RickM

The general consensus that I have always heard (and my usual practice,) on this topic is to give your muscles a day of rest in between workouts. The reasoning is that the workout creates micro-tears in the muscle fibers that then need the time to repair themselves (that's how muscle tissue grows and strengthens, not be creating more cells or fibers.) Some who are really into it will alternate days, doing an intense upper body workout one day followed by the lower body the next day.

As with most things involving these surgeries, individual docs will have different views and practices on this point (as will insurance companies!) My doc has had several patients well into their seventies (and most of them had the more complex and invasive DS.) Patient health and prospective outcome seem to be more important than a simple age number - some younger patients may be rejected because of significant health problems that preclude surgery while older ones are fine for it. You find similar considerations and discussions regarding very young patients.

I occasionally had a few saltines during the early weeks starting the week of the surgery (part of the doc's plan). They weren't a staple or anything, but they are useful for soaking up excess stomach acid if things feel a bit off. I probably wouldn't do any of the whole grain crackers early on, but saltines break down so fast that they are basically liquid by the time they hit your stomach.

I was on puree, along with liquids and some soft Proteins like eggs and yogurt, in the hospital. Docs vary on their programs based primarily on their own experiences, and a lot of docs are still getting their feet wet with the sleeve after years of doing bypasses and lapbands while others have been doing sleeves for twenty years or more.

I was starting to play with small salads at a month out - typically chopped spinach instead of lettuce for its' better nutritional profile - along with misc. salad veg and some leftover or deli meat for a bit of protein. As you can see, some have problems with salads for a while (particularly the lettuce, it seems,) while others do not - it's a bit YMMV thing. The best suggestion comes from my doc's program which is to try new foods one at a time to test for tolerance before mixing things up. I've been having these salads for lunch most of the time since then and they still provide the majority of my fruit/veg consumption for the day.

If not impossible, it's exceptionally difficult. I lost about 10 lb of lean mass out of the 100+ lb that I lost and that was with a reasonable strength training program along with overall exercise (primarily swimming), much as I had been doing prior to surgery. The 60-80 g of protein that we typically consume (upwards of 100 or so for some guys,) is a basic maintenance level - what we need to maintain our lean mass as opposed to building more. To add, say, another 10lb of lean mass over 6 months or so can require an additional 40-50 g per day in addition to a well developed, consistent strength training program. Whether that can be fit into a caloric deficit that will allow for the substantial weight loss that we need, along with other nutritional requirements that go along with muscle building is, dubious at best. From what I have seen, those that do get real serious about their exercise and conditioning tend to do what building they do after they get to goal and can increase their consumption. For the vast majority of us, the best that we can do is minimize the amount of lean mass that we lose during our loss phase. And, at 5'11", I suspect that 70 g protein is a bit marginal for maintaining your lean mass (despite the normal differences between men and women in their ratios of fat to lean mass); 80-90 g may be better (my target is/was 105 g to maintain the 150+ lb of lean mass that I carry.

With the small amounts that we are typically eating early on, it doesn't make much difference calorically whether you use low fat or full fat on most things. I usually used low fat cheeses at that time because they usually have a bit more Protein in them which is what we are after at that time (but some applications work better with full fat cheese, particularly when it gets melted.) In maintenance now, I just use the full fat cheeses as the protein difference is insignificant for my current needs. It's mostly a judgement call after reading the labels as to which is better for your needs - for instance, the greek yogurt line that I use most (Trader Joe's) has a full fat one that is very rich, but fairly low in protein (9g per cup with around 260 calories) compared to their nonfat and low fat versions (20-22 g protein per cup and around 100-120 calories) so for me, the much higher protein of the lower fat versions wins out (though today in maintenance I blend in some of the full fat yogurt to boost the fat content while still keeping the protein up on the high side.)

I'm close - my wife has had a DS for the past 9-10 years, so I've been living with one! It doesn't look like there is a specific DS guy's board, but most guy issues are common across the WLS spectrum, and the DS specific issues aren't generally guy/gal oriented. Besides, you still will have a sleeve, so that counts.

