ChunkCat

Call your surgeon to discuss the incisions and the bruising/hard lump. You look like you *might* be having an allergic reaction to the glue. It isn't unusual. Some of us are blessed (cursed) like that! I had a bad reaction to it and a veteran of the surgery advised me to ask my doctor for mometasome cream because the hydrocortisone wasn't working. OMG, the mometasome cream worked overnight! It was so much relief... I was really grateful.

There are things like miracle noodles, heart of palm noodles, and of course most of our "fullness" should come from veggies once we are a year out. Think high volume low carb veggies like lettuce, mixed greens, cabbage, cauliflower, broccoli, as well as colorful things like bell peppers, tomatoes, onions, green beans, etc... These paired with a little fat and a decent amount of protein should help you feel fuller longer. I think it is very well possible you could be experiencing true hunger. You are MUCH taller than the average woman (if you are not a woman I apologize for the assumption) and the dietary guidelines that surgeons and nutritionists hand out are usually useless if you fall outside their standard patient. If you are exercising enough to get your heart rate up for a consistent amount of time or doing weights/strength training, you could be burning a fair number of calories too. Both of these things would make me think you may have a higher caloric need, even though you are a sleeve patient, than the average sleever would. If your surgeon's nutritionist isn't interested in customizing your true caloric need given your frame, height, and activity level, you may need to have a few sessions with someone else who is trained in bariatrics and will actually help you work through this so you can stop feeling guilt when you eat more than your surgeon wants you to. Also, have you tried the Millie's sipping broths? You can get a sample pack of their flavors on Amazon for a pretty reasonable cost. They might help ease the hunger between meals until you find a dietician to talk to.

Yay for approval so fast!! You'll have a surgery date in no time!!

I told everyone I had the surgery. Most of my friends and family have watched me struggle for decades and have been supportive along the way, so I wanted them to be able to celebrate with me! NONE of them think I took the easy way out because I'm very transparent about how HARD this is. I wanted to be able to encourage open dialogue about the surgery and reduce the stigma around it. Even people I don't know very well have been really accepting and encouraging and curious.... It has been interesting for me to experience. Sometimes people judge us less than we think they do. I have had a hard time most of my life dealing with other people's judgments of me. But I decided a few years ago that was a THEM problem, not a ME problem. I have a few choice phrases for people who judge me to my face. Those that do it behind my back have issues and I really don't need to know about them... That said, I tend to live most of my life as an open book so people are used to it. LOL Every person's journey is their own and I support people who keep it completely secret the same way I support people who shout it from the rooftops! You do you. It is perfectly okay to keep it to yourself, it is your body. You do not owe anyone an explanation for how you've lost weight. Just smile, say thank you, and change the subject. If they keep asking you can give one of the suggestions here or just say it is something you are still working out and you don't really care to talk about it. People need to learn to respect boundaries! I may be considered rather blunt (or a b***h) by some but I try to be kind about it. It has taken me years to eradicate the people pleasing side of my personality and I don't really want her back. 🤣

You could be craving fat. Beef is one of the fattier meats and a low carb bibimbap dish would have been full of fat from the oil everything is sauteed in, and the egg, and the dressing. Plus Korean food often has fermented veggies which are really good for you. I crave Korean food and Japanese food a lot. I finally realized part of the reason why is because they eat a little bit of a lot of things. Banchan and Bento boxes! *swoon* Quantity doesn't satisfy me, I hate eating one thing per meal. I need a bite or two of multiple things to feel satisfied. A little fat, a little fiber, a little carb, a lot of protein...something crunchy, something sour or pungent, something a bit sweet, something creamy. I have to hit multiple of those categories to feel satisfied in a meal. So I eat a tablespoon or two of numerous things. Then I'm satisfied and happy, even if I'm not bursting at the seams full... So you might be needing more variety and a bit more fat?

Oh!! And never look at the number on the scale and compare it to others. If you really feel the need to compare, use percentages. Those at a lower weight tend to lose slower, those at a higher weight tend to lose faster. For instance, your excess weight is 50 lbs. That's the amount you want to lose. A 10 lb loss means you have lost 20% of your excess weight already in 4 weeks! That is a lot even though it doesn't look like a lot on the scale. In comparison, my surgery weight was 307. So for me, 20% is 27.4 lbs. It took me until 9 weeks post op to lose that much... So you are a bit more ahead of schedule than it feels! Percentages are a way better gauge of where your progress really is.

