RickM

I wouldn't want to give my stomach that much time off without exercise (it is a muscular organ, after all...) The length of post-op liquid diets that some docs impose makes it hard enough for a lot of patients to get back to handling real food again; I wouldn't want to make that any worse. Certainly go low cal (and low carb as well, if one is so inclined) to get a jump on the weight loss, but excessive liquid diets aren't necessary for that.

Yeah, useful information - like women's TOM influences their hormones and weight loss. Imagine that.

Hi Dave, and welcome to the (prospective) club! I have been monitoring this WLS world for about nine years now, since my wife and I decided to get serious about our respective weight problems - she had a DS about seven years ago and is maintaining well at a normal weight and down 200lb. Beyond researching and starting to go to support group meetings/seminars, we started doing the classic diet/exercise program that is often required by insurance companies as a roadblock to approval, and while it didn't do much for her, I found that I liked getting into the gym, doing strength training that I had never been into before and going back to swimming. I fairly quickly lost around 50lb (335-285) over six months or so before hitting an extended plateau. I kept at it, basically with sane balanced nutrition and moderate caloric restriction - I was looking for long term results with permanent lifestyle/habit changes rather than crash or fad diets - and over time hid a hard wall at around 240. No doubt with some laxity (but not a lot,) I did regain some of that back to the 280 range, but maintained that for several years. That basic stability gave me the confidence to use the VSG as the tool for moving the rest of the way down the scale over the stronger medicine of the DS which does offer better regain resistance for its more invasive character (the RNY gastric bypass was never under serious consideration for numerous reasons.) I had the VSG last May, and hit my goal range of 190ish in a little over seven months by applying the restricted intake of the VSG to the basic balanced diet that I had already adopted - no ultra low carb or other fad diets involved - emphasizing the Protein as is common with all WLS programs and cutting back the lower nutrional density items in the diet. I typically was running in the 1100-1200 calorie range at 100+g protein thru the weight loss period without any particular struggle or discomfort in doing so; it was more of a struggle to get up into my current 1800-2000 calorie range to maintain things, but that's comfortable now (note that it's generally easy to add junk calories as most junk food are so-called "sliders" that slide on thru; adding nutritionally valuable calories is a little tougher, but not impossible - it just takes practice.) On the med front, the consensus medical opinion is that there is no problem with NSAIDS with the sleeve (or DS), though there can always individual variations. Indeed, this factor is often used in successfully appealing insurance decisions directing patients away from the VSG and DS and toward the RNY. Some surgeons apply their RNY experience to the VSG when they are still getting their feet wet with the less familiar (to them) procedure and warn against using NSAIDs, but surgeons with long sleeve experience have no problem with NSAID use, though many will want to minimize their use early on while things are still healing. The NSAID issues stems from how the RNY is crafted, where a part of the intestines that are not resistant to stomach acid is connected to the RNY stomach pouch, and the duodenum (the part of the intestines immediately below the stomach which is acid resistant) is bypassed along with the rest of the stomach. That suture line between the RNY stomach pouch and intestine is constantly being irritated by stomach acid, so the blanket medical advice for bypass patients is to avoid any of the drugs classed as stomach irritants. Since the basic stomach and duodenum anatomy remains intact with the VSG, there are no such medication restrictions long term. Good luck in your decisions and journey!

That's great to hear, Dave! While your wood may not get any worse, it will certainly become more prominent with more of it living outside your body as you lose the surrounding fat!

Meg has some good suggestions there. For chocolate drinks, I add some unsweetened cocoa powder to the mix to boost the chocolate flavor while cutting the sweetness. If that's too much chocolate, cut it with more milk or yogurt. I do the same thing with my greek yogurt - I'm still not up for straight plain yogurt, but I make a blend of plain yogurt and sweetened vanilla yogurt plus a little vanilla extract; just a touch of sweetness now, but nothing like the commercial flavored yogurts.

