RickM

Peanut Butter is a good start, and you should be having it with those crackers you mention (preferably whole grain) - as with most vegetable Protein sources, peanut butter isn't a complete protein and needs to be complemented by something like whole grain bread to make it complete, carb counts notwithstanding -it's real hard to do both low carb and vegetable protein at the same time. The lunch meats are a good choice as well. I used to roll them up with cheese for a quickie (cheese really is an option, you can always have a little more meat instead for the protein,) though now I usually melt the cheese over the meat on a slice of whole grain bread when I need the extra carbs. I often have some turkey Breakfast sausages (about 15g protein for 3 links) or turkey bacon at about 6g protein per strip (at least the uncured bacon at Trader Joes, if they are in your area, are that high.) I cook up the whole package of either at one time and can then warm up what I need when i need them. I sometimes make a protein loaded SF pudding with one scoop of Protein powder per cup of milk - 10-11g protein per half cup. Greek yogurt may be tolerable if you mix it into the pudding instead of one cup of the milk and scoop of powder. Protein loaded Jello is another possible, though I got tired of that early on from overloading on it in the token clear and soft protein stages I was on, but that may appeal to you. Any leftover meats can be used for quick snack by themselves, or added to any salads or Soups you may buy to boost the protein content.

My goal weight is based on body composition, aiming to get to 15% body fat, which is on the lean side of normal for men (or middle of the "fitness" range on some charts) but still short of the athletic range. For me, that currently works out to about 190 (22 more to go!) which would still make me "overweight" on the BMI scale at 27, but as noted, BMI is fairly meaningless on an individual basis.

As noted, check with your doctors - surgeon and/or PCP and any med concerns. Were you given any post-op instructions by the surgeon or the hospital? That said, Prilosec/omeprazole otc twice a day is what I am on; I periodically drop one of them for a couple days to check progress.

I was starting to play with small southwest style salads (leftover meat w BBQ sauce tossed into chopped spinach, grape tomato, avo, pepper, green onion, carrot & cheese) around the end of the third week, and I still have them for lunch frequently. Tolerances and progression varies with us all, but it's worth a try; I was cleared to add veg at the 10 day mark since I was getting in more than the requisite Protein, so I could tolerate dropping the meat content of the meal in exchange for the veg. If you're still having problems with protein, that should still be your priority, but adding some variety to the protein may be a help. My program's general advice is to experiment with one new food at a time to test tolerance and if something doesn't feel right, try again in a couple weeks. Good luck with it all, and have fun (hopefully) exploring these new things.

Are you allowed the SF puddings at this point? I cant take the plain unsweetened yogurts either, but do make them mildly sweetened by mixing sweetened and unsweetened with some vanilla, but that would seem to be off your doc's menu as well. On the pudding front, if that is allowed, I mix some of the plain greek yogurt into it in place of one of the cups of milk. Add in a scoop of Protein powder and I get about 11g protein in a 4 oz serving, no obvious Protein Powder taste and only a mild tarting up from the yogurt. But, yes, it does sound like a death sentence - I can understand the no added fruit at an early stage if they're worried about seeds or skins going thru, but they must be anally no-carb to sacrifice your protein intake for the sake of a few grams of sugar at such an early stage; it makes no sense from a structural perspective. Good luck, and I hope you make it off death row soon!

I would certainly look for a surgeon experienced with the procedure that best fits you - don't fit yourself around the surgeon's desires or experience. I'm not sure about the numbers of surgeons experienced at what level, or where the numbers come from (ObesityHelp has some of that data, though I don't know how accurate or up to date it is.) Widening the field a bit is the fact that the DS has been around for quite a while and that is a VSG plus intestinal re-routing, so I would count DS experience in favor of a surgeon. My doc is listed on OH as having done about 90 VSGs but well over 1000 DSs, so he is well up the learning curve on it.

