RickM

I was taking normal pills as soon as I got out of the hospital - the only ones that I used alternatives for (chewables) were the Calcium horsepills. Many docs have a fear of pills post-op from their RNY experience where things like pills can very easily get stuck in the stoma (the little hole in the bottom of the stomach pouch that does the job - sorta - of the pyloric valve in a normal or sleeved stomach). This typically isn't a problem in our normal functioning sleeved stomach.

If you are on a pre-op diet, it is usually because your surgeon is looking to improve the condition of your liver to make things easier on him when he is working around it during your surgery. This typically is a low carb diet of some sort and as alcohol is a carb, you don't want it from that perspective, and then you also don't want it for its toxic effects on your liver at this time. Not all docs require these diets, but if he does, then want him to be as comfortable as possible when he is working inside of you; some docs take this seriously enough that if they take a look inside and don't see what they like, they close things up and tell the patient to try it again in a few weeks.

Early on, of course, you will be limited to Soups and the like until you get into real foods. Talk to the server as to what they can make up to fit with whatever food texture you are limited to at the time. Once at that stage, most anything is game, with the main consideration being re-usability as you will only be having a small amount of what you order and taking the rest home in a box - you start to get disappointed if you can't get three meals out of a restaurant meal. I never tried entree salads again until I was well into maintenance as I couldn't have enough of the good parts (the meat and veg) to make it worthwhile, and they don't keep well. At a place like Outback, I'll have some of the steak and veg, nibble a bit of my wife's salad and have the french onion soup packed to go. At a Mexican place, fajitas are a good bet - meat and veg and usually some rice and Beans and it all keeps well for another meal or two; or have an enchilada or burrito and eat the insides while leaving the tortilla behind. The main caution with eating out a lot is that restaurant fare is usually higher calorie and sodium than what we would normally make at home, so check online menus and nutrient charts before leaving and see what fits best from that perspective. also check their breakfast/lunch menus as there may be something suitable there that isn't on the dinner menu - they can certainly make up some eggs for you if that is appropriate (even if they only "serve breakfast until 11am".) They are usually interested in keeping their customers happy will do whatever is reasonable to accommodate special needs.

The best potassium supplement that I have found (since non-Rx supplements are near useless at 3% RDA max,) is low sodium V8 juice, at around 1100mg per 11.5 oz can, and about 70 cal. Alternate that with the coconut Water to avoid getting tired of either. My wife is on Rx liquid supplement (and not always that compliant!) and mixes it with orange or tangerine juice to make it palatable (and as a bonus the juice is a decent source, if a bit hi-cal.)

What I have found from my multiple orthopedic and PT experiences over the years is that the heat promotes bloodflow to the injury site which helps the healing (blood brings in more oxygen and protein) while the icing reduces the inflammation which reduces the pain that goes along with it. That's some of the PT's will start the session with heat, exercise and work the area and then end with icing. Alternating heat and ice is also a common recommendation.

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I measure almost exclusively by weight. Most of our solid foods are approximately the same density as Water, so an ounce of volume is an ounce of weight. Those things that are less dense soon get compacted to about that same water density once in the stomach, so again, weighing gets you to about the same place. It also avoids the problem of measuring low density foods - just how much is a half cup of spinach? How finely chopped or compacted? Does that half cup weigh 5 grams, or 10 or 20? To me, particularly with some multi-ingredient dishes, it's a whole lot easier to use a digital scale than multiple measuring cups and spoons (start with 10g chopped spinach, add 20g grape tomato, 15g avo, 10g scallions, 10g shredded carrot, 10g dressing and a couple ounces leftover meat.... I would go insane trying to measure all that volumetrically!) Another point to consider as you move along on this journey is that different foods behave differently for us, going through the stomach at different rates (some things are "sliders" that slide right through while others stick around in the stomach for some time being processed before going on to the intestines.) You may comfortably be able to eat two or three ounces of meat, but six of yogurt, so it starts getting to be a matter of experience no matter how you measure.

Most people seem to be getting along with five or so mini-meals, and 5-6 feedings is a common program recommendation. Some programs emphasize three meals a day only, and then parenthetically mention a couple of snacks as well - the main concern that some of those programs are trying to avoid is grazing - just munching all day long, and it can sometimes be a fine line between frequent meal/snacks and grazing. It's awfully hard for most to get in the nutrition that we need (primarily protein early on,) with our small stomachs on just three meals a day. The best thing is usually to have specific meal times and serve up only the amount that is consistent with our sleeve's capacity to avoid getting too full. I started out with six meals a day that were roughly equal calorically (that wasn't a firm rule or goal, but just the way it usually worked out,) and dropped one meal after a month or two as my capacity and meal sizes increased some - there wasn't all that much time between my breakfast and lunch times to fit in that extra meal, though in maintenance I have added that extra snack back in as I usually need the extra calories and nutrition to maintain a stable weight.