My doc's general practice with the VSG is that if he feels stones in there when he's doing the procedure, then he will take the gallbladder out; otherwise he leaves it in as the risk/reward doesn't warrant removing it. With his DS patients, however, he removes it as a matter of course as, should the gallbladder give trouble later on, he doesn't want another surgeon going in there and getting lost in the altered anatomy in that area - something that's not a problem with the VSG. There are some medications that I have seen some docs prescribe for their WLS patients that is supposed to prevent or minimize such problems - that may be an option to discuss with your surgeon or PCP. I don't know what the specific numbers are, but my impression is that it's something on the order of 5-10% of WLS patients may have these problems, but when reading these forums it may seem like a much more common problem as you don't hear much from those who have had no problems and only hear from the few who do. For the record, I had no gallbladder problems and never took any medication for it. Good luck,

I think that you have answered your own question there - you barely eat, so there is little to come out the other end (but there is still plenty of storage capacity within the colon for what little is going through.) I used to be as regular as clockwork, 15 minutes after rising every day, but even after 3+ years and a relatively generous/normal diet (for sleeve post-ops) of around 2000 calories per day, its an every 2-3 day thing (I guess that a healthier diet is also a lower-residue diet - more gets absorbed and less waste than our previous junk food laced diets!)

Take a look at this book - http://www.amazon.com/Chronic-Cough-Enigma-recognize-neurogenic-ebook/dp/B00HT53JOI/ref=sr_1_1?s=books&ie=UTF8&qid=1411413823&sr=1-1&keywords=chronic+cough I have had chronic cough problems for a couple decades without resolution so looked into it. This doc sites one of the major problems with the medical world in regards to this problem (which can manifest itself as any or all of symptoms such as cough, post nasal drip, hoarseness, burning in throat, etc.) is that it straddles the fence of several medical specialties (GI, ENT, pulmonary,) so none of them go much beyond their anatomical/geographic limits in finding the source of the problem - the GI guys don't go into the airway, the pulmonary guys don't go into the esophagus or larynx, the ENT guys don't go into the esophagus... Her normal treatment is usually some combination of dietary changes and medication with claim that most of the cases that she sees are resolved with some long term dietary changes after a stricter introductory diet and one can usually be weaned off of the meds once the chronic irritation is resolved. I am working her induction diet this month to see if it yields any of the results that she claims can occur from just that step alone before getting into talking to more docs. If nothing else, it's worth the $10 just to learn a bit more about what is going on with that part of our anatomy that is bothering us.

From what I have seen, the general consensus of hospital nurses is that you at least wait until you get home - they really don't want to have to deal with that!

My first phase was a month long, which included liquids, purees/mushes and soft proteins; after that, anything was fair game as tolerated with the general rule throughout being to test new foods for tolerance one at a time.

In general, your surgeon is correct that insurance won't cover it if you don't have a qualifying BMI (the typical 35/40 depending upon comorbidities) but it never hurts to ask. I have seen, as Domika has experienced, people get the revision when the band is giving problems, so as with reconstructive surgery, it seems to get down to that old "medical necessity" problem. If you can document problems with it, particularly to the extent of it having to be removed, then there is a good chance for it. Beware of policies that limit a person to only one bariatric surgery per lifetime.

I was on purees, etc. from the outset, having things like scrambled eggs and yogurt in the hospital, and progressing into soft proteins such as tuna, as tolerated, later in that first month. Their recommendation as progressing into firmer meats after the first month was to favor dark meat poultry over white meat due to its greater fat and moisture content making it easier to handle early on (I never had much problem with chicken breast, either, though some do for quite a while.

My doc's plan was somewhat similar to what the OP's sounds like - liquids, mushies, purees and soft Proteins as tolerated for the first month progressing to everything else as tolerated after that. I had things like scrambled eggs and yogurt (and pureed lettuce?!? ewww...) in addition to the normal broths and juices in the hospital.

There can be wide variations in how much we can tolerate early on, primarily due to the amount of inflammation in and around the stomach after surgery. When my wife when through this a few years ago, she could barely consume her nominal stomach size in liquids in one sitting, whereas I could put away a seemingly limitless amount of liquid - both quite normal according to the doc. Mushies are a bit more restricted than liquids, but much the same can happen. I generally limited myself to 2-3 oz of non-liquids early on as we don't always have all the feedback of being full in place yet.

Physiologically there is no reason that you can't get your protein from regular food for the typical pre-op diet as long as the carbs are on the low side (assuming that the point of the diet is to improve liver conditions prior to surgery.) As docs have as many reasons for the diets that they impose as there are diets, it's best to go with what your doc wants, or at least discuss deviations with him or his staff (I still have no idea what the purpose of an all-liquid pre-op diet is,)

Nominally 3 weeks, or when the incisions are sealed; as I still had one that was weeping a bit, it was 4 weeks for me.

Another possibility is that they won't cover it if it is also available over the counter without prescription - many of the PPIs (like Prilosec/omeprazole) are in that situation. But if you are prescribed a dosage that's not available OTC, then it will go thru with the insurance coverage. Prilosec OTC is 20mg so that is often not covered by insurance, but if the doc prescribes the 40mg size, which is a prescription dosage, then it does get covered.

