RickM

You are correct that it is Water weight and it is very common as they pump you full of lots of fluids in the hospital. 12 lb is on the high side from what I have seen but there can be lots of variation; I gained 5-6 lb over the hospital stay, but didn't get to weigh in until 3-4 days after surgery, so I may have been higher in the interim. I gained a similar 5 lb earlier this year from just a morning outpatient shoulder surgery. The incisions can itch as they heal, so there's nothing to worry about there, just try to avoid scratching them; and yes, sometimes there are odd dents or shapes left behind by the incisions - they usually work themselves out but there can be some lasting oddities, too.

Some protein drinks are high in sugar for good reason - the resultant insulin spike helps in transport of the protein to the muscle cells to start repairing them after a workout. This is a good thing for those who are working to build muscle mass but they aren't the appropriate thing for most of us during weight loss when we are simply trying to maintain what muscle mass that we have. Check the label and look for ones that are low in sugar. As others have suggested, log what you are eating so that you can see where problems may lie. Some minor weight fluctuation (including minor gains) is to be expected as we lose due to changes in hydration and water retention, and there are lots of things that influence that - salt in diet, TOM, glycogen/carb depletion, etc., but 12 lb is a lot from that source. To the OP - was your early protein drink trial run in addition to what you were already eating, or were they meal substitutions? In our early stages, it's difficult to get enough calories in to create any genuine weight gain, but there are many reasons for stalls, and the classic third week stall is one that most experience irrespective their dietary phase.

It doesn't seem to be that common with the VSG as there is not an inherent mineral malabsorption as there is with the RNY, and to a lesser extent, the DS, but I guess it can happen to some individuals who are prone to it. It may be strictly a dietary issue (not enough potassium rich foods, which are hard to get in with our minimal intake, and made worse by the popular low carb diets) and it can be a carryover from pre-op dietary habits. My wife has always been marginal on potassium and after her DS she needed to use the liquid supplements sporadically, though now is getting by with strictly dietary intake - but it is something monitored regularly. She also needed the infusions after blood loss from her reconstruction work but the hemo feels that she is stable as long as she has no major bloodloss (as opposed to slowly degrading levels as some may have, requiring periodic infusions - not an uncommon thing with RNY patients who absorb Iron poorly and often have minor constant bloodloss.) and so far, three years later, he is correct. At this point, with the overall low intake levels typical in this phase, the best that can probably be done is to continue the monitoring and supplements/infusions until things get more stable and you can handle more of the load through diet. If possible, work with the hemo or a dietician to work more potassium and iron into your diet to try to keep things stable in the future. Good luck,

Diana Cox's treatise on glycogen and stalls is one of the best and most understandable out there. It is also good to recognize that this is just one of many different reactions and cycles in that our bodies go through that involve changes in hydration and Water retention - someone else mentioned increased salt consumption, which is one, as are changes in exercise or activity routines. As Diana's article notes, there are up to around ten pounds in play just from the glycogen cycle, so two or three pounds off of trend is not at all unexpected. Another thing to be ready for is that when your loss does pick up again, it will probably be somewhat slower than it was initially, as that initial loss comes from glycogen (basically stored carbs) that burns rapidly at around 2000 calories per pound, while once you get past this initial stall you will be burning mostly fat which burns more slowly - around 3500 calories per pound. But burning fat is what we are here for, so rejoice!

It's a variable depending upon your surgeon's experience and philosophy. Some will allow alcohol after a couple of months or so of stomach healing while others not allow it as long as one is losing weight (and a few may say "never again!") My doc is in the none during weight loss camp, the concern being that our livers are already not in the best of shape from being obese and then they are more heavily taxed with their role in metabolizing all the fat that we are losing - they don't need any more stress from metabolizing alcohol. As my doc is also a liver transplant specialist along side of his bariatric practice, I tend to take his word when it comes to liver care.

At this point, 18 months out and maintaining things for most of this year, most certainly this would be a do-again. The only second thoughts about it would be if I couldn't hold my weight and got into a regain problem in the coming years, which would indicate that the DS would have been the better choice to start with.

The typical advice is 1-2 years after your weight stabilizes to get the best results. There can be some skin bounce back (hopefully,) and there is some redistribution of muscle mass and remaining fat as the body adjusts to its new size. My wife had most of her reconstruction (LBL, thighs) done 2-3 years after stability and that went well and is now looking at finishing things up with her arms a couple of years later. I have a consult with him next week, which is only about 10 months after stability, but I have a convenient hernia that needs to be repaired, so there are some decisions as to whether or not it makes sense to coordinate the two jobs and the timing of them.