As usual, check with your surgeon (first) and your PCP on any medication related questions. Tylenol is a good start but NSAIDs like ibuprofin, aspirin or naproxin are generally acceptable with the sleeve - the no NSAID rule comes from the RNY side of the bariatric world (the RNY has specific problems with such medications which doesn't apply to the sleeved stomach,) but many surgeons aren't yet comfortable enough with the sleeve to recommend them to their sleeve patients.

You are right on time for the initial (third week on average) stall - here is a great article describing what's happening right now: http://www.dsfacts.com/weight-loss-stall-or-plateau.html You will note in there that between the glycogen and the Water that keeps it in solution in our bodies that there is around ten pounds (eight from water,) in play from just this mechanism alone. Add to this other things that affect water retention such as TOM/hormones, changes in sodium intake or exercise/activity patterns and you have the making for a bumpy ride on the way down the scale. So, keep to your plan and enjoy the ride; just don't fret so much on daily (or even weekly) aberrations in scale weight.

Do you have any YMCAs in your area? They tend to be very family and newbie friendly and usually have some sort of special program for newbies, introducing the different cardio machines and having you work them for a couple weeks and then starting you up on the various weight machines a few at a time. They usually have a separate workout room for newbies as well, so it's less intimidating. The most important thing, though, is usually convenience to your daily routines so that it will get used regularly - a super fancy gym with all the bells and whistles isn't of much use if it's too far out of the way.

I started back to the gym and weights (at low levels, and using machines to avoid stressing the core,) after about three weeks, but was told to avoid crunches, sit-ups and the like for twelve weeks to avoid incisional hernias (and am on such restrictions again now after having said hernias repaired even though followins those instructions.)

Not nearly as tempting as the post op penis size thread which fits, uh, hand in glove with this one.

It's all part of our body adapting to a long term weight loss situation - for a week or two our bodies will just burn off its short term reserves of glycogen (basically stored carbs) but when it gets the idea that you are serious about shorting it of its normal supply of calories, then it has to go to the bank to start tapping that big fat account that we have saved up - which can take some time. Here is a great article explaining the physiology of whats happening now - http://www.dsfacts.com/weight-loss-stall-or-plateau.html Good luck, and many happy pounds lost in the future!

No liquid only phase at all post-op; mushes and soft proteins as tolerated and protein drinks used to flesh out the protein numbers.

The main reason that we see limitations on NSAID pain relievers (and other stomach irritating drugs) such as Motrin is that with the RNY gastric bypass, the duodenum (the part of the small intestine immediately downstream of the stomach) is bypassed along with the stomach, and the part of the intestine that is brought up and joined with the new stomach pouch isn't resistant to stomach acid like the duodenum. Consequently, the suture line between the stomach pouch and intestine is constantly being irritated by stomach acid and never fully heals, so it can't take the added irritation of these classes of drugs. This isn't a problem with the sleeve since they're not fooling around with the duodenum or its' relationship with the stomach, and once healed a sleeved stomach is not markedly different from a normal stomach in this respect. In general, surgeons who come at this from the DS (duodenal switch, which is a sleeve with intestinal rerouting for malabsorption) perspective rather than the RNY side of things have little problem recommending the use of NSAIDs post-op - my doc suggests their use for post-op pain after things have gone below the point where the stronger narcotic pain relievers are appropriate. Indeed, this divergence is well enough known in the medical and insurance worlds that patient need for NSAIDs (or even a family history thereof,) is often used to overturn insurance decisions favoring the RNY over the DS or VSG. In short, this is far from a universal opinion, and is very much a function of a particular surgeon's background. We certainly don't want to recommend going against your surgeon's advice, but there is certainly room for discussion with him on this point, It would be worth doing a bit of research on this point to get more comfortable with it - some of the DS forums would be a good place to investigate as the VSG has a lot more in common with the DS than with the RNY Good luck, and there is hope for continued control of your pain problems; and do take instructions and limitations on Tylenol use seriously as acetaminophen poisoning is a hazard from overdoing it.

There are/have been various types of studded condoms around, though it's been some years since I have been in the market. Somewhere around here I have the patent number for a musical condom that plays music while you, uh, use it - though I'm not sure what tunes a rumble roller condom would play!