I would second that - the fat shrinks along with everywhere else, but there is still some skin sag (along with other places), so the locker room appearance may not have changed a lot, but there is more practical "reach" there now, just as there was when my wife lost her pubic pad after her surgery a few years ago. I expect that I will need to have a bit of tightening done when this is all over and that would get picked up along with the ab region.

I think evolution of thought is the right term for this, just as other practices in the medical world have evolved. I equate this situation with the general evolution of how surgical patients in general have been treated in recovery. The stomach is a muscular organ, which actively compresses and manipulates the food as it processes it for transfer to the intestines. After a major injury, it does deserve some rest and recovery, but also some physical therapy and exercise. One may recall that in the 'good old days' patients required days or weeks of bedrest after surgery, while today the normal practice is to get us up and moving as soon as possible because that promotes healing. I suspect that there is an analogous situation locally with our stomachs, that they do better with some moderate early exercise than if they are prescribed weeks of 'bedrest' first. It seems that the docs who have been working with this stomach configuration for a while - those with longer term VSG and DS experience - would lean more toward this philosophy than the docs whose main experience has been the RNY which eliminates much of these basic stomach functions and replaces it with a more static pouch that mostly just gets stuffed and stretched. What still doesn't make a lot of sense to me is the extensive liquid pre-op diets some docs impose - I can understand the interest some have in pre-op weight loss and its effect on liver condition, but allowing an organ to effectively rest for so long before surgery is counter to the normal practice of wanting patients to be in the best physical shape they can be in prior to the knife. Again, maybe that harkens back to RNY practice where they are basically throwing the organ away after surgery and don't care about its' recovery?

That's one of those things that seems to vary with the individual. The generic OTC prilosec/omeprazole works fine for me but may not for others, I tried the generic Zantac and it didn't do anything for me, so it was back to the prilosec. It what you are using or were initially prescribed/recommended isn't working well, try another one.

Deli meats and cheeses are a classic early soft/solid staple. I still sometimes take a slice of turkey or ham and roll it up with a piece of cheese inside for a quick protein fix.. All of these things tend to be a bit high on the sodium front, but that usually isn't big issue with as little as we are eating during this phase. Enjoy the noshing!

There's no reason to be disappointed, and if you were on a pre-op diet losing some, that just moves the goalposts back since you started your weight loss early. What's happening is that the initial weight loss comes from your ready stores of carbs and protein; once those are depleted the body usually stalls until it starts tapping your fat reserves, which is what you want. Our bodies have all sorts of mechanisms in them to preserve weight when it senses starvation, but it can only do that for so long before it throws in the towel and lets some of that weight go. That's why most "diets" are fairly easy for a week or two when the initial weight comes off fairly easily but then the stall before the fat starts burning creates the frustration that causes many such efforts to be abandoned early. With the surgery and its' forced limited intake, we have no choice but to stick with it thru the stall, but it will happen. And, it will happen again, maybe several times during the loss period as our bodies resist giving up that weight. When your loss resumes, don't be surprised if you lose at a somewhat slower rate than before - that initial loss from your ready stores comes out at a rate of around 2000 calories per pound, while after getting into the fat burning mode the rate is around 3500 calories per pound, but now it will be mostly fat. That's worth celebrating (but not too calorically!)

Yeah, that's right. The findings, IIRC, are that the fake sugars trigger the same insulin response as the real stuff, so they may cut some of the calories, but they aren't necessarily an effective substitute for diabetic issues. They're one of those things that I use selectively - they work in some things that aren't overly dependent on added sweetness, or I blend them with the real thing where appropriate. The whole grain waffles I used to make (off the menu since surgery, but will probably be back on once in maintenance mode since they do have a useful nutritional contribution) used agave nectar because it worked well in the recipe that I had evolved and the caloric impact was negligible with the amount used. And, indeed, you have to look at the labels and any other info you can - some of the "lighter" fare has some positive impact on the caloric count while some aren't worth the trouble. I usually use the lower fat cheeses because they often have an extra gram of Protein in them along with the moderatly reduced fat/calorie count; however cooking with them doesn't work as well so I tend to use regular versions for those applications. On the milk front, I evolved into using skim milk years ago, but will use the higher fat milks sometimes if they're appropriate for the use. The fuller milks do have a bit more protein in them, but not enough to make up for thier higher fat/calories on a nutritional basis - I can add a couple extra ounces to the cup of skim milk to even out the protein if needed (which it rarely is in my case,) and still be down 30 calories vs. the 2% variety, but that's just me (sorry, my brain has been in optimization mode for too long!)

