Wheetsin

Finding that hair's line between "enough" and "ouch" is an ongoing game. Sometimes "ouch" is bite #2, sometimes bite #20. Fortunatey I have different degrees of ouch, and ouch hits quickly (before I can grab another bite). I had a nice soft stop for the first few weeks but that seems to have stopped... dang it.

The stage I'm at now is cycling through the possibilities, really (more Water, more Protein, more carbs, fewer carbs, more exercise, less exercise, etc.) I just went through this a handful of years ago and it's already a drastically different experience, but I've hit hat magic (tragic) "closer to 40 than 30" milestone since then, so... My water intake generally exceeds 120 oz. I don't have many problems with water anymore, thankfully. I usually drink it plain & very cold, no flavorings or additives. I spoke with the head nutritionist about a half an hour ago and she wants me between 60 - 70gm carb per day, 80 - 100gm protein, adding in weight training (I'm mostly doing cardio), and reducing my exercise by about 300 calories' worth... take that for a week and call back if nothing changes. I also asked her to give me a breakdown of protein/carbs/fat and what percentage I should be targetting for each. She took my height, weight and average exercise & was going to look up what she felt would be an ideal ratio. I'll post it when I hear back, it's something I've been curious about for WLS for a while now.

I was sleeved on 3/27. On 4/13 I weighed 296. On 4/30 I weighed 297. On 5/15 I weighed 296. On 5/22 I weighed 297. I can throw in a few more weigh dates (I only weigh at Dr's office), but you get the idea. 8 weeks sleeved, 5.5 weeks stalled. I dont' weigh at home, but I do take measurements, and those haven't changed either. I just made my 5th call to the nutritionist and was basically told she has no idea what to tell me - she's basically out of ideas and nothing makes sense. She suggested I call one of the other nutritionists, and said "You're doing everything right. There's no reason for that much of a stall this soon. I don't know what to tell you - you're an anomaly." Last week's suggestion was to up calories specifically in the form of more carbs, and give it a week. No difference. This week's suggestion is to reduce exercise while trying to add in about 100 more calories and see if a higher net carb count makes any difference. If that doesn't work, she has no idea what to tell me other than "be patient." My patience ran out around week 5. I'm too fat for this crap. She knows I "get it" in terms of what the body is doing, and I understand how weightloss works and what stalls usually amount to, but both of us agree that this is just reaching the point of being ridiculous. Grrrrrr....

BMI calculator BMR calculator Your BMR is basal metabolic rate - how many calories you need to do nothing, and not lose weight. To your BMR you add the number of caloies you actually use up in a day through various actvities, exercise, etc. That's the number of calories you need to maintain. Subtract that from your daily caloric intake. If you end up with a positive number, you're eating more calories than you need to maintain. If you end up with a negative, you're eating fewer and will have a defecit (weightloss). You won't equal out, so don't worry about that. That's a really fundamental equation. All kinds of variables. But what it takes to gain, or not lose, depends on a lot more than your BMI and on a lot more than statistical averages like "2000 calories a day".

Is it maybe so the GI doc can see how well you tolerate the additions of the laxative/supplement? A large number of sleevers need both at some point in time post-op. If you don't think that's the case, I'm not sure what the point would be - and I'd suggest calling to ask the "what for?" question.

The two parts you posted are referring to different things, I believe.

I know this answer doesn't help, but it depends. Mostly on the hospital. Insurance companies don't really care about copays since they're between you & the physician. Your insurance company doesn't even know if you've paid the copay or not. Deductibles on the other hand... My hospital copay was due when I pre-registered. I paid it in full, but was asked to pay at least half and pay the other half prior to surgery. I don't have a deductible oran OOP maximum. Just last week I received a bill for a copay on my surgeon's fee, but the copays for all of his office visits had to be paid at the time of the visit. When we go to the ER at our local hospital, we are billed our copay about 4 weeks later. When I went to the ER where I had my surgery (since it was directly related and I figured the smarter option) a lady actually walked in after I'd been in a room about 5 mins, literally interrupted me telling the nurse what was wrong, and wanted full payment of my copay right then and there. She even had a portable payment machine strapped to her chest.

I've heard of people going to extremes -- basically insurance fraud (things like sewing weights inside of their clothes to make themselves heavier). How much can you lose and still make the BMI requirement? Maybe shoot for somewhere in between. That way you aren't sabotaging your approval, but you're also starting on weightloss. I'm glad you finally got ahold of someone who knew up from down. Just like with anything else, there are good ones & bad ones.