NSAID compatibility is one of the major benefits of the VSG and DS (which is a VSG combined with intestinal rerouting for malabsorption) but is a major no-no for the RNY due to structural problems that are unique to the RNY. Many surgeons who forbid NSAID use for their VSG patients are drawing from their RNY experience; I don't know of any long experienced DS/VSG surgeons who forbid NSAIDS (like a couple others have mentioned here, my doc with about twenty years of sleeve experience behind him recommends their use as needed for pain relief as soon as the normal post-op narcotic pain relievers are no longer appropriate.) For those who are stuck in the quandry of a surgeon recommending against NSAID use, but finding no satisfactory resolution with the suggested pain relievers, by all means discuss the problem with your surgeon and look for better alternatives. One can also research the recommendations of other surgeons more experienced with the sleeve to get more comfortable with the physiology - a good place to start is looking through this list of surgeons - http://www.dsfacts.com/duodenal-switch-surgeons.html who are all long experienced DS/sleeve surgeons. Look through their websites for whatever post-op protocols they may have posted; most will also list NSAID use as one of the advantages of the DS (and the VSG by association.) A final note is that even though many of these various pain relievers are non-prescription meds doesn't mean that they are completely safe or free of long term consequences. Even for "normal" people, long term use of NSAIDS (and most any OTC medication) should be monitored by a physician. Even the "safe" alternatives like Tylenol can be problematic when used to excess - a recent study indicated that there was a higher than average incidence of acetemetifin (Tylenol) poisoning amongst bypass patients - not real big numbers or percentages, but enough to give pause to those who are restricted from using more effective pain relievers that these lesser "safer" meds can also cause problems when overdone.

The typical number that I see is six months to a year after reaching goal or stable weight, as our weight continues to redistribute some once we have stopped losing and the skin can shrink and bounce back a bit. About the time that I reached goal weight, I started working with a trainer with my wife and noticed how much the skin on my back was folding up when moving around on floor mats, but that was not a problem a year later (it had either tightened up some or I had learned how to avoid the problem or likely some combination of the two.) Likewise, at around the same time I had new seats put into my racecar which were a snug fit as they are supposed to be, but a year later I was noticing that they were looser on my butt even though my weight hasn't changed in that time (but my shape has!) Like many things in life, this is a compromise between what may be optimal and what circumstances and individual tolerances, preferences, timing and funding may permit.

Clear liquids the day before (and then liquids, purees, mushes and soft proteins as tolerated from the hospital on out for the first month on the post op side.)

It's not entirely zero, but close. Iceberg has a decent amount of potassium and vitamin K in it, though romaine is better on both counts (along with a good dose of vitamin A as well,) so romaine is certainly my choice when choosing a commercial salad, but I'm glad that I learned to like spinach for my homemade salads as it's another step up (though how much difference it made early on when I could only afford about 10 g of it in my salads is debatable!)

On the salads that I make at home I use spinach instead of lettuce to get a bit more nutrition into it. Tolerance for these things is a big variable between people - I was starting to play with my little spinach/veg/meat salads at about a month out and did try an occasional bite of lettuce from my wife's salad when we would eat out. Others may have problem with lettuce (or other foods) for many months before they can tolerate them. I never had much of a problem with red meat during this process, though my wife did have problems with ground beef for a while when she went through this a few years ago. The surgeon suggested that patients often tolerate filet better than ground beef (one of the best "prescriptions" that we have ever gotten from a doc!)

My doc's protocol is no immersion or swimming until the incisions are fully closed, which is typically three weeks, but I was down for four weeks as I had some lingering seepage from the umbilical incision.

2 weeks is not unusual for those docs who do a pre-op diet - maybe half the docs require them (mine didn't, and doesn't even do a liquid only phase post-op, either.). Of those who do such diets,some do the liquids only thing while others just do some form of low carb, sometimes with a liquid component (like 2 shakes a day and a low carb meal.) There's lots of variations out there.

Yes, it is the dreaded three week stall (or third week, since it doesn't necessarily last for three weeks!) Here is a good article explaining the physiology of what's happening now - http://www.dsfacts.com/weight-loss-stall-or-plateau.html As noted in the article, there is around ten pounds of Water and glycogen in play here, so it is not unusual for there to be some small amount of gain happening while you restore your glycogen reserves and switch into fat burning mode, so don't beat yourself up over any perceived dietary sins - it's just nature at work and can happens to most when they go thru this phase.