Mason

The quality of pre- and post-operative care where I am currently living and working is not what it is in the Western world. I have received lots of contradictory information. Consequently, I am working with a physician friend of mine back in the States. I used to lift weights, as recently as eight years ago, so I am very sensitive to and aware of minimum Protein needs: I do not want to burn one ounce of muscle during this early recovery process. I am not nearly as concerned about daily caloric intake as I am with meeting minimum protein needs, no less than 56g per day especially at my weight. On the other hand, I don't want to try to function with anything more than a 1,000-calorie deficit per day if I can avoid it. Admittedly, it's not easy. I have always had a very sensitive stomach. We think that my digestive system is trying to adjust to the radical change in gastric fluids and chemistry. Doctor prescribed Imodium for it and it is easing up a bit. As for the Water weight, I gained about 4lbs from the saline/dextrose solution, which passed within 24 hours upon my return home, i.e., my post-operative weight returned to my preoperative weight within a day or so after discharge. I dropped a total of 7lbs within 48 hours after discharge and half of that was water. The remaining six pounds, at least according to my BMI/lean mass scale, is real fat loss. Thanks for the concern.

I also have the same concern that I'm losing too quickly. My surgery was on Thursday, December 13 and I returned home on Saturday, December 15. My weight Saturday evening was 239.9lbs. My weight this morning, December 28, was 227.1lbs for a net loss of nearly 13lbs or 18.5 percent of my excess weight (70lbs). I think that's a very rapid weight loss and I'm now very concerned about ending up with loose skin. I'm dong my best to consume enough calories to meet my BMR and I'm getting in all my Protein. What's strange to me is that even at 1290 calories per day, a goal I am having trouble meeting on liquids and soft solids alone, I should be losing an average of 2lbs a week, not an average of 1lb per day! I assume part of that total loss is Water weight but still. I'm guessing (hoping) that my weight loss will "even out" over time, especially when I move to higher density foods. I really do not want to lose more than 2lbs a week. Dehydration and hypotension have been major issues for me since returning home because of the rapid weight loss and diarrhea (which, unfortunately, I still have).

The only thing I am trying to encourage fellow forum members to do is provide external citations and authoritative evidence for their assertions instead of relying on personal experience and anecdotal evidence as some type of proof... without much success it appears. By any chance, do you have any external references that document the percentage of post-VSG patients who have experienced post surgical leaks "weeks" and even "nine months" after surgery? The longest post-surgical leak case I could find in the literature is 35 days post op and it is extremely rare (.16 x .01). As a matter of intellectual curiosity, I have compared VSG post-op progressive diet plans across three different continents. The longest duration of any such plan is three months. If, in fact, it is true that one isolated patient had died from a VSG-related leak nine months after surgery, certainly, it could not be reasonably argued that the belated leak was associated with poor patient compliance but with a residual mechanical or structural failure of the surgery itself. Related, I'd be particularly interested in any research literature you have that documents a statistical association between poor patient compliance and post surgical leak rates and death (i.e., "putting food in your mouth that you are told not to can lead to death"), especially after 21 days post-op when the staples themselves are redundant. I can't find even one case that links poor patient compliance with leak rates and death and I've searched our university's Dialog Database Service several times. Exactly. VSG patients need to be properly informed so that they can understand what's involved in their recovery. Proper patient compliance is enhanced by providing valid information, not by using ridiculous scare tactics. Guilt and unfounded fear are not effective motivators yet they are frequently used on these forums. And you're still alive to write about it!? Imagine that!