Your feelings are valid @Nan CC, surgery is stressful and the idea that we have done so much for so little loss in the beginning is discouraging and depressing!! I have some thoughts to share about your experiences... 1. That hunger you are experiencing is normal. It doesn't go away for everyone. I woke up in the recovery room ravenous which pissed me off because all they kept saying is I wouldn't be hungry! And I ended up more hungry than I'd been in years!! The first two months I was hungry all the time. True hunger. I think it is because the body is panicking and trying to figure out what is going on. Plus we've been lied to, that growling sound is often not hunger, but just our system digesting and moving air and fluid through our system. After surgery our internal digestive process sounds louder to us for some reason. Maybe because we are paying more attention?? I don't know. But I had true hunger constantly. One thing that will help this is a PPI (proton pump inhibitor). Our tiny tummies are still making enough acid for a normal tummy and that can irritate it as it heals. That gnawing hunger can often come from this and gets worse at night... 2. No, you aren't supposed to automatically feel full with 1/4 cup of food. A lot do, but not all by any means. The reason for this primarily is because all the nerves that communicate fullness to us were cut during surgery. It takes at least 3 full months for those to heal enough to accurately communicate again. The 1/4 cup portion size is to keep you from inadvertently overeating and stressing your healing stomach. At about 8-10 weeks you may notice you can eat more, that's because the internal swelling has gone down. By then you should be able to start gauging your fullness signals. They are often different post op and can look like sneezing, a congested or runny nose, hiccups, pressure in your breastbone, nausea, etc... By 3-4 months out you may be eating more like 1/3 to 1/2 cup of food at a time. Not everyone progresses that way, some have high restriction all the time and have to stick to smaller portions. But the key here is to start building that relationship of listening with your body and learning that the feeling of hunger does not mean you are starving. If you are eating 1/4 cup of food 5-6 times a day, you are getting enough nutrients for your stage in the process. As @AmberFLmentioned, I suggested Millie's sipping broths (you can get a sample pack of all the flavors on Amazon) they help a LOT when you want something, the warmth and savoriness can really soothe the extreme hunger until it balances out on its own. 3. Stalls are normal and can happen early and often. I lost about 15 lbs in the first 3 weeks and then proceeded to stall for 6 weeks and gain and lose the same 4 lbs!! I was horrified and really worried my surgery wasn't going to work. I lose weight VERY slowly, my body is resistant to losing, and I have diabetes and such like you, which I think makes losing hard too. This stall was normal, even though it didn't feel normal. DS patients are known for losing dramatic amounts of weight and my surgery weight was 307, there was no good reason for the stall. But my body needed to take a break and recalibrate and heal, so it did. Finally after those 6 weeks I SLOWLY started losing again. Then at the beginning of February the weight loss finally started to pick up! A lot of people lose a ton at the beginning, I didn't. Apparently my body needed 3 months before it felt safe to start dropping weight steadily... All you can do is get good movement, good sleep (sleep is crucial to weight loss), good hydration, eat every few hours, and stay off the scale for a bit...it will break when it is ready to. 4. Hunger does eventually return to normal, or whatever is normal for you... I'm almost 4 months out and mine is back to what is normal for me. I still have to eat every 3 hours, if I don't I feel drained and irritable and my weight loss slows... I drink plenty of fluids during the day, it helped with the hunger. I feel my fullness signals clearly now, I think all that healing is finally done. I just have to eat slow enough to allow those signals to get to my brain (it takes longer than you think!). Broths, milk, coffee, tea, flavored waters, all these will ease hunger pangs, but the best cure is time and learning to heal your relationship with your hunger so you can feel it and not feel stressed about it. The great thing about eating every 3 hours is the next meal is around the corner, so I can drink something and tell my system to wait until mealtime. This helps heal the insulin resistance too by allowing your body to go through the full insulin response cycle post meal. I'm sorry this feels so hard. I hope your stall breaks soon! And I hope it helps to know you are not alone. ❤️

Thank you!! Yes, aquamarine is my birthstone and has been my favorite stone since I was a child. It reminds me of the ocean, which is my favorite place to be... I'm glad you love it too! It is an underappreciated stone!

