RickM

Generally, the Isopure is the only decent protein source that falls under the "clear liquid" category, though I think that Unjury has a chicken soup flavor of protein powder that may be acceptable as well. Thankfully, I only had to do clear liquids for the day before thing so never had to explore it too fully.

You are right about all the differences in the plans that are used. My read on this is that, overall, your WLS doesn't really care what kind of diet you use (in my engineering days we would say that it is insensitive to that variable,) In the dozen or so years that I have been involved in this WLS game (my wife had hers a little over ten years ago,) I have seen all kinds of diets work. Atkins style low carb diets are the current fad in the diet industry, and many on these forums have failed at them before they submitted to WLS, and then all of a sudden, it's the greatest (and only!) diet to use. The same happened during the low fat fad - those diets work just fine, too, when combined with WLS. From what I have seen, what we need to do as individuals going through this process and life change, is to address what got us here in the first place - the WLS will help us get the weight off and provide something of a reset (or a do-over) allowing us to start fresh again, but we need to learn to live for the long term while avoiding what first got us into trouble. These days, most people have gotten into trouble with junky carbs, particularly the overload of added sugar and sugar analogs in most of the food we eat (primarily in the processed/packaged food category) so some form of carb restriction is appropriate. To me, the counting of overall carbs is overkill and eliminates the good along with the bad. Much the same happened during the low fat fad - the primary abuse had been junky fats, and the diets addressed that problem but also went overboard with throwing the baby out with the bathwater.

I never worried about carb counts (surgeon never jumped onto that bandwagon when it came into fashion a few years ago,) though my intake was typically in the 70-100 gm per day range and never had any problems with loss rate or stalls - caloric deficit is your primary determiner of loss rate. The plan did seek to minimize simple carbs and sugars had little objection to complex carbs (once Protein goals are met, of course.) As we often see in our endeavors, quality tends to count more than quantity - most who strive to keep carb counts ultra low by using artificial sweeteners (some of which behave the same as real sugar as far as cravings, insulin response and addictive properties, though they are "zero carb") and frankenfoods like "low carb" breads don't do any better than those who consume a greater count of high quality complex carbs.

What I did was blended my own to my taste. I generally preferred the chocolate flavored shakes, and found that some of the EAS powders were fairly delicately flavored (at least they were four years ago when I was playing with them), so that I could add a bit of unsweetened cocoa powder to the mix to boost the chocolate flavor but cut the sweetness. One can do a similar thing by using vanilla or unflavored protein powder and then adding flavor and sweetener to taste.

I have been taking a standard oral B complex including B12 for several years before and after my VSG and my lab readings for B12 are always top of the scale or above. My doc's program doesn't call for any specific B12 supplementation, though it is part of his routine lab protocols so that it can be addressed as needed. It seems that while our absorption of B12 via the intrinsic factor in our stomachs may be somewhat affected by our VSG, the general mania about routine liquid/sublingual/injectable B12 supplementation may be yet another carryover from RNY practice.

Like maybe Serjio?

It's something for your doc or RD to answer - I have never found a good explanation for an extensive liquid diet pre-op (other than the day before to clear out the GI system.) Doing a low carb diet for a couple weeks to improve the liver condition makes some sense for those surgeons who need that extra help (though such a short time provides only a marginal benefit at best,) but liquid only doesn't seem to make a lot of sense, particularly given how long some docs have their patients on liquids post op, too. If they are allowing protein bars along with the liquids.....gotta ask the doc, or his staff, on that one.

I don't know - the sleeve doesn't care. Its often a no-no for the bypass due to the concern of it getting stuck in the stoma, but that isn't a concern with the VSG since we still have the pyloric valve in the system. Some maintain a belief that carbs are bad (much like fat was bad a few years ago....) so for them corn is probably out on that account. I didn't have it much while losing simply because its nutrition isn't all that high relative to its' caloric cost, but there was no physical reason not to have a bit of it during a summer BBQ.