I'm not sure what your NUT considers a "regular diet for life" or if that is the title of some formal program, but it sounds like what you are hoping for and what I was doing at that stage and currently - 18 months out and in maintenance for most of the past year. Pending any individual tolerance issues with you, and what caloric restrictions the doc or NUT imposes, the sleeve doesn't really care what you eat after things have healed. I was having spinach,veg & meat salads within the first month (some can't tolerate lettuce for months - YMMV) and dabbled with some breads (whole grain, of course!) fairly early on, though didn't have much of it for a while until I specifically needed to add some complex carb to my diet at around four months. My diet has not changed markedly in composition between my loss phase and maintenance phase, though proportions of things have changed as my caloric allowance has roughly doubled (protein requirements don't usually change much, but now there's room for a lot more fruits, veg and grains.) Good luck; I, too, am curious as to what they consider the "regular diet for life" - hopefully they don't mean "Atkins for life"!

Generally, the complex carbs (the courser, whole grains and more fibrous vegetables) are the preferred, but the simpler carbs can be worked in as well if combined with your Proteins - a little fruit mixed in with greek yogurt, for example. Carbs in general don't provide much in the way of lasting sataity and can even promote hunger in short order (that's why restaurants often hit you with a bread basket as soon as you sit down - it sells more appetizers and bigger entrees!) but if combined with proteins, which provide the longest sataity, things average out. Some vegetables mixed in with meat is great - a stir fry or stew, or extra veg added to chili. A few whole grain crackers or half slice of whole grain bread with some sliced meat and/or cheese worked well for me - the trick is to add just enough without going overboard, and watching if any of these things trigger you into overconsuming them - you don't want a couple of crackers to lead to the whole box! The premise of the low carb diets, whether done intentionally or just as a result of low calorie/high Protein diets that we are typically on post-op, is to keep our body's reserve of glycogen (short term stores of carbs) at a minimum to promote fat burning from our long term fat stores to get the energy that we need. The problem is that some of us don't metabolize those fat reserves all that quickly so we run out of energy easily, or we have fairly high activity levels that burn through the glycogen quickly - it's somewhat like the "good old days" when if we wanted to buy something we had to go to the bank to cash a check rather than just use a debit card. The trick is to keep your "pocket change" of glycogen/carbs high enough for routine living while still low enough to keep burning that fat.

The first few weeks can be fatiguing - recovering from surgery, catching up on lost sleep, etc., but by now I would expect the energy to be picking up from the weight loss - it certainly did for me after a couple months. My sleep schedule shifted an hour or so earlier from the immediate post-op energy drain and that kept up for several months, but typical daytime energy levels were great. Are you getting in enough Protein and Water (the usual things!)? What are your carb levels - carbs=energy and not everyone can metabolize their fat stores fast enough to keep up with their body's energy demands, so the low carb diets can lead to lethargy (that's a simple one to test.) There are also a few of the common nutrients that can sap energy if they are deficient, so maybe some early bloodwork would be in order.

Most hospital nurses advise that you at least wait to get out of the hospital. My doc's advice is to wait until you feel like it (and obviously, choose positions that don't stress your abdomen - avoid hanging from the rafters, etc.)

Overall, there is little (if anything) that needs to be avoided because of the sleeve - that's one of its' advantages over some other WLS. Early on different docs have different things to avoid for various times and some have little, if any, outright food restrictions once onto full regular foods other than to test for individual tolerances (there is always something that doesn't sit right with someone - even in the normal world of non-WLS people.) My doc's plan has little to avoid beyond things that should be avoided for the benefit of weight loss - simple sugars and basic junk foods; his general rule is to test new foods for tolerance one at a time - if it works, great, if not, try it again in a couple of weeks. Some people or doc's programs are more restrictive, using specific limits for calories, carbs or fats. On salads and lettuce, I was having small salads in the 3-4 week range, while others have problems with lettuce for several months. I generally use chopped spinach instead of lettuce as it has a bit better nutrition, but I had no problem with lettuce at the times I tried a bite or two of my wife's restaurant salad. It's one of those YMMV things. Good luck