Bowel movements the color you describe is usually do to fat malabsorption. That wouldn't be unusual since you had the Bypass and that causes some malabsorption. It is good they are doing a HIDA scan and ultrasound, as nausea with things like peanut butter could indicate you are having issues digesting fat. Some people get that when their gallbladder starts to misbehave. I have never had bloating that distends the belly like that, so I can't relate, but I have had about 6 colonoscopies for other things so if they go that route don't worry, you'll take a nap and it'll be all over. LOL The prep is definitely worse than the test. I hope they figure out what is going on! Some people develop SIBO after bariatric surgery and that can cause a lot of bloating, so if their tests don't show anything you may want to chat with a Gastro doc about that possibility!

I agree with Arabesque that your body is probably more along the lines of what things would look like for most people at 4 months. The central line feeding would have been high calorie to prevent malnutrition, so I'm assuming you didn't lose any weight on it? Or did you? I remember reading about your rough start, I'm glad you've been able to get off the feeding tube and that you are able to eat, even though you are taking meds to help with that. Going from the high caloric intake of the central line to an extremely low caloric intake has probably been a shock for your body. Many of us stall somewhere in the first few months, some for a few weeks, some for a month or two, as our body readjusts and tries to decide if it is starving or not. I know you can only get in so much food with your digestion issues, but is there a reason you aren't supplementing with whole milk or shakes a few times a day? These wouldn't be affected by your slow stomach issues. And they may give your body a bit more energy to work with. Protein waters could work too, things like SEEQ are thinner and as easy to get down as water. The watermelon flavor tastes like a watermelon jolly rancher. LOL Weight loss post surgery is a delicate balance. We want to be in enough of a deficit to facilitate good weight loss, but if we are too low our body goes into stress mode and won't release any weight because it thinks we are in a famine and are trying to burn through our reserves. So we have to eat enough to reassure it that we aren't slowly starving to death. Decreasing your activity and increasing your intake a bit (even if it is just a shake or a few glasses of milk) might give your body enough of a signal that you aren't starving and have what you need to continue to lose weight safely. Things like hydration and sleep are crucial too, as these are also markers the body uses to determine how much stress it is under and if it is safe to lose weight. In fact, some studies have shown that sleep is MORE important for weight loss than even exercise is! I tend to think they are both important, but the point is, you have to look at the holistic picture of how much stress load your body thinks you are carrying in relation to how much energy it has to give. My last stall lasted 6 weeks and drove me crazy! But my body broke the stall when it was ready to, I just kept eating well, drinking well, and resting well. That's all you can do really. You can't push the river. ❤️

Welcome Cyd! I had that sensation of things going down every time I swallowed after surgery. It was so weird, I could literally feel air displace in my digestive tract to make way for the fluid! And I would get this gurgling sound like fluid going down a drain! 😂 It was so strange. Fortunately it only lasted about 2 weeks. You have to keep in mind that your stomach has just been cut and stitched together, everything is VERY swollen internally right now, so there is very little space for fluid to go down! It is like a little tunnel right now, so that's why you feel it. Over time the swelling will go down and you'll feel it less and less until it is gone. I had weird stomach twisting pains with every swallow too, so drinking was annoying. But I kept reminding myself that hydration is number 1 for the first two weeks and that if I didn't get my fluid in by drinking I'd end up in the ER needing fluids and I didn't want to end up exposed to the germs. LOL So I drank, discomfort and all!! But everyone is different... Be sure to let your surgeon know you aren't anywhere near your fluid goals. They may need to arrange for you to have some IV hydration until you feel swallowing is less uncomfortable. Also, remember, your body is full of anesthesia that affects mood and surgery itself can induce depression for a bit for some people. So try to be kind with yourself if you are feeling sad. Regrets are not unusual early out after surgery because everything is so new and feels awful. It will ease in time!! You aren't alone. ❤️