As noted above, go with what your surgeon's plan permits - that's what you (or your insurance.....) are paying for. On my doc's plan, I was served scrambled eggs in the hospital (not my favorite form though,) and had boiled eggs the first week home.

You need to check with your surgeon's team on this, as programs vary all over the map. For example, mine was liquids, and mushes in the hospital progressing to soft proteins as tolerated during the first month, then progressing to everything else as tolerated after that - quite a difference to Jackie's plan. Your doc is probably somewhere in between and likely something on the order of what you posted.

Everything as billed is "too high" in this business - it's part of the game. What's important is what is actually paid under contract, which for this item will probably be in the $1500 range. We had much the same thing happen with my wife's DS - about a year later Medicare started covering it which meant that the insurance companies could no longer use the "investigational/experimental" dodge that they often use. An RNY or band would have been fully covered, but she wasn't going to go there. The 30k we paid for it bought her an extra couple years of much improved health.

Certainly touch base with your surgeon, and particularly the insurance coordinator in his office. Lots of things get billed and ultimately adjusted as they go through the insurance process (there are lots of inflated charges that get submitted that no one seriously expects to get paid in full - it's part of the game. My surgeon is also out of network (though the hospital was in network) and I paid him up front, but by the time the insurance got around to paying things, the max out-of-pocket level of the policy had been reached and they paid his fee 100% even though he was out of network. Here's hoping that yours shakes out as well.

No drain here - as you can see, some docs use them and others don't. Other common variations (from a patient's perspective) is that some docs use a urinary catheter while others don't (mine did,) and some require extensive pre-op diets, sometimes liquids only for a couple weeks or more, while others don't. It's all a big YMMV thing.

No specific limits on carbs; limit sugars particularly added sugar. I typically ran in the 70-100 gm range the first four months or so post-op, then added more complex carbs before certain workouts to promote better endurance, bringing the averages into the 100-120 range. I would not have wanted the weight to come off any faster than it did (assuming that carb counts have anything to do with loss rate, a dubious proposition.)

As Babbs said, you have much to look forward to! Now, when my wife (she had her WLS ten years ago, mine was four,) and I go out and draw a booth, we often start moving the table back and forth (if it isn't bolted to the floor,) because it's so far away from both of us. In many places, tables are still preferred because of this

Lettuce in particular seems to be an issue for some people - who knows why, but it's just one of those YMMV things. I generally use chopped spinach instead of lettuce for its' somewhat better nutritional profile; I've been having salads with a little meat in them since around the end of the first month, The thing to do is to try the various components one at a time to see where the problem is, and avoid that food for now and then try it again in a few weeks.

It sounds like you may be lactose intolerant, so a couple of things can be done if that is the case. One is to look for a Protein powder (or pre-mixed) that is 100% whey isolate, which has the lactose filtered out as part of the isolate process; most whey protein products use a whey blend or concentrate that is mixed in with the isolate because it is cheaper. The whey isolate is generally the preferred protein source for us as it is better absorbed and available than other protein sources. You can then mix it with your preference of fluids - Water, lactaid milk, or any of the various milk-substitute products that are on the market. It's good that you can experiment with these things now when you are on a once-a-day regimen to find out what works for you for later when these drinks become a temporary staple for us.

I just had a clear liquid diet the day before surgery, but nothing else required before that (with a low 40s starting BMI). Likewise, when my wife went thru this a few years ago (with a mid-60s BMI) she had the same plan.

No, not all docs charge a "program fee" (the usual title for it) but many (maybe half or less?) do charge one to cover various costs that aren't covered by insurance - their support groups, pre-op education classes, consults with nutritionists, physical therapists, exercise therapists or trainers, etc. etc. etc. When charged, the fees are typically a few hundred dollars but I have seen some in the $5-6k range. My doc didn't charge a program fee, but rolls the additional program costs into his surgical fee, but doesn't work thru any of the insurance networks, so he is out of network for most - you pay whatever added services there are one way or another.