deleted (wrong button again...)

I guess that, other than dairy, I would say that I don't use much of them, but then I don't use a lot of products that have SF or low fat alternatives. My basic essentials are skim milk and nonfat greek yogurt. I avoid things that are intensely artificially sweetened since they tend to have too much of the fake sugar quality about them. I don't drink much tea anymore since we're not drinking with meals, but when I did, I usually used the Equal or Splenda provided; if only saccarin was available then I used regular sugar, but I was never sweetening to the extent of most of the pre-packaged sweetened teas. The yogurt use is a blend of real and fake sweetener - I'm not fond of plain yogurt, but most of the commercially flavored yogurts are too sweet for my taste, and other than Trader Joes, the only nonfat flavored yogurts I find at the markets are all artificially sweetened, and too intensely fake sweetened at that. I make a blend of plain and (real) sweetened vanilla nonfat greek yogurts (3 to 1 ratio these days, down from 2 to 1) with some vanilla extract and Splenda or stevia added to taste, and that works well for me. I think that the mayo, or miracle whip or whatever we have is the light version, but I haven't used any of it since surgery. I do use the lower fat salad dressings generally, but don't agonize over it at restaurants - I generally get what I prefer rather than forcing myself into their token lowcal offering (unless that one is to my liking to start with) and get it served on the side since I prefer my salads on the drier side, at least relative to the places the glop on lots of dressing. The only other place where I use a marketed SF version is with the SF puddings - that knocks about 2/3 of the calories out of the mix, and leaves lots of room to boost the nutritional value of it by adding some Protein powder and greek yogurt to the mix. This brings the protein count up into the 11-12g per half cup serving with about 100 calories, which is a pretty good trade off, and has enough complexity to its flavor blend that the SF aspect of it isn't noticed, but the missing 70 calories is useful at the end of the day, either by keeping the daily caloric total in check or by adding some other essential nutrition to the daily score. In short, I seek high nutritional density while minimizing energy (caloric) density within the bounds of sane taste. I have been adapting/evolving my tastes and preferences for several years to this end, and the surgery has now helped drop the volume to the point where I can actually lose again. I want to continue to keep the fats (saturated fats in particular) and simple carbs under control for the long term and not get into the "I'm having so little that it doesn't matter" mindset as overall calories and good dietary (and exercise) habits are essential in the long run to keeping the weight off once it has been lost. As with the bands and RNY, weight regain is going to be the major long term challenge for many of us VSGers, even if most are still in the honeymoon phase and don't realize it yet.

My program doesn't specify any numbers beyond the basic 60-80g of protein that's common to all of the programs, and the general instruction to avoid simple carbs and otherwise empty calories. I'm typically running in the 1000-1100 cal per day range, and have been for much of the post-op period and the weight has been, and is continuing, to come off at a quite reasonable rate that should be hitting goal weight around month seven; the 6-800 cal levels in some programs may be more appropriate for the ladies who should end up in the 120-130lb range and have an RMR to match, or those with hundreds to lose and need to maximize their caloric deficit to reach their goals. I don't control to carbs, fat or any of the other trendy indicators - our bodies really don't care what form the calories take as it will rearrange those resources to meet its need; it does care about getting all the amino acids that make up the proteins, and the other essential nutrients that come along with the carbs and fats that we consume, so it's better to concentrate on getting as nutrient dense and energy (calorie) light foods that we can since we are so restricted on the volume we can get in. Cutting out major food groups can have some value short term for special cases but is a long term nutritional loser.

