RickM

Sounds good. It's probably the lime juice that helps it keep - that's often the advice one hears to keep an opened avo fresh. For general use as in salads, etc. I slice up the avo and freeze the slices, then thaw and use as needed. Grilled chicken breast with avo and jack cheese....

There is some ongoing discussion within the bariatric community as to what stomach size is optimum - too small and there seems to be more problems with reflux and too large is thought to lead to more regain longer term. This is an area where they are waiting for more 5+ year studies to provide guidance. Our bodies do adapt in time and we can consume more as time progresses and we move to a more varied diet Generally, they will talk in terms of the starting size of the sleeved stomach because the % removed is a large variable due to the variability of stomach starting sizes (so that 85% figure that we hear so often is an average or generalization.) My stomach started at about 2.5 oz at surgery (RNY pouches tend to be around 1 oz) while a larger stomach of maybe 4 oz is commonly used with the DS in concert with its malabsorption. At about 15 months out, I have little problem getting in 1800-2000 calories per day with a well balanced healthy diet and that is maintaining my weight well (I've been at goal for most of this year.) Many who are smaller at goal (and women, who typically have a somewhat lower % of lean body mass than men,) need less to be stable, while others who are more active than I need somewhat more and are able to accommodate those needs. DSers, with their malabsorption, often need around 3000 calories per day to be stable and get in the nutrition that they need - a level that would have the vast majority of us VSGers back at our original weight in short order. As to the reason they settled on the sizes that they use now, I suspect that since the stand alone VSG evolved from the DS and has no malabsorption component to help it along, they felt that a somewhat smaller sleeve than they typically use in the DS would work better for most getting the VSG by itself.

It is really one of these "it depends" type of things. The general rule is to have your Protein first and then some veg or whatever if you have room. I never had much problem getting in my protein allotments (doc was adding veg to my diet at the 10 day follow up checkup) so I have been able to fudge some on that rule. Also, my sleeve seems to be fairly predictable day to day while some people report large variations in their restriction levels from one day to the next. Since I know that I will be getting my protein in for the day, I can have small salads with leftover meat, meat and veg stews, chilis, stir-fries and the like and not have to pick the meat out first. One of the advantages to mixing your protein and veg is that much of the veg tends to be a slider (at least they are for me,) so while my comfortable capacity is about 3 oz of meat protein, if I cut that back a bit (or sometimes not, depending,) and add some veg in a combined dish, I can comfortably have 5 oz or so of the mix. That adds some useful nutrition with little calories. I am like you in that I'm not much for sweet potatoes. I never bothered adapting to them and just used regular potatoes when appropriate - often an ounce or so of roasted yukon golds - as they both are one of the most calorically efficient sources of potassium (which we need but don't supplement effectively.) I guess it all comes down to philosophy - yours and your docs. Some people don't want to have anything other than the bare necessity level of protein in as few calories as possible, while others (like me) seek to get as much balanced nutrition in as makes sense with whatever caloric restrictions we are using. I preferred to eat as normally as reasonably possible during the loss phase to help make the transition to maintenance easier.

Mine was purees and soft proteins for the first month with everything else added as tolerated after that. Pre-op was clear liquids the day before surgery.

My doc's plan has liquids, puree/mushies and soft proteins as tolerated from the hospital on out. I think I was served scrambled eggs and yogurt in the hospital and did yogurts, puddings, boiled eggs and tuna in addition to the typical protein shakes, soups and jellos those first couple of weeks (got tired of soups real fast!) The doc and his brother have been doing sleeves in their practice for around twenty years, so I figure that they know what it can handle. My wife was on the same program when she went through this several years ago though she progressed a little slower - just some of the variations between us all.

I was having small salads with leftover meat and some salad veg after 3-4 weeks. I normally used chopped spinach instead of lettuce for its somewhat better nutrtional content, but I would sometimes have a bit or two of my wife's restaurant salad to no ill effect. As with everything else, try a little to test for tolerance and if it doesn't work, try again in a couple of weeks.

I have used thinly sliced strips of bell pepper and onions as a spaghetti noodle substitute. Another approach is to go with a cacciatore type stew using chicken or Italian sausage with veg like peppers, onions, tomatoes, shrooms, carrots, etc. Reduce it down to a thick sauce and it doesn't really need any pasta accompaniment.

That must be another guy thing - I was pushing 900-1000 calories within a couple of weeks, though I was able to move some semi-real foods at that time and not just liquids (doc was adding veg to the diet at the 10 day mark because protein consumption was more than adequate at 90g.)