A well made sleeve should not experience significant stretch, but there are a lot of variables. One problem is that the stomach and the sleeve is curved, like a banana, but the tools that the surgeons use - the bougies and lap staplers, etc. are straight, so it takes some experience and practice for them to figure out how to make these curved stomachs with the straight tools, and avoid folds or kinks in the middle. Sometimes too much of the stretchy fundus is left up near the top (which sounds like the OP's situation,) and sometimes a bulge is left at the bottom near the pyloris. As the OP noted, this may also be a result of damage done, or surgical restrictions imposed by the band. Typically, we will have a fair amount of initial restriction caused by inflammation, which will diminish as the inflammation resolves itself, but then we will see increased restriction again as we move to firmer Proteins like meats, which will stay with us for the long term. Over time during out loss period it may seem that we are losing restriction, but that is usually a function of increased variety of foods consumed, with more slippery foods being consumed along with our Protein. In time (as in years, or at least many months,) our bodies do tend to adapt to the changes that have been made - our cells are continually replacing themselves and all of our organs renew themselves over time, so it's not out of the question that our stomachs will grow some over time to adapt to the new demands being placed upon it. It will never grow back to what it was, but some growth can be expected. Some people's bodies are more aggressive than others in such adaptations (which is why many of us have such a hard time losing weight once we got where we were.) In the DS world, it is not unheard of (but not common, either,) for the active portion of the intestine (the common channel) to almost double in length over time, in the body's effort ot adapt That's a function of growth and adaptation as opposed to physical stretching which is the impression most have of what happens to the sleeve over time.

I use the low fat or regular cheeses, depending on the application. The low fat cheeses tend to have a bit more protein in them along with the somewhat reduced calorie count, so they work well during the loss phase. Now, in maintenance, I use the regular cheeses more since I need to have more fat (along with everything else,) in my diet now.

I started at 292 and reached my goal of about 190 (based upon being in the middle of the "normal" range of body fat % for men rather than BMI,) in about seven and a half months. No real stalls, even the dreaded "3 week stall" was just a kink in the loss curve when things predictably slowed a bit - I only had one week when I didn't lose anything. I never made any attempts at keeping "low carb" (wasn't in the plan) but kept the nutrition as balanced as possible beyond the basic protein requirements - maybe this is why I never really stalled, by not totally going into glycogen depletion mode as Atkins would prefer. I am a moderately heavy exerciser, alternating swimming with strength training for an hour or so per day, 5 days a week.

The rapid initial weight loss (in any weight loss effort,) comes from burning up the body's quick energy stores of glycogen (basically stored carb) before getting into burning the long term stores of fat - it typically takes a couple of weeks to get to this point. Glycogen burns at a rate of about 2000 calories per pound while fat burns at a rate of about 3500 calories per pound, so that's why your loss slows down some when you start burning the fat. Once the glycogen is burned up (typically about two pounds worth, plus about eight pounds of Water to keep it in solution,) your body needs to start burning fat to replace the glycogen, When it does that, it also needs to retain water to replace that which was lost in the initial burn, so even though you are starting to burn fat, your weight may stall as you retain water until the glycogen is topped up again - this is where the typical "3 week stall" comes from. A better treatise on this can be found at http://www.dsfacts.com/weight-loss-stall-or-plateau.html

I started with six meal/snacks per day and dropped that back to five after a few weeks as I could then get enough nutrition in five by then and breakfast and lunch were close enough in time that I could skip a morning snack. Now, in maintenance, I'm back to six a day to get in enough nutrition and calories (2000ish now) to be stable.

There is nothing about the sleeve that requires a low carb diet (or any other specific diet, for that matter,) - it is quite amenable to whatever diet your specific needs require that are consistent with weight loss; low carb is popular with the sleeve (and most WLS now,) and has been adopted by some (but by no means all, or even a majority of,) surgeons simply because it is currently popular in the non-WLS weight loss industry.Low carb has its merits and is appropriate for many in our current society, but low fat, balanced, low carb and all of the various combinations thereof work well with the sleeve as well - the sleeve merely helps with the restriction of intake. Many of the serious low carb-ers get upset at the amount of carbs in the liquid and puree phases of their programs (which are also quite variable between programs - I had no liquid or puree only stage in my doc's program,) so I wouldn't worry too much about those phases of the process. Discuss your concerns with your surgeon of choice (particularly if he is one who has jumped onto the low carb bandwagon) and your PCP, and he should be able to tailor his program for your needs - that's what you are paying him for! I worked with a balanced diet approach (beyond the basic relative high Protein requirement) during my loss and subsequent maintenance phases, and indeed, boosted my complex carb levels midway thru the loss phase to better fuel my workout energy needs; I reached my goal in little over seven months and really wouldn't have wanted the loss to have been any faster. There are many ways that one can successfully work the sleeve.

