RickM

Health is usually a bigger consideration than age - one needs to be strong and healthy enough to withstand the anesthesia. My doc has done several in their early seventies, and that's with the more complex DS rather than the simpler VSG; indeed, for patients (of any age) who are too weak and or heavy to comfortably withstand the lengthier RNY or DS procedures are often given a band or VSG to help them lose enough weight to be healthy enough to go in for the longer procedure.

Is this your sleeve surgeon or your orthopedist telling you this? I had the same discussion with my orthopod for my shoulder surgery post sleeve, as he was assuming (as most non-bariatric docs do,) that WLS=RNY=no NSAIDs, but I assured him that they were fine in our program. In the bariatric world, there is some controversy on the NSAID issue, based largely upon surgeons' background. With the RNY, NSAIDs are a giant no-no due to specific problems with that procedure's fundamental architecture, while the sleeve based procedures like the VSG and DS are much more forgiving on that point. While NSAIDs are serious drugs that, if used consistently, should be used (by anyone, not just WLS patients,) under a doc's supervision due to their potential side effects, and with a sleeve we may be more sensitive to them than the general population, we are no where near as sensitive to them as an RNY patient.

As ISG noted, you really have to check with your surgeon's team to see what they want. Docs vary widely in their progression rates and stages, for instance, I never had a liquid only phase post-op as we could have purees and soft Proteins as tolerated along with liquids from the outset. Docs have their reasoning for their post op programs based upon their own training and experiences, so only they can really provide this kind of guidance to you. As a side note on differing philosophies, some docs will be fine with you juicing (whether it would be considered to be a "clear" or "full" liquid is yet another matter!) while others won't want you getting into (or continuing) a habit of drinking calories, and others may not want you having any fruit at all while losing due to their typical sugar content. So, you can see that this is a great big YMMV thing in this WLS world.

I didn't have any stalls until about 3 1/2 months when I didn't lose anything for a week (my definition of a stall) which can probably be chalked up to a bit of water retention from travelling (higher sodium intake from eating out more, altered activity routine, etc.) Weight loss did slow as expected at the three week point - that's when we typically exhaust our short term energy reserves of glycogen, which burns quickly, and start burning our long term stores of fat, which burns more slowly.

It depends upon your surgeon's philosophy on such things. Advice varies from a few weeks post-op to never again. My doc's take on it is none during weight loss as it imposes an additional unnecessary stress on the liver.

Almost everyone has experienced it. Though it is usually referred to as the three or third week stall, it can come anytime in the first 2-4 weeks of any major weight loss effort. It is not linked to the surgery, but to when you start going into a large caloric deficit (like a pre-op diet) http://www.dsfacts.com/weight-loss-stall-or-plateau.php Another little factoid to help keep your sanity through all of this - our bodies are like a big Water balloon (what do "they" say, our bodies are 50, 60, 70% or more water?) and there is almost no end of things that influence water retention - diet, hormones (both TOM for the ladies, and from the hormones that have been trapped in the fat that we are burning off,) medication, exercise, etc. so while we may average losing 10-15 lb per month (depending upon our average caloric deficit,) there is little reason to expect that loss to be even day to day or week to week. Indeed, the normal expectation is for it to be a declining function, with the loss rate tapering off as we get closer to goal.

Generally, anything less than 150-200 gm/day (depending upon the source) is considered to be low carb. It's not something I paid any attention to while I was losing as our protein minimums and calorie limits keep both carbs and fats very low.

I've just been using pills, as part of a B complex, since before surgery and B12 levels continue to be at the top of, or above, the normal range. Do you have any lab results that would indicate that a change in form is needed, or just a preference?

Hi Mallory, I'm in the SFV, though my SF doc has a support group in Ventura that my wife and I frequently attend (she went through this ten years ago.) You have quite a ride in front of you!

It sounds like you are right on schedule for the classic "third week stall", which normally happens around 2-3 weeks after any major weight loss effort (such as the start of your pre-op diet rather than date of surgery.) Here is a good overview of some of what's happening now - http://www.dsfacts.com/weight-loss-stall-or-plateau.php Note also, that this has nothing to do with what phase of post op dieting you are in, as it is common to everyone, to varying degrees, irrespective the composition of their diet - it happens as long as you are in a substantial caloric deficit. Good luck,

It simply means that your diet is low in carbs at the moment; it will go away as your diet improves. Some diets promote it as a good thing in order to sell you more of their diet products, but it has little to do with successful weight loss; one doesn't need to suffer through bad breath and BO to lose weight and burn fat.

