theantichick

No but it can reduce inflammation

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They are on the same spectrum, but are not the same thing. Generally speaking, if your pancreas still makes insulin you don't have to worry about DKA. There can always be exceptions, so talk to your doc if you're worried about it.

Until the stomach is healed, oral steroids or NSAIDs can irritate the healing tissue. At any time, NSAIDs or steroids regardless of how they're taken (pills or shots) can increase the risk of ulcers because of how they affect something called prostaglandins. All of my specialists including my WLS surgeon agreed that because of my auto-immune arthritis I will need to occasionally take NSAIDs and steroids, and we try to protect my stomach with a PPI (omeprazole). The risk isn't completely eliminated, so I will have to keep an eye out for symptoms of ulcers.

I'm happy to report the guy who is my trainer is awesome. He's worked with WLS patients before. And while he hasn't had anyone with auto-immune, he understands the need to progress very slowly. I'm glad I didn't cancel tonight, I actually started feeling a little better after getting myself moving and am glad I met up with him.

I am a certified personal trainer, and I completely agree with you. It upsets me when "professionals" step outside their scope of practice like that. I also have strong feelings toward Planet Fitness that I will spare you, lol.

The problem with personal trainers is that their certifications run the gamut from organizations like AFAA and ACE, which are extensive and comprehensive programs, to weekend certifications that allow anybody with a credit card to become a trainer. But please believe that some of us do understand what you are going through, and that we are not all meathead idiots. I promise.

The guy I actually worked out with was great, and wasn't overbearing or an idiot. It was the VP who was annoying me. I'll meet the trainer I'll actually be working with tomorrow evening. I don't have a problem standing up for myself. I admit I'm not knowledgeable about how to design an exercise program, so will use people with more training and experience than I have. But I'll stand up for myself there too. I overdid it yesterday. Muscles aren't too sore though my abdominal muscles are NOT HAPPY. But with the auto-immune, I have to watch my overall energy/fatigue as well. I have to increase my intensity/length of workouts very slowly or I'll get an auto-immune flare that can really cause a problem with ongoing activity. we'll see if my regular trainer has experience with clients who have similar issues, and if not, he's in for some education.

So what is your explanation for someone eating 600 calories a day and working out and not losing for between 1 and 3 weeks? I would tend to agree that there's an upper limit (or lower limit depending on your perspective) for how far AT can modify metabolism.

I have lots of reasons I think having someone 6 weeks out from surgery eating under 800 cal a day and asking them to work out is nuts that don't have to do with AT.

However, I am in contact with several people who are saying they are eating 600 cal a day and working out 3x or more a week and haven't lost in 1-2 weeks. It doesn't seem medically possible I agree. However, short of assuming their reporting is inaccurate, I don't have an explanation.

However, the literature related to anorexics indicates that the body adjusts to these very low levels of intake and weight loss slows significantly, prompting the patient to further restrict because they feel they will start gaining weight if they don't.

I joined Planet Fitness and sat down with the "personal trainer" there. I started off telling him that I've had the sleeve done and just need to know the following things so I don't end up passed out on their floor:

Weights

Reps

Sets

As long as I'm given a routine to do with that information, I can do it.

After explaining what the surgery is and how I have to eat now he gasped and told me I HAVE to have carbs! (Had told him Protein first then if I have the room veggies and fruits). I explained this is the diet given to me by my surgical team and that's how I'll eat. He proceeds to tell me I need to go to some government website about nutrition to find out how I should be eating and how many calories. I looked at him and asked "Did you not just hear what I said?" He shrugged his shoulders and told me that maybe I'd find some other ideas.

When it came to the exercise portion he wrote down what muscle group I should be working on each day. For Tuesday it was Legs/Bottom (I'll get to this in a minute). He then proceeds to tell me I need to go to a body building website, choose the muscle group I was going to be working out that day and choose 3 videos to watch so I can learn how to do the exercises when I come in. When I asked what bottom meant on leg day he said "You know, like your calves...the bottom of your legs." I asked "Um, wouldn't that just be, you know, legs?"

I had to tell this guy he didn't know what he was doing and for someone like me that has above average knowledge of this stuff compared to someone else walking in off the street he was going to have someone seriously hurting themselves on his hands.

I've moved to another gym and will be starting soon.