Pre-op or post-op? (You're post-op but asking about pre-op, so not sure which you meant). I'm trying to up carbs so starting today, actually, I added in a Pure Protein bar for lunch. 200 cals / 6g fat / 16g carb ((9g net cars) / 20g protein. I bought several individual bars, all different brands and flavors, so sample and find what I like so these aren't my staple or anything. There are higher protein & lower carb bars out there. Look at Quest brand bars if you're conscientious about carbs - they're as low as 2g net carbs (and those 2g aren't sugar carbs). I have to say the Pure Protein Bar went down nicely. I was able to eat the entire thing in about 10 mins, which is fairly unheard of.

I've never tried the unflavored nectar. I would probably use it for baking, or mix with a flavored protein, or stirred into something that has a lot of its own flavor like jello or sonething. The suggestion to use it in popsicles is good - SF koolaid makes a good popsicle base. Unflavored definitely doesn't mean flavorless, but it can be tedious to find something that the flavor (of the unflavored protein) pairs with. You could also use it in ice cream. There's not much, I don't think, that a few heaping tbls of PB2 can't mask effectively.

Agreed! Your BMR now is not what your BMR will be in a year. It's important to remember that as you lose weight, you need to eat less. So the 1200 calories you're eating now should absolutely not be 2400 calories in a year. Just my BMR now is maintenance for many others.

I'm 2 month post-op and have to really work at it to get in 700 calories (I'm trying to get in even more). I'm eating several fairly low calorie foods though. Also trying to up carbs. If you want to maintain Protein but lower carbs/fat, try eating more fish/seafood. If it weren't for sashimi I'd still be trying to force down Protein drinks all day long. Low fat cheeses also tend to have low carbs and decent protein (I use either Babybel light or Gruyere as a snack). Carbs aren't a bad thing, you just want them coming from the right sources. A good guideline: buy your food from the perimeter of the store. That's where they tend to keep the good carbs like fresh fruits, vegeatbles, dairies, etc. The center of the store is where all the crap processed foods are. It might come down to needing a separate meal from your family. For no more than we eat, it's not hard to make something on a weekend and just portion it out during the week, just in case. Some foods they want I just can't eat yet. Many I choose not to eat (e.g. I do not eat red meat). DD eats a combo of what I make for DH and what I'm having.

Thanks, all, for letting to "think out loud" - so to speak. On a brigher note, I did have an NSV today. I pooped without Miralax for the first time in about 7 weeks. Yes!

Emily - I go in for my 2 month post-op on 6/6, so it's will be more like a 10 week post-op. I'm def. going to talk to my surgeon then. I know he'll question no loss, if I still haven't had any change by then. I had full labs drawn yesterday (which was when I asked to use the scale) and he'll review those for my appt. as well. I know I'm posting my frustration, but I'm not terribly stressed. Does that make sense? I don't own a scale specifically so that I can't obsess over numbers. I think scales are usually contradictory to systemically healthy weightloss. For the first several weeks I was just like "go figure, whatever." It's nothing for me to stall for 4 or so weeks (happened all the time with my band, between very large & quick losses). And being as low carb as I was, I know that the cycle of glycogen/fluid depletion and intake was going crazy. And I can tell from my jacked up TOM that I still have weird hormonal side effects. And I know that this is exactly what my body is supposed to do. Maybe I can just try to see it as having a superior survival mechanism in the reptilian portion of my brain. Yesterday when I asked to weigh, I amost didn't. The thought I had was: Why bother? It won't be any different. That's atypical for my way of thinking, and it surprised me. I don't normally post my own issues unless it's as anecdote, I usually post in hopes of helping others/sharing info. But having thought that was a bit of a wake-up call, and what drove me to call the NUT back and try to figure out a Plan C, or D, or K...

