RickM

I make my protein pudding with both protein powder and greek yogurt. To me, using strictly protein powder (in the normal one scoop per cup of milk ratio,) had too much of that protein shake taste to it, so I cut it back to on scoop powder, one cup milk and one cup plain greek yogurt. This yields a pudding without any whey powder taste and just a hint of tartness from the yogurt and isn't overly sweet like many things can be post-op.

I was having small salads, including some meat and cheese, at a month out. I found that if I cut back my normal serving of about 3 oz meat to only 2, I had room for another 3 oz of salad veg - chopped spinach, tomato, avo, pepper, green onion, etc.

You seem to be incredibly, boringly, normal - liquids tend to go through with little restriction. Some will have more inflammation in the stomach after surgery than others, which can restrict the flow of liquids (hence the usual advice to sip, sip, sip your liquids or they might come back up on you if you are suffering from that level of inflammation.) People who are having problems tend to post on these forums more than those who don't, so the problems "seem" to be normal and we get concerned if we don't have them. And, you aren't going to gain weight with the very small amounts that you are consuming this early out, and the matter that you aren't having any problems on your liquid phase has no bearing on how much you will ultimately be able to consume later on.

I don't know what an MGB is (other than an old British sports car,) but pre-op diet protocols for WLS in general vary widely from surgeon to surgeon from weeks of liquids to nothing at all. My doc only requires the semi-normal day before GI surgery of clear liquids and a bowel clean out (same basic thing as is done before a colonoscopy,) for his sleeve and DS patients. From my perspective (and his as well,) the less of that the better, though from the long term success perspective, the sooner that you can adopt/re-adopt an overall healthy eating pattern the better.

I would second Dr. K as one of the best in the business (besides, I don't know who else in the LA area does them, at least anyone that I could recommend.) Call his office and explain your situation (probably to his insurance coordinator) and ask which of your options would work best.

It seems like the docs can define things differently (and whether it really makes much of a difference is anybody's guess.) My doc didn't discriminate between liquids, purees, mushes and soft Proteins, but just let us move between them during that first month as our tolerances dictated. It sounds like your interpretation is reasonable, though yogurt isn't usually pourable (except for some of the yogurt drinks.) If in doubt (beyond checking with the doc or nut), you can thin things out a bit with Water or milk, or just see how the thicker consistencies go as they are acceptable on some programs and there is so much overlap between the different programs. Don't be afraid to call the doc's office with any such questions, as if things aren't clear to you, they likely aren't clear to lots of other patients on the program, and the instructions should clarify such things, and if they don't they should be rewritten so that they do.

Is it a no-no based upon your doc's program, or based upon what other people do? Surgeons' programs vary widely as do peoples' opinions of different foods based upon various diet fads. Mashed potatoes have long been an acceptable early soft food (depending upon what phase one is in - it was fine for my doc's program at five days) but some consider carbs to be evil because that's the way the diet industry swings at the moment. Many things that are on ones' program at whatever point one is at may make you feel a bit off or worse, but that's just normal variations between people - count that particular food out for a couple weeks or more and then try it again.

While specific insurance policies may differ, typically the industry standards of 40BMI (or 35 with co-morbidities such as hypertension or sleep apnea) still apply. I have seen some that cover the revision with lower BMI if there was a mechanical problem with the band - slippage, erosion, etc. Any chance that you have developed any of those co-morbidities since your last surgery? It would be a shame and counterproductive to have to gain weight to qualify to lose weight, but that is sometimes how the game has to be played (ankle weights, anyone?) The psych evaluation is pretty much a standard provision, though the requirements for nutritional and exercise programs vary widely. Somebody in the process (the hospital or surgeon's practice typically) will usually want the deductible up front and sometimes an estimate of the copay as well.

The Protein levels that are typically recommended are our basic maintenance needs, or a little above - the amount needed to do the normal replacement of our muscle and organ tissues over the course of our daily living, plus what's needed to supply the amino acids that drive various biological functions in our bodies. These maintenance levels generally correspond to our lean body mass, so most women are fine in the 50-70 gm per day range while most guys need in the 70-100 gm per day range (more if one is particularly muscular, and still more if one is actively trying to build muscle mass.) Think about it - 100 gm protein is 400 calories, or 10-20% of our typical pre-op couch potato diet, so hitting those basic levels is largely incidental amongst all the other things that we are eating. However, post-op, we still need that basic maintenance level, plus a bit more for healing, etc., so we work to minimize most everything except protein in our post op weight loss diets - we may be running 50-80% protein, representing the dramatically lower proportions of carbs and fats during that time. Also, protein tends to be more satisfying, and longer, than carbs or fats, so there is another emphasis on protein there - it's easier to eat less overall if we eat protein forward so many eat more protein than the minimum for that reason.