OMG, that's awful. I'm at L.A. Fitness, since it's the closest gym with an indoor pool (with my arthritis I have to start with Water walking and work my way up to more serious cardio and workouts). While they obviously have some issues around the nutrition/WLS thing, I was very impressed with the trainer for the workout piece. They're all certified "master" trainers, and really seem to know what they're doing with demonstrating exercises and modifying for physical limitations.

A severe texture aversion to most fruits and veggies played an active role in my inability to lose weight and my constant weight gain while growing up. I always tried to explain to the doctors/nuts/etc, even when I was just a child, that I WANTED to eat these foods and I TRIED to eat them, but the moment I put them in my mouth, my gag reflex kicks in immediately and I literally get sick trying to force these things down my throat. I would still try, and still get sick, all the time, and no one I ever talked to ever believed me. I was just a fat kid that "didn't want to" eat healthy foods. Never mind that my texture problems extend to plenty of unhealthy foods, like popcorn, twizzlers, Gummy anything, etc.

We think mine started as a texture aversion. However, my father took it as an affront to his authority and started force-feeding them to me. One of several reasons I started seeing a therapist when I started down the path to WLS. We've been treating it as PTSD, though I hate applying that label to something that seems so minor in the scope of things. I'm starting to branch out and try new foods, but between the aversion and the sleeve haven't worked up to veggies yet.

I swear 95% of trainers have never had issues with food. Its like me telling a smoker, just stop smoking. I have no idea how it is to smoke and be addicted. I never understood how people would tell me they forgot to eat the entire day until 10pm. Whaa? So I cant pay a trainer to tell me about nutrition and how he could have saved me from surgery.

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Exactly. And with my food issues, I don't know if most people are able to just make themselves eat stuff they find gross, but I know body builders just shrug and down it. So they don't know what it's like to literally not be able to force oneself to eat something. "Just do it" doesn't work like that for me.

.... ANYTHING but exercise.

Idiot.

Ok, so the head trainer at my gym was great yesterday. I enjoyed the workout (gosh I'm in bad shape) and decided that using a trainer a few times a month wouldn't be a bad idea. I did exercises I wouldn't have thought to do, and the encouragement helps. He made a good argument for starting strength training immediately even though I believe I have a long way to go on cardio first.

So while we're setting up my contract, I get introduced to the VP over operations, and he asked what my motivation for being there was. I told him I had a bunch of health conditions that piled on last year, and ended up deciding to have the sleeve 6 weeks ago, and I don't want to blow it. I want to make the lifestyle changes needed to make this stick.

Cue the standard crap from him:

* His mother had the lap band and then bypass. She gained all the weight back from the lap band and is only being successful with the bypass because she's finally following his directions.

* He's has "lots" of experience dealing with post-WLS patients.

* If I'd come to him earlier, he could have prevented me from needing the surgery. After all, the people who get the surgery say they've "tried everything" but they really haven't.

* All the surgery does is enforce Portion Control, and that can be done without surgery.

* But since it's already done, we'll work with what we have.

* My surgeon doesn't know what nutrition is needed. *HE* (the VP) will tell me what I should eat. (I will give him this - I am not eating enough Protein, I'll have to really ramp that up.) Sorry, dude. When you tell me that I can't count Beans or Peanut Butter as Proteins because they're not "complete" without discussing my knowledge of nutrition, you fail. I was raised vegetarian and know perfectly well how to combine foods to get a complete protein.

Bite me.

So I finally got rid of him, and got back to the head trainer who wanted to go through food lists (at the prompting of the VP). I had to explain to him (because I wasn't bothering with the VP) that I get *incredibly* ill in ketosis, so his "carbs are the enemy" lecture doesn't wash with me. I am willing to control my carbs so long as I'm above ketosis levels, and concentrate on complex carbs and healthy choices, but I will *not* do a ketogenic diet. Then I get a mini lecture on how tilapia is not a good choice (already knew that, but it's better than some other choices) and how swai fish is a GREAT choice. Looked that up when I got home, and it's a catfish from the far east. Sorry, dude. I don't eat bottom feeders or filter fish.

I get that most people they deal with are not well educated on nutrition. I get that trainers know more than the average bear about the subject. However, both of these guys are competitive body builders. Their nutritional approach is not going to work for everyone, and they need to learn to be flexible about it. I'm just glad we didn't even discuss veggies, because they'd be horrified to find that I just don't eat them (though I'm working on expanding my palate). And telling me to "just eat them" doesn't work, since I basically have PTSD around veggies and can't physically make myself eat something or I'll throw it up.

