PatientEleventyBillion

I actually understand this quite well, and it's impacted my wife significantly to the point where she's hopelessly an introvert. My mentality and understanding regarding the surgery have changed significantly from when I started in the Canadian Weight Management program until now. Of course, as the stereotype you suggest above is entirely true for me, I'd have never even considered this surgery if it weren't for the health issues I have (I've gained and lost 60 pounds before in my early 20s), I do recall in all my classes women were asking questions surrounding their skin and appearances. The (few) guys were asking questions about their health issues. Kinda scary how true that stereotype seems to ring in hindsight.

I honestly wouldn't expect anyone to be more informed at anything watching TV.

Don't put this surgery up on a pedestal for fixing what seems to be psychological issues.. you will only wind up disappointed and who knows what happens then. This is merely a tool.

Any pictures of this?

Welcome. Best of luck on your journey.

Having read every post in this thread (not counting if any were deleted), I'd say this is an accurate assessment.

The best date.

Bingo.

Agreed with this. I weigh myself 2 times a day. It's not stressing me out or anything, especially when I had a small gain and stall first week post-op due to IV fluids. I just stick with the plan and know the changes I've mad will ultimately have good results.

Yup, and no flavor unless you add toppings (butter, seasoning, etc) which are even more carbs/sugar/sodium/crap. Wasn't a fan of popcorn before surgery, even less so (of the idea of popcorn) after.

Since the day after discharge I've had milk, yogurt drinks, unsweetened applesauce, high protein oatmeal, and cleared on liquid stage for fruit smoothies which I'll have starting tonight and until soft foods stage.

LOL

What are you eating?

I legit had a good chuckle at that.

There's nothing you can do other than prove them wrong. I make sure to do absolutely nothing to quell their concerns, they are irrelevant. I'm doing this for myself not for anyone else, so proving to myself is the only essential part.

The reason for liquid at the start instead of solids is so you don't damage your sleeve causing a leak. Medicine is not like solid food. Just don't crush up time-release medication unless given the okay to do it. I take metformin (fast acting, very large circular pills), cutting it into halves, and while it's still rather large even in halves, it causes no problems. If it requires a full stomach (I know some must be taken with food so as not to cause nausea, but never heard of full stomach), just take it with food. If you get nausea anyways, ask about taking an anti-nausea medication.

Open book, eh?

Thank you, but yes, your issue is very light, at least, for now. I've seen other patients who had VSG even with cirrhotic liver. Of course, 1) the risk was higher to them, and 2) the surgeon was EXTREMELY careful when doing it, and had much higher demands of them pre-operatively. It's very important people understand that the risk isn't the same with everyone. It depends on numerous factors that cater to one's individual case, but some general logic applies.. those with more comorbities have increased risk of something going wrong during surgery, but that risk is dramatically increased anyways just living life. There should be no justification for, as you mentioned about someones doctor threatening not do have surgery because of fatty liver, not doing a surgery because of NAFLD+NASH. Even if the liver is enlarged, as it would be in the vast majority of obese people (particularly if their obesity is diet related), it's amazing how fast the liver will shrink doing a proper pre-operative diet. One who is obese should also note that weight should fall off along with the liver shrinking, it's virtually the same mechanism. I would tell that person to find another doctor, should be easy.. that one just seems like an idiot. NAFLD and NASH do not add much risk to the surgery whatsoever. Fibrosis does add a bit, and cirrhosis adds significant risk. As for weight loss causing fatty liver, it would be in all likelihood if one is starving themselves. The ketogenic diet for example puts the body into ketosis (initial panic stage) but with decent protein it will adjust when it realizes all is fine. If one is simply starving themselves the body changes from utilizing carbs for energy synthesis to utilizing carbs for storage. This excess glucose made will overwhelm the liver's reserves and cause fat infiltration as it converts the glucose to fatty acid for long term energy utilization. Its a defense mechanism. Then when the person starts eating normal again the body gains significant weight back, which also causes more fatty infiltration. Weight loss, when done the healthy way, will not negatively impact the liver whatsoever, in fact, it will utilize the fat within the liver, allowing the liver to, by itself, heal and regenerate hepatocytes.. if the body's immune system did it instead (as is the case with progressive liver disease), it would simply damage the liver with fibrosis (fibrotic scarring occurring as a result of the immune system trying to heal the liver in its own way).

