RickM

Tylenol is fine, as are most of the other OTC pain meds for occasional use - aspirin, ibuprofin, naproxen (Aleve) and the like - though some docs are still stuck in the bypass world that limits one to Tylenol only, but the rationale for that doesn't apply to the sleeved stomach.

Generally, most any of the over the counter pain meds are fine with the sleeve, though some docs (both bariatric surgeons and general docs,) are still stuck in the RNY paradigm of Tylenol only. The sleeve doesn't have the physiological shortcomings of the RNY that limits the use of NSAIDs (ibuprofin, naproxen, etc.) and other stomach irritating medications, though with our smaller stomachs, some care should be used with NSAIDs and generally a PPI should be taken with them. I have yet to run into an experienced sleeve/DS surgeon who doesn't allow NSAID use post-op, and while some may limit their use during the initial healing phase, that too, is far from universal - my doc recommends NSAIDs for pain relief as necessary as soon as the usual prescription narcotic meds are exhausted, and that comes from some twenty years of sleeve/DS practice.

My doc is one who recommends the use of NSAIDs, even shortly after surgery if necessary. NSAID tolerance is one of the fundamental advantages of the sleeve (and the DS, which uses the sleeve as its basis,) over the RNY, and has been successfully used in appealing insurance decisions favoring the RNY over the DS. For those who are stuck with the "no NSAIDs" instruction from their docs and looking for valid alternate opinions, one direction of research that can be done is to investigate the recommendations of surgeons who have been doing DSs and sleeves for a number of years - a good listing of such docs can be found at dsfacts.com.

In principle, our sleeved stomachs have a certain volume, (mine was about 2.5 oz at surgery) so measuring volume with cups and spoons is what our stomach wants - sorta. But, since most of our foods have a density similar to Water (a Fluid ounce of water weighs an ounce, or to be pedantically accurate, has a mass of one ounce,) weighing will do as well as measuring, so do whatever is most convenient. Some foods are very low density, or don't pack well into measuring cups (how much chopped spinach is a half cup - how finely chopped, how firmly packed....) so weighing is the only sensible way for those items. Complicating things is how our new stomach handles different types of foods. Firm Proteins like lean meats will sit in our stomachs for a long time as they get processed for passing on to the intestines while most liquids flow on through with little restriction, and most other foods are somewhere in between. We can usually consume a lot more yogurt at a sitting than meat, so we can safely allow ourselves somewhat more of those foods, or may need to artificially limit the amount that we serve ourselves. My nominal capacity for most meats has long been about 3 oz by weight, and I could easily double that amount of yogurt, but typically only served up 4 oz as that is all that I needed. Mostly we tend to go by experience with how much of what we can, or should, have at a time and use whatever measuring scheme is most convenient for us. For me, I weight virtually everything as it is most convenient for me and avoids fiddling around with numerous measuring cups and spoons, and cleaning them all the time - tossing different amounts of things into a bowl on the scale is much easier for me. YMMV

Generally, our salt consumption will be fairly low due to our overall consumption being low. Adding a bit of salt as seasoning usually won't make that much of a difference to your overall sodium levels - most of the sodium in our Western diets comes from processed and restaurant foods rather than what we typically add while cooking at home or for seasoning. Read the ingredients labels on the box and look for things like monosodiumglutamate - that's were the bulk of our sodium comes from. +

Different dairy products have differing amounts of latose in them depending upon their processing. Higher fat products such as ice cream are often tolerable to those who can't tolerate milk; ditto for yogurts and cheeses (my wife fits into this category after her DS.) Lactaid milk is available for those who are lactose intolerant as is lactaid tablets that can be taken before/with dairy. This may resolve over time or it may not - YMMV

Generally, any of the common pain relievers are usable with the sleeve - indeed that is one of its' primary advantages over the bypass, which is severly limited in what meds can be used. Some docs may limit use of NSAIDs, including aspirin, for a time after surgery while others will recommend them for use as soon as the narcotic pain relievers are no longer needed. Some docs who are still operating under RNY protocols may say that they can never be used, but they have some catching up to do with the rest of the VSG/DS world. Given the wide variety of responses between surgeons, it's best to check with yours to see what his recommendations are. An increased dosage of PPI is sometimes recommended with use of NSAIDs with the sleeve to help protect the stomach lining, but we have no where near the sensitivity to them that bypass patients have. There are now some recent studies indicating an increased risk of acetemetiphin (Tylenol) poisening and resultant liver damage due to the over-dependence upon Tylenol as a pain reliever in bypass patients. That's another good reason that I'm glad that I got the sleeve!

