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RickM

Gastric Sleeve Patients
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Everything posted by RickM

  1. RickM

    Glad to see I'm not alone.

    I can't comment on the plication surgery, but I would expect that your goal is reachable with it - most of the common procedures offer enough restriction that 100 lb loss is quite reasonable during the 12-18 month prime loss period (the bands seem to be the least reliable in this area.) I am also looking to lose around 100 lb with the sleeve and am down about 65 lb after 3 months. The big differences between the different procedures for those of us in this "moderate" weight range is the durability of the loss along with the rate and severity of potential complications. The sleeve, with its relative simplicity seems to have a relatively low complication rate and its weight loss durabiliity seems to be similar to the other restrictive procedures like the RNY, while the bands seem to suffer from both poor loss durability and high longer term complication rates. I can't comment on the plication as it is even newer than the sleeve with less of a long term track record, but I would expect its basic near term loss to be similar but with a somewhat higher complication rate due to its band and folded type stomach restriction. As with the sleeve and RNY, I would expect that long term durability of the loss will be highly dependent upon your ability to stick to the lifestyle changes required to maintain a stable weight once the pounds come off. On the protein drinks, I find the EAS brand powders to be pretty good (or at least the least objectionable) with their chocolate having a fairly delicate flavor that can be enhanced with a little cocoa powder if desired. I use the Unjury unflavored powder as a mix in to other foods to enhance their protein component. Taste is such an individual thing that it's hard to give a solid recommendation other than just to experiment with the different brands. Good luck in your ventures,
  2. Many docs feel the same way, in part because they are most familiar with the bypass, and in part because it is the most sophisticated procedure that they offer (unless they do the DS, in which case that is what they would usually recommend for their high BMI patients). Some docs feel that the threat of dumping from the bypass will help as a behavior modifier for their patients (yeah - fat people need to be punished for being fat...) There is not a lot of long term data yet on the VSG regarding weight regain, but what is there suggests that it is no worse than the bypass, which isn't all that impressive to start with, and some docs feel that there is reason to believe that it will be somewhat better due to its functional pyloris. There are quite a few on these boards (and on obesity help, too,) who started in the 60+ range and have good success so far. Probably the best procedure for the high BMI people is the DS which offers statistically better loss and better long term maintenance, however, it is a more technically challenging procedure so many of the docs don't do it, though to the patient the downsides are generally less than that of the bypass. Many prospective patients don't like the idea of the added intestinal rerouting that goes along with the DS and bypass and that is a fair perspective, though with many that is the price of long term success - only you can decide for yourself what is best for you. Bias disclaimer - my wife was a 60+ BMI when she had a DS a little over six years ago and is still maintaining a weight of around 135, while I opted for a VSG since I was a 40+ BMI and had already lost and maintained a reasonable amount of weight on my own through the requisite diet/exercise/lifestyle changes, but couldn't get the rest of the way due to volume issues. I never considered the bypass as, overall, it has all of the downsides of the DS (often more severe,) without the DS's better weight loss and maintenance performance, or looking at it from another angle, the bypass offers similar loss/maintenance performance to the VSG at a much greater cost in side effects and lifestyle restrictions.
  3. Depending on what your doctor's program requires (some people are still transitioning from mushies at two months!) you may still be restricted, but your body will probably be accepting most foods by then - I was on mushies in the hospital, transitioning to more real food over the first month. Restaurant meals should be no problem by then, but you will be getting lots of leftovers to take back to your room (try to get a room with a fridge!) Your current clothes will probably be falling off within the first month - there is usually a big drop the first couple of weeks before you get a stall and then resume loss at a more moderate pace - I was down about 30lb the first month and another 20 the second (more than half way to goal then!) Some will lose quicker than others, but something is wrong if you don't see a substantial drop in the first couple of months.
  4. My program's directions say that if it doesn't work, try it again in a couple of weeks. Mashed potatoes are on our recommended list for the soft/mushies phase (and they can have some protein powder mixed in to help with your daily protein intake.) We start our soft phase in the hospital and work into more solid foods as tolerated over time. Potatoes aren't on the list of some of the more carbophobic programs out there, and they aren't the most nutritionally dense food out there so it's not good to make them a long term staple, but they usually go down well early on so they have their value there. I haven't had any baked potatoes since getting sleeved, (just can't have enough of one as part of a meal, or want/need/should have them often enough to make it worth the leftovers, but do have some mashed occasionally as part of a restaurant meal, or one or two of the mini gold potatoes roasted up with some steak (a lot of potassium in those suckers...)
  5. As noted by others, stomach healing and irritation is an issue at your early stage, and the alcohol is just empty calories that impede your weight loss. The third major issue is indeed your liver - even though it hasn't been physically touched by the surgery (or maybe it was, but not cut...) the liver is usually not in the best of shape in obese patients to begin with, and the rapid weight loss further taxes the liver by virtue of its' role in metabolising the fat that we're losing so it doesn't need any extra aggravation from alcohol during the period of rapid weight loss. My doc is one of those who is out on the farther end of the scale on booze consumption - none during the 12-18 months of prime weight loss - and for good reason : his other specialty beyond bariatrics is liver tramsplants, and he doesn't want to see any of his bariatric patients coming back to him for a transplant. Take it for what you will.
  6. Your doctor may be disappointed, but you shouldn't be. If you are eating the right things, that's the majority of the battle - I had been eating the right things, too - I had evolved into a good healthy diet over the years before surgery, but couldn't get the volume down enough to lose any more, which is why I needed the surgery. It's good to start the good postop habits early and experiment with new compliant foods - what Protein drinks do you like best, etc. Some docs claim that they use the preop diet to shrink or prepare the liver for the procedure. My doc is a liver specialist outside of his bariatrics and he doesn't have a specific preop diet, so that should say something about the validity of that claim. I gained a bit in the month before surgery from the serial last suppers (we won't be able to eat here for a while, and as long as we're out for this preop medical appointment, why not...) and it hasn't effected my weight loss postop - I'm 2/3 to goal weight in three months. Don't add any more stress to your life at an already stressful time (and hopefully your doctor won't, either) Good luck with it all,
  7. RickM