I was definitely a deviled eggs person!! They are so easy to pack in a snack box with some cheese, deli meat, and when safe, some cucumber and cherry tomatoes! I think I did pickles until I was cleared for raw food. I did not do chicken well unless it was chicken thighs in a sauce. I ate mild thai curries, shredded pork bbq with a no-sugar sauce, salisbury steak, turkey in gravy, meatloaf, pho with no noodles, just the meat and veggies, deviled eggs, tuna, swordfish, etc... Honestly by week 8 I was cleared for most foods so I ate whatever, within reason, protein first, then a little veggies, maybe a bite of starch if I had room. Lots of whole foods, as little processed food as possible. My fat requirements are higher than most people so I was more generous with the cheese and eggs than someone else might be. I ate a fair bit of deli meat at first because it was soft and easy to eat in small portions. Poached meat would be good too.

I don't have this but I was tested for it during an Epstein Barr Virus flare... I remember it can mimic a fair few conditions. I think the vampire myth came from it because of the relation to heme helping alleviate the symptoms of certain porphyria if the attack is caught early. Of course in reality this needs to be a heme analog given through IV, not heme in human blood consumed with fangs, but what is accuracy in historic myths?? LOL I'm so sorry you are dealing with this. Unfortunately with any significant trauma to the body (car accident, illness, surgery, death of a loved one) you can trigger an autoimmune condition or genetic condition to express itself. It's frustrating because there is no way to know if something will cause it, and there is no way to know what genetic things lie dormant in our systems, waiting to be triggered and misbehave. I hope they have luck with all the testing and find a source to the symptoms you are experiencing... It is distressing to have things going on and not know the cause of them. ❤️

OMG, @BabySpoons I tried your suggestion and cracked myself up! It seems that my index finger that used to be a US size 10 1/2 is now a US size 9. 😂 There goes all the pretty rings I have for that finger... But the wedding set actually looks kind of cool on my index finger!

Yes!! This is what I did! I had to do it before when I outgrew my original wedding ring... People often thought I was wearing an actual diamond, it was kind of funny. I got a pretty Celtic one this time for under $20! 😂 I used to wear one like that before I was married. It doesn't keep the jerks away, but it does warn off the mostly nice guys who I hate having to have that "I'm not looking right now" discussion with. Plus people really do treat you differently when you are traveling with one on...

Yes, that's what happened, my hands were cold and they just came off and I was like "Ummm...well then." 😂 Yes, I might do that with the stones, good suggestion! The ring set is relatively new, I had been holding out on buying a new set for when I lost weight (you know how that goes) but after the whole cancer thing I decided to stop holding off on things I really want. So we bought the rings. Then a year later I decided to do bariatric surgery. LOL Go figure... But I adore the stone, it is a lovely aquamarine solitaire and the rings were custom made. So I'll be thinking on what to do with it all... If your rings are loose by themselves you may be able to use the ring snuggies that wrap around the band to make them fit better on your hand until you resize them. They worked great for me until the size difference became too big!

You know, I never thought of wearing them on a different finger! LOL I love wearing rings on various fingers. They might look cool on my pointer finger... My hands are usually well decorated with metal and stones, though the changing sizes has impacted this! I'm glad you are wearing rings again, they are such a great way to accentuate our individual style!

Oh this is wonderful!! I know what a big goal this was for you and I can relate to feeling like it was impossible a few years ago and now it is here. I'm so excited for you!! I wish you much luck in getting your BMI into the 20's. I think a lot of people forget how big of a deal it is to feel better in our bodies and be able to move better and be off of medications and such. Not everyone had those issues pre-op, but for those of us that did, it is a very powerful metric of success. ❤️

TPN is Parenteral Nutrition. It is nutrition through an IV. There are also forms of nutrition that can be given through the stomach. I agree that focusing on hydration and sleep are important for you at the moment, but you can't totally ignore protein at this point. You are 6 weeks out, not 1 week out. Right now you really SHOULD be relying on protein shakes! Shakes count towards your fluid goals and will give you enough nutrition to combat the fatigue and weakness that comes from not eating enough. Most patients rely on protein shakes for the first 6 months after surgery to help them get enough protein in. I'm 3.5 months post op and I eat just fine, but I still need a shake in the morning to get 120 grams of protein a day! At the stage you are at, you should be drinking some protein shake every hour in addition to your water/electrolytes, so you keep a steady supply of nutrition up. Of course you can and should try eating too, as the nausea eases eating will be easier. But shakes will actually help your hydration goal, not hinder it. ❤️