Try not to be scared. Post-surgical leaking at the staple line, although a very serious complication, is relatively rare in that it occurs in less than one percent of all cases (approximately .9 percent). When it does occur, in almost every case, it typically occurs within 2 to 7 days after surgery and it's not related to poor patient compliance but, in five out of six cases, to an inherent physiological weakness at the esophagogastric junction (the top of stomach just below where the esophagus meets the new stomach) due to high intragastric pressure caused by impaired peristaltic activity. This is why it is so important to keep the new stomach as well hydrated as you possibly can. Try to drink four to six ounces of Water or sport's drink every hour if you can. If the intraoperative blue methylene test was negative and you don't spring a leak in the first week following surgery, you really shouldn't worry about doing so from that point forward. The new stomach will continue to heal for weeks to come so proper nutrition, especially meeting minimum Protein requirements and keeping the new stomach walls well hydrated are critically important. Whether you "cheat" with a piece of pepperoni on day 11 or eat a piece of Tilapia instead of a piece of shell fish at the beginning of week four is not nearly as important as meeting your daily BMR caloric intake and nutritional requirements. If you eat the "wrong" food (given where you are in your recovery process), eat too quickly, or too much, you'll simply regurgitate the food into your mouth like a cow. For personal reassurance, take a look at this article: Nonsurgical Treatment of Staple Line Leaks after Laparoscopic Sleeve Gastrectomy. You can jump straight down to the discussion section.

I suspect there are as many different "food issues" on these forums as there are members. One person's safe and routine manner of eating can conceivably be another one's downfall. We need to be very careful about generalizing personal experience and biases to others when posting here. Members of Overeaters Anonymous will admonish against the use of sugar, wheat (flour), and alcohol, while lifelong members of, for example, Weight Watchers will espouse the importance of moderation and a well-balanced diet including the use of alcohol and wheat-based foods. In addition and, for example, those with a starting BMI of 50 are going to face different ongoing post-operative food issues than those with a starting BMI of 35. When it comes to the vertical sleeve gastrectomy, subsequent weight loss, and weight loss maintenance, one size most definitely does not fit all. Aside from individual patient differences, everyone's surgeon seems to have different ideas about both pre- and post-operative diets. My surgeon, for example, did not require me to lose weight or go on a liquid diet before the surgery. I underwent the procedure on Thursday, December 13th and, on day 9, he instructed me to move to soft solid foods due to chronic diarrhea and a day-5 readmission to the hospital for dehydration and hypotension. Of course, my surgeon also sutures the new pouch after stapling it with self-absorbing stitches to further protect his patients from themselves. When asked, he replied that he had absolutely no concern that I might spring a leak on day nine by eating a piece of feta cheese or poached egg. According to the research literature, in the vast majority of patients, the new stomach is completely sealed by day 14. In a very small percentage of patients, that seal could take as long as 21 days to permanently set. That means that in 100 percent of all VSG patients, the staples are serving no practical purpose after day 21 and, for most patients, after day 14. The goal of the post-operative diet progression is to slowly introduce foods of increasing density as molecular density is directly related to stomach contractions. That is, most of us are restricted to a clear liquid diet for the first 14 days in order to avoid any stomach contractions while the new stomach is still adhering to itself. What would happen if you tried to eat a 3oz piece of Ribeye steak on day 22? Due to the relative high density of that particular cut of meat and the fact that your stomach will still be swollen, you will most likely feel very uncomfortable and then end up "coughing up" everything you had just eaten. Chances are you won't try that again until the second or third month when all the swelling is gone. As for "damages," those would be limited to whatever you paid for that Ribeye steak you just threw up. Pressure and discomfort notwithstanding, you would not have hurt your new pouch at all, not by the end of week three. Writing entirely for myself, I didn't undergo the vertical sleeve gastrectomy so that I could live on low-fat cottage cheese, plain poached eggs, and liquid Protein drinks for the rest of my life. I most definitely plan on eventually eating pepperoni pizza, hamburgers, and everything else I used to eat before the surgery with the one and only exception of carbonated beverages. Of course, the portions will be quite smaller than they used to be, which is why I'll lose the weight I need to and then keep it off. I didn't become obese by eating one gingerbread man or drinking one small cup of eggnog at a Christmas party. By the way, the Withings Wifi Body scale has been a very useful tool in helping me monitor not only weight loss but relative lean vs fat body mass. It's important to make sure we're not losing muscle but only fat. Meeting our daily minimum protein requirement is very important. The scale also links directly to the MyFitnessPal.com account. Best of luck to all the relatively new sleevers!