It is a side effect of being in ketosis which comes from not consuming enough carbs. Some take it as a good sign that they are burning fat (though it is far from essential for burning fat...) while others just look at it as the smell of someone who is not eating their vegetables. It will pass as you progress and are able to eat a wider variety of foods, and there are some ways of masking the effect for those who chose to stay on the ultra low carb diets.

I was trying out beef by the end of the first month - tritip, pot roast, ground beef; pot roast sat the heaviest on my stomach, and still does a year and half later. My wife had problems with ground beef for quite a while when she went through this a few years ago and the surgeon suggested that filet is often better tolerated than ground beef, so we still follow his advice and get his "prescription" filled regularly. This is one of the big time YMMV things.

Headslap on you! If what you cheated with is basically low carb, you should be fine. Many docs don't do pre-op diets at all, and the liquid only aspect that some do is controversial, to say the least. The main point of the exercise is to improve the condition of your liver for when they are working on your stomach underneath it, and that basically entails minimizing the carbs that it has to process during this time. If you have had some weight loss during this pre-op period, that is a big help for the doc and implies that your liver will be in better shape for surgery, even with the cheat. But don't do it again! Good luck with the surgery, and we'll see you on the post-op board.

I never had any problem taking most pills early on - they provided pain and nausea pills after the IV was removed in the hospital. I just took them one at a time with a sip of water each rather than the usual handful that I used to take. The only exception was the calcium supplement which I took as chewables for a while.

Pretty much when your diet returns to normal, or at least can get in enough carbs to keep things in better balance. I never had the problem, but I kept my diet in reasonable balance throughout the loss period (as balanced as one can be with the Protein requirements and calorie restrictions that we have - my diet was roughly equal parts protein and carbs.) My wife would occasionally have the problem even years out which indicates that her DS was malabsorbing a fair amount of the carbs she was having since she is rarely short of carbs in her diet. I wouldn't expect that with the VSG unless one continues to do low carb diets in their maintenance phase.

I like it! How do you get the jello out of the bottle?

If you are determined to make it work, that is a big first step. Do you have goals in mind, or discussed this with your surgeon? Some docs seem to be fairly pessimistic on their goal setting, siting something like an average of 60% excess weight loss for the sleeve, so that is a good goal, while others are more aggressive and want to see. their patients to attain 100% EWL. You should certainly follow your doctor's program which hopefully involves tracking your intake, exercise and progress (and if it doesn't, do it yourself anyway - how else can one tell what is working and what isn't?) If your doc's plan is serving you well and you are progressing at a satisfactory pace - great! If not, take a look at your tracking data, talk to people here or in any support groups that you have available, see what others are doing who may be making better progress and see what you can incorporate into your own program. As with most things in life, there are those who aren't very successful in their endeavors, and others who are successful. If you are determined to make the changes in your life to make it work (if you haven't started already...) there is no reason that you can't be successful as well. Down 105lb in a bit over seven months here, and holding since January. Good luck on your journey as well!

It basically means that your diet is short on carbs; whether that is good or bad depends upon your perspective and what kind of post-op plan you or your doc wants you to follow. Many take the resulting state of ketosis as a good sign that you are burning fat, but we will also readily burn fat on a more balanced diet that avoids the bad breath and body odors, though the rate of burn may be somewhat slower (at least that is the hypothesis - YMMV.)

They are pretty good, but not as good as the hydrostatic (dunking) or Bodpod tests, or a dexascan, which are all more of a one time measurement that you go someplace to have done and costs a few bucks (or more than a few.) For a snapshot reading, the scales have their limits, as their measurments are based upon body impedance which varies some with hydration. Readings first thing in the morning, when one tends to be deydrated, can be 4-5 points higher in BF% than one taken in late afternoon when one is more fully hydrated, and there can be some day-to-day variations as hydration levels vary some depending activities, weather, etc. Also, changes in medication that effect Water retention can have an effect on it - when my doc took me off of a diuretic BP med a few years ago, my weight didn't change, but there was an almost immediate jump in the BF% reading. That said, if used it consistently to average out the daily variations, I have found that they correlate quite well with the hydrostatic tests that I have had done. One other source of error in them comes from where they measure your impedance and where you store your fat. Typically the scales measure between your bare feet, so those who store their fat in their legs and butt (pear shaped) will read a somewhat higher BF% than those who store their fat around their abdomin (apple shaped.) Some gyms or trainers may use a device that you hold in your hands, which will read the opposite as it is measuring more of the abdomin; there are some scales out there that have a hand held attachment that takes a reading from both the feet and hands to correct that error. If total accuracy of the number is most critical, or as a periodic calibration of scale readings, then certainly go get one of the better snapshot measurments done, but the scales are a useful tool for monitoring things on a daily basis if you keep their shortcomings in mind.