Yes, you can make Jello or pudding with Protein powder to make a reasonable protein rich snack. With the Jello, I mixed the Protein Powder into the cold Water that then got mixed into the Jello mix and hot water mixture as the protein powder doesn't usually like getting too hot. I used the unjury unflavored protein powder for this use, four scoops mixed into one of the large boxes of mix - the ones that use 2 cups of hot water and 2 cups of cold water. It yields about 10g protein for a half cup serving and it worked OK for me, but I was glad that I didn't need to use it for very long. Protein loaded pudding, however, I still use after a year and a half. For that, I started with two scoops of protein powder (chocolate for chocolate pudding, unflavored or vanilla for the other flavors of pudding) mixed into the two cups of milk used in the small boxes of SF instant pudding (or three scoops in three cups of milk for the larger box - you want to use the instant pudding instead of the cooked variety as the protein powder doesn't like the heat,) and that worked pretty good. Mix the protein powder into the milk well before adding the pudding mix. To my taste, that had a bit too much "protein powder taste" to it, so I cut the milk and protein powder in half and added a cup of plain greek yogurt to the mix, and that eliminated any "protein taste" in exchange for some tartness from the yogurt - to my taste buds it's a pleasing compromise that I still use though I no longer need to load up on protein. I mixed the milk and protein powder together first, then mixed in the yogurt and then added the pudding mix. Good luck and happy blending!

They do have a Slimfast "high protein creamy chocolate" variety that has 20g of protein for 180 calories (and 4g total carb for those counting such things) - that's not a bad exchange if you can find that variety. Further, being as much a meal replacement drink as a protein shake, it does seem to have a broader nutritional profile than the typical protein shake, so that wouldn't be a bad way to go if you like them. The standard slimfast is only 10g protein and 190 calories, which is harder to stomach when adding things up.

I had the semi-typical six-month-insurance-roadblock-to-approval routine in which I lost nothing (didn't particularly try as years before I had already made as many dietary/exercise adjustments as were reasonably possible with surgery.) There was no surgical pre-op diet required other than the usual day before clear liquid routine.

Typically we see a recommendation of 60-80gm of Protein per day, though some docs may start out with a somewhat lower number reflecting the difficulty that many patients have getting in the larger amount of protein. The protein recommendation is largely based upon the maintenance needs of our bodies, and that varies depending upon the amount of lean mass we carry (muscles, organs, skin - most everything except our fat and bones) - women tend to need less while men tend to need more; some docs will recommend 80-100gm for men. Complicating matters is that our bodies need more than the basic maintenance level of protein when healing from a major trauma (like surgery), but I haven't seen any docs who recommend these higher levels and then lowering them to the basic levels later on - most likely because most patients have a hard enough time getting in the basic protein levels. So, the short answer on this would be to aim for the 60gm level and err on the higher side rather than the lower side. The 90-120gm level would be overkill in most cases, unless you were a tall, muscular man. On the water/liquid front, doc's recommendations are all over the board on this, which basically reflects the wide variation in how different patients respond after surgery. Water will not stretch your sleeve. Your stomach will be inflamed to start with as it recovers from the surgery, so it may not hold or pass as much through it as it will later on. Between the restriction from inflammation and the pyloric valve that controls the flow of food/liquids between the stomach and intestines, water and liquids will move through the stomach at differing rates between different people, and if you drink too quickly, it will just come back up. This is why we sip,sip,sip our liquids to start with. If you are sipping slowly and not feeling anything adverse and nothing is threatening to come back up, you can continue sipping, whether that is 8 oz in an hour or 16 oz in a half hour. My wife, when she went thru this a few years ago, could barely pass her nominal stomach capacity of fluids thru in a normal meal sitting (say, half an hour,) while I had no problem moving 6-8 oz of broth and a half cup of juice thru in the same amount of time in the hospital - individual variations between us, but nothing of concern to the doc. Listen to your body and it will tell you if you are sipping too fast.

