Mason

What Exactly Is A Stall? The last time I was on Weight Watchers (June 2011 through February 2012), I lost an average of .9lbs every week and I followed the program religiously. Forum members report first month losses of 20, 30, and even 40 pounds and then refer to a two- to three-day hiatus as a stall?! I don't get that. The body morphology has to catch up with the tremendous weight loss. That necessary phenomenon isn't a stall. A "stall" is what I experienced during my last month on Weight Watchers: no movement at all in close to 30 days. A massive weight loss of 20, 30, and 40lbs in one month cannot reasonably be referred to as a stall. I am only 29-days post-op but what I see is a two- to three-day "body adjustment (or catch-up) period" followed by another one- to two-pound drop on the scale. This is normal. You can't expect to see the scale drop every single day for an extended period of time. No one loses weight like that, not even malnourished cancer patients in the end stages of their disease. What I've noticed is that during this "body adjustment period," I will not lose pounds but mass. My stomach will tighten a bit more and areas that used to have fat will have less (or no) fat. On many other forums, they have a list of definitions of commonly used terms that members can refer to. Maybe we can agree that a "stall" means no movement on the scale for a minimum of seven days when weight loss was reasonably expected. Obviously, if I am consuming 3,000 calories a day, I can't reasonably refer to my failure to lose weight as a stall because I shouldn't expect to lose any weight. The point of this post is not to be picayune (nor is this directed at anyone in particular) but to alert forum members to the fact that, when it comes to weight loss, mindset is everything. If you expect to see the scale drop every single day for weeks and weeks on end, you are unnecessarily setting yourself up for frustration, disappointment, and resentment. I have lost 23lbs in 29 days: that's just over 1/3 of my excess weight in less than one month. The scale doesn't move every day nor do I expect it do. If I had experienced even 25 percent of this kind of weight loss on Weight Watchers, I NEVER would have signed up for the surgery. Do you know how long it took me to lose 23 pounds on Weight Watchers? It took 26 very difficult weeks or half-a-year! This surgery has expedited my weight loss by a factor of 83 percent! Should I be bummed-out, depressed, and resentful because my scale remains still for as many as three continuous days at a time? Should I refer to that three-day hiatus as a stall? Of course not. Knowing what to expect and having reasonable goals are critically important to maintaining a healthy and positive mindset.

I'm at 29 days post-op and still taking Imodium for diarrhea every day to two days. My surgeon doesn't seem very concerned about it. He had me submit a stool sample that came back normal (no bacteria or other pathology). He said that many patients suffer from diarrhea for as many as 30 days after surgery. Well, tomorrow is 30 days for me so we'll see.

A lot of members report that food doesn't taste as good to them after surgery as it used to but, truthfully, there is no physiological explanation for that result. I think the explanation lies in your second sentence. Upon realizing and accepting that food cannot be consumed (utilized?) in the same way as it had been, some patients adjust by emotionally decathecting (withdrawing psychic energy) from food and then reinvesting that energy into other things, e.g,, family, friends, new hobbies, etc. I hope I get to that point. Right now I am dealing with this mind/body conflict in which my eyes are registering how little I've eaten of food that tastes every bit as good as it used to, while my stomach is telling me that I'm full to the brim (after just a few bites). It's both a relief and a strange mental sensation at the same time.

Thanks for sharing this. I hope I have the same leeway. Doing my best to make the necessary mental changes before it's too late. I agree with this 110 percent but I have to add that it's just too damn bad they haven't figured out a way to remove 75 percent of our 10,000 taste buds along with 75 percent of our stomachs! It would make things a lot easier if food didn't taste as good now as it did before the surgery.

This thread, in particular, has placed the fear of God in me: Rapidly Gaining Weight 2 Years Post Op Sleeve Surgery. Members write about regaining 20, 30, and even 42 pounds back after surgery. Here's my personal take on this. I've got three to six months to redefine my relationship to food or: 1) I'll never reach goal, and; 2) I'll start regaining the weight I had lost. I've got up to half-a-year to make moderation (as opposed to abstinence) a new habit or, basically, I'm screwed. I consider myself blessed in that I was never a "grazer," i.e., someone who eats frequently and between meals out of boredom or habit. My problem with food was that I ate too quickly, never heard of portion control, and raided the cupboard at night for carbs (terrible night hunger). From everything I've read, this surgery does a nice job of addressing this particular kind of problem eater, especially in regard to the hunger pains as they completely dissipated four days after surgery. This afternoon we went to Chili's for lunch. My wife ordered her usual Swiss and mushroom burger and I ordered a bowl of chicken mushroom Soup. It took me about 20 minutes to consume exactly 10 spoonfuls. My wife ate the rest and commented how, before the surgery, I needed all of about three minutes to knock off the entire bowl. It felt good, in an amazing sort of way, to feel so satisfied after consuming what was probably no more than 1/2 cup of soup. Sorry to repeat myself but I must write this again: This surgery is emancipating.