    Would you consider WLS "elective"?

    From the perspective that the surgery does not need to be done today and can be put off, it can be considered to be elective - hospitals faced with labor actions will put off elective procedures but will continue to do emergency procedures. That it is medically necessary for most of us here, there is little question - which is why insurance generally covers it (unless ones employer chooses to specifically exclude WLS coverage in general.) Just because there are alternatve treatments available, i.e. classic diet/exercise programs, drug treatments, etc. does not alter its medical necessity or its validity as a viable treatment. There are usually several medical treatments available for any particular ailment, and some treatments work better than others for different individuals. The medically supervised ultra low calorie diet programs do work - for maybe 5% of the cases. Bariatric surgery has the best record of success, but there are still lots of failures as it is still just a tool for the patient to use and sometimes the tool isn't used correctly, or the wrong tool was used (bands vs. RNY vs. VSG vs. DS, etc.) Don't get too upset over others' ignorance - you can try to educate them but it's not your job to educate the whole world. People who don't have a particular problem tend to be ignorant to its ramifications and solutions - If they had an orthopedic problem like a torn knee or shoulder, they could be ignorantly criticised for having surgery to repair it rather than just doing physical therapy (which can work on its own in some cases.)
  8. RickM

    Potatos

    Mashed potatoes were on my immediate postop mushie list; at home they could have some protein powder mixed in to help get in the daily protein allotment. I will occasionally have a some roasted potatoes (lots of potassium in them, despite the carbs for those on the highly carbophobic programs. I would certainly stay away from the fried potatoes as that doesn't add anything but empty calories which you don't need now or later - a habit that would be good to break. Long term, there is nothing particularly wrong with potatoes other than they are relatively low on the nutritional density scale, but they do have useful nutrients in them - you just don't want to make them a staple long term as that will make maintaining your weight loss more difficult.
  9. I set my goal based on body composition, looking to get down to around the 15% fat mass level, which is on the lean side of normal for men. Using the gross assumption that only fat would be lost, that would put me in the 200lb area as the initial goal, with a re-evaluation as I get closer. Now that I'm about 2/3 to that goal, it looks like 190 or so is the appropriate weight, so I will adjust accordingly. That would still be "overweight" on a BMI basis, but I'm in this for my health, not some numbers on an insurance company chart.
  10. RickM