The onlne charts and calculators are a gross (very gross...) approximation at best. The 65% suggestion that they supply probably comes from their overall OH community, which given the relative popularity of the different procedures, will include a lot of band patients who averag 40-50%EWL, which brings down the average quite a bit. The other mainstream procedures - RNY, VSG and DS have averages in the 75-90% range; 80% is a good planning number for the VSG, and 100% is quite do-able even with 200lb to lose. Another point to consider is the basis for establishing one's goal weight - BMI, while having good validity for population studies, is a poor indicator of an individual's health. One can be a normal BMI (20-25, though most docs use 24 or 25 as their basis for their EWL figures) and still be overly fat if one's lean muscle mass is too low, and conversly, one can be very lean, fit and healthy and be "overweight" on the BMI chart. I set my goal to be in the mid teens on body fat %, which is on the lean side of normal for men, but that leaves me at just under an overweight 27 BMI - a normal BMI for me would be excessively skinny and I would have to lose too much lean muscle mass to attain that number. Not good. So, don't worry too much about the numbers at this point, but rest assured that you can attain a healthy weight with the VSG. Goal setting the way I did it does involve a bit of a moving target as we do tend to lose some muscle mass as we lose weight (we don't have all that fat to heft around anymore,) and no matter how much strength training we may do as we go through our weightloss, some musclulature is going to get lost as things redistribute. My original scale weight goal was 200lb based upon the gross assumption of losing only fat was readjusted down to 190 as my overall weight went down and my body comp shifted some. I've been maintaining 185-190 since January. Hunger post-op is something of a variable - some will experience little or no hunger while others will still have hunger. Our body's feedback systems for telling us that we are hungry get disturbed by the surgery (beyond the loss of the grehlin hormone production from the sleeve) so some may experience some phantom or head hunger for a while - I would sometimes get hungry shortly after a filling meal (and it doesn't take much to get filled up) but I knew that I wasn't really hungry. But that passes (if it happens at all to you,) and now my hunger is pretty much normal - I get hungry at meal time, if I am distracted and busy at that time, it will pass even if I skip the meal (which then means that I need to catch up to meet my nutrition and calorie goals for the day.) It is not unusual for me to have a snack or something without being particularly hungry for it, but I need to do six meal/snacks a day to get what I need (though I could easily get the 2000 calories per day that I need in three meals if I have mostly junk!) I maintain a healthy, balanced diet that fuels a fairly active lifestyle (swimming, hiking, chasing the puppy, racing cars, etc.) with minimal supplementation and no particular symptoms of deprivation (the weakness and light-headedness that you mention) nor did I experience any of that during the loss phase (at least after the initial couple weeks of surgical recovery. As to whether the VSG is the right choice, that is a personal decision and is dependant upon many factors. If you have regain concerns from your past history (who here doesn't?) the VSG by all accounts is similar in that regard to the RNY; the duodenal switch is the only one of the mainstream procedures that offers demonstrably better regain resistance over the other WLS. Whether that is worth the added supplemention discipline is a personal matter, but it is something that is worth having on the radar. My wife is 7+ years out on a DS, lost 200lb to normal weight and has maintained that so far, despite many of the classic emotional/psych issues that often accompany morbid obesity. We all have doubts going into this, but the vast majority of us ultimately find it to be a worthwhile journey with the positives far outweighing (so to speak,) the negatives.

This article gives a good description of what is happening during this phase and why we stall - http://www.dsfacts.com/weight-loss-stall-or-plateau.html As noted in the article, when rebuilding your glycogen stores, the body has to hoard Water to keep it in solution, so you are just seeing some water retention. Hydration effects is almost always the cause when you see rapid weight transitions, either up or down, and is why we tend to stair-step rather than lose smoothly. One bit of bad news that goes with this is that once you start losing again, your loss will be slower - the initial loss that you have experienced is glycogen (basically carbs) which burns fairly rapidly at around 2000 calories per pound; once you start losing again you will be burning fat which burns more slowly, at around 3500 calories per pound - but burning fat is what we are here for, so rejoice and enjoy the ride!

If anything is going to bother you about the pineapple juice, it would likely be the acidity, or possibly the sugar content that may not agree with you at this point. The bit of pulp is not a big concern - some surgeons' programs have their patients on mushes and soft proteins at this point, so your infant sleeve can handle a bit of pulp.

At least you have the dog to blame! A couple of things can be happening. One can be the consumption of sugar alcohols that are frequently used as a low calorie/carb sweetener in Protein shakes, bars and other calorie reduced products (look for ingredients ending in -ol, as in maltitol or xylitol). Since they are incompletely digested (the reason that they are lower calorie than regular sugar,) excessive use can cause problems with diarrhea or gas - some people experience these problems to varying degrees while others don't. Another possibility is simply that your digestive system getting used to its new diet after being cleaned out and much of its bacterial flora being wiped out by the antibiotics given after surgery. Probiotics can be useful in re-establishing the beneficial bacterial culture in your gut that promotes proper digestion. Even without surgery or antibiotics, some people can experience these problems with dietary changes that their systems aren't used to handling. Good luck, and hopefully your dog can escape any further blame!