It sounds like you have some lactose intolerance in you. Whey Protein is generally the best absorbed protein for us, which is why it is preferred in most plans. Try to find one that is 100% whey isolate which has the lactose filtered out as part of the isolate process; it is more expensive which is why many products use blends of isolate and cheaper whey blends. There are also a few products out there that use egg protein which is supposed to be similar in absorption. You can also try using Lactaid tablets when dairy is unavoidable. As a side note, the greek yogurt that is a high protein staple for most WLS folks has most, if not all, of the lactose fermented out so is usually well tolerated. Usually, the idea of the pre-op diet for those docs who require them is to improve the condition of the liver prior to surgery, which primarily involves cutting the carbs way back, so the fruit would most likely be a no-no, but the small amount of fats in most of the recommended products would be OK. Why some docs require liquids only while others go with a more straightforward low carb diet pre-op is a mystery; I've never found a particularly good answer for that (my doc didn't require any of that so I never paid much attention to it when I was pre-op.)

The most common answer that I see on these forums, and my doc's position on it, is simply "when you feel up to it." Obviously, no swinging from the rafters for a while, and you need to watch your positions, but any that allow for comfortable engagement is fine - there is nothing inherently damaging to your surgery from the consequences of your fun.

I'm a bit late on the uptake on this thread, but my choice in socal would be Dr. Ara Keshisian in Glendale (I believe that he also still works out of Delano, in the Central Valley, if that is any more convenient to Barstow.) He is one of our long-experienced DS surgeons, which means that he has been doing sleeves for a very long time, and usually isn't afraid of the larger or more challenging patients (the DS is a sleeve with added intestinal changes for some malabsorption.) At your size, he will no doubt try to move you into a DS, which wouldn't be a bad thing to consider as it overall shows better results, particularly for high-BMI patients and in regain resistance - it should be something that is on your radar to consider. If you really want to stick with the sleeve, look into Dr. Paul Cirangle in SF, as he has developed some pretty successful protocols for making the sleeve work well with high-BMI patients, so he is probably your best shot at getting where you want to go with just the sleeve (though even with insurance he is on the expensive side with a rather high added program fee.) Good luck on your venture, wherever you decide to go!

Three things that I can think of would be iron anemia, vitamin B12 anemia (our stomach changes may inhibit B12 absorption) or hypoglycemia from the low carb diets that we are on to varying degrees. Hopefully your labs will point you in the right direction.

Yes, things usually improve over time. When my wife went through this ten years ago, it took her the better part of her first year to be free of her diabetes meds. The doc's experience is that generally, the longer one has been under treatment for diabetes, the longer it takes to get off the insulin and/or meds. My wife had been under treatment for about twenty years at that time and her case had degraded about as far as it could go and still be under control by meds - she was just short of being insulin dependent. This is a generalization, and as usual, there will be variations and some outliers who will be walk out of the hospital free off insulin and/or meds. But, she has been free of her diabetes since then (though she had the DS which is a more powerful tool against diabetes than the sleeve or bypass.) On your other concern about drainage, that may or may not be related. I had a bit of lingering drainage from one site which kept my out of the pool an additional week beyond their usual three week limitation for everything to be sealed up, and I am not diabetic; on the other hand, my wife had no problem in this area even though she was. It's a big YMMV thing.

Here is a great article on the subject - http://www.dsfacts.com/weight-loss-stall-or-plateau.php Additionally, Water retention can come due to any number of sources - hormonal changes (both TOM for you ladies and and all of us can experience changes from the hormones that have been stored in our fat getting released as we lose weight,) changes in medication or diet (sodium in particular) or changes in our exercise or activity patterns (stressing our muscles requires additional water for the repair/growth/strengthening process) or moderate dehydration which can cause the body to hoard what fluids it has (keep sip, sip, sipping your water, or drinking normally as things heal!)