According to your profile, you are more than two years out, 11lbs under goal with a current BMI of 22.4. Fantastic! That is wonderful. I am genuinely happy for you. In what I'm guessing is not a coincidence, as it is predicted by the literature, your starting BMI was just under the 45 mark. If I may ask, how deliberately or consciously are you monitoring your food intake? Is your fantastic weight loss and maintenance success mostly the result of being more active or are you consciously limiting your caloric intake on a daily basis? Congratulations again.

Especially with something as personal and emotionally charged as morbid obesity and postsurgical weight loss, there's always an understandable tendency to over-identify and generalize based on personal experience. This is why I've been reading as many scientific journal articles as I can find in the university library about the long-term effects of the laparoscopic sleeve gastrectomy. I really want to know what I can expect based not only on the wonderful anecdotal evidence I have gleaned from these forums but, perhaps more so, on the professional literature. There are considerably more research studies on the long-term postoperative effects of RNY than VSG simply because the former has been used as a standalone procedure for many more years. Much to my surprise, the 2-year postoperative weight loss effects of VSG are statistically better than the 5-year follow-up statistics associated with RNY: One study reports a weight regain rate of 50% after five years with gastric bypass (see Magro, Geloneze & Delfini, et al., 2008), while several studies repeatedly cite a 24-month weight regain rate of no more than 20 percent with sleeve gastrectomy (Bohdjalian, Langer & Shakeri-Leidenmühler, et al., 2010; Gumbs, Gagner, & Dakin, et al., 2007). According to researchers Baltasar, Serra, & Pérez, there is a positive correlation between starting BMI and likelihood of long-term regain, i.e., those with BMIs over 45 at the time of surgery are overrepresented in the 20 percent of 2-year postoperative VSG patients who regain weight from the nadir, i.e., the lowest postsurgical weight-loss point, (2007, p. 1125). As is true with any Internet forum, there is always the question regarding whether people who frequent digital forums are truly representative of the larger population in question. In other words, are forum members who post regularly on Vertical Sleeve Talk representative of your typical VSG patient in the world today? That's a very hard question to answer and social psychologists who study Internet behavior, particularly Internet addiction, have been arguing this point back-and-forth for years. Computers and Internet access are certainly far more common and available today than they ever have been and it's fair to assume that anyone who can afford to pay for elective surgery can also afford to own a computer and an Internet modem. However, it can also be argued, for example, that those who frequent Internet forums are--on the average--generally more sedentary than those who don't and, consequently, are more likely to gain weight in general and, in particular, after weight loss surgery. Nevertheless, if we can agree--for the sake of this discussion--that Vertical Sleeve Talk members are truly representative of all VSG patients in the world today and if the research literature I have read (not to mention the information provided to me by my own surgeon) is reliable then--in reality--approximately 80 percent of those who posted on these forums--at one time or another--and have received the surgery have kept the weight off since reaching goal. My one major criticism of the research articles I have read (and those included below are only a small representative sample) is that--with the one exception of starting BMI--they don't identify those variables that are associated with long-term success or failure. That's why I think it would really be nice to hear from forum members who have reached goal and kept the weigh off after the two-year postsurgical mark. At any rate, psychosocial factors associated with postsurgical long-term success (and failure) really do need to be explored in the professional literature. Notes Baltasar, A., Serra, C., Pérez, N., Bou, R., Bengochea, M. & Ferri, L. (2005). Laparoscopic Sleeve Gastrectomy: A Multi-purpose Bariatric Operation. Obesity Surgery, Vol. 15., pp. 1124-1128 Bohdjalian, A., Langer, F.B., Shakeri-Leidenmühler, S., Gfrerer, L. , Ludvik, B. & Johannes Zacherl & Gerhard Prager (2010). Sleeve Gastrectomy as Sole and Definitive Bariatric Procedure: 5-Year Results for Weight Loss and Ghrelin. Obesity Surgery, Vol. 20, pp. 535–540 Gumbs, A.A., Gagner, M., Dakin, G., & Pomp, A. (2007). Sleeve Gastrectomy for Morbid Obesity. Obesity Surgery, Vol. 17, pp. 962-969 Magro, D.O., Geloneze, B. Delfini. R, Pareja. B.C., Callejas, R. & Pareja, J.C. (2008). Long-term Weight Regain after Gastric Bypass: A 5-year Prospective Study. Obesity Surgery, Vol. 18, pp. 648–651

