RickM

Three weeks out I was having basic salad makings - spinach, tomato, carrot, pepper, onion, avo - with some leftover meats with no problems. We all have some variation in when we can tolerate things, and our program encourages experimentation - if something doesn't work, try it again in a couple weeks - from their experience that patients tend to do better with real food.

Pills are certainly do-able post op, though they are more of a PITA than pre op - instead of taking a handful of them with a gulp of water it's one at a time with each sip, and taste becomes more of an issue. That's why chewables are often suggested but not really necessary. After a few weeks thing begin to normalize and pill taking is much the same as pre op - several at a time with a swig of water, though some of the bigger horse pill type supplements like calcium are often still more palatable in a chewable form. Overall, it is a good move to trade meds for vitamins. During this intesive weight loss period when we aren't eating much the supplements are essential to maintaining nutriional balance. As things progress and you can eat more, more of your nutritional needs can be met by your food intake. But that is something that does need to be monitored since it is unlikely (hopefully) that you will be eating the volume that you did before. Even without WLS, most of us should be taking some supplements, even if it's just a good quality multivitamin, simply because of the classic American, coupled with the lower nutritional value of many of our foods relative to historical values, doesn't provide everything we need. Many WLS post ops take additional supplements simply because they are better educated than they were before.

I was surprised to read about how long so many are on liquids (maybe it's a holdover from RNY practice?) since my doc's practice is mushies/soft foods from the hospital on out - I guess that just seems normal to me since it's the same protocol my wife was on when she had her DS a few years ago. Our progression starts with the liquid Protein drinks/yogurts/puddings/purees and introducing softer solids like tuna and seafoods as they are tolerated, then progressing to firmer Proteins like dark poultry and firmer cheeses - if they don't sit well, go back a step and try again in a week or so. Experimenting is encouraged, within reason, as they note that most patients do better as they get into "normal" foods. I had no problem tolerating anything that I tried as things progressed, and by the 10 day checkup they suggested adding some veg to the diet since I was having no problems getting in the requisite protein. On the other hand, my wife had a harder time introducing new things and couldn't get in any more liquid than her nominal stomach size which meant that the Protein drinks had to be so concentrated that they were intolerable. According to the doc, both are compeletly normal - just the variations between us as individuals. Whatever protocols our docs use, it's best to stick to whatever you signed up for with your doc. Maybe this is one more thing to research when looking into different procedures, surgeons and practices, as they evolve their procedures based on their experiences (or copy them from more experienced surgeons...) I can hardly say that my doc's practice is wrong or overly aggressive since they've been doing VSGs for upwards of twenty years (primarily as part of the DS,) and have adopted the protocols that they have found to work the best for them and their patients. Other docs whose pre-VSG experience were centered around bands and RNYs may be more comfortable with with protocols based more upon what "they grew up with".

I frequently have a mini salad to use some leftover meats. Since I'm not having any problem getting in the protein, I cut the meat down to 2oz and add in about 10g each of some chopped raw spinach, pepper, onion, carrot, avo, tomato tossed with a bit of dressing and cheese. My system hasn't complained and I'm a bit shy of 2 months out. But then, I haven't had any problems with anything that I have tried yet. Maybe not such a good thing - who knows?

I generally go with the lowest fat alternative that I can tolerate out of pre-op habit and long term post-op considerations. Since we don't have the fat malabsorption that the DS guys have, we don't have their fat forgiveness built in. That said, I am not overly anal about ultra low fat or low carb but more go for nutritional density (I don't mind throwing some avo into my salads, as its' fat/calories come with a good nutritional balance). As with fat, I try to minimise sugar and other simple carbs, but sometimes the level of artificial sweetners needed to make SF or low carb products isn't tolerable. I can't take totally plain yogurt, but do blend it with sweetened vanilla yogurt (which on its own is overly sweet) and find that to be a better compromise than the artificially sweetened SF yogurts. Alternatively, I'll throw a little bit of jam into the plain yogurt to sweeten it up a bit and add some flavor, but don't bother with the SF jams due to the small amounts used. Many of the lower fat cheeses have a gram or two more protein per ounce than the regular full fat cheeses, so I'll go with them.

My doc's insurance coordinator let me know that they had approved it - they called him first and I got a letter in the mail a week or so later. Their turnaround back in March was about a week, which shocked both of us considering their reputaion for foot dragging (of course they are dragging their feet about paying the surgeon now, saying they need "more information" despite it being approved and them paying everyone else involved. Situation normal in the insurance world!