I'm sure that he has seen holiday weight gain before. That said, surgeons are quite variable as to what they expect or want of their patients pre-op. Some are really into pre-op diets and "proving you can do it" efforts while others are not. My doc takes the view that "if we could do it on our own, what do we need him for?" and doesn't go in for any pre-op dieting. YMMV Does your doc even require a pre-op diet, or are you going off of what others here online go through with different docs?

This often happens early on - we naturally have a big loss the first two or three weeks as we use up our short term energy reserves of glycogen (basically stored carbs,) before moving on to living off of our fat reserves. Glycogen burns very quickly while fat burns more slowly, so we experience a slowdown (and often the dreaded third week stall,) when we go through that transition. Since that is often around the same time as various diet programs are moving from one phase to the next (Clear liquids to "full" liquids to purees to soft Proteins, etc.,) people often associate those different diet or food progressions with a slow down in their loss. However, those of us who don't go through discrete diet progression phases experience that same slowdown at that time.

It's nothing that I have ever found - real milk in protein shakes, greek yogurt, cheese, etc. I guess that there could always be some outliers that might respond like that, but they would be just that - those well outside the norm.

I think that whatever you tell him, he will know, as the rapid weight loss will tell him. Perhaps you can come up with a credible alternate procedure that would produce those scars (and most any abdominal lap procedure will produce similar scars, gallbladder perhaps?) but in the absence of WLS, the rapid weight loss is usually a red flag for something being seriously wrong - the most immediate concern to most who see us after a few weeks or months without knowledge of our WLS is cancer.

The default is to do the procedure open if they can't do it lap, and we usually sign something to the effect that we understand that and approve of it. If you have any doubts (and it would be worth checking with the surgeon to make sure that you understand what he said, or meant) a second opinion would certainly be in order. Even amongst surgeons who are similarly "experienced" (like ten or twenty years of bariatrics,) they can still vary widely in what those "experiences" are - for some the potential complication that you present may be very concerning to him while to another with a somewhat different background it is no concern at all. We get a hint at this by looking at all the posts here on these forums about pre-op diets to "shrink the liver" - some docs are very strict about everyone doing two, three or more weeks of heavily liquid dieting to give them more space while working in there while others require little or nothing at all as they are comfortable working with those issues.

By the time Aetna got around to paying the surgeons fees, we had hit the max out of pocket level, so they covered that 100% even though he was out of network. The hospital was in network so that was 80%, so maybe that was $1000 or less (don't really remember now.) That's something to consider if scheduling works toward later in the year. If insurance is covering it, even if is winds up being a bit more than some of the cheaper MX docs, it's usually worth the extra cost if you can possibly afford it as the aftercare and post op support programs that are usually included can add a lot of value to the process.

I suspect that this is a holdover from RNY practice, as their stomachs don't work the same way as a normal stomach (or a sleeved one, for that matter, which is a lot closer to ":normal" than an RNY pouch,) I have had no problem with gelcaps and the like, and it was never brought up as being a problem in our education process, but then my doc doesn't do bypasses anymore.

No OTC supplement does potassium well, as 3% of RDA is the legal limit in the US, so I guess they figure, "why bother?" Most multivits have that 3% in there so that they can all themselves "complete". The best non-prescription supplement that I have found for it is the low sodium variety of V8 juice (I guess they figure that it's harder to OD on V8!) Vit K, while essential for us, is also a big influence on blood clotting, so possibly they figure that it may not be desirable for bariatric patients to take a lot of K (particularly if you are taking their vit pills pre-op) without specific direction from their surgeon. It plays havoc with blood thinners that some may be on, and many surgical instructions call for minimizing K before surgery. Fish oil is great, but the horsepill sized capsules can be hard to manage for a while post-op until the inflammation in the stomach recedes.

There are a couple of things that are pretty easy to do. One is to add some plain greek yogurt to the mix- the yogurt's tartness helps tame the sweetness. Another is, as you suggest, dilution - I like my shakes thick, like a real milkshake, so I blended it up in a blender with the milk and added ice to thicken it up; then if the flavor was too weak, add unsweetened cocoa powder or vanilla extract to boost the flavor without added sweetness.