Thank you Linda for answering the questionnaire. Your responses were very helpful and their similarity to Cheri's lends additional support to the points being made on this thread. You are 100 percent correct about this but, let's face it, this is a lot easier said than done. For many Euro-Americans, including myself, food has become symbolically fused with love (and in many dysfunctional families, it was a substitute for love). Related, the number one social activity that my wife and I engage in as a couple is using the 2-for-1 coupons in our Entertainment book to try new buffet restaurants! Obviously, we're going to have to find something else to do together besides dining out. Maybe I'll take up bowling again. Smile. For those who are not put off or angered by Freudian psychology, there is an excellent book written by a psychoanalyst, Judith Viorst, called Necessary Loses. The entire premise of this book is that in order to grow as mature adults we do need to come to terms with letting go of the past. I am rereading the book as one way of mentally preparing myself for surgery as I know the sleeve will change my relationship with food forever. I think you were very fortunate to have such a honest and caring surgeon. I consulted with three surgeons in 16 months and not one said a word about long-term postsurgical dieting and nutrition--not a single word. They don't want to discourage any patient from signing up so the more mercenary physicians do present the VSG as a final solution to yo-yo dieting and that's a terrible disservice to their patients. I'm very grateful to the OP for starting this thread because it has led to some very stark and necessary "mental realigning" for me.

A tremendously big thank you to the "old-timers" who shared their bi- and triennial experiences with the sleeve: Cheri, Susan, and Coops! Cheri and others have also been very generous with their time via personal messages. The end result of all this great anecdotal evidence for me has been reassurance and relief. I have never been a between-meal grazer and I don't anticipate becoming one after surgery: my problem has always been portion control, overeating simply because everything tastes so good. From what many of you have told me, the sleeve is an excellent solution for this kind of problem eating. It's considerably easier to eat less when you don't have the hunger-producing hormone ghrelin coursing through your bloodstream and your new stomach's capacity is 4 to 8 ounces. I think the more realistic one's expectations are about the long-term effects of the surgery, the more successful one is likely to be. It is very revealing to me that not one of the three surgeons I consulted ever mentioned the long-term need to monitor food intake years after the surgery. They sell the procedure by showing you a chart of how much weight you can expect to lose the first three to six months with the unspoken inference that the future will just take care of itself. Unfortunately, it doesn't really work that way. As I have shared with others via PM, I don't mind the idea of having to be on, for example, Weight Watchers for the rest of my life just as long as I get results. My last time on the program, from June 2011 to January 2012, I followed the program religiously and walked virtually everyday on the treadmill for at least 30 minutes. With all of that, I lost only an average of just under one pound (.5kg) per week. My doctor was thrilled with that consistent and moderate loss but, from my perspective, it was very slow going. I worked my rear-end off (having gone to sleep with hunger pains on more nights than not) for eight months to have lost only 26lbs or so. Then, in January 2012, I had complications from eye surgery and was visually impaired for 10 solid weeks (I could read a report by holding it up to my face but I couldn't watch TV, I couldn't drive, and I couldn't make out the faces of people around me). Within three brief months after my eye surgery, I had gained back half the weight I had just worked my butt off to lose. It was at that point that I privately conceded to myself that I needed more than just dieting and exercise. I will have my surgery in 11 days and I believe I am ready physiologically, mentally, and emotionally. The surgery won't be an end-all, cure-all but it will make it a lot easier for me to follow a program like Weight Watchers without having to grit my teeth and bear down every night from hunger pains. The absolute to relative loss of the hunger drive alone will make the surgery worth it to me. For those who are still struggling, maybe you need to thoroughly mourn--in the true psychological sense of that word--before you can successfully move on. According to Elisabeth Kübler-Ross, there are five stages of grief: denial, anger, bargaining, depression, and, finally, acceptance. Conduct an Internet search on Kübler-Ross, take a look at the definition of each of the five stages and it won't be difficult for you to immediately recognize the applicability of each stage to yourself in the context of how one's postsurgical expectations regarding the sleeve can be feeding (pun intended) denial, anger, and depression. Writing entirely for myself, if I secretly hoped or believed that paying someone thousands of dollars to remove 85 percent of my stomach would be the end of all my food problems for life and it didn't turn out that way, I would definitely feel cheated and I would be angry as hell. Knowing myself the way that I do, I would continue to bargain with myself every day in regard to what I should or shouldn't be eating and I would be wrestling with anger and depression until I finally came to terms with the fact that I will never be able to eat the way that I want to and stay thin at the same time. That is a painfully difficult realization to accept yet it's absolutely essential for maintaining weight loss, even after the sleeve. Of course, the good news is that with a new stomach that is only 15 percent of what it had been prior to surgery, it is going to be a lot easier to lose the weight I need to and to keep it off once I allow myself to mourn what I'll never be able to do. In fact, that's really how I've been preparing myself emotionally for this surgery. I have been actively grieving and mourning my old relationship with food to the point of tears. I won't lie and write that I am not going to miss eating food the way that I had for 58 years. Of course I will, I know that. However, I have gradually come to accept that I will not live to be 60 unless I make some very dramatic changes. My father and mother died at ages 62 and 61, respectively, from obesity-related cardiovascular disease and I don't want to join them, at least not for the next 30 years or so. I have a lot to live for. Thanks again to everyone and wishing those who are still struggling a speedy recovery.