No no no. First off, liver disease is a comorbidity that adds to the importance of getting this surgery done. Second, the issue with liver disease and the surgery has to do with both the size of the liver (hence the liver shrinking pre-operative diet - livers with fatty infiltration will be larger and more slippery and harder to control with laparascopic instruments, the liver literally sits right on top of the stomach and must be moved out of the way) and the "hardness" of the liver. As the liver moves from NASH to fibrosis to cirrhosis, the liver hardens significantly. The risk that is run is that when the surgeon uses tools to move the liver out of the way, the liver can crack and bleed, and you could hemorrhage to death. Have you ever had a fibroscan done? MRI/MRE? Fatty liver is not a logical indication of not doing the surgery.. it's a condition of necessity of having this surgery done.. a hardened liver is, on the other hand, something that would, and should, make a surgeon nervous. The staging of NA liver disease is as follows: Nothing, NAFLD (fatty liver), NASH (steatohepatitis), fibrosis, cirrhosis. I was stage 3 fibrosis, near the stage of cirrhosis (irreversibility). I just had this surgery and my liver looked fantastic.

Good luck!

I would pester whoever clears you for your diets about why you can't be on full fluids. I was on clear fluids for an hour or two before being cleared for full fluids. While no one here can know any medical reasons for your circumstance, if you were discharged I assume you have no issues with vomiting, and you've been checked for leaks.. I personally wouldn't understand why you can't have full fluids. My OR date was last Thursday (April 20) in the morning Leak tests/barium swallow done Friday morning, confirmed all fine Started clear fluids Friday afternoon, cleared for full fluid meal for dinner (soup, Jello, non-SF popsicles), ate that with no issues, was discharged a couple hours later Friday evening on full fluid diet until around May 11th when I can have soft solids. Current diet is mainly water (1.5-3L), 2% milk, high protein M&BS oatmeal, unsweetened applesauce, YOP yogurt drink, and was just cleared via phone call from my case manager to make fruit smoothies.

I just want to point out, from one public relations person to another, that you are doing far more damage to yourself and your company's reputability than @Alex Brecher could ever hope to do. And I thought United's PR was bad. Please stick around, this is quite entertaining.

I cheated significantly on my diet by this criteria. I couldn't tolerate the liquid they wanted me on. Instead, I researched the premise of liver shrinking, liver function, and how it correlates with long term healthy diet, and for the 3 month pre-op diet, I was on liquid for maybe a week or two, in uttery misery, did not do it again for 80% of the diet. My diet consisted mainly of string cheese, home made meatballs, almonds, peanuts, peanut butter, burgers (even fast food burgers minus buns and minimal condiments), taking bariatric vitamins (up until a few weeks before surgery), liver looked outstanding at surgery. I was given a picture of it when I woke up in short stay which I'm keeping forever. I don't buy that liquid diets do any better.

The issue for most people when it comes to obesity and diabetes (talking exclusively of type 2 as a result of obesity) happens primarily hand in hand with liver function. High carb, high cal diets damage the livers ability to synthesize sugars and regulate sugars your blood cells carry. This is why liver damage is highly associated with diabetes. The onset of surgery provides restriction which lowers intake of carbs (generally, presuming you aren't sipping milkshakes all day), this effectively causes the liver to synthesize adipose tissue rather than get damaged by bombardment of carb synthesis. Sugar being carried by the blood is lowered as a result.. so it definitely has an effect on helping blood sugar. However, it also depends on how badly damaged the body's organs are, like liver (<- especially the liver) and kidneys. In my case, my blood sugar has vastly improved from pre-op alone (7.9 to 5.7), but because of extensive liver damage I was only able to get off 1 of my diabetes meds (Forxiga), and am staying on Metformin likely until my next hBA1c in early June, where its pretty likely I'll be off that too. Due to the extensive damage I did to my liver (fibrosis) with crap food, the process of glycogenesis takes time to repair as the liver needs time to repair itself as well. If liver function isn't severely damaged this process of getting off diabetes meds should be quicker.

The premise of shrinking your liver comes with the removal of fat surrounding and within the liver. It's fat infiltration that expands it in the first place. So if you're on a low carb/low cal diet that adequately burns up fat from the liver causing it to shrink, it's also burning adipose tissue away throughout your body too. Weight loss should come hand in hand with shrinking the liver. The mechanism is the same. One thing to keep in mind is having adequate protein would ensure that energy (which is what the body uses adipose tissue for when there isn't enough stored carbs) isn't burned from essential areas like your muscles. Starches are an absolute no-no for pre-op diet. If you're going to make crab cakes, substitute bread crumbs with almond meal. No potatoes. There's nothing special about "liquid" that shrinks the liver any better, just watch your intake.