I was experimenting with beef at around the first month point and have been having it since. What kind is best tends to be an individual thing - I found that some pot roasts were more difficult than other forms (I think it was the stringiness of it - depends on the cut used I guess,) but that was not consistent. When my wife was going thru this, she had problems with ground beef and the surgeon suggested that filet is often better tolerated (gee, if we have to have filet instead of hamburger, I guess we can make the sacrifice!) I haven't had any problem with prime rib (haven't had much problem with anything, for that matter,) but have generally gone with leaner cuts during the loss phase to keep the calorie count down. All you can do is give it a try, and have lots of leftovers for future meals. Good luck and have fun exploring,

I was talking to my trainer last week about this, and he advocates this same practice for "normal" people for the same reason - to let the stomach work on the food at its own pace and maintain sataity as long as possible. So it's not just a WLS thing!

But a nice petite filet may still be in your future! My wife got a "prescription" for that from her surgeon after complaining about having difficulty with ground beef; we still refer to a trip to Outback as refilling her "prescription". The sleeve helps reset our priorities to quality over quantity. You are right about testing small amounts of new thing - that's one of the hallmarks of our doc's program which is otherwise on the liberal side of things progression-wise. I was able to tolerate more things more quickly than my wife could when she went thru this a few years ago - YMMV Congrats on your pending "overweight-edness"!

I will second topgun's advice on really understanding the your problem - is it physical failure of the band (slippage, erosion, etc.) or incompatibility of the band procedure with your physiology/psychology? The different procedures have different characters which make them compatible with some patients and imcompatible with others. If it's a physical failure of the band, then the sleeve is a sensible revision; however if it's a problem of compatiblity with the restrictive nature of the band, then another restrictive procedure may not be the best fit for you. Look carefully (as you are doing here) to understand how the two procedures differ, and how they are similar, in how people use them to lose weight. It may be that a more malabsorptive procedure like the DS may be a better fit; few people like the idea of the intestinal rerouting, but sometimes that's what is needed to get the weight off and keep it off. The bands are often sold and chosen based upon them being a simple and quick procedure, and this is also an attraction for the VSG, but that doesn't mean that they are necessarily the best choice for an individual in the long run. In our support group meeting last night we were discussing a patient that they had on the table yesterday who had previously revised a band to an RNY, and when that didn't work was getting the RNY revised to a DS - three WLS over about five years. This is something that you would like to avoid, so do all the research that you can and do a lot of soul searching on understanding yourself to make the best decision that you can.

That's right - it's those hormones! There's a lot of hormones stored up in the fat that we are losing, so in addition to the normal hormonal effects, we have those extra hormones coming out for the stored fat that we're losing. It can even happen to us guys, so you are not alone.

I'm 5'10". A small word of caution on how we evaluate ourselves at the start - a lot of the classic measures of frame size or "big-boned-ness" (which almost seems cliche to us when we're fat!) work OK for those in semi-normal weight ranges, but can deviate and change some when we are seriously overweight Our ribcages will contract some as we lose all the fat between our organs, and places where fat is not normally carried in "normal" people does carry fat in the obese. By the measure of thumb and finger around the wrist bone (just touch, overlap, don't touch...) I was a medium frame with my fingers just touching, but now I have some overlap - my fingers and wrist are skinnier than they were implying that I'm now a medium-small frame. On the other hand, my lean mass at around 155-160lb implies that I have fairly decent musculature on a not-so-large frame and 190ish pounds. Another clue on this is that I have gone from a XXL helmet to an L (though in different manufacturers sizes, so that muddies the Water a bit.) So I'm not as much of a fat-head as I used to be. If you can, it's worth getting a body composition test done (or buying a body comp scale, they cost around $100, give or take some depending on features) and use the body fat and lean mass readings as an additional guide to basic scale weight. That will help get you a better idea of what a healthy weight is for you. Mid teens on body fat % is a good "normal" number to shoot at for us guys, mid twenties for the gals (we have one ex-NFL guy in my doc's practice that got himself down to 4% BF - talk about obsessive/compulsive at the gym!) Most of all, have fun and enjoy the ride!

When I'm out and about my first choice is Chipotle, I get the three soft taco meal, have one and save the other two for other meals - meat, veg, rice, beans, salsa, cheese, guac and usually lost the corn tortilla during loss phase but usually have part of it now in maintenance. Other alternatives when available are for Panera and have a half sandwich and soup or salad which I save for later, or go to In 'N' Out and get a protein style (lettuce wrapped) cheeseburger which is just about the right size for a sleeve (no more double doubles though!)