Based on several recommendations, I stocked up on unjury chicken Soup for my upcoming surgery. I haven't tasted it yet (I'm saving it) but I am told it is fantastic. If you're in the States, I'm sure they can get it to you in a day or two.

One of the "limitations" of these forums for me is the terribly skewed selection bias in active membership. The most active members are preoperative and relatively recent postsurgical patients. Postoperative members hang around just long enough to report their continued weight loss and, then, after a year or so—especially if they are successful at keeping the weight off—fade away into the sunset. For the most part, active members with more than two years after surgery are still struggling, which is why they are still posting (staff notwithstanding). The other problem is one of equivalence. The vertical sleeve gastrectomy as a standalone procedure is only a few years old and the procedure has been modified even within the past year (essentially, they are removing more of the stomach body now than they used to when it was the first stage of a two-stage procedure ending in RNY). I’m guessing that three- and four-year postsurgical patients, who have had less stomach body removed, find it easier to gain weight as their sleeves are bigger and a small part of the fundus is still intact (they would still feel some hunger pains although not as intensely as before the surgery). We really need to hear from two- to three-year post-surgical patients who have been able to successfully maintain their weight loss. Specifically, I would really like to know: What contributing role would you say your sleeve (reduced stomach) plays in your ability to successfully maintain the weight loss (e.g., 25, 50, 75, 90 percent)? Related, how much conscious effort does your continued weight loss require? That is, must you deliberately monitor your food intake on a daily basis or does the restriction of the sleeve necessarily limit how much you can eat so that maintenance is relatively effortless? How has your relationship with food changed, if at all? Related, do you still enjoy eating or, currently, is food just something you must consume to sustain life? Compared to the type of hunger pains you had experienced pre-surgically, while on a calorie-restricted diet, how would you rate the degree and quality of your hunger pains now after the surgery? That is, do you still feel hunger pains and, if so, how is your hunger drive different now than it was before the surgery? It occurs to me as I write this post that not one of the three surgeons I consulted with over the past 16 months had ever addressed any of these very critical issues with me. I’m guessing the reason for that is they simply don’t know the answers because they—at least the surgeons here in the UAE—don’t follow their patients beyond the three-month mark. In fact, I think I will be approaching my surgeon after the procedure about collaborating on a research study of the qualitative and quantitative psychological and physiological changes experienced by VSG patients. These data would be far more useful to prospective patients than just knowing the surgeon’s fatality and leak rates. I am not undergoing the expense and difficult postoperative recovery and effort involved in this surgery just to say “Hey, guess what guys, I’m wearing a 32-inch waist pants again!” only to be back in my 44-inch pants two years later. I (we) really need to know what’s involved in long-term recovery and, specifically, what has changed (and why) for the 80 percent of all WLS patients who keep the weight off. After all, that and that alone is the reason I am going to pay a surgeon to remove about 85 percent of my stomach in less than two weeks. If this was just about weight loss, I wouldn't need the surgery. I've lost well over 300lbs since I was 12-years-old (over six distinct dieting episodes). I can definitely lose weight without surgery, no problem. I just can't keep it off for more than a year or two at a time and I'm getting too damn old and sick to continue this cycle of yo-yo dieting any longer. Not everyone on these forums has gained weight in the same way, for the same reasons (before or after surgery). Some suffer from eating disorders such as bulimia and are binge eaters. Some are “emotional eaters” and will knock down a quart of Ben and Jerry’s after a particularly frustrating day. Others, like myself, regain the weight back over time due to consistent overeating during normal meal times, that is, we eat more than we should at each sitting simply because it tastes so damn good. For those with more than two years out who have generously and courageously shared that they are regaining weight, I would encourage you to specifically explain exactly what it is you are doing to regain that weight, i.e., how often and how much are you eating in one day? In this way, in addition to being enlightening and putting preoperative members on notice that it is possible to regain weight after being sleeved, the post would also be instructive in advising whether this issue is applicable to the reader. For example, if someone writes "I'm regaining weight because I'm consuming 3ozs of leftover Halloween candy corn every 60 minutes, 10 times a day, to the exclusion of my Protein, I am personally not going to take this warning to heart because I have never engaged in that pattern of overeating whereas other members might be able to identify with that and learn from it.