Congratulations on your progress. As I noted to my wife when she was going through this years ago, it's like going through puberty again (to the cries of nooooooo! not again!) with having to get used to the changing sizes and balance. One of the things that I did that she didn't (as her WLS was 10+ years ago while mine was just 4+ years back) that seemed to help was to get a Wii Fit system. It has a lot of balance games in it along with a basic balance evaluation each day when you log in and weigh up. Exercise-wise it's pretty "gym-lite" but some of those games do seem to help in getting back in touch with where everything is. Another possibility that a couple we know did was to hire a kinesiolgist to help them with their balance issues. I don't know how specialized that may be vs. a general physical therapist, exercise physiologist or trainer, but that is another avenue to pursue that has given good results for some.

Poke around in here and you will find a forum specific to this issue (it's that common!) Generally, with insurance, unless you are under any one WLS per lifetime restriction, you need to have the same qualifications as any WLS - BMI above 40, or 35 with specific co-morbidities such as high BP or sleep apnea.

In addition to the issues of basic healing time, the prospect of transfer addiction, and "cheap drunk" tolerance changes the other biggie that tickles some docs more than others is liver health - as WLS patients, our livers usually aren't in the best of shape due to our obesity (hence the number of surgeons who put their patients through those "liver shrinking" pre-op diets,) and the extra load that the liver takes in metabolizing that fat that we are burning off doesn't leave it much margin for handling the added load of metabolizing the alcohol, which after all, is a liver toxin (that's not a moral judgement, it's just biology - there are plenty of things that we consume in small quantities that are toxic in larger amounts,) My doc is a bit more anal about this than most as he also does liver transplants in his spare time and doesn't want to see his bariatric patients coming back on his transplant table. His rule (which we sign up to when signing up with him) is no alky while in the weight loss phase; after that, moderation is fine once the liver has regained the ability to do its' job (though in his view, ideally never...) Those are the issues, we are all adults, take if for what you will.

Your loss will naturally slow down as you progress. Initially we tend to have a very quick drop whenever we start a major caloric deficit as our bodies burn up our quick energy reserves of glycogen (basically stored carbs,) which burn very rapidly. Then, once your body gets the idea that this caloric deficit thing that you are imposing upon it is for the long haul, it starts tapping its long term energy reserves of fat, which burn slower. So, your progression is quite normal. In addition to these initial effects, over the months that our weight is dropping, we simply are hauling around less weight which requires less energy - we burn fewer calories carrying around 200lb than we do 300 or 400. Carbs are a personal thing - most restrict them more then necessary because it's the thing to do these days (it used to be over-restriction of fats,) while some have a genuine medical need to do so. I varied between 70 and 120 during my loss phase, though I was not controlling them to any particular number, but working to optimize the nutrition of the non-Protein part of my diet, and that's how the numbers worked out. As long as we are in a substantial caloric deficit, we will be dropping some ketones as we will be burning up our fat reserves to make up that deficit and that is a natural result of it. However, there is no reason to take things to the extremes that we have to put up with bad breath and BO (which is what most refer to as being "in ketosis" - that's just marketing hype to keep people buying Atkins products despite the unpleasant side effects.) The "smell of burning fat" that some refer to is actually the smell of not eating your vegetables as people have been burning fat and losing weight for centuries without smelling bad as a result.

I haven't convinced anyone to have WLS, but haven't hidden mine, either. There is a guy at my Y that fits the profile of someone doing the 6 month insurance thing, and I have considered how to approach him to offer any advice he may desire. As many have found, this is a touchy subject for all involved. I have greeted/chatted briefly with him in passing as a start (and how many people start up a conversation with the fat guy/gal when it's not their job?) and figured that when I found an appropriate opening I would let it drop that I had been there, too, when I started at the Y and just leave it up to him to pursue the point if he wanted to. Comments or suggestions on that?

Congratulations - you are having an easy recovery! It's entirely normal for liquids to go straight on through with minimal restriction - that's what liquids do, lol. Some people have a harder time with them at this point because they have more significant inflammation in their stomach, making things flow through like a pinched soda straw, but that resolves as the swelling goes down. That's why we are told to sip, sip, sip our liquids, to avoid them coming back up if things are inflamed down there. If not, enjoy. My wife was very restricted on liquids at this stage, while I had virtually none and was similarly concerned about it - we were simply at opposite ends of the range of normal outcomes. Liquids don't always satisfy hunger all that well, and also, excess stomach acid can feel like hunger, so a PPI or other type of acid reducer is usually prescribed early on - if you are not on one, ask your surgeon about it.

It's fundamentally a fad diet variant that gets you back to very low calories and carbs for a few days, which some find helps them reset their cravings if they have gone overboard on junk food. Any diet that significantly cuts back the junk does the same thing. It has nothing to do with testing a pouch as we don't have one, and running liquids or yogurt through one (for those who do, as in bypass or band patients) doesn't test anything, either.