    Liver Cleanse

    I don't know if there is any validity to the whole pre-op diet/liver prep/cleanse idea or not, but my doc doesn't have any special pre-op diet and he's a liver specialist who does transplants when not doing bariatrics, so he tends to be rather anal about liver health (as in no alcohol period during the 12-18 month weight loss time, etc.) Or, maybe he's just more skilled in that area so that whatever minor differences such pre-op treatment makes is insignificant to him.
  11. The Band was never a consideration for me due to its poor performance and high complication rate. The only other option considered was the DS which, unlike the RNY, offers a notable performance improvement for its added complexity and side effects, but in my situation I decided that I didn't need the bigger hammer to solve the problem.
  12. I was on pills as soon as the IV was removed in the hospital. Granted that it was more of a PITA taking them one at a time with a sip or two of Water rather than the handfull with a gulp preop, and I use the chewables for the calcium rather than the horsepills they normall come in, but that's not much of an issue anymore. I use the chewables now because I have them but probably won't re-order them. No mention was ever made about liquid form or crushing pills,. Though I expect that it would be suggested for those who had problems taking their pills, it apparently wasn't enough of an issue for them since they didn't mention it in their patient manual. Has your surgeon done many VSG's? This sounds like a holdover from RNY practice that doesn't really seem to apply to the VSG. My doc doesn't even have this limitation on his DS patients, so this seems to be more of a concern about pills getting stuck in the little orifce that the RNY uses for restriction (another reason to keep your pyloris!)
  13. I'm 11-12 weeks out now and my typical day, as it has been for the past couple of months, is: B: 3 turkey sausage links, strips of turkey bacon or leftover meat S: half cup greek yogurt w raspberries and slivered almonds or granola L: mini southwest salad w 2 oz leftover chicken or steak, chopped spinach, green onion, pepper, tomato, avo, carrot, snow peas, cheese S: Protein shake on workout days (most days) or more yogurt D:3 oz meat w some token veg or 2 oz meat in a more veg intense dish (fajitas, cacciatore, etc.) depending on protein load for the day S: hi pro sf pudding or hi pro sf cake typ 1000-1100 cal w 100-110 g protein and of course - water!
  14. RickM

    Risks vs. Rewards

    The VSG is probably the least prone to complications due to its relative simplicity. There is the risk of leaks, as with all of the stomach reducing procedures including the RNY and DS, but this is an immediate postop concern the probability of which reduces to virtually nil after the first week or two. Some, or most, surgeons do leak testing a day or so after surgery before releasing you from the hospital - something that is more difficult to do with those who do "outpatient" VSG's - check with your surgeon about their procedure. The RNY and DS are more complex procedures involving some intestinal rerouting, so there are more potential leakage points with them. Longer term, adhesions can cause problems with things sticking internally that shouldn't stick, but the chances of that happening increases with the more complex procedures. The bands seem to have less risk of initial complication due to the simplicity of the procedure, but have more complications down the road from band slippage and erosion, along with statistically poorer weight loss and maintenance. Nutritional issues are a concern with any of these procedures, particularly with the RNY and DS due to their malabsorptive components (though at least with the DS you get some benefit in return in the form of better long term weight maintenance which one doesn't really get with the RNY) but even the VSG can have some problems in this regard simply because we are eating a lot less, so there is less opportunity to get in all the nutrients that we need. So, some supplementing will probably be necessary, though not usually to the extent that is usually needed for the RNY and DS. Even pre-op, most of us need some supplementation just to make up for the typical American diet, but post-op we tend to be better educated about it so it is a bigger concern for us! Reflux is potential problem with these procedures. There is some controversy amongst the surgeons as to ideal stomach size (if there is such a thing,) as the smaller stomachs seem to be more prone to reflux problems while it is feared that larger stomachs won't produce as much success in overall weight loss and maintenance - there is not firm consensus on this as the procedure is still relatively new and longer term data isn't very available. Talk to your surgeon about your concerns and see what he can do to tailor things for your situation. My wife had an unknown hernia when she had her DS a few years ago, and they simply repaired it as part of the job. On the other side of the coin, you have to weigh the risks of not doing anything, the complcations and health issues of being overweight. Good luck with your decisions,
  15. RickM

    This whole not drinking while eating...