Good for him, I'm glad he's catching up (and that shows the value of cheating, within reason, when things don't feel right.) I could never understand the extensive liquid diet requirement as my doc's program starts at mush/puree/soft Protein stage (and liquids as needed, of course) from the outset at the hospital, and they've been doing sleeves for upwards of twenty years in their practice and they obviously haven't had problems moving their patients along at this pace. Obviously, people progress at different rates, with some having trouble with liquids for a while with others able to progress more rapidly; it's good to have a program that recognizes this and isn't one size fits all. Their experience has been that patients do better with more real food, so they try to encourage that progression within the patients' ability and good medical sense.

I second kemo's suggestion of becoming familiar with the boards here, and also the surgeon's program. I went thru this with my wife when she had her DS a few years ago. Going to the support groups and doctors appointments are a big part of it, too. My wife and I both needed the help, so we were both going thru all of the pre-op business together for that reason (though her health issues made her the lead patient.) Helping to keep track of instructions and advice that may be indiviidual and not in the program books is helpful (although, for some reason, my wife didn't have any problem remembering that the surgeon 'prescribed' filet mignon when she was having problems digesting ground beef - strange how selective our memories can be!) Obviously, any physical help that you may need is essential - that's a variable thing on the amount and type needed depending on individual circumstances. She gives me a lot of credit in helping with her dietary requirements post-op. I was already doing much of the cooking, but ignoring that, helping with the serving would be a big help - I would serve up the appropriate amount for her, she would say 'that's not nearly enough!" "That's three ounces, that's all you can fit in." Afterward it was, "you're right, I couldn't/shouldn't eat any more than that...." Hint - get a digital food scale for weighing things if you don't already have one. It also helped that she didn't have nearly as much to do when I went through it this year since I was already well up on the learning curve on these things, though she does get dragged to the support group meetings (it's good for her, as a long term post-op!) Good luck with your journey, and it's much better when taken together!

Your instincts for the orange juice was probably a good one - that is often used by the diabetics to counter a dive in blood sugar as is one of the quickest absorbed forms of sugar; it's also good in potassium if that is part of the problem, though that level of symptomatic potassium deficiiency usually needs more intensive treatment. Saltine crackers are good for absorbing stomach acid - my doc recommends them for helping to counter stomach upsets, and says that if we dont have Breakfast prompty in the morning, to have a couple saltines to soak up the acid from overnight. Are you on blood pressure meds? Too much of them can cause some of these symptoms that you're having - my PCP was fairly aggressive in dropping my doses as he preferred that I be a little high for a while than risk being too low. You probably should have stuck around the doc's office, even if the staff wasn't being too helpful - if something more serious had happened they could have moved you up the priority list, or at least had you in a place where emergency treatment was close by. I don't think that my doc's staff would have let me leave if I was showing those type of symptoms - if the docs weren't available that day because they were in surgery, they would have gotten me in to see someone else, to the ER next door if they thought it was serious enough, or at least rest/hydrate and eat something until I was stable. It does seem that you have something going on here, since this isn't the first time now. I would certainly get some medical attention from your PCP if not the surgeons office, or maybe one of the walk in urgent care clinics that can do some labwork. Something is wrong, some sort of deficiency or imbalance most likely, that you need answers to.

125ish would put you into the 24-25BMI range that most docs use as their 100%EWL standard (looks good when they publish their results!) But a lot of it also depends upon you and how you are built - if you are heavier boned and somewhat muscular then higher would be OK, while someone lighter framed and leaner could be less. My goal puts me at around a 27BMI because that would put me on the lean side of normal for men (or "fitness" range by some standards) due to my musculature. Does your doc use a body composition or body fat scale when you weigh in with him? That's a good guide as to how much you should be losing, since it's the fat we want to lose, not the muscle mass.