I wish they'd stick to the exercise piece.

I count them (myFitnessPal), but I don't have a set carb limit or goal. My doc said if I get all of my Protein in at this point (6 weeks out) you pretty much can't overdo the other macronutrients. She wants me to focus on choosing nutrient dense foods (healthy foods) high in Protein and says the rest will sort it self. I'm ending up with 60-90g of carbs a day.

Thanks so it's not something they would do at an accident scene. I could just put the info with my insurance card or License?

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No, the only tubes they will typically put in before the hospital are breathing tubes and IV's. The gastric tube is something the ER places. Usually without any kind of scope, because with "normal" anatomy it's no big deal. If you had a lap band or bypass, I'd put it on something they would see immediately like a Bracelet or necklace, because lots of times we haven't had a chance to dig in the wallet when we'd be dropping that tube. For VSG, a card in the wallet would likely be plenty. I could see a gastric tube being a little more difficult with a VSG just because the anatomy is tighter, but it's not being put in with enough force to cause a problem. You can always check with your surgeon. Also, if your surgeon has restricted you from NSAIDs and steroids (or any other meds), that would be something to include on the card but wouldn't be necessary on a bracelet or such.

My understanding from my research is that it's necessary to slowly get your calorie intake up enough so you are properly fueling your activity. The weight loss will sometimes stall during this process, but it's important to not try to stay at 600, 700, 800 calories especially if very active. While the VSG seems to reset the "set point" so our bodies aren't driven to regain the lost weight, it's also important not to get your body back into starvation mode where it's trying to hang on to every resource it can. My surgeon said that by this point (I'm almost 6 weeks post op) she wanted me in the 1,000 cal/day range, and as I get more active more calories in. But she said it's important to make certain I'm hitting or exceeding my Protein goal every day, as the Protein is what drives weight loss and maintaining a stable weight.

Former ER nurse here - for the VSG I can't think of any reason it would matter. Any tube we would be putting in the stomach would be smaller than the one used for the surgery. For lap-band or bypass, it could matter, since it could cause damage to try and put a tube through the small passage between the pouch and lower. I would suggest putting a card in your wallet with your drivers license and/or your insurance card with your relevant medical history. Someone at some point will be getting those things out of your wallet. I have several medical conditions including some drug allergies, so I wear a MedicAlert, and if they pull my record it has the VSG listed in my history, but it's not on the necklace/bracelet I wear.

​The nagging has stopped, and now she's doing the whole "well, we won't be able to eat together now" thing, which you all and I know isn't the case.

LOL. My sis had VSG about 4 years ago, and my parents were worried about my having it. At first they were telling me how they were concerned that all of her health issues seem to be related to the VSG. When I let them know that they are not related (I'm a nurse), they backed off that track. The next time I saw them, they were worried that I'd become a downer and no fun to eat with anymore because my sis is one of those people who has to tell you about everything and how things work (even if she doesn't really know). I let them know that as far as I'm concerned, I'm not the food police so I don't speak about what other people are choosing to eat, and after a few months I'll be able to eat whatever I decide to just in smaller portions. And unless you ask me, I'm not going to go on and on about why I'm eating smaller portions or what you should/should not be eating. They finally decided to quit hassling me about it. LOL

but but but

I should add to the above post that the rest of my body was all aches and pains before my dx, as well, but since my life was literally my hands, I just chalked it up to turning 40....

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Rough. I had decided to pursue nursing as a mid-life career change, with the goal of becoming a nurse practitioner. I loved ER nursing, but especially with my primary symptom being in my feet and making it incredibly painful to stand, and treatment compromising my immune system, I couldn't stay bedside. I miss the heck out of it.

Luckily in my former life I was a data warehouse analyst, and a good one. So I changed my grad school track from NP to Healthcare Informatics (will graduate Dec 2017 god willing) and am back behind a computer. Where I didn't want to be, but at least it's an option that gets me off my feet, pays well (better than nursing), and with all of the assistive tech available, I'll be able to keep doing it as long as my brain works.

PsA/RA here too.

My rheumy had me stop the sulfasalazine 3 weeks prior to surgery. I'm 5 weeks out, and see her next week to get my date to start biologics and see if I can start the sulfasalazine again in the meantime. I think she said I can't start biologics until 3 months after surgery, can't remember what she said about sulfasalazine.