    I think you have hit on an important point, and that is that many of the rules that are imposed on some of us are a holdover from RNY experience and many surgeons still don't have enough experience with the VSG to break out a new program for it. That video link is a good demonstration as to why the non-drinking is important for the RNYers; thankfully, the pyloris is smarter than an RNY pouch. though no doubt that effect is still there to some extent. That said, my surgeon's instructions follow the general trend of avoiding drinking before, during and after eating, despite him being primarily a DS guy, though they don't seem to be as firm about it as some practices are. I don't drink the volume of Water, milk and/or tea that I used to around meals, but I can't avoid sipping some while eating.
  16. I can certainly understand his concern about getting into eating disorders in an attempt to hit an "ideal" number, and I can see that this may be a problem with some as it doesn't seem that overshooting the goal is as common with the VSG as it sometimes is with the DS, but I don't think that that is any reason to change your current weight loss behavior in order to avoid hitting that ideal. I would just continue doing what you are doing and let your body settle out where it does. Another consideration in this is how well your skin is adapting to the weight loss and whether reconstruction to remove excess skin is in the cards sometime in the future - that can easily result in another 10lb or more of loss. My goal has been to be still in the overweight class at around 200lbs based on my body composition - in the ideal case of losing only fat mass that would put me at around 15% body fat, which is on the lean side of normal for men. As my composition shifts and inevitably some muscle mass is lost during the weight loss period, then my goal may change some as i get closer to it, though so far, at more than half way to goal range, I'm still pretty much on track to meeting that target point. The 200 range is where I was when I was a fat boy in college too many years ago, but I'm in better shape now (and in recent years) than I was then, despite the excess weight that I've been carrying. So, with the extra work you have been doing lately you may not be as chunky at 150 than you were then. Be flexible and see how things work out as you get closer to the goal range.
  17. RickM