I know exactly what you mean. I have the same reaction to low-fat cottage cheese and soy milk.

The $64,000 question in this context is: What is the best way to address the problem of "sliding" into frequent trips to the refrigerator and cupboard, abstinence or psychotherapy (specifically, redefining one's relationship with and to food)? From everything I have read on these forums, VSG is not an effective treatment for obesity caused by excessive snacking, i.e., those who pop three to four Cookies in their mouths every time they pass the kitchen, because one can just as easily do that (two to three) months after surgery as before. I personally don't think the best way to address this type of eating disorder is through abstinence because those who compulsively adhere to the abstinence model are at risk for suffering what is referred to as the "abstinence violation effect," i.e., as consuming even one cookie (for example) is viewed as a total failure, the patient decides "well, now that I've fallen off the wagon and I'm a total failure, I might as well eat the entire bag!" Moderation, not abstinence, wins the race. In my opinion, those who cannot eat in moderation or control excessive snacking (grazing) with the sleeve should consider seeking additional professional help because, ultimately, the sleeve alone will fail them.

This is great to know for when I am able to consume more than 2oz of solid food at a time and more calorie dense foods such as steak. With the struggle I am having every day to meet my Protein and BMR calorie requirements, I am extremely grateful for every single calorie in that 2oz of ice cream I am able to eat in one sitting.

Approximately 85 percent of the ghrelin in your body is produced by the cells in the fundus, the part of the stomach that is removed during surgery. That leaves 15 percent that is produced by your brain and other organs. For most patients, the net result is not an 85 percent reduction in hunger pains but a qualitative change in the sensation of hunger itself. After surgery, it took about two days for the excess residual ghrelin to dissipate from my body. At that point, the sensation of hunger as I knew it was gone. Are you sure that the sensation of hunger you are experiencing is not a screen memory? For example, I am physically full (to capacity) if I eat 2oz of lox or hamburger meat but I still go through this mental exercise of saying to myself: How the hell can you be full given how little you have just eaten? It's not hunger, per se, but more an experience of disbelief. Related, I occasionally think I might be hungry but, in reality, it's more of a memory of what used to be. Could this sensation of hunger you are experiencing be more of a mental image than true physical hunger? Just a thought.

double-post

The first two to three weeks are tough, I agree. Three days after discharge I was readmitted to the hospital for malnutrition and dehydration. I'm only one week ahead of you and I can tell you it does get better. The swelling has finally receded and, last night, I was able to keep down a couple of saltine crackers for the first time (have not been able to keep down any bread products until last night). After a short period of time, you'll be able to eat anything you want except in much smaller portions. If two to three ounces of your favorite food allow you to feel full, do you really think you are going to feel deprived because you weren't able to consume four times that amount? The other day (with my surgeon's blessing), I was able to consume (and comfortably keep down) about 2oz of chopped meat. Normally, before the surgery, I could easily consume two 8-oz patties in a matter of minutes. It's a strange phenomenon really because my brain is trying to process two conflicting messages: You are full, yet you only ate one-fourth of one hamburger! Hey, what's going on here?! To be honest, I love the freedom this surgery is providing me with... and I see it as freedom, not deprivation. If I could have eaten 2oz of hamburger or 2oz of Ben and Jerry's ice cream and felt satiated, I wouldn't have needed the surgery. It's okay to be limited to, for example, 2oz of lox if those two ounces leave me feeling comfortably full. For the first time in my life, I know that not only will I take the weight off but I know in my heart and soul that, this time, I'm going to keep it off.