Success after surgery is most definitely a matter of changing one's relationship with food: It's a "head job." According to this BMR calculator, when and if I reach my goal weight of 170lbs (a weight I haven't seen since my late 20s), assuming I remain relatively sedentary, I will need no more than 1879 calories per day to maintain that body weight (by the way, the BMR requirement drops down more than 1000 calories to 1708 for a woman who is 5',5" at 150lbs). If I am accurately reading between the lines of what people are writing on these forums, it appears that it is not difficult to consume far more than 1800 calories per day after the two year post-op mark. This is precisely why the surgery is not a cure for obesity. I'm guessing that it's a lot easier to limit oneself to 1879 calories per day when your stomach has been reduced to 15 to 20 percent of what it had been before surgery especially when you consider that the ghrelin-producing fundus has been removed but, obviously, it's not fool-proof or the long-term success rate would be 100 percent instead of eighty. My best friend's uncle is six months out after a gastric band to VSG "conversion." He had successfully lost all the excess weight with the band but knew he would gain it back without the VSG. He has now fallen below goal and, in order to work on his head, is attending both Weight Watcher and OA meetings every week for support. Eighteen months from now, I'm betting that Uncle Tony is going to be contributing to the 80% side of the equation because he's working on his head (only six months out) instead of using (abusing?) the surgery as just a temporary obstacle to eating the way he used to. Good for him. I'm thinking that those of us who have undergone the surgery in the UAE should consider starting some sort of self-help support group where we can start working on our heads before that "golden period" expires. A few weeks post-op, I'll be contacting Smoggy and DesertMom to brainstorm about this.

This thread has been particularly enlightening to me. It appears that I have anywhere from 12 to 18 months (maybe a little longer) after surgery to redefine my relationship with food so that I view it as nothing more than sustenance. If, instead, I primarily regard and use that "golden period" as just a temporary obstacle to eating the way I used to eat preoperatively, I will most likely not reach goal and/or will very likely start gaining back what I had lost as do 20 percent of all VSG patients (as advised by my surgeon). If, after six months post-op, I see that I am still thinking about food in the same way I do now, then I will know that I need to seek professional help before my new pouch is able to accommodate 1000 calories in a single sitting. It would be nice to hear from post-operative VSG patients who are more than two years out and are either at or below their desired weight. I'd be very interested to know specifically what they attribute their success to, i.e., how their relationship with food has changed as a direct result of the surgery.