You are pretty much assured that you will lose some muscle mass as you go through this. While we work to minimize that loss by virtue of our Protein intake and the recommended resistance exercise, that only goes so far. Consider that our legs are being stimulated/exercised by all the excess weight that we are carrying around, and they are going to atrophy some as we lose that weight - a couple hours a week doing some resistance training at the gym isn't going to compensate for that extra 100+ lb (or whatever) that we are carrying around all day, every day. I, too, set my goal based upon body composition (mid teens BF%, to be on the lean side of "normal" for guys), making adjustments to the scale weight goal as I lost and got closer to "normal". With a moderate amount of weight training along the way, I wound up losing about 10 lb of lean mass out of the 100ish total that I lost.

It is quite variable, but not at all a worry if you can. It depends upon how much inflammation you still have in your stomach. I was a bit concerned that I could consume similar amounts in the hospital, while my wife could not when she went through this. Both are normal according to the doc.

Yes, it is likely ketosis, and it will go away as your diet improves. Some diet promoters like to claim that it is the "smell of burning fat" to keep people buying their products despite the unpleasant side effects, but more accurately it is the smell of not eating your vegetables.

I walked out on them a few months ago because they wanted to charge the $15 "membership" fee to get basic retail price that I could get from the manufacturer (or Amazon) rather than their inflated marked up price. I have found that Vitamin Shoppe charges about the same as GNC's "membership" prices without the added fee or the mark up games.

A lot of the numbers that we hear on these forums primarily apply to the ladies, as they are the dominant demographic in the WLS world. If one's metabolism keeps them stable at 1200 calories and they regularly consume 1500, regain will happen fairly quickly. One of the problems that we have is that generalizing is difficult to do as there are so many variables involved, and the typical formulas to estimate metabolic rates don't work very well on us fatties and former fatties. Most, if not all, of us have some degree of metabolic damage from our obesity history (sometimes referred to as "the fat trap") where we don't burn calories as readily as normal people do, even after we lose the weight; it might be minor on the order of 10% or so, or major on the order of 50% or more difference from what we "should" burn. Degree of obesity, length of time at these higher weights and yo-yo dieting seem to be major contributing factors. Most of us guys do have stronger metabolisms (strongly correlated to muscle or lean body mass) than the ladies overall, which is also why most programs put some emphasis on strength training over cardio exercise, along with our Protein intake, as a means of minimizing muscle loss during our weight loss phase. 2000+ calories would be a typical stable intake for an average 175 lb man, give or take some depending upon activity levels and metabolic damage (I'm maintaining in the 2000-2200 range) but there are some who wind up down in the 1200-1500 range. Other issues that lead to regain involve our getting lazy over time - stop tracking our intake (we have it down, so why bother?), letting junk start slipping in again, drinking calories, cutting back on our exercise/activity levels as our new found energy becomes normal and we get busy with other things in iife (and don't compensate by cutting back our intake...)

Generally, a taller person (particularly in the torso,) will have a longer stomach than a shorter person, so even if the doc uses the same sized bougie (the guide tool that many docs use to form and size their sleeves) the taller person will wind up with a larger stomach post op; some surgeons may tailor their sleeve for the individual while others will do the same for everyone. Many/most programs recommend that guys get more Protein than the gals - typically 60-80 gm per day for the ladies and 80-100 for the guys (I aim for 105+ for my muscle mass.) Also, generally (there's a lot of that here, since we can't get very specific without knowing a person better...) men will lose quicker and more than women since we tend to have a higher metabolism due to the greater muscle mass that we usually carry; but that's not a guarantee as there are plenty of things that can screw up one's metabolism. That said, losing too much is fairly rare with the sleeve (getting to goal is still a struggle for many,) and usually comes from a complication not allowing food to pass readily (fairly rare) or from the patient developing an eating disorder - afraid to increase their consumption out of fear of losing control on the up side (again.) Once you get into this, you will find that there are plenty of ways to "eat around your sleeve" to increase your calories and nutrition once you get where you want to be - even when our stomachs wind up being roughly the same size a year or two out, the "style" of eating can make a significant difference in our intake, such that some may be able to stick to around 1200 calories per day (fairly common for the ladies, particularly the shorter ones,) while others can ingest 1600, 2000, even 3000 calories per day if needed to be stable. I average in the 2000-2200 range and know of a couple others who are gym animals who run in the 3000+ range to feed their needs. The tricky thing is keeping down low for those who need to, and for everyone, making the best nutritional choices for whatever our level is. There are a number of WLS "rules" that are intended to help us keep our intake and calories down - eating protein first (Proteins, meats in particular, pass thru the stomach more slowly, and provide longer satiety so we don't get hungry again so soon) and not drinking with or immediately after meals (to help keep the solid food in the stomach as long as possible, are two primary ones. But we can be flexible on these rules if we need to ingest more - the tricky thing is for it not to become too much of a habit that we can't reverse things if we need to lose a bit again.

