SteveT74

While my group goes to puree and mushies the day of discharge, I am stuck at his phase for 4 weeks. So, yes every group is different and they all have there reasons. One thing to be sure is that no ACMBS approved program would put their patients at risk. Sent from my SM-G965U1 using Tapatalk

I trust my surgeon and his group. He was one the earliest surgeons to use the sleeve as a primary procedure in 2002 at the University of Pittsburgh. He's done over 3000 sleeves alone. He believes this is the better peri-operative protocol, so I will follow his instructions. I know other groups do things differently, but this is what my group recommends. Sent from my SM-G965U1 using Tapatalk

The bloating and gas suck. I up 2am because of gas and bloating and I am 24 hours a head of you in recovery. I consider it more like unpleasant discomfort, not real pain. I have had occasional hiccups, but not continuous. Those do suck a lot!!! Suck=hurt!!! I have no advice on that. I hope other chime in.

Well, I had my surgery yesterday and was released from the hospital this afternoon. The surgery went well, text book according to my Doctor. As far as pain is concerned, it's been minimal for me. A little gas but nothing terrible. My abdomen is sore, like I over did it on crunches (a lot). So far there is no we pain at the incision sites---except when I cough or sneeze. I think I had some mild pain and nausea when I woke up in the recovery room, but they gave me morphine and anti-nausea meds and I was ok. The only thing that surprised me was how hard it was to pee from the anesthesia. I also had a sore throat but I brought biotene and chlorosceptic sprays with me and they helped a lot. I didn't eat or drink anything until this afternoon--after I passed radiology. They gave me ice water to start. That was not great. It made my stomach spasm. The for lunch they gave me tuna salad, cream of chicken soup and a cup of milk. I just had a few small spoonfulls of the chicken salad and soup and was stuffed. The chicken salad was a little tough to eat. That was rough for a first meal. When I got home, I made myself some proti soup (cream of chicken) and I drank half a premier shake For dinner, I had a tablespoon of rigotta cheese with cinnamon and nutmeg. I was stuffed from a tablespoon! Weird! I also had a soft boiled egg. I just finished my premier shake to try to get my protein in. Drinking went ok.....just lots of sips. Warm us easier to drink than cold. Anyway, I am now 36 hours post op...so the post op phase begins. I am attaching some pictures from a couple of hours post op and some "before" pictures prior to leaving for the hospital. I lost 17 pounds on the pre op diet on top of the 15 I took off since my first consultation on last As April. Sent from my SM-G965U1 using Tapatalk

Weight loss happens in the kitchen, not the gym. That goes for pretty much everyone regardless of whether or not they have surgery. However, the gym is great for improving muscle tone, fitness and cardiovascular health (with high impact interval training being the best combination of the above). You don't want to rush back to the gym after surgery because your body needs time to heal!!! Every time you lift weights or work out, your causing damage to your muscles, which then heal (which is how you improve muscle mass and strength). This process requires your body to consume protein and other key nutrients. That's fine under most circumstances, but after surgery you need the small amounts of protein and nutrients you are able to consume to be used to help your body heal. So, it's best to take it slow and not do any heavy workouts for a few months until you settle into a healthy routine and get used to your new body. After that time period (and if your surgeon says its ok), you can hit the gym as hard as you like. As for Doctor Vong, I have mixed feelings about him. I have watched a lot of his videos, but I find him to be very preachy. He says controversial things at times just get his viewer count up. It's not that he doesn't have valuable things to share (he does), but it's like his way of doing things is the only way to do things--and it's not. As for youtube surgeons, I really like Dr. Matthew Weiner. If I lived anywhere near Detroit, I would have gone to him for a consultation. He just has such a nice way about him. I even bought his book, A Pound of Cure--which suggests that your post-surgical diet should focus on vegetable proteins and whole foods etc. Dr. Weiner's recommendations are pretty actually similar to Dr. Vong's--but without the messiah complex included. I will try to adopt some of Dr. Weiner's recommendations into my post-surgical diet when it's appropriate, but otherwise I am going to follow the advice and counsel of my own surgeon and his group's staff (after all they have my charts and should be in the best position to guide me through this journey).