It is quite normal to lose quickly at first - I lost about 32lb the first month (I started at 292), then 14-15lb each the next two months, then about 10lb per month thereafter. What happens is that the initial loss from any serious weight loss effort comes primarily from your quick reserve energy stores of glycogen (basically carbs) which burn at a rate of about 2000 calories per pound. Then, once the glycogen is exhausted and your body decides that you are serious about this caloric deficit/famine thing it starts drawing from your long term energy stores of fat, which burns slower at about 3500 calories per pound. Many people experience a stall at about that time (the dreaded third week stall, but the timing can be variable,) as it can take the body time to kick into fat burning mode, and restoration of the needed glycogen reserves involves hanging on to some Water to keep it in solution. Rapid weight loss is stressful on the body, but so are a lot of things. Ideally, we should lose our weight at a slower more sustainable pace but that's not how things are structured - either the WLS themselves or our psychological makeup (I would much rather lose it over two years than six months, but who has the patience or confidence that it will actually work if we don't have the constant reinforcement of the measurable loss?) That is in good part why I went with a more moderate balanced dietary program than many do, averaging in the 1100-1200 calorie range with no particular carb considerations, and still hit goal in a little over seven months - gotta love that guy metabolism, I guess! Good luck with the continued loss - it will moderate shortly,

I wasn't on any specific carb restrictions beyond the general avoidance of simple carbs and things that otherwise qualify as junk foods. Most of the fruit that I had during my loss phase were of the low glycemic index type - tomato and avocado in my salads and an ounce or so of raspberries in my greek yogurt. I tried a bite or two of banana when my wife was having one but they didn't sit well with me at that time - seemed to be a similar sugar rush as piece of straight chocolate. I tended toward more complex carbs when possible - more fibrous veg and whole grains.

In addition to the well known "good" fats, having a minimal level of dietary fats is useful in helping to absorb the fat soluble vitamins (A,E,D,K); I'm working on getting in around 60g in fats in maintenance mode. You also need a lot of the nutrients that come along with carbs, but that's out of fashion at the moment (unfortunately, our bodies don't understand these fads, so they still insist on this nutrition.)

Carb intake depends upon your surgeon's plan - some have jumped onto the low carb bandwagon while others have not. Some find low carb diets to be helpful while others find them not so useful, but there's nothing about the sleeve, or weight loss in general, that requires it.

If you need to use NSAIDS like aspirin, ibuprofin or naprosyn for any of pain issues, those are a big no-no for bypass patients, and are often used in appealing insurance decisions that favor the bypass over NSAID friendly procedures like the VSG or DS. 100 lb loss is very do-able with the sleeve and almost seems to be a sweet spot where the sleeve works very well while the RNY and DS are a bit of overkill for many (I lost about 105lb in a little over seven months with little effort, and could have lost more had it been healthy for me to do so; many have lost 200 or more.) Why BCBS approved you for the bypass and not the sleeve is anyone's guess, unless they provided some reasons in their correspondence; some companies reserve the sleeve for patients with a BMI of 50 and above (who knows why - tho there are some years' old ASMBS position papers to that effect though those are long obsolete and some of the staff or consulting docs for the insurance companies are just old like RNY guys and aren't familiar with other procedures. But if you need occasional or continual use of steroids or NSAIDS, that is often enough to force the issue with them, or to get their decision overturned by higher authorities Good luck in your efforts.

Based upon the common questions that I see on these forums, and how much variation there is between different surgeons' programs, beyond your basic questions, I would ask for:: Calories, carbs, fats, etc., if they specify (some docs give specific numbers while others don't want to get too wrapped up in numbers and prefer that patients concentrate of food types and quantities.) If you're a numbers type who needs such details and your doc isn't, try to get some ballpark figures, or at least try to understand the philosophy of their plan - establishing healthy long term eating habits, being ultra compliant with some specific diet plan like Atkins, figuring out what works best for you.... What is the intent of any specified pre-op diets - some docs do low carb (liquid or not) diets for "shrinking" or otherwise improving the condition of the liver prior to surgery, while others do a diet to get you used to the post-op regimen, while others want a certain amount of weight loss pre-op irrespective the method while yet others have no particular pre-op diets. I find it easier to stick to a plan when questions and variations arise if I know the intent of the plan, then if, for example, I can't get or run out of a doc's specified Protein drink (if he specifies) then I can find an equivalent product that will fit his requirements. What specifically is included in the various post-op phases or stages? Docs have various phases they specify for different amounts of time - Clear liquids, full liquids, mushie/puree, soft Proteins, firm proteins, etc., and one of the most common questions in these forums is "can I have XYZ during puree stage?" where some docs may consider XYZ to be puree while others would put it into their soft protein stage. (My doc made it easy by lumping everything short of hard proteins together in one month long phase depending upon individual tolerance.) Your doc's guidebook should give you a good idea with suggestions of what is included where, so if you don't have his guide yet, try to go over a copy with the NUT so that you understand it. I'll try to throw in more questions as I think of them. Good luck tomorrow, and with the rest of your journey,

2 days. It might have been one day except that they didn't have the report from the leak test filed yet so I was still on the IV at Breakfast time the day after.

I had one sometime in the middle of the second month, though I probably could have had one earlier given all the other "normal" type foods that I had been having before that. I have evolved into having the Quest bars when I have one as they have one of the best protein per calorie ratios out there, I like several of their varieties, they have little or no sugar alcohols in them (depending on variety - many people have problems with sugar alcohols), and they have a lot of fiber which most of us can use.