My doc's plan allowed for that, but many do not. If you don't have a guide book put out by your program, then call your doc's office and check on what their plan allows when.

Yes, ketosis is fundamentally a result of one's diet being low in carbohydrates; it really isn't a result of losing weight as the OP's doc suggested - as you suggest, one can happily lose weight without the side effects by increasing carb intake. I never had any particular problem with these symptoms, but kept my diet relatively balanced (within our minimum protein requirements and calorie limits). When my wife was going through this, she occasionally experienced these symptoms though she wasn't specifically on a low carb diet but occasional variations in her diet would drop her below her symptomatic threshold.

I see that on a lot of profiles here, so it looks like bug in the system, or perhaps a default if no other date is put in? Alex?

The DS world is a fairly small one, and most of the docs know each other, and most patients (like my wife, DS ten years ago,) tend to learn who the players are in that craft. Since most of the DS docs that I know don't need to do these "liver shrinking" diets, your stated diet and a surgeon from Montreal narrowed things down to a good guess. And, I know a couple other VSG patients who used Dr. Gagner as well. I prefer dealing with the DS docs as most have been doing sleeves, by way of the DS, for 10-20 years or more - which is part of why they tend not to get into doing the extensive pre-op diets as they have tools and specific experience that negates the need.

Is Gagner your doc? I had the same protocol - just Clear Liquids the day before. From what I have seen most of the long time DS docs don't need the extensive pre-op diets and usually just do the clear liquid and bowel prep thing the day before (gives you good practice for colonoscopies!)

I've have long had a sports car of some sort (MR2, Z4's and the like - I topped out at 335lb 13-14 years ago) so my girth never entirely excluded me from those (your height may do as much as girth though!) but my preferences haven't really changed much. Surgery has offered more opportunity for occasional interesting diversions like a Formula Ford (those little skinny-assed open wheel cars) and a NASCAR stocker (the kind with no doors where you have to climb in thru the window...) My old M3 track toy was accommodating enough for my former size, but now I have proper skinny-assed racing seats in it so I dont go sliding around inside it. On a semi-related topic of travel preferences - airline travel isn't nearly the issue that it used to be (though, again, your height may make it so irrespective weight considerations,)

It's not unusual for something like this to happen at times - our bodies have a lot of Water in them (what's the number we hear quoted - 50, 60, 70% or more is water?) and it doesn't take much to alter the balance of things through the retention or excretion of water. Hormonal changes (hormones that were trapped in our fat are released as we burn off that fat, also TOM issues for the ladies,) dietary changes, particularly sodium or carbs for those on low carb diets, medication changes, exercise or activity changes - increases in activity/exercise require more water intake and if we don't get it, the body will hoard what water it has, also muscle tissue damage via strength training requires more water for repair, so the body will hold on to water. These are a few of the factors that I can think of, and there will certainly be more. Most of us tend to be stair-step losers where we will dwell or stall for a few days and then suddenly drop several pounds in a day or two, and sometimes the weight may go up a pound or two before the next drop. My pattern always had some net loss every week, so I didn't worry about what happened day to day (I only had one week of no net loss, and that I could chalk u to sodium intake via increased eating out and altered activity/exercise while travelling.)

I never had any carb limit, rather I just tried to optimize the nutrition from the non-protein part of my diet which worked out to roughly splitting carbs and fats, but that wasn't a specific goal. I couldn't afford the potential side effects of being overly low on carbs, so I let the caloric deficit do its job that it has always done in losing weight. Part way through my loss phase, around four months out, I specifically increased complex carbs in certain meals to improve exercise endurance.