She and my surgeon both agreed that VSG was the only WLS open to me because I'll have to be able to take NSAIDs and steroids periodically. They are strictly prohibited for bypass and band. Some surgeons will say no with the VSG because of the increased risk of ulcers, but when the benefits outweigh the risks, they'll usually say it's ok. They'll likely require you to be on a PPI (omeprazole or the like) to try and prevent the ulcers.

Interestingly enough, by day 3 post op my surgical pain wasn't nearly as bad as my arthritis pain, but without any meds or NSAIDs my arthritis pain has been decreasing. Rheumy said that both the stomach tissue and fat tissue increase the inflammatory factors, and the surgery should help decrease my inflammation as well as reduce joint stress with the weight loss. I didn't expect it to be this significant. So we may want to just try back on the sulfasalazine for a while and see if it does the trick, dunno.

Several of the RA boards I'm on call prednisone "Satan's little tic tacs". When we were getting my diagnosis and trying to find a med that worked, I begged my rheumy for steroids. Without going into the long drawn-out story, I'd been having symptoms for a year or more but they were atypical. One of my hellish symptoms was plantar fasciitis that turned into these incredibly painful knots in the arches of my feet. In a desperate attempt to figure out what was going on and get some relief as I was an ER nurse at the time, I got a doc to give me a round of steroids. I hadn't realized that my pain levels had gotten so high... I would tell people I lived at a 3 or 4 with all the joint issues I've had most of my life. The steroids brought my pain down to a 0 to 1 for the first time in decades. No telling how long the auto-immune was a factor. I had actually been living at a 6 to a 7. I didn't need a lot, just 20mg a day to get it under control and 10mg a day to maintain. I seriously considered black market prednisone. I understood what junkies feel for the first time.

Rheumy held the line though, and it was a good thing because while on the pred, my bloodwork wasn't showing anything. Got me off the pred for about 2months, and my bloodwork popped.

Methotrexate helped, but not enough. Now I wish we'd tried the shots. I don't have an issue with needles, and the pills were rough. I had what we think was an allergic reaction to mtx so now we can't go back to it.

When we started talking biologics, I asked my rheumy about WLS. She was enthusiastically for it. The data isn't all in, but she said there's good evidence that the stomach fundus is responsible for a bunch of inflammatory factors. And of course all the fat tissues and the hormones they secrete is responsible for a bunch more. She said it wasn't likely to put me in remission, but it could really help.

Going off my sulfasalazine (which was working some but not 100%) for the 3 weeks needed before surgery, I thought I was going to go nuts with the pain. My surgery pain by day 3 wasn't as bad as my arthritis pain. But it's been gradually getting better. I see my rheumy next week to get a date to start biologics (I think she said 3 mon after surgery) and see if I go back on Sulfasalazine in the meantime. And of course bloodwork. I'm curious to see where my factors are now because my pain is pretty much back where it was medicated.

It's a roller coaster. I don't expect remission, but if the VSG helps the meds work better so I can function better (and get active again) then it's worth every bit of it. And of course I'd welcome remission if it comes.

A few years ago when I had a change in my Migraine patterns, my neurologist ran every test under the sun. He found non-diabetic neuropathy in my feet and my B6 levels were through the roof. The only thing we could attribute it to is that I was taking a "whole food" multi-Vitamin that was very high in the B complex Vitamins. B6 is also known as pyridoxine and may be listed that way instead of B6 in some enriched foods. He had me stop taking any Vitamin that had B6 in it at that point. We never determined if the high B6 was the cause of the neuropathy in my feet, but the neuropathy is mild. Subsequent testing has been normal, but my PCP and I keep an eye on it now. I think that so many things have the B-complex "for energy" now that it's hard to get away from too much supplement.

Sleeved 9/17. No gas pain, I don't know what my doc did different, but I didn't have any of that shoulder/back pain people talk about. First couple of days were rough trying to get in my fluids. But I have had no nausea, even post-op. Which was surprising for me because I have a history of severe nausea after surgery. My doc's anesthesiologist listened to me talk about it and did something with the IV mix and gave me a pill to take and that took care of all of it.

The restriction made it hard for me to get to Fluid and Protein goals for a little over a week. I was super fatigued until I could start on soft foods and get my carbs up enough to get me out of ketosis (I get VERY sick on ketosis) so I haven't been able to start working out yet. I signed up for the gym on Friday and will start my Water workouts this week.

But every day things got more comfortable and easier. I'm at almost 5 weeks now and am doing pretty good. I'm getting usually 800-1000 cal in a day and meeting my Protein goals. I've got enough energy to move around more now and am feeling pretty good.