My hands are getting smaller!! Specifically, my fingers. I've had chubby little hands since I was 14 and my autoimmune disease showed up. When I was 200 lbs last time I was still an 8 1/2 on my ring finger in US sizing. Yesterday I finally took off my wedding rings when I noticed that even with the ring snuggies they are spinning around on my finger and threatening to come off. So I decided to measure them. I had gotten up to a US size 9. Now my ring finger measures as a US size 7!!! Never in my life have I ever wore a 7 in rings except maybe when I was 12?? 😂 I cannot get over how differently our bodies lose weight with these surgeries. I have to find a substitute ring to wear now because at this rate I'll be a US size 5 when I'm at goal! LOL I never thought I might have to sell my wedding rings because they can't be resized due to the difference being too much! This is so fascinating...

I agree with Arabesque, this sounds like a post viral syndrome. I'm so sorry you are going through this! You were doing so well!! What many people (and doctors) don't understand is getting any sort of virus that hits the body hard can result in a number of conditions afterwards, some caused by trying to recover from the virus, some caused by opportunistic viruses showing up when your system is low from one virus already, and some can actually be autoimmune conditions that are triggered to show up from a viral infection. Any of these could be contributing to your condition. A few years ago I got cat scratch fever (that's what I get for fostering litters of kittens! LOL). I was sick with it for a few weeks. My immune system had already been behaving badly that year, I have an autoimmune disease that flared so bad it effected my digestive system, my eyes (I was having vision problems), as well as my joints. But the virus kicked my butt royally. Then a few weeks later I started spiking high fevers at night out of the blue. I was so exhausted I started sleeping more and more every day until I was sleeping about 18 hours a day. My doctors were absolutely useless and said it was probably chronic fatigue syndrome caused by the autoimmune flare and started putting me on courses of steroids. My bones started aching so bad I would cry. I could barely walk to the kitchen to get a glass of water. My GP made out I was pain med seeking so I fired her, her lack of support was appalling. I started fainting when I tried to shower. I had vertigo all day. After fainting twice with temps over 104 I ended up in the ER where they did labs and said nothing was wrong, it was probably a virus and to go home and sleep it off. A week later I ended up in the ER again where a wonderful doctor said I was experiencing acute kidney damage from dehydration due to the fevers and that I was NOT leaving the hospital until someone figured out what was wrong. I was in the hospital for almost 2 weeks, two different hospitals where I continued to run fevers at night up to 105, it was absurd. Then suddenly one day the fevers and pain stopped. The infectious disease doctor was baffled. But when my advanced labs came back they finally understood what was going on---I had atypical Epstein Barr Virus. Atypical because mono didn't show up when tested for in the ER and I only had one lymph node swollen on my whole body, a tiny one behind my ear. Apparently atypical presentation doesn't show up on mono tests, only the two week test. Epstein Barr Virus is notorious for showing up with other viruses and generally making a pain of itself. It took me another two months before I could reliably get out of bed, and honestly my body took several years to return to a new normal. They thought I had POTS but turns out it was just severe physical deconditioning from the virus and bed rest. All this to say--if you still can't figure out what is going on after a couple of months, you might want to consider talking to an infectious disease doctor or immunologist, whoever is in your area that can treat long Covid and can test for other viruses that might be complicating the picture, as well as autoimmune conditions. Your symptoms sound so viral or autoimmune in origin. My Dad ended up with post viral arthritis. Viruses are such weird things and they can really give our bodies a hard time! Oh and one suggestion. You might want to give this device a look, it was made by two guys, one who had long Covid. https://www.makevisible.com/ I've considered getting one as I love that it helps track your activity in relation to pacing which is shown to help with post viral recovery, and in managing autoimmune conditions, chronic fatigue, fibro, etc...