I never netted out the calories - the exercise "calories" recorded by the gym machines or listed in various tables aren't all that accurate so it never made sense to me to try to compare one against the other; I generally cut the numbers in half when I did my mental calculations of what I was doing, and then just did a weekly tally to track exercise progress apart from dietary progress. I let my body tell me if I needed to make adjustments to the diet. That way I didn't fall into the trap of "gee, I worked off an extra 500 calories today, so I deserve a....."

When dealing with such technical questions, I suspect that the more important factor is the overall success and complication rates of the surgeon than the specific technique or products that he may use. There is usually so much overlap in outcomes that one is probably better off with a more skilled and experienced surgeon using a technically inferior technique than a less skilled surgeon using the latest and possibly superior techniques or product. There is usually enough debate and controversy about such details amongst the experts who do these things every day that it makes evaluation by us laymen very difficult.

We will all tend to see the most rapid weight loss at the beginning, no matter what our diet may be (assuming that it does have the requisite caloric deficit to trigger weight loss!) When we first go into a caloric deficit, as when we start a weight loss program, or get into a famine, that deficit is made up with our quick energy reserves of glycogen (basically carbs) which burn fairly rapidly at a rate of about 2000 calories per pound. When our body gets the idea that you are into something serious and the caloric deficit is not going away anytime soon, then it starts tapping into its long term energy stores of fat, which burns more slowly at about 3500 calories per pound. It typically takes 2-3 weeks to get to this point, which often coincides with a change in diet phase in post op WLS programs. This is also when many people experience their first stall - the dreaded third week stall - when the body has to take a rest and rebuild its glycogen reserves to more normal levels, which involves some hoarding of Water to keep it in solution. I was on mushies and soft Proteins from the outset, and also experienced my most rapid loss those first three weeks after which is slowed down as my body moved into fat burning mode. So, it really doesn't matter if one is on clear liquids, thick liquids, mushes or steak and potatoes those first couple of weeks, you will lose quickly assuming that the caloric deficit is there. On the original question, I typically ran in the 90-110 g Protein range (appropriate for the metabolism of a guy with relatively high lean body mass,) carbs were in the 80-120g range (workable and at times essential for a relatively high activity level,) simple carbs & sugars were minimized, though some fruits, berries mostly, worked their way in over time, and calories averaged around 1100 during my loss phase. The 50g protein level quoted by the OP is on the low side of typical recommendations (normally in the 60-80g range) but is in the ballpark if the OP is a relatively short and small framed woman (say, 120lb or less of "should be" or ideal weight.) Many find that 600-800 calories to be something of a sweetspot for weightloss with the sleeve, and at that level, if one is meeting the protein goals, there isn't a lot of room to go wrong on fat and carbs with the remaining calories.

The OP has a question for which I have yet to find a logical answer. The "liver shrinking" effect (for which there does seem to be some debate) for those docs who need that extra help, requires carb restriction but one doesn't need to do liquids for that; many docs who do these pre-op diets simply require a couple weeks of low carb diet - lean meats and veg primarily and sometimes a protein shake or two to get the patient used to them. Some docs don't do any pre-op diet other than the usual day or so pre-surgical liquid diet. The colon doesn't need two weeks to get cleared out, so that doesn't answer the question, either. The biggest negative that I can see for them is that along with the weeks of post-op liquids that some docs do, the stomach is left without any effective exercise (the stomach is a muscular organ,) for up to a couple of months on some plans, which can make the progression back to solid foods more difficult than it otherwise would be.

This article gives a good explanation of what is happening during a stall, and why you may gain a little during that time - http://www.dsfacts.com/weight-loss-stall-or-plateau.html Hydration and patience are your friends. Also, be prepared for your weight to drop a little more slowly once things start up again - that initial loss is mostly glycogen (carbs) which burn quickly while it will be mostly fat that gets used once you start losing again, and fat burns more slowly (it's that 4 cal per gram for carbs & Protein vs. 9 cal per gram for fats thing - it works in reverse, too.) The good news is that once you do start dropping again, it will be mostly fat that you are losing, which is what we are here for!