Hi Nikki, Thank you so much for sharing this. It was very helpful to me. I have always eaten food for the taste of it, not to satisfy hunger. Consequently, I have consistently overeaten my entire life. I believe that you are entirely right in that unless I establish an entirely different relationship with food after the surgery than I have now, I will eventually gain the weight back: According to what my surgeon told me, 20 percent of all bariatric surgery patients do. The fact that you are able to identify your food issues has to be 90 percent of the battle. Keep at it and treat this slight detour as a warning sign instead of a failure. I'm rooting for you. Just get back on track. Thanks again for sharing. I took everything you wrote to heart and will take heed.

Same here. I was told to stop eating 12 hours before surgery and to stop drinking six hours after that. When I specifically asked if I should try to lose weight before the operation, the surgeon answered "Why? That won't help me." He then leaned across his desk, poked his forefinger and middle fingers into my stomach and pronounced "I have plenty of room to work here!" Prior to scheduling with this particular surgeon, I had consulted with another surgeon who required a two-day preoperative diet (Clear Liquids only). To be perfectly frank about it, my decision to switch surgeons was in great part influenced by the fact that the second surgeon did not require a preoperative diet (that and the fact that he makes only three incisions, inserts only one drain tube, and sutures the new pouch after stapling it). A 28-day preoperative diet? Wow, that seems quite excessive to me. If I could stick to a liquid Protein diet for 28 days, I wouldn't need bariatric surgery.

Am scheduled for surgery on December 13 with Dr. Al Taie (decided to change surgeons after meeting with Smoggy and, then, consulting with him directly. Three incisions and one drain tube are a lot better than five and two respectively, and, besides, he doesn't require a preoperative diet ). Congratulations on the continued weight loss Smoggy. I thought you looked great when we met three weeks ago.

I think most people--especially and paradoxically those who have struggled with yo-yo dieting their entire adult lives--are very critical of those of us who undergo bariatric surgery. The psychological knee-jerk reaction is to view it as a desperate and drastic act of self-mutilation in which praise for the dieter's improved appearance is subjugated to this (usually) unspoken concern that the weight was lost under very unhealthy or unpleasant circumstances. Viewed in this way, you would no more congratulate a patient of VSG for losing weight than you would someone who had lost a significant amount of weight from, for example, complicated bereavement or cancer. For this reason, I have no intentions of telling anyone at work. I'm already sorry that I mentioned it to my first cousin who just replied that she and her husband strongly concur that I should see a psychologist before agreeing to have a good part of my stomach removed. In other words, "You've got to be out of your mind." It is not a coincidence that--like me--my cousin has also struggled with yo-yo dieting her entire life. Mum's the word.

Thank you DesertMom for your kind reply. It's good to know I was given a fair price. I’m always concerned about receiving an expat surcharge. I think laparoscopic surgeons in the UAE are sensitive to the fact that the fee for this procedure is dropping in the United States and, of course, one can have it done for less than $5,000 just south of the Texas border. My biggest concern now is with Asia’s severe phobia of opiates in regard to pain management. I went to the dentist last month at Al Noor Hospital with an abscessed wisdom tooth. My jaw was swollen to twice its normal size. The earliest appointment he could give me was 17 days away. His solution for my pain was Ibuprofen and Panadol. I almost fell off my chair in disbelief! Fortunately, I had some Percocet (5mg tabs Oxycodone) left over from another extraction I had performed in the States two months earlier. I discussed this concern with my surgeon. They use an IV-drip of a synthetic opiate for pain relief called Tramadol (better known as Ultram in the States), which is considered less potent than Tylenol #3 (with codeine). He claims that this solution will be more than sufficient to manage the post-operative pain. I hope he’s right. Thanks again!

Hi Everyone, I am currently living and working in Abu Dhabi and am giving very serious thought to having the VSG performed in a couple of months. I was given the name of a surgeon in Dubai by my internist and had a consultation with him yesterday. He is asking 40,000 dirham ($10,483) for "everything" (meaning surgery, anesthesia, two-night stay in hospital, and one-week follow-up). The subsequent three-month follow-ups are not included but will probably be covered by my insurance. I would be very interested in learning what other people have paid in the UAE, particularly in Abu Dhabi, and good experiences others have had with surgeons here. Thanks so much.