74035's topic in PRE-Operation Weight Loss Surgery Q&A
Typically, those docs who require these diets do so for an average of two weeks, though three or four is not unheard of; neither is none at all or something in between - it depends upon the surgeon's preferences and prior experiences. Many who do these diets just do a low carb, low calorie diet (which is the essence of what the liver needs to improve its' condition for those surgeons who are concerned about that,) and many do some combination of liquids and low carb meals. If you are self pay, then you can choose any surgeon that you want. I've never found a good explanation of the value of these purely liquid diets vs a general low carb diet for these pre-op concerns, so you can look for a surgeon who is a bit more patient-friendly in that regard. Hint - look for surgeons who have substantial experience with the DS (duodenal switch) as from what I have seen, most don't require anything beyond the typical day before routine. It seems that experience with that procedure provides skills and tools that negate the need for these diets (DSFacts.com has a listing of some of the well-regarded DS docs around). As a bonus, since the DS uses the sleeve as its basis, the average DS doc has been doing sleeves much longer than the average bariatric surgeon, so you get additional sleeve experience on your side.