The loss of cravings has been nothing short of amazing. After I got cleared for soft foods my hubby and I went to the store. I passed a lot of things that were binge triggers for me in the past, and part of my brain went "ooh, that would be good, and it would count as soft" and the other part of my brain would imagine eating it and go "eh. doesn't sound that great, actually". So I can walk away from pastries and sugary stuff with no problem.

I'm loving my sleeve!!

I apply a different tool. Your diet/nutrition is what works best for you.They (doctors, nuts, dietitians) work for me, but they give me guidelines and I make choices thru trial and error. If you want to eat steak then eat steak. What's the worst case scenario? Will your head explode? Will you find that it's ok to eat steak again-in your own tested way. The he said she said doesn't help. You made the choice, had the surgery, and sounds like you've gotten thru the hard part. Now continue with being in charge of your diet and experiment to find what works best for you instead of broad based format diet "guidelines"

that work generically.

Guidelines are what reduces complications including possible death! This isn't a trial and error kind of thing (for several weeks anyway). Eat steak - what's the worst case scenario?? Umm...blockage, leak, infection, death, failure...

Oh, are we talking about eating choices BEFORE being cleared for a full diet? I think I lost track in the thread. I NEVER suggest rushing the diet advancement plan from your doc. I've heard some that I think are absolutely nuts, like zero Protein allowed for 2 weeks, but bottom line is that your surgeon is the one you've put your trust in for this surgery, follow their plan for advancing the diet, period. They have reasons for setting that. Now, once you're cleared to a full diet, I think that a cookie cutter approach isn't the best.

ETA: But I will also say that it's a good idea to at least START with what your surgeon/team is recommending for a diet plan, and if it doesn't work, start researching and modifying from there. I've done extensive dieting over the years, and know from extensive experience that ketogenic diets make me very ill. I couldn't stay out of ketosis while on liquid and soft foods, and the experience just reinforced what I already knew. I will still refrain from simple carbs and sugars, and emphasize the Protein in my diet, but I have to have 70+ carbs a day or I get very sick. That's what *my* body needs. Incidentally, I made sure my surgeon/team was on board with that before I chose them for my surgery. I didn't want to be fighting my team if they were going to be pushing a different program.

The NUT I had to see wasn't in the same practice as my surgeon. She didn't know what the surgeon's diet progression was, nor did she know what the surgeon's pre-op diet was. She gave me printouts of the standard 1,200 and 1,500 cal exchange diet. You know, the one we all started with in the 80's that hasn't changed a bit? She wanted me to get blood testing to show what foods I should be eating (to the tune of about $400) and wanted me to go on a low FODMAP plan. She went on and on at length about how I could "cure" my auto-immune arthritis with supplements that conflict with my treatment medications, and with an eating plan that has no scientific evidence behind it.

NUTs aren't regulated in my state, there's no licensure or required certification. I could hang a shingle and call myself a nutritionist (though I think the state nursing board would have an issue). I repeat my statement that I have yet to meet one worth the oxygen. Every single one I've met had bought into one fad or another and several have given really bad nutritional advice.

Registered dieticians are another group altogether, but I wasn't given an option to meet with an RD.

food cravings stopped immediately. I have told the story several times now where I went to the store after I got okayed for soft foods and walked by the pastries that used to rule my life. Part of my brain went "oooh, that would count as 'soft' food" and the other part of my brain that was imagining eating it went "eh. doesn't seem so good".

Eating habits had to change immediately. Right after surgery, it's a chore to get all the Fluid and Protein in. I'm on a full diet now, but still can only eat 4-5oz of pudding consistency foods and only about 2-3oz of solid foods. So meal planning has to be a thing, so that I can get all of my Protein and nutrients in. Hubby will dish what he thinks a small serving is, and it's still 3 times what I can actually eat. LOL.

I had been worried about changing pant sizes too quickly, but I'm 4 weeks out and right now it's my tops that are starting to look like clown wear. That started by about week 2 but is getting full blown at this point. My pants are looser, and my "fat pants" have had to go in the giveaway box, but they haven't changed as fast as my tops size.

I'm so thrilled with my sleeve. It makes some things about life a little challenging, like having to plan meals always. But it's so worth it.

I only had an option of a NUT. Dieticians are fine but most programs have NUTs. And I frankly have never met one worth my time.

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