I've been eating Ben and Jerry's ice cream since day 14 with no harmful side effects and I've lost 22lbs and nearly five inches in 26 days. Ice cream goes down very easily and stays down but I limit it to 58g (2oz) per serving. I use MyFitnessPal.com to track everything that goes into my mouth. It's real easy to rack up empty calories with ice cream. However, ever since returning home from the hospital, I've been struggling with meeting my Protein requirements and consuming enough calories to meet my BMR. It will be 8 o'clock in the evening and, according to MFP, I will have only consumed 650 calories for the day. After meeting my protein goals, ice cream helps to provide a lot more energy than yogurt and, as long as I am well within my calorie goal for the day, there isn't one iota of guilt to contend with. The consumption of ice cream (bacon, chocolate, etc.) doesn't sit well with the abstinence model people (who warn against eating anything with processed sugar, wheat, and alcohol) but I don't believe in abstinence when it comes to food with the exception of carbonated beverages after VSG surgery. Learning how to eat in moderation is the key to long term success. Limiting foods high in calories in an attempt to offset the damages from grazing is the wrong approach I think... at least it is for me. The healthier approach is to abstain from grazing, not foods that you enjoy.

Over the past few weeks, I have read numerous accounts on these forums of VSG patients who have lost large sums of weight over the first month or so. Obviously, the more weight you have to lose, the faster you lose initially. My specific question is—to those who have investigated this for themselves—how do you explain the weight loss when the numbers don't work? Here's what I mean. I entered surgery on December 13 at just about 240 pounds, approximately 70lbs overweight for my height and frame. I am now 19 days out and have lost 17lbs, i.e., over 24 percent of my excess body weight, bringing me this morning to 223 pounds. The problem is the numbers don't work at all. At 240lbs, my body required 2421 calories to sustain its basal metabolic rate (assuming little to no exercise). On the average, I have been consuming approximately 800 to 900 calories per day since returning home from the hospital. Assuming a daily consumption rate of 800 calories, that calculates to a daily caloric deficit of 1621 or 30,799 calories over this 19-day period. A calorie deficit of 30K equates to a projected weight loss of 8.79lbs (30,799 / 19), not 17 pounds. How can I explain the additional loss of more than eight pounds? The math just doesn't work. For those of you who have lost a large percentage of weight, more weight than can be explained by the energy surplus/deficit model (i.e., 3500 calories = one pound of fat), how did you come to explain or understand this? Did you happen to discuss this phenomenon with your nutritionist or doctor and what, if anything, did he or she have to say about this? Of course, I am not complaining. It's just that I don't understand how this kind of weight loss is metabolically possible.

Mine is actually a yellowish-orange, a color I've seen before in this context.

Same here: Sleeved on December 13 and am still taking Imodium.

My stomach could not tolerate the Isopure Protein shakes: they were passing right through me. I was so malnourished and dehydrated during my first week that, for the first time in my adult life, I was actually hypotensive (95/60) without the use of any medications! Now, I am running 140/80 again with my medications back in play (Diovan and Plendil). This is why my doctor moved me to soft solid foods at day 9, instead of day 14. I was basically starving on those Protein drinks and Soups.

That's a great question. I didn't count calories, per se, before the surgery but I did sign up for Weight Watchers one last time in June of 2010 and stayed on it for eight months. At 244lbs, my starting point value was 43 per day. I once read somewhere that each point is equal to roughly 50 calories. So my initial daily calorie intake was 2150 and eventually went down to 37 points or 1850 calories per day when my weight dropped to 218lbs (the point at which I stopped and eventually regained). I lost an average of .9lbs per week on the Weight Watchers program. That calculates to a calorie deficit of 3150 per week or 450 calories per day. If we assume, at 37 points, I was eating roughly 1850 calories per day at 218lbs, that means my BMR was approximately 2300. What's interesting to me is that MyFitnessPal.com is telling me I need to consume 2190 calories per day in order to lose 2lbs per week (7000 calorie deficit per week). That means, according to MFP, my BMR is closer to 3190 per day. If that's true, and given that I'm consuming about 800 calories per day, that would leave me with a daily deficit of 2390 or .68 of a pound, which is very close (.9lb) to what I am actually losing now. With the recovery process, based on the amount of weight I've been losing, I'm guessing that my BMR is something like 3950. I'm assuming that will decline as my health improves. According to that article, up to 2lbs of glycogen are stored at a time, accounting for no more than the proverbial quick 10-pound weight loss (2lbs glycogen + 8lbs water) during the first week of any crash diet. As I mentioned in one of my subsequent posts above, I lost 7lbs over days 3 and 4 and then "stalled" for almost one week as predicted by the article. If we take the information in that linked article literally, I should now be in the fat-burning phase of weight loss: "You start mobilizing fat from your adipose tissue and burning fat for energy" (para 3). The water expended for glycogen burning would not account for a 17lb weight loss over 19 days, not in the context of 70lbs excess weight, nor would it explain a 4-inch loss in the waistline. Undoubtedly, most of the initial 7lb drop over days 3 and 4 was from water. I was after all re-hospitalized on day 4 for dehydration. BMR figures are normally distributed (like I.Q. scores for example), meaning that the mean, mode, and median are all the same. It's not a 50/50 split because, although a bell curve is symmetrical, the proportions are geometric, not linear: the majority of the population (mode) does line up right smack in the middle, at the average. According to one source I could find (Examine.com), one standard deviation is 6 to 8 percent of the mean BMR figures. What this means is that if the BMR for a 58-year old man at 5',7" at a sedentary level for maintaining a weight of 244lbs is reported as 2400, then 68 percent (+/- 1SD) of the population of 58-year old men at 5',7", weighing 244lbs, will fall between 2208 and 2592. The difference in extremes, for 68 percent of the population, comes to 384 calories per day, which is significant when you are counting calories. However, that BMR figure of 2400 will apply for the majority of the population in question, not half. I will update this thread as I have something eventful to report.