I've never been a big carbophobe, but have long concentrated on getting the best nutritional density that I can - the most protein, vitamins, minerals, etc. for the calories/fat/carb/evil d' jour that I can, but now I can keep the overall quantity down. My doc doesn't give a particular target number beyond minimizing simple carbs but I'm generally running in the 60-70gm range (at around 100gm protein level) - which is a fair bit better than the 300+ preop

This is a common theme amongst WLS people, even long term. I've been going to support group meetings for about 8 years, though was sleeved only last month (my wife was DS'd six years ago) and it's very normal to see your reflection in a mirror or store window and think "who's that person? - Oh, yeah," My wife reports that that is fading, and she resolved the "can I fit thru that space, or in that chair?" mindblock some time ago. But just last year, when we were at a gathering of friends who never knew her before, she told me she had the thought of "these people don't know who I really am... - wait a minute, I'm still the same person!" It takes time for our brains to catch up with the rest of us.

I had to do the bowel prep regimen, too - same as for a colonoscopy. It seemed to be a bit of overkill considering what's going on in the surgery, but since my docs are coming at the VSG from the DS perspective, I can understand it. On the other hand, I didn't have to do the extensive liquid diet program and could transition to real food sooner, a tradeoff I would gladly do again.

My difficult time was the first part of the second week, when my GI couldn't decide if I should have diarrhea from the liquid/soft diet or constipation from the pain meds. Before that I was already outpacing my wife on our walkies. I was also another one who never had any problems with nausea - never took any of the anti-nausea meds that they prescribed - or vomiting, despite early experiments with solid foods.

I hear you - I'm also a May 9, and am down about 35 with just a minor 3 wk stall - maybe dropped a pound that week and then back to some reasonable movement. Likewise, I don't feel like I have as much restriction as others have - maybe I just have a looser pyloris? I have never had much restriction with liquids and even the soft stuff like yogurt and puddings go thru fairly quickly. My wife, on the other hand, had a DS about 6 years ago and even with the larger initial stomach she could not drink more than her nominal stomach capacity in a reasonable time - her Protein shakes had to be so concentrated to get enough protein in her within a reasonable time that it was just gagging, but even within the first week or two I had no problem downing a 1 cup + powder Protein Drink in a reasonable time (maybe 10-15 min), and a 2 cup drink was workable if I was running short on protein that day. Even in the hospital, 10oz or so of broth and juice in a meal was workable. Solid foods like meats are limited to 3 oz or so, but if I mix some veg into maybe 2 oz of meat then the meal may be 4-5 oz. 1000 cal days are not unusual. You might ask your doc what size stomach he left you - mine was 2.5 oz. As with others, pizza is a concern, even if tolerated, mostly from the nutritional density perspective - the crust kills what can otherwise be a reasonably nutritious meal. Even at 6 years out, my wife still only eats the toppings (incl cheese, of course!) and leaves the crust behind (and she's a bread-a-holic.) It sounds like you recognize the problem of your mindset, and now need to learn how to make healthier substitutions so that you can reach and maintain your goal. And learn to follow the first commandment - Protein First! Good Luck fellow 6 weeker

My doc is one of those that starts us on the soft diet in the hospital and nominally for the first month, transitioning to more real foods as tolerated, with some sane experimenting encouraged - which was fine with me since I was losing tolerance of Soups and Jello fairly quickly. On the other hand, they're very anal about passing leak tests before tranistioning from IV to oral fluids (they didn't even want me swallowing the Water from the ice chips) - something that probably wouldn't be possible with the outpatient VSG model. I wonder if this is a difference between practices that are going at the VSG from a DS perspective (as mine does) as opposed to the guys coming at it from an RNY perspective? Rick

Walking right away, was outpacing my wife at about a week. Re-started weight machines at the gym after about 3 weeks, upper and lower body only, isolating the core/abdomin, cut the weight back to 1/2-2/3 what I had been doing before on a toning basis. Light swimming after 4 weeks or so. At 6 weeks am still apprehensive about tickling the abdomin too much - don't need hernias!

Being only 5-6 weeks postop, I'm still working on my initial goal weight which is based on attaining a body composition of around 15% fat mass, which is on the lean side of normal for men. Assuming that the weight loss is primarily fat (ideal and not necessarily entirely accurate, but a decent starting point), that would put me at a BMI of about 28 and 200#. I figure that I would re-adjust as I get closer to goal and see how things progress and feel. I suspect that 200-210 is where I will end up as that was a long term stability point way back when, and my 3 week stall happened in the 260-265 range which is another stability point in my past (both on the up side and the down.)