Thanks guys! I'm trying to keep logical brain strong. I know how this works, and I know that I truly do lose in "spurts" -- but this is a really long lag so soon into it -- I think that's the crux for me. I had an 18 month stall with my lapband, AFTER losing about 175 lbs. That I get. This just pisses me off. I added in the carbs she suggested last week (she said specifically "strawberries and crackers"... she wasn't having a creative day!) - as well as almonds, cashews, BelVita crackers, ssshhh - 6 or 7 salt & vinegar Pringles - my favorite and I don't even like chips, really -- but I only had them once, and Greek yogurt with honey (hard for me to eat, thick foods don't agree with my sleeve)... the occasional half piece of toast with Breakfast, half biscuit with dinner, whatever. I did manage to get my carbs up. It had a moderate impact on my calories. I had previously been very focused on low carb since that's typically what it takes for me to lose with any consistency. I know I need more calories (this was my primary question to her today - how? I'm seriously at capacity almost all day long) but unless I switch to crappier foods, which I don't want - nor does she - it's going to be a struggle. I'm already eating 5 - 6+ small meals/snacks spread over about an hour each. My restriction is crazy at night so I pretty much stop eating around 6pm, or I have a tendency to reflux. I'm going to also try to add in another Protein drink of at least 20gm once I'm done with solid food for the day. Last time we spoke she also wanted my protein up to 70 - 80gm. I probably manage between 60 - 70 (I'd have to look at logs to know for sure). She told me that since I'm tall (5'10 female) I need more protein than their standard 65 - 70. Never heard of it being height-related, but I'm in no position to second guess, and it makes sense. I've tried a higher carb Protein Drink (the one I'm using now is zero carb) but higher carb usually = thicker which = sleeve discomfort OR a lot more volume to offset the viscosity. I told her on the phone, "I know this has to give eventually. Someome with my BMR cannot continue indefinitely on 600 calories a day or I, personally, could become the cure for world hunger... but it has been long enough and I've tried enough alternatives/variations/etc that the emotional part of my brain is starting to wander into pitfall ways of thinking like Maybe I should've had the RNY or Maybe this is just how it's going to be or -- BAH! -- logical brain needs a major break!" As for sleep I get about 7 hours. I don't have sleep apnea or anything, but I have a husband who snores loudly (and tends to punch me in the head when he turns) and a DD who has taken to waking up at 4am and laying next to my bed (door opening wakes me up, she wants me to put a blanket on her, etc.) I can try to adjust this, but 7 is a lot for me. I historically go on about 6. Good thoughts on the sleep, that hadn't occured to me but it should have. Mike - do you keep a fitday or myfitnesspal log? I'd like to see how you're spacing out/divvying up your calories. Thanks all, for your responses. I get this. I really do. But it's really starting to wear me down.

Hmmm weird. Does your surgeons do lapbands? If not, you might want to have him talk with one who does. He can advise on the portion of stomach tissue that is sewn over the band. I've never asked, but I always thought the folded part came from the region that is removed (upper/fundal area, upper greater curvature). As already mentioned, staples should also be visible through imagery. I would really think there'd be some way to at least really closely approximate their position. I mean, they don't have a hard time finding out exactly where bullets are, or shrapnel. I don't think... You don't want scar tissue joined to scar tissue, that's correct. As a bandster, you will have adhesions. Generally part of the revision is to address the adhesions. Whether the staples were removed or not, you'd still have adhesions there, so to my not-a-surgeon logic, is makes sense that the staples should make it easier, if anything (because they can be more readily seen/located). It's not like pulling the staples out is what will cause your scar tissue (at least not the vast majority of it) - it's already there. Might want to call your band surgeon and ask why those staples were never removed if it was going to create such an unknown down the road, as well. I think more questions all-around are warranted.

There are always exceptions, but generally yes - your propensity for stretchmarks impacts your skin's ability to "bounce back." Stretchmarks indicate a lot of things, but chief among them are 1) the rate at which your weight was gained and 2) your skin's inherent ability to accomodate distortion. 1) Rate of gain isn't so much of a factor with skin (think pregnant women), but how much gained (small amounts rarely leave stretchmarks) is, as is the amount of time the distortion occured (some pregnant women's saving grace). 2) Some skin is more elastic than others. True for you vs. someone else, but also true for some parts of you vs. other parts (I have stretchmarks on the tops of my shoulders, which aren't THAT big, but none on my thighs, which are huge). If you have stretchmarks, and are "only" around the 100 lb range to lose, your skin is not the most elastic skin. Especially if you have stretchmarks in more unusual places (I've seen ankles with stretchmarks, elbows, etc.) Elasticity can also have a large genetic influence, so consider your parents' skin (if they are/were overweight). But skin is a systemic organ, so everything from age to lifestyle to genetics to your personal obesity is going to play a role in the condition of your skin when weight is lost.

Completely depends on the PsyD and program. Most likely, a little "chat" followed by a standardized test (or multiple tests), and a follow-up visit to discuss results. At least 1 follow-up. My PsyD likes to see people pre-op twice (test, results), 1 month after (see how things are going), and then every 6 months just for mental maintenance.