    Pre-Op in SF Bay Area, CA

    I don't think that you can go wrong with either the LapSF guys or PacLap - both have extensive experience in bariatrics. I went with Dr. Rabkin (paclap) mostly because my wife had her DS with them and I've been going to their support meetings for the past eight years, so the comfort and trust levels had already been established. Another thing that you should do is look at their pre/post op procedures as that can vary widely between different practices. I believe that LapSF is one of the groups that has you go thru a more extensive pre and post op liquid diet while Paclap doesn't have any particular preop diet and starts you on mush/puree in the hospital moving to more solid things as tolerated. Both have their reasons for their programs and it's hard to argue with the success of either practice, but it's something to consider (one week of Soups was more than enough for me - haven't had any since) beyond the basic qualifications of the surgeon. It is certainly worth going to support meetings for both and get a feel for how they work and get a feel for which procedure they may recommend for you - they may recommend a different procedure for your circumstance and that should be considered before making a final decision. Also, if you have any hint of liver problems, Dr. Rabkin is the one to see as he is also a liver specialist in his non-bariatric life. On the other hand, if you think that you may have a problem giving up drinking alcohol for the 12-18 months of major weight loss, then the LapSF guys are probably more tolerant of that than Dr. Rabkin, for the same reason.
  18. Weight regain is a risk we assume by having a restrictive procedure like the VSG and from what I have seen there is little to choose in that regard between it and the RNY and bands. The more relevent question to me is for that risk, how much complication/side effect risk does one want to assume, and the RNY and bands are much worse than the VSG in that regard. To get a worthwhile improvement in the long term regain area it seems that one needs to go to the DS with its metabolic changes that move one closer to a "normal" person. Given the quality of what passes for medical "research" and the poor understanding of statistics shown by the medical profession in general, I would seriously question the sanity of a doc like this who swings his opinion based on one study. If he is having problems with weight regain within his practice, that may be a reason to shy away from the procedure, or at least figure out why it is happening and what patients are successful, and if his results are markedly differnent than his peers' results, and why.
  19. There is controversy within the VSG surgeon community as to how big to make the stomach - too big and there is increased risk of inadequate weight loss and regain while too small brings on the risk of chronic reflux. Since the VSG is still relatively new in the WLS field, everyone is waiting on more extended data, at least 5 year post op data, to refine things to find the sweet spot. The DS surgeons have gone thru much the same thing in working out an optimum common channel length, and as with them, I expect that experience will eventually guide the VSG guys into better matching stomach size with specific patient characteristics - an experienced surgeon will use a somewhat different stomach size for different patients. Discuss your concerns with your surgeon, and be honest about your past successes and failures. Try to get his perspective as to the advantages of the larger size and what problems might be anticipated from it, and how to prevent them. If possible, attend some support group meetings of other surgeons in your area to get a feel for how they operate - it doesn't hurt to check out the competition. Good luck in your journey,
  20. Most docs don't mention it because they don't do it - it is a longer and more technically challenging procedure than most of the other WLS procedures. The DS uses a VSG, usually leaving a somewhat larger stomach than our standalone VSG, and then it does some intestinal rerouting that results in malabsorption of the fats you eat - you just don't absorb them very well post op. It has a long term record of very good weight loss along with good durability of the loss, generally the best of the mainstream WLS procedures that are widely accepted by Medicare and the insurance industry. Interest in the VSG as a routine weight loss procedure came from DS experience, where some of the heaviest patients who had severe health problems such that the DS surgery was too risky for them were instead given a staged DS where they first got a VSG and then after they lost some weight and their health improved some were given the intestinal rerouting as a second stage procedure. It was found that a fair number of such patients lost enough weight and maintained it that the second stage wasn't necessary for them. The vast majority of DS procedures are done single stage. The other case where you might go through this again is if you need a revision - if the original procedure wasn't successful in reaching and maintaining your weight loss goals or if other complications exist. Many people having VSGs are being revised from failed lapbands. Likewise, if the VSG doesn't work for you, it can be revised into an RNY or a DS. The VSG, since it is already a part of the DS structure, is much easier to revise into a DS than a failed RNY. All of these procedures have ups and downs to them. One needs to do their research and get comfortable with the tradeoffs involved in whichever one they choose.
  21. I think that you can say that there are issues with any of these procedures that we may choose, but overall it is the price we pay for the tool that helps us live a better life. Much of it is dietary - you learn what foods cause problems and avoid them, or plan for the result if it's something you really value - some of it is just individual metabolism. Stool is going to tend to be looser since there is the unabsorbed fat going through there too (which goes back to learning what causes what problems - you may not absorb all the calories from the fat with a DS, but it's still going through you. A permanent Xenical, if you will. Probiotics (and the right probiotics - different ones work for different people) seems to help many people with those issues as well. I would be surprised if Dr. Hess were doing anything extraordinary to be creating the problem, as he has been doing them about as long as anyone. There are always going to be variations in the results that people get, and perhaps part of the problem is compliance and willingness to learn how to use their tool - people can get poor results with any of these procedures if they don't want to work with the tool they have been given (or bought.) You can similarly get poor results from the VSG or RNY from not learning how to use them correctly. Eating poorly with a VSG may not slap us with foul gas or dumping, but the scale will tell the tale. I've been living with a DS postop for the past 6 years, and sometimes it is a problem, but rarely since she has been able to learn what causes it and can generally avoid it. When we went back up to San Francisco for her one year follow up we had a get together with around a dozen other DS post ops in the back room of a small Italian restaurant (danger, danger!) but the place did not get fumigated by them, and I can't recall it being an issue at any of the support group meetings (that are DS intensive) that I've attended with her the past eight years or so, though it is certainly a frequent topic of discussion.
  22. My doc's revision rate for DS with inadequate weight loss or regain is in the 2-3% range, which is a bit more than their revision rate for excessive loss; these past few years they've been doing more tailoring of the common channel length based on their experience with different patient and body types. But some people's bodies are more aggressive in adapting to the changes made, experiencing substantial growth in their common channels - that seems to be a harder one to predict.
  23. The vast majority are done single stage; they usually only do a two stage procedure if a patient has such extreme health problems that they can't tolerate being under anesthesia long enough to do it single stage - do a VSG, lose weight, improve health and strength, then go back in and complete the DS.
  24. That is the classic reason for two staging the DS. However, if one is getting the VSG alone, with the idea that if it fails it can (relatively) easily be revised into a DS, then what I posted applies - do it before you suffer any significant weight regain. The best results, in my doc's experience, is to do the DS in one stage, or if necessary for surgical risk reasons, a planned 2 stage procedure. Doing a later revision from something else, including the VSG, doesn't usually yield as good of a result, though certainly better than whatever failed the first time.

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