Exactly. The increased sodium consumption from the sport's drink combined with the discontinuation of the water pill would result in water retention, not water loss. Right now, until the diarrhea resolves itself, I'll gladly take the water retention.

I wouldn't know how to calculate the contributing percentage of water in the total weight loss over 19 days. Specifically how would you do that? I gained over 3lbs from the saline/dextrose solution that I received in the hospital and that passed over a 48-hour period. I didn't include that gain or loss in the reported numbers because it's artificial. After the loss of the saline-induced increase, I dropped 7lbs over the third and fourth days after surgery. Then my weight plateaued for the following six days (no change in weight at all). From days 10 through 19, I have been steadily losing an average of .9lbs per night, for a subsequent decrease of 10 additional pounds, which is what has been concerning me. I was told to discontinue my daily dose of HCTZ 50mg (diuretic) that I had been taking for hypertension due to post-operative problems with diarrhea and dehydration. I am currently taking Imodium on a daily basis, which is controlling the diarrhea and, consequently, water loss and dehydration. If anything, I've been retaining water lately as, per doctor's orders, I'm drinking 1000ml of Pokka Sport's Drink every day. In addition, water loss wouldn't account for the 4-inch decrease in my waistline. I entered surgery wearing a size 46-inch pair of pants and I'm now back in my 42's. I suspect, what I fear, is that some of this loss is not from water but muscle mass, despite the fact that I am killing myself to meet my daily Protein requirements.

Interesting that you should mention this because I also have diabetes and am taking medication for it as well. It's an occupational hazard I guess. I'm a teacher and one of the classes I teach is statistics. Smile.

Thank you for this very thoughtful reply. I knew in a very general sense that the answer lied in a greater BMR requirement than I was calculating but that also didn't make much sense to me. It never occurred to me that the recovery process itself would require extra energy, as many as 1,000 extra calories per day, but it makes perfect sense now that you've mentioned it. Thanks again.

I completely lost my hunger drive by the fifth day post-op. What I experience now is a sensation of emptiness, which is not the same as hunger at all. It is this empty feeling that alerts me that it is time to eat.

Honestly, I don't think you can make a proper differential diagnosis based on the personal experiences of other patients. What concerns me is that you are indicating the presence of "deep pain" while stationary. I'm not a physician but I don't think that's normal: some discomfort, minor tenderness, some residual swelling at the incision sites, yes... but "deep pain" while remaining still? You need to call your surgeon. Not that this should or will necessarily inform you about what you are experiencing but I was relatively pain free from the day of surgery while remaining stationary. The only time I felt any pain or discomfort at all was when I tried to move or get out of bed and that only lasted for four days post-op. By the fifth day, I was completely free of any discomfort. Call your doctor, just to be sure.