Based on most studies, the average person with a sleeve looses 60-65% of their Excess body weight (meaning the amount they weigh above the normal BMI for their height). This 60-65% number is based on a study of multiple studies of VSG outcomes at 1, 3 and 5 years. The average person in the study started with a BMI of 42 and 80% of the participants were women with an average age of 45. Men seem to do a bit better with weight loss using the sleeve than women for reasons that are no fully understood (while men and women perform equally well with the RNY). People that start the weight loss process with a lower BMI (under 40) tend to do very well with the sleeve (often with losing more than 80% of excess body weight and sometimes 100%). Co-morbidities pre-surgery seem to have some impact on outcome. People that smoke seem to have better weight loss numbers (not that you should take up smoking) and people with diabetes tended to perform less well (depending on the study). Finally, there are people that have a genetic predisposition to responding to metabolic surgery. Some people are predisposed to be super-responders. These are the people that seem to lose 100% or more of the excess body weight and can do it without following their post-op diet religiously--and they keep it off forever (or so it seems). Other people have the opposite outcome. They can follow their diet religiously and they lose very little weight and have a tough time keeping it off. Most people fall somewhere in the middle--those are the people that lose 60-65% of their excess body weight. If losing 60-65% of your excess body weight does not seem sufficient to you, there are other procedures available---including RNY, a duodenal switch or a newer procedure called SIPS (or modified duodenal switch). These other procedures promise better total weight loss results (particularly for the SIPS procedure), but the trade offs may not be worth it. That's really between you and your doctor(s).

I agree. Everyone needs to do what's best for them. Frankly, you don't have to tell anyone anything. I don't discuss my health condition with anyone that doesn't need to know. When it comes to close family that loves me, they are going to notice significant difference in my lifestyle as well as my appearance (eventually), so I think it made sense to share this information with them. P.S. You are wrong about one thing though. In the medical professional labels matter and these procedures are being called "metabolic surgery", not just weight loss (or bariatric) surgery. That's why the American Society for Metabolic and Bariatric Surgery changed its name to add the term "Metabolic" a few years ago. This is the case because these procedures, which were originally popularized for weight loss benefits, are now being used to treat many different illness that are not necessarily related to obesity. Even the American Diabetes Association strongly supports the use of "metabolic surgery" to treat Type 2 Diabetes. This surgery is also used to treat very thin people that suffer from treatment resistant gastroparesis and other GI and metabolic illnesses. Sure, a large number of people are having these procedures done primarily because they are tired of being overweight, but to call it weight loss surgery does make it seem like "the easy way out" to the outside world. Metabolic surgery has a different connotation to the layman's mind as well as the minds of insurance companies. So, I suggest getting away for the use of the term "weight loss surgery" as much as possible.

I guess I have been very lucky because everyone that I have told has been very supportive, family, friends, employer etc. My dad had some concerns at first, but it wasn't the "why can't you just stick to a diet!" type of BS. It was just concerns about the risks of surgery--which is understandable. I think the reaction you get from people is related in part to how you explain the surgery and your reason for getting the surgery. In my case, I told people that "I had been diagnosed with Type 2 diabetes and I have a family history of heart disease. I having 'metabolic' surgery at the recommendation of my cardiologist because he thinks it will significantly improve my diabetes and reduce my risk of heart disease etc. The fact that I will lose a substantial amount of weight is great, but the real goal here is to become much healthier, live longer and have more time with my kids." First, I am calling it metabolic surgery, not weight loss surgery. Weight loss surgery makes it sound like this is just another form of cosmetic surgery, like lipo---and it's definitely NOT cosmetic surgery (not that I have a problem with cosmetic surgery). No one is going to be judgmental when you say you're having surgery to treat diabetes or some other co-morbidity (just like they wouldn't question someone having surgery to remove a tumor--who the hell would leave a tumor in place if they could have it safely removed??). Even if you don't have any co-morbidities, that only means you probably have a BMI over 40 which also puts you at risk for heart disease and orthopedic issues. In that case, I would still tell people that you are having the surgery at the recommendation of your cardiologist and/or orthopedist (since weight and joint issues go hand in hand) etc. Not many people are going to question you for following your doctor's advice. Again, the less you make this about appearance the less likely people are going to judge you negatively. More importantly, I am not suggesting anyone lie--only that they share information in a way that makes it easier for people that don't have understand this surgery to appreciate why you would choose those over just going on another pointless round of weight watchers or jenny craig.