The surgeon's and hospital's past experience does seem to make a difference, both on the outcomes of these procedures and on their expectations. My doc is primarily a DS guy, so he expects good results, particularly with relative lightweights like myself where he is used to seeing 90+% EWL as an average. His program is tailored from the DS program, but at least they do change the title pages! (There are differences inside, too, mostly simplifications from the DS requirements - my wife had a DS with him so I'm intimately familiar with that program and can see the differences.)

These docs must be doing a lot of bands to be that discouraged about their own work!

I don't know about the validity of those claims, but I have been evolving my diet for several years, minimizing the bad fats and carbs while emphasizing the good fats, carbs and Proteins - I haven't noticed a significant change in the taste of things post-op (the past 4 1/2 months) while others have reported significant taste changes. So, there might be something to it, or it might just be another one of those variations between us all. My wife experienced numerous taste changes after her DS several years ago - not specifically intensity as this claim implies but more of an alteration in preferences - is that a function of the metabolic changes brought about by the intestinal rework of the DS, or was our dietary evoluton less advanced at that time? Our diets did not change markedly after her surgery, mostly just the volume that she could have (just like with mine after the VSG) yet her tastes changed and mine did not at that time. Too many variables to contemplate early on Sunday morning - my brain is starting to smoke! There might be something to it. Maybe. Something to think about, though.

Most procedures that are marketed as reversable really are not in the long term - body parts that are not used atrophy over time. That part of the stomach that they sew off and is no longer used, may be able to be put back into service for a few months if needed, but over a few years time there will be nothing to reverse. Same applies to the RNY where the remnant stomach is set aside where it can, in principle, be reattached and reused, isn't really in any condition to be used after a couple of years. The bands are heavily marketed as reversible, but more accurately they are removeable, as the damage they can cause is often not reversible. The best thing that you can do is to choose the procedure that makes the most sense to you, and go with as experienced a surgeon in that procedure as you can reasonably work with. As Tiffy noted, gastrectomies of different kinds have been done for decades for correcting other problems, and the sleeve technique has been done for weight loss purposes for 25 years or so as part of the duodenal switch, and as a stand alone for ten or so years, so there is quite a lot of experience with it

So far, so good, and no regrets. I won't know for several years (hopefully) whether the DS with its better regain resistance would have been a better choice, but all indications pre-op and so far post-op (75+% to goal in about 4 1/2 months) were that the VSG was the way to go for me.

The body composition scales are sensitive to your hydration, so they will vary some day to day depending upon how well you are doing on your hydration efforts, and during the day as your hydration naturally changes with the time of day. i routinely see about a five point shift in my fat% between early morning, when we are dehydrated from sleeping, and late afternoon when we are typically fully hydrated. The instructions with my Tanita says that a late afternoon reading, before dinner, most accurately represents your actual body composition. With as much hydration variation that we have, it is difficult to put much significance to a percent or two change in a snapshot reading at the doctor's office every few weeks or months. What is most significant for me is not any particular reading, but the trend of the readings. Those late afternoon readings I have been doing are now showing some 24's and I'm rarely seeing 27's anymore, so I figure that 25.5-26 is about where I'm at right now (which is a lot better than the 42 that I started at, but still short of the mid teens where I would like to be.) We will naturally lose some muscle mass with our weight loss, as our body no longer needs as much strength to carry around that extra weight, and adjusts to it. The body adjusts to our usage, so if it's not used, we lose it. One rule of thumb that I have heard is that we will normally lose about a pound of muscle for every nine pounds of fat lost. I don't know the validity of that figure, but it is consistent with my own experience, and I do regular strength training (and have for several years.) Likewise bone density will tend to decline with weight loss as there is less weight for the bones to support; strength/resistence training helps to maintain and improve the bone density by giving the bones something to do - resisting those stronger muscles!