Hmm...surgery 5/17, so it's right about time for the fatigue to hit, and it hits pretty hard. Not sure about the psychological stuff - it all sounds pretty normal considering. If you woke up thinking about blood clots, perhaps you'd had a dream about them that carried over momentarily, or it's something you've been concerned with and perhaps shoving onto the mental back burner. Tell me how you feel about your mother... I think everyone newly post-op kinda freaks the first few times they can hold more of something than they expect to. You can't break your sleeve, but you will have times when you can hold more, and times when you can hold less. For me this depends a bit on time of day (I have a lot more restriction at night), and also on what you're putting in it. And whether or not your stomach is contracting normally, and... so on. Tea, even green tea, is a diuretic. This might've contributed to feeling dehydrated. You also could've just had a "thirsty" day. You're a little dehydrated before you feel it. When you feel it is when your body's already reacting to more Water loss than it wants to have. My house has three stories, two that we use most of the time. No joke, after the fatigue hit me (right around the end of week 1) I could barely make it up the stairs without having to stop and rest. (Moral of the story, I'd avoid going out because being able to shower or change meant going either up or down a flight of stairs and I just couldn't stand the thought.) I'd trudge into the bedroom and sit on the bed for a few minutes before getting in the shower. About halfway through my shower, or any time I'd bend down at the waist, I'd feel a bit light-headed and fatigued all over again. I actually had to sit down during the shower - thank goodness I have a large shower with a bench built into it, or it wouldn't have been pretty (I'm sure it still wasn't anyway). I'd get out, wrap up in towels, and have to sit down again. And so on. Mad fatigue. Lasted a good 3 weeks... lightened gradually over a week. Right around the 4th - 5th week I felt back to myself.

BCBS is pretty good about clearing up confusion. It just may take a few calls to get someone who knows head from arse. I have Anthem BCBS CA but I was a revision so my 6 month diet was waived. Never had to deal with that. Normally your surgeon's office advocates for you, gets your requirements, and can answer questions but they can also misinterpret. I've seen it several times. You might want to take (if you haven't already) a copy of your requirements to your PCP and let them read for themselves what's required. If they haven't worked with a WLS patient in the pre-op stage before, they may truly just have zero clue what's what. Be diligent, and keep posting any questions you have. There are a few of us around who have good "insider info" on the workings of insurance companies, who will be happy to help as much as we can.

The generic purpose of the pre-op diet is to deplete the liver of sugar stores (glycogen) and indirectly the fluids it takes to store those sugars, which are significant. Together, in MO patients, that can easily exceed 20 - 30 lbs. If you've ever started a low carb diet and just lost oodles of weight in the first week or two, the depletion of these stores is the majority of what you're seeing. There's a lot of debate, even in the medical world, about the necessity of shrinking the liver. On one side, why not shrink it just to have as much access as possible. On the other side, if you're a skilled surgeon retraction should be enough. I've heard both sides and tend to favor the former. If you can, why not. liquid pre-op diets specifically have some added benefits. But they, too, are almost always low-to-no sugar.

I had to go in today for my 2 month post-op labs so I asked to use the scale while I was there. Guess what? I weighed 11 oz less than I did 5 weeks ago. This was also at 2pm and I'd been fasting since 9 the previous night, so those silly 11 oz weren't really a loss. Not that 11 oz would be a loss anyway. So I'm still good and stalled. Heading into 6 weeks stalled... and 9 weeks sleeved. I have patience, but this is really, really getting ridiculous.

I got either plan or lemon (really it didn't make any difference) and drank it warm. Later found out it's supposed to be better cold. I can't imagine anything really making much difference. It tasted like very salty, sour, very bitter, boiled eggs. It was really in the "horrible" category. I ended up plugging my nose and chugging it, then walking around the house until the nausea subsided. The taste really REALLY stays with you for a while. If it makes you burp, you'll taste it again. And when it finally works, normally what comes out smells exactly like how it tastes. BTW, there's no guarantee on when this stuff starts working. I was supposed to take mine before 4, which I did -- and it didn't kick in until about 6am the next morning as I was trying to get ready to head to the hospital. The entire time I was getting prepped I was running back and forth to the bathroom.

Search for "not losing" or something similar. You will see countless explanations of what's going on. This topic comes up several times a day and many good explanations (both summary and detail) have been provided. Freshly post-op you're probably dehydrated, and even very mild dehydration will cause headaches. Most people don't realize that when they take Tylenol, often it's the glass of Water that does more good.

I think your skin looks great. It looks pretty normal, except when you're smooshing it up. There's a "look" that a lot of WLS patients have when dressed. E.g. you can normally see a flattened pannus in their small size pants. You don't look like you'd have any of that.