congrats man. You're over the hump. Hiccups suck!!!! Is there anything they can give you for that?

My surgery is on the 17th as well. On day 8 of the liquid diet... which I can't stand!!!!!! This has to be the worst part of the process since the hunger is suppose go away after the surgery.

@AFVET I say, you know your wife best and stick to your guns. It's never good to lie to your spouse, but you don't always have to tell the whole truth either. White lies save marriages. Just tell her you love her cookies, but you didn't get 80% of your stomach cut out so you could go to town on them--no matter how wonderful they are! Everyone is happy this way! Good luck with everything!!! P.S. Endowment Member here. Molon Labe brother!!!

See you on the other side!

Well, there are about 10g of fat and 12g of protein in two eggs (0 carbs). If you skip the yolk and only have the whites, there almost no fat and it's pretty much pure protein. I can't see how egg whites wouldn't be on the pre-op diet (as long as you don't cook them in anything that adds fat or calories)--hence hard boiled egg whites. I think some of these guidelines they come up with a general rules intended for "uneducated" patients that don't know the difference between having a hard boiled egg white and cheese omelette fried in butter. I like Premier Shakes just fine, but how can a processed chemical protein mix be preferable to natural pure, egg whites???

I am allowed yogurt at least, but plain. I added a little salt, parsley, chopped onion and garlic to it for flavor. It wasn't bad, but I miss chewing.

I wanted to go with the RNY, but my surgeon convinced me that sleeve was the better option for me. If you're at risk for GERD due to a hiatal hernia, you should definitely go with the RNY. GERD sucks and it can really damage your quality of life. In terms of weight loss, RNY does have better overall results long term. Missing your sleeve date will not be the end of the world if it means you avoid serious GERD issues. Go for the RNY!!! You'll do great!!!

Wow, good luck to you guys that have surgery tomorrow. That's exciting stuff. I am on my third day of my 14 day pre-op diet. This is not easy. I am suppose to have 5 protein shakes a day and then I am limited to sugar free jello, plain yogurt, broth etc. I don't know how I am going to do this for 11 more days! I already "cheated" twice---with hard boiled eggs. Not technically on the diet, but they have no carbs and lots of protein and at least it's something to chew!!!

I would definitely choose good ol' weed over the percoset or opioid for pain control any day. I would just be concerned about the pain that would occur should I have a coughing fit (which I can get from vaping too) and, of course, munchies. I don't know how weed effects you post surgery, but if I am high, I can eat and not feel any fullness ever. That could be a dangerous situation for a sleever--especially a new sleever.

I am scheduled for surgery on the 12/17 as well. Start the liquid diet on 12/3. 😞 It's not purely liquid in my protocol though.... I am allowed one egg per day, sugar free/fat free pudding etc. during the pre-op diet per day. I'll deal with it, but I am NOT looking forward to it at all. However, I should probably loose around 15-20 pounds on this pre-op diet, so it is a nice jump start to getting the weight under control in a twisted sort of way.