As far as my doc is concerned (20+ years of doing sleeves) it's not a problem at all, and he even recommends their use as soon as the post-op narcotic pain relievers are no longer appropriate. The ability to use NSAIDs where appropriate is one of the fundamental advantages of the VSG (and DS) over the RNY; What does your doc recommend? The no-NSAID admonition is basically an RNY thing as that procedure has specific weaknesses that preclude their use, which don't apply to the sleeve based procedures like the VSG or DS. As a class of drugs, they shouldn't be taken lightly even by "normal" people, and consistent use of NSAIDs should be done under the supervision of an MD, but in that respect, we of the VSG persuasion are not significantly different from normal, non-WLS people. While we should always seek guidance for medical issues from our surgical team, for those whose docs advise against NSAIDs, it pays to check with your doc periodically as they build more experience with the sleeve as their recommendations will likely be changing over time to be more consistent with their more sleeve-experienced peers.

Indeed it is just a stall, and one that quite commonly occurs at this time. Here is a great article explaining the physiology of what's happening now - http://www.dsfacts.com/weight-loss-stall-or-plateau.html#.U67PZ0CcSpo Another thing to not worry about is that when your loss does resume, it will probably be at a somewhat lower rate than it was initially. As Diana notes in this article, this initial loss comes from our short term stores of glycogen (basically carbs) which burn quite rapidly (at around 2000 calories per pound); but once that has been depleted, we start burning the fat that we really want to be losing, however, the fat burns more slowly (at around 3500 calories per pound), so just sit back and enjoy the ride.

My choice in the central valley would be Dr. Keshishian. While now based down in Glendale, I believe that he is still operating out of his old digs in Delano (ok, the other end of the valley for you, but the best are worth a trip,) He is one of those long experienced DS surgeons (which means that, by default, he's been doing sleeves for a couple decades) which to me are much preferred over the guys who are just now adding the sleeve to their existing RNY/band practices. A similar distance over into SF is home to several very good choices (Drs. Rabkin, Jossert, or if you're a very high BMI and really want a sleeve, Cirangle.) I have seen a couple of names listed in Modesto over the years but don't know anything about them. Good Luck,

As a follow-up to the above, what happens if you call your surgeon's office number now - do you get endless ringing, voicemail, or a live answering service? Chances are that you will get a bored college student at an answering service who will tell you that office hours are X to Y, but if you tell them that it is an emergency, they will take down your message and forward it to your doc or on-call staff person and you will get a call back from them. That should be step one before going to the ER. And, if all you get is voicemail or an answerdroid, please post the surgeon's name here so that others will know to avoid this guy - that would be very unprofessional practice for one in his line of work (if he didn't want to be bothered with emergency calls, he should have gone into dermatology - there aren't many overnight emergencies in that end of the medical world!)

Don't worry about your surgeon getting upset - you should be upset if he doesn't have 24/7 oncall provisions (in this line of medicine, somebody knowledgeable on staff should always be available to answer questions/concerns from new post-op patients.) They should be able to recognize common symptoms and provide some guidance (whether that be a change in medication or diet, waiting until the next available Dr. appointment, or go now to the ER.) These are new experiences for all of us as we go through this process, particularly the early post-op phase, and we can't be expected to recognize all of the symptoms of potential problems - that's what the doc and his staff are for, so tough Cookies if they get upset at you making a decision for your medical care when they were not available to provide the guidance they should be providing. With that vent done, if you can't get a hold of your surgeon's staff, I would go to the ER because the symptoms you describe may be for something quite serious that you don't want to wait on - possibly a stricture, twist or kink in your sleeve that isn't allowing things to pass (even Water not going through is a concern, unless it was water immediately following some solid food that is slow to go througn.) But if even water isn't going through, you are in danger of getting dehydrated which can be an hospital trip unto itself. It may be something quite benign, but without proper medical guidance (and we aren't doctors here....) you really can't tell on your own. When my wife was going through this, "not right" feelings the first weekend after surgery, she called the doc's number and talked to his RN program director (who was the on-call person that day) who listened and told her that she was just constipated - yes, it can feel different than it did before - but try this and that and call again on Monday if things don't improve. She would have had no hesitation to direct us to the ER if symptoms dictated (and we were 100 miles away from them,) and there was no question that the surgeon would have been on the phone to the ER docs if such action was necessary. Care for yourself first, and then worry about others' feelings. Good luck on this,