I'm a month shy of a year out but have been at goal for about three months, down a bit over 100lb (292 down to 185-190,) I probably could have taken it lower if I wanted to, but I'm comfortably in the middle of the normal range (or fitness range, depending on the chart) on body composition even if BMI says that I'm still slightly "overweight".

Not really a step backwards (many would consider it a step forward!) but more of a sideways step - the RNY and VSG overall provide very similar results, though the VSG does it more simply. Yes, the RNY bypasses the majority of the stomach, (along with the duodenum and a small part of the small intestine,) with a small portion of the original stomach being formed into a small pouch between the esophagus and small intestine. There are a number of problems created by the RNY configuration that are avoided with the VSG while offering similar performance, which is why we are seeing a growing use of the sleeve, and many RNY surgeons learning how to do sleeves.

It's possible, but not too common - revising to a DS is much more common. When getting around to re-routing the intestines, it's just as much work to change them to the DS configuration as it would be to put them back to "normal". The tricky part is restoring the stomach to normal and sleeving it - there are only a half dozen or so surgeons in North America who are genuinely qualified to do RNY/DS revisions (or as noted, revising to the VSG is a similarly complex job) - check out dsfacts.com for more information on the DS and on RNY revisions and a list of qualified surgeons. Also check out the DS board on ObesityHelp.com. My big concern would be the viability of the remnant bypassed stomach after ten years - things in the body that aren't used tend to atrophy over time. The other option is to stick with the RNY and have one of the more experienced RNY surgeons do one of the revisional surgeries that are used to correct some of the RNY problems, such as tightening or banding the pouch, tightening the stoma, or changing the intestines to a distal configuration. None of them work as well as the DS since they're simpy rejiggering the RNY configuration some, but they are more widely available procedures.

Whatever Protein drink that you find that you like and will drink is the best - the highest protein/lowest carb or fat drink is of little value if you can't choke it down. I've played with the Protein drinks for years (since my wife rejected them after her WLS several years ago). For chocolate shakes I have settled on the EAS powder that can be bought at Target, Walmart, etc. which I find has a fairly delicate flavor with little of the sometimes objectionable protein taste; adding some unsweetend cocoa powder can boost the chocolate flavor while cutting the sweetness while the SF chocolate syrups can boost the chocolate flavor while adding some sweetness - use whichever floats your boat. I also use the protein powders in SF instant puddings along with greek yogurt to boost their protein content. I also use the EAS to blend with other protein powders that I have tried and found to strong on their protein taste or aftertaste on their own (I wind up blending a lot of things in this post op world to hit the right taste/calorie/nutrition compromise.) Adding fruit to the shakes is a common and popular addition, though check with your doctor's plan - the rationale for most of the pre-op diets is to keep low carb to improve liver condition, so they may not want you adding fruit at this time for that reason. If they're just wanting you to lose a bit of weight pre-op and get used to protein shakes while watching calories, it may fit in. Good luck and welcome to the club.

There are so many variables in how the policies are written that it's hard to judge based upon others' experiences. I have Aetna but when going into surgery we were already part way between having the deductible met and maxing the out of pocket expense. So, while most of the pre-op and hospital expenses were at our normal 20% copay, by the time they got around to paying the surgeon's fees, he was covered 100% even though he is out of network (we go for quality, irrespective what the insurance company says!)

This is why the better surgeons tend to target the upper end of the BMI range for their patients, noting from experience that those patients have better reserves to fight illness and stay healthy long term. Combine that with the matter that most of us will be able to lose another ten pounds or so of excess skin (whether we choose to do so or not) and there is good reason not to go too far on our goals. There has been other work showing that the overly lean do not have as high of a life expectancy as those who are in the middle of the normal range.

I always went for the nutrition and never worried about the carbs - milk has a useful amount of Calcium and potassium in it that's well worth whatever carb count it may have (we're all supplementing calcium, but potassium is difficult to supplement without prescription.) Not being ultra low carb (I was typically 80-120g per day) didn't seem to bother my weight loss; at least I certainly didn't want to have lost any faster than I did, getting to goal in a little over seven months. In regard carbs, the VSG is quite flexible when it comes to diet in that it has few outright requirements or limitations as is found with the RNY. If you have had past success with low carb or ketosis type diets like atkins, those will work quite well with the sleeve and many people have had good success with them post-op; but the sleeve also works well with more balanced diets or even low fat diets (though those aren't as fashionable these days as the low carb diets are.) Whatever helps you get adequate nutrition in (particularly Protein during the loss phase) and keep the calories in check will work just fine.