Protein is really no more essential after surgery than before as there are certain minimums we need to function (typically in the 50-60 g per day range and somewhat higher for men or ladies with a higher "ideal" weight. Our bodies can get by without carbs or fats as it will convert whatever we eat to the sugars and fats that it needs (though there are lots of essential nutrients that come with foods with carbs and fats in them that we shouldn't miss, so diets that are short on either aren't good news, either.) Protein, however, is made up of a number of essential amino acids that our bodies use for many basic functions (including building and maintaining muscle tissue) and our only source is from the protein that we eat. One may recall from school learning about the four amino acids that make up our DNA, and there are around a dozen and a half others that our bodies use in all of its' various functions. So, while muscle maintenance is the main thing that we think of for protein, it is involved in just about every other aspect of out body's functioning. The amount of protein that we need is most closely associated with the amount of lean body mass that we have - muscles, organs, tissues, etc. - pretty much everything besides bones and fat. Our tissues are continually regenerating themselves, so we need a constant supply of protein to maintain everything. This is where the basic number of 60-ish g per day that we hear comes from. Some smaller people may need a bit less, while larger, more muscular people may need more, upwards of 100+ g per day. And, if we want to actually build muscle mass, then we need even more. If we don't get enough for our basic maintenance, our bodies will strip away the protein that it needs from our muscles to get the amino acids that it needs for other critical functions. The problem here is that while we want to lose fat, we don't want to lose muscle mass. More muscle equates to a higher metabolic rate and greater calorie burn even at rest, so that helps our weight loss, while losing muscle mass reduces our metabolism and makes weight loss more difficult. So, short answer here is that the basic minimum amount of protein recommended by your doc is there to maintain your body and help you in losing the weight that you want to lose while maintaining the physical functions of everyday life.

What worked for me, after consulting with my RD (a more fitness oriented NUT as opposed to one in a bariatric practice,) was a small meal/snack that was relatively high in complex carbs and moderate in protein and fat consumed an hour or so before a workout. This did help stretch my endurance in the pool beyond an hour where I previously had hit a wall, but didn't seem to make much difference in my strength training routine which is typically 75-90 minutes (though I never really had much of an endurance problem on the strength days,) I usually had a protein shake after the strength workouts, and that was usually the only time I used them after the first few weeks and I no longer needed them for basic protein intake. I didn't change my overall calories but simply shuffled the dietary composition some and timed it for the workouts.

Most people have a stall at around the three week mark, but stalls can come anytime. Most people are stairstep losers - lose a bunch and then rest for a week or two, then lose some more and rest. I am one of the abberations who didn't really have any stalls (only one week where I didn't lose anything) during my entire loss period.

Surgeons' policies on pre-op diets vary widely in length, composition and intent of the diet as well as whether or not one is needed at all. Diets for the sake of weight loss or post-op practice are of dubious merit while those for "liver shrinkage" do have some value for those docs who need that extra help. My doc doesn't do pre-op diets, other than the typical day-before surgery diet, no matter what the patient's BMI is. The best thing is to check with the surgeon or his office to see what his practice is.

Cheese sticks are one of the standard post-op staples. As with anything, however, there are always some who have a problem with one food or another. The general rule on such things is to test new foods one at a time for tolerance - it if sets well, then great, and enjoy; if it doesn't then try it again in a couple of weeks (or months).

I was using the regular prescription narcotic pain relievers as soon as they took out the IV and I used them on and off for the next few days. Tylenol is the standard non-narcotic pain reliever that is recommended, and most of the NSAID pain relievers such as ibuprofin and Aleve are acceptable to the experienced sleeve/DS docs (many of the RNY based surgeons don't recommend them since they are a big no-no for bypass patients and those docs are still catching up with their sleeve peers.)

The first couple of months things the weight usually comes off fairly quickly and then slows down to a more steady pace, with maybe a few stalls along the way. I was down about 32 the first month, 15 lb each of the next two months and then 10 lb per month thereafter until goal (a total of 105 lb lost). Any weight loss from the quicky pre-op diets (1-2 weeks or less) that some docs impose should usually be counted in that first month's loss since physiologically the rapid weight loss starts when you start the serious weight loss effort and experience a major caloric deficiency, and not just at the date of surgery.

Just the day before clear liquid & jello thing. I was 292 lb at bmi around 42, but my doc doesn't do pre-op diets for anyone, even his heaviest patients.

I was having small salads with leftover meat in them by the end of the first month - this really seems to be one of those YMMV things. I usually use chopped spinach instead of lettuce, mostly for its somewhat better nutrition, but lettuce seems to work as well for me. Small amounts (what else?) of tomato, avo, shredded carrot, pepper, scallions, snow peas, etc. with a bit of shredded cheese made a good blend for me.