My doc's plan was two basic stages, with liquids, purees and soft proteins including eggs and seafood the first month, progressing as tolerated, then everything else as tolerated the second month and beyond. I had scrambled eggs served in the hospital and hard boiled eggs at home the first week.

1 day pre-op, none required post-op.

String cheese and the like was on my first month list, though I'm not sure when I had it; I did have some of the babybel mini cheeses within the first couple of weeks and had some melted swiss cheese in some french onion soup around the end of the first week, so I guess that counts.

While most of the junk that we're supposed to stay away from are sliders, so too are a lot of good foods - many of the fruits and veg that help us get in the nutrition that we need, either now or as we move to maintenance mode. While my typical capacity for firm Proteins like meats is about 3 oz (and continues to be a year + post op) my capacity for combinations of meat and veg in the form of meat and veg salads, stir frys or stews is more like 6 oz - so a lot more nutrition added for very little added calories. Use your sliders for good, not evil!

The transfer addiction that aviiva refers to is a real concern for many, and can turn a pre-op casual or occasional drinking relationship into full blown alcoholism, as it can turn a previous food addiction to another addictive behavior (shopping, gambling, etc.) - we have one gal in our support group who reported going to casinos where she never had any interest in them before, so it was something that she had to handle. So, finding another source of comfort should be high on your list of things to do (adopt a puppy or kitten!) The other concern with alcohol, which is a variable between different doctors, is the effect on our bodies post-op. Most docs have some restriction for a few weeks or months post-op for the benefit of allowing the stomach to heal; my doc is one who restricts its consumption during the entire weight loss period (and that's part of our psych eval - can you do without for the year or more that it takes to lose the weight?) His concern is liver health, since being obese or worse, our livers are rarely in good shape to begin with, and the liver has a major role in metabolising all the fat that we are losing during the loss phase, and it doesn't need to be taxed further by metabolising alcohol at the same time. My doc does liver transplants along with his bariatric practice, and doesn't want to see any of his bariatric patients coming back as transplant patients!

Yep, it's the dreaded three week stall, which commonly occurs 2-3 weeks after the start of most any serious weight loss effort. This article http://www.dsfacts.com/weight-loss-stall-or-plateau.html provides a great explanation of what's happening and why. You will also probably notice that after you break this initial stall, that your weight loss will be somewhat slower as well - and this really is good news. The initial weight loss comes from your quick access energy reserves of glycogen (basically carbs,) which burn at a rate of around 2000 calories per pound, while your longer term energy reserves of fat that you will be drawing from after the glycogen stores are depleted, burn at a slower rate of around 3500 calories per pound - but it's the fat that we're trying to get rid of so that slowdown means that we're really doing what we are here to do! I never really stalled at this point, or any other for that matter, possibly because I never went seriously low carb on my diet as many do, so I never went as seriously into the glycogen deprevation mode as some (tho that is somewhat speculative,) but my loss certainly slowed down at that three week mark. Good luck and happy losing!

I started making small meal salads by the one month mark. I used chopped spinach instead of lettuce for a bit better nutrition along with some tomato, avo, green onion, bell pepper, carrot, snow pea (typically only 10-15g of each) along with a couple ounces of meat and a little cheese. It was great change from the standard meat, cheese and yogurt staples and kept me sane!

LOL! We do tend to do that. I think that a good part of the improvement in our overall health after WLS comes from better awareness and education that stems from the whole process. My wife has a DS, and that is a procedure where one really does need to be one's own advocate since most NUTS and MDs don't understand the procedure and the changes that come from it - if they know anything about WLS it's usually the RNY gastric bypass which has a whole different set of requirements. Once getting into it, you find that things aren't all that different from "normal" people, but you do become more senstive to those areas where you personally are different, and make accommodations.

We typically don't see it expressed in percentages, as is often used with the "typical" 2000 calorie per day diet since our post-op diets are so far out of whack with anything approaching normal. Our basic diets are Protein first (usually 60-80gm per day, with men often advised to do more like 80-100gm per day) and everything else is secondary. Those that are into the low carb diets will try to limit their carbs to 40gm per day (something about Atkins implies that if one hits 41gm then they turn into fairy dust or something.) As the protein gram requirements don't really change whether one is on a 600 or a 1200 calorie diet, the precentages can change markedly depending on the overall calorie level. My basic goal was to balance things out as best I could beyond the basic protein requirements, so for my nominal 1000-1200 calories per day during my loss phase, my percentages varied from roughly 50-25-25 protein-carb-fat to 33-33-33, with the main driver for it being the protein level for the day which for me was anywhere from 90-120gm. For someone on a 600 calorie per day diet, those percentages would be more like 70-15-15. Now, in maintenance, the protein percentage is usually somewhat lower as the level is still in the 100-120gm per day range, but I'm consuming a lot more fat and carbs to keep things in the 1800-2000 calorie range that I need to be stable (typically 60+gm fats and 150-180gm carbs, though I'm more tracking and controlling micronutrients than the macronutrients of fat and carb.)