Funny how every practice has such different protocols. I am a lower BMI patient (35 BMI) and I have to do a full 2 week liquid diet, which kind of sucks. I am not sure how I am going to do this and have the energy to work (and deal with all the crap in the office that we have around Christmas time). On the plus side, being a December sleever means I'll be one of the few people I know that will be losing weight this Christmas season. That'll be a first for me!!

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Hey guys, My insurance carrier approved me for surgery a couple of weeks ago and I am scheduled for my VSG on December 17, 2018. I have been holding off on posting and trying not to get too excited because I have been dealing with some issues because my first endoscopy on October 4 showed that I had a few duodenal ulcers, which probably are a result of me taking prescription strength NSAIDs after I had a grade 3 sprain of my ankle last Spring. So, I have taking protonix (2x daily) and carafate (4x daily) since then. I went in for a follow up endoscopy on November 9 to see if the ulcers have resolved, but they couldn't see anything because they I had too much food in my system (despite a 15 hour fast). Apparently, I probably have gastroparesis (delayed gastric [stomach] emptying), either because I have T2DM or because I am taking Victoza and now two ulcer meds (all of which cause gastroparesis). So, now I have a third endoscopy scheduled for next Tuesday and I have to be on a 48 hour clear liquid diet for this one. Fortunately, VSG is one of the treatments used for gastroparesis--if it's not actually caused by the medicines I am taking. I just hope that the ulcers are gone and there's nothing happening in my upper GI that will prevent me from having the surgery on the surgery on 12/17. My bariatric surgeon (Dr. Spencer Holover from the New York Bariatric Group) is going to be performing he endoscopy, so at least I know someone I trust is evaluating the situation. I am just going to keep my fingers crossed and I'll be able to start the journey with you guys. --Steve

It sounds to me like what some of your are describing are inherently flawed relationships. These weren't healthy relationships pre-surgery and the fact that had surgery is placing a new pressure on an otherwise unhealthy relationship. This can push a relationship to the breaking point faster, but the truth is the relationship was on a downward trajectory already. Any partner should be thrilled that his or her loved one is doing what they need to do to lead a healthier lifestyle. If they are trying to sabotage it or can't cope with the changes, they may not be the right person for you. If they are willing to go to couples counseling to work through the issues, there's hope at least. If they aren't willing to do this or they try to shift the blame to you or use guilt to manipulate you, they are not a partner--they are an adversary.