I am not a physician but a professor of psychology and I've spent weeks reading the literature on VSG and the recovery process. I encourage you to run all of this by your surgeon for confirmation. According to the empirical research I've read, the titanium staples are redundant after two to three weeks, maximum. On the average, slightly less than one percent of all VSG patients will experience a leak and the vast majority of leaks (5 out of 6) occur (and are detected) in two to five days following surgery. Tissue swelling recedes in three to four weeks, maximum, and, consequently, some leaks (1 out of 6) are concealed and not detected until the swelling recedes (typically around the four-week mark). You are five weeks out: You should know by now if you had a concealed leak. There would be stomach pain, possibly left shoulder pain, and very likely fever. In every documented case of post-surgical leaks I could find, the etiology was traced to the day of surgery itself, the location is commonly at the structurally vulnerable esophagogastric junction (upper part of the new stomach by the esophagus), and is rarely, if ever, attributed to poor patient compliance despite the frequent hysterical admonishments of serious injury and death you often read on these forums from those who are convinced that any post-operative diet other than the one prescribed by their particular surgeon—and only their surgeon—is dangerous and ill-advised. If you are into statistics, according to the literature, your odds of developing a leak at this point in time are (.16 [1 in 6] x .01) or .00166, which is 1.66 out of 1,000. I'm not a gambling man, but I would say you can breathe easily now. Congratulations on your excellent result.

If I had not had significant health issues such as diabetes type II, severe sleep apnea, aggravated hypertension, and poor blood circulation in my feet and hands, I would not have had this weight loss surgery. If my obesity had been strictly a matter of appearance, I would have simply continued to buy larger pants every few months or so… but it wasn’t. I knew in my heart and soul that if I didn’t do something other than diet and exercise, I would make my young wife a young widow. I didn’t think it was fair or morally correct of me to eat myself to death over the course of the next few years as both my parents had. My father and mother died at ages 62 and 61, respectively, from obesity-related illnesses and, at the rate I was going, at age 57 with a BMI of 38, I knew I was right behind them. One of the deciding factors for me was reading how much post-operative patients can actually eat one to two years after surgery. Yes, the short-term (first three months) recovery process is hell but if those patient reports are accurate, I can certainly be content on a slice-and-a-half of pizza or a 6-inch Subway sandwich in one sitting. Am I really going to feel deprived two years from now because I can “only” eat a half-foot meatball marinara sandwich instead of my previous one-footer? The answer is no, not if I’m not hungry. I’m in my third week of post-operative recovery now and am looking forward to moving past poached eggs, Laughing Cow cheese, and pureed Beans as my main source of sustenance. I am still struggling with chronic diarrhea and subsequent dehydration and I fear I may be taking Imodium for the rest of my life. Yet, honestly, the only regret I have is that I didn’t do this a year-and-a-half ago when I first ventured into the surgeon’s office for an initial consult. At that time, I was interested in the gastric band. My surgeon nixed that idea in five seconds as ineffective in the long-run and recommended either the gastric bypass or sleeve. It took me over one whole year (not to mention another episode of weight loss and regain) to wrap my head around the idea. With the 14lbs I have already lost, my sleep apnea has disappeared. I hadn't had a good night’s sleep since I lost some weight a year ago (of course, I regained all of it by this past August). Now, I am waking up refreshed and alert, and—no matter how few calories I consume on a daily basis (sometimes as few as 850 or so)—much to my amazement, I am never hungry. That alone makes this very unpleasant adjustment period worth the price of admission. Even if my stomach eventually dilates to a 16-ounce capacity in two years as my surgeon advised (and I hope to hell it doesn’t), with 85 percent of the hunger-producing hormone ghrelin gone from my body, I know that I will be able to permanently keep the damn weight off this time around with relatively little effort. Related, based on everything I’ve read, those of us who are “grazers,” i.e., perpetual “snackers”—who eat not out of hunger but as a matter of habit every time they pass a bag of chips or Cookies or whatever—have a special burden to bear and challenge to overcome. The vertical sleeve gastrectomy is not very effective in altering that behavior over the long haul, certainly not after all the swelling recedes and the stomach relaxes and dilates. If despite the initial weight loss and the future promise of freedom from chronic morbid obesity, you are still feeling “OMG, what have I done?”, you might really want to consider some form of therapy to grief and mourn your old relationship with food or, eventually, you will return to it. It's unlikely such patients will reach goal and they will very likely begin to regain some of the weight. The restrictive benefit of this surgery only seems to be significant up to one year (and less for others). Best of luck with this very unpleasant early recovery process and, hopefully, forever changing the way you think and feel about food. Okay, now it's time for my lousy plain poached egg and one wedge of Laughing Cow cheese. Yuck. Smile.