Hi SleeveGirl88. Having GERD isnt' the same thing as having reflux every once in a while because you ate some food that disagrees with you. When they are discussing GERD as a contraindication for VSG, they are talking about people that have it regularly at least one or two episodes a week that don't necessarily have anything eating greasy food. You also don't seem to have any co-morbidities and a relatively low BMI of 40 (the average bariatric patient has a BMI of 42.5). If you're goal is weight loss, I would probably go with the VSG. While RNY may have slightly better total weight loss numbers and slightly lower regain rates over 5 years, the differences aren't really statistically significant--particularly for someone with your BMI. You'll do great with either the sleeve or the RNY and you're not going to get much of a weight loss advantage going with an RNY. There have been a lot of comparative studies that have been published over the past two years that support this conclusion. In terms of weight regain, some people start to see it earlier in the process with the sleeve but in the limited number of long term studies that track people beyond 5 years--there really isn't a long term statistical difference. What does seem to make a difference your starting BMI. Whether you're a sleeve or an RNY, if you start the journey with a BMI of 40 or less, the chances of you having BMI below 30 after one year is 95% and the chance of you maintaining a BMI under 30 after 5 years is over 75% with either procedure. The numbers for both procedures drop considerable the higher your BMI is at the time of surgery. The other thing to think about, particularly if your young (under 50), is that you're going have to live with this surgery for a long time. While RNY may have slightly better 5 year outcomes on the whole, the differences aren't really statistically significant. For someone like you, it might only mean a 5-8 pound difference (maybe)--but ultimately, it's probably not much of a difference at all. Ten or 15 years post op, you could be at a point where you have had significant regain with either procedure (hopefully not) and then you have think about revision (since obesity is a chronic condition). With this in mind, you should consider which procedure gives you the most and best options for revision. With RNY, you're revision possibilities are currently limited. In some cases, the pouch can be made smaller. Surgeons can also increase the length of the biliopancreatic limb to increase malabsorbtion or convert you to a distal bypass. The weight loss benefits of these procedures are disappointing for the most part, but these procedures can help treat co-morbidities. A more aggressive or radical approach would be to reverse the RNY and switch to a totally different procedure, but this is a very complicated and risky procedure that most bariatric surgeons aren't comfortable performing (at least not in 2018). In truth, your options of revision from and RNY are limited and may not be very effective for weight loss/regain. Options for revision from a sleeve if there is significant weight regain or re-occurrence of co-morbidities are numerous and more effective. Resleeves are common, easily performed and can help get you back on track. Since holds more volume to begin with and the pyloric valve is preserved with a VSG, resleeves seem to be more effective than revisions to a RNY pouch for treating weight regain. A sleeve also can be easily converted to an RNY down the road, but this is usually done to treat severe GERD--not so much for weight loss (although it can be used for this too). The most exiting option with a sleeve is that it can easily be converted to a BPD-DS or modified duodenal switch (also called a loop DS, SIPS, SADI-S), which is still considered an investigational procedure in the United States, but is probably the future of bariatric surgery. This is essentially a VSG with a single long limb bypass that attaches midway down your small intestines (roughly speaking) and has only one anastomosis (one connection point). It gives you most of the benefits of a BPD-DS (which is by far the most power bariatric surgery, but also the most risky), with approximately the same risk factors as an RNY. More studies are needed for the modified DS before it will be widely adopted in the US, but it's being adopted by many surgical centers and long-term RCTs are being done as we write (with excellent short and mid-range results). As a revision from a VSG, the SIPS procedure will be an easy upgrade that will only take about 30-60 minutes and will mostly likely be performed on an outpatient basis in the future (The SIPS bypass is much less complicated and less invasive that the VSG part of the procedure). In the end, both the RNY and VSG are excellent options that are very effective for weight loss. You can't go wrong, with either one. However, if you like and trust your surgeon and if he or she has been gently nudging your towards the sleeve, you should probably take his or her advice.

luvs2, good luck!!! Thinking good thoughts for you today!!!

I agree with James. There can be some temporary stretching of the RNY pouch or sleeve if you over eat, but the idea that the pouch or sleeve can be permanently stretched out is urban legend based on outdated theories. What does happen is that over time, your hunger can return (this can take 5 years to happen with RNY and 3 years or so with Sleeve). The stomach capacity, however, remains where it was at the time of surgery and you still get full with small portions. People can then defeat the benefits of surgery by eating bad foods more frequently, slider foods (milk shakes, potato chips etc.) or by over eating (which ends up resulting in stacking food in your esophagus--which is bad for many reasons). Surgery is just a tool so if you don't use the first couple of years post-op to change your bad lifestyle habits, weight regain is possible (even likely). As for the bounce, that's a normal part of the process. The surgery changes your set point weight, so your body thinks it's suppose to weight 190 pounds instead of 300. This is called the set point theory--which is how your body maintains a certain weight. When you're on your way down the scale post up, you'll likely drop below your new set point if you follow the new dietary guidelines so you might hit 170 or 180 at your lowest. You'll then gain some weight back and stabilize at your new set point (190). In truth, if you follow the guidelines and do your part, you probably aren't "regaining" weight in the first year or two post op. Your body is just adjusting for your new set point. If you don't follow the guidelines and you eat the the wrong foods, your weight game can be genuine and that's issue. If you're working with a nutritionist (which will be required as part of post-op care), you'll know if you're going out of bounds with the food. If you have RNY, you'll probably get that info every time you have a dumping syndrome episode.