My band size keeps changing every few weeks! Bras for big boobs are expensive. I'm sure the boobs won't be big for long at this rate but still, it is a funny problem to have. I have no clue why my body has decided that my bra band area is the best place to lose weight post op. 🤣

I'm not a doctor and you should definitely ask your doctor about these results! They are the only ones that can really interpret these things for you!! However I can tell you from experience that sometimes the B supplements they have us taking after surgery can really push up the B12 levels, even into the abnormal category. But far as I understand it, the body will deal with the extra B12 just fine. At least that is what I was told and it may be true for you, so try not to worry until you talk to your doctor! Also, rapid weight loss post op can do odd things to our labs overall, especially our liver labs. That is because all that fat we are losing has to be processed in the liver and it stresses it out a bit. This is one of the reasons we are advised to avoid alcohol for the first year, that liver doesn't need anything else going on to stress it out! Plus there is a risk of transfer addiction but that's a whole other story... So try to remind yourself that your body is working very hard right now and that will probably show up as some unusual labs for a while. Your doctor will let you know if there is anything to be concerned about. And finally, being in ketosis post op can do weird things to our labs as well, especially when it comes to what shows up in your urine. So again, try not to fret too hard until you talk with your doctor about this. It is possible this might be something they want to follow, or it could just be because of surgery and rapid weight loss in ketosis. Only they can tell you what is really going on. ❤️

I had nausea until about 8 weeks out. It was constant and impacted my ability to eat, drink, and take my vitamins. A few things helped me (and others like me) that may help you: 1. Ondansetron only takes the edge off of nausea for me. It is rather ineffective for my body. I have much better results with promethazine, it actually manages to eradicate the nausea for a number of hours. I'd ask about a prescription to try it, at this point it is worth trying something else for the nausea and they have a number of meds out there that can help with this. I took it several times a day. 2. My surgeon told me to be gradual with my addition of vitamins. I had to take the chewable B complex everyday, and the little B1 pill because my complex didn't have enough B1 in it alone. But these were pretty gentle on my stomach. The actual multivitamins though he said are rather activating for the stomach and some people can struggle to incorporate them early after surgery. It could be these are contributing to your stomach pain and nausea, especially if your multivitamin contains iron, as it can be a little hard on a new tummy. So talk to your doctor about this, perhaps they can switch you to a bariatric B complex and let you try adding in the multivitamin closer to 3 months than all at once right now. 3. When my stomach would hurt I'd massage it in clockwise motions with firm, but not painful, pressure. I got twisting stomach spasms for the first few weeks with any food or water and this was the only thing that helped ease the pain of them. 4. My PPI needed an extra dose and for me, omeprazole is worthless. Some people metabolize it fast and for some it just doesn't work as well. Have they considered switching you to Pantoprazole? It is often used in the hospital because it is so effective. It might be worth switching to it to see if it is any more effective for you. A lot of bariatric patients end up having to switch around to find the most effective one for them. 5. Hydration is crucial early out of surgery. They should have had you exclusively focusing on hydration for the first two weeks along with the B complex. It sounds like your electrolytes are off, probably because you are chronically dehydrated. Nausea is made MUCH worse by dehydration!! You are 6 weeks and still struggling. Unfortunately at this point you DO need to be trying to get in some protein with your hydration to prevent malnourishment. Greek yogurt is great for this, but there are other options too. Have you tried any protein water powders like SEEQ or Syntrax Nectars? These are easier to stomach and come in nice flavors. SEEQ watermelon is seriously tasty. LOL Try some sample packets!! It is okay if you can't hit your full protein goals yet, every little bit helps. If the change in meds doesn't help you at all, I hope they consider doing some imaging and a scope to ensure you aren't experiencing something like a stricture. They are rare, but they do happen, and they can cause issues with progressing the diet. 6. Water flavoring packets can help with getting in more water, as does sipping it around the clock out of those tiny cups until you get the hang of getting more water in. It can and does feel like a full time job and you will feel like you are floating! This is normal. Electrolyte powders are a great addition to water at least once a day because they really help you get minerals you are missing since you aren't eating them in food! And try a variety of things and a variety of temperatures. Some hot broth or tea, some flavored water over ice, something room temperature, sometimes the tummy has an opinion about what the best temp is! I am so sorry you are dealing with these issues 6 weeks out. It sounds like your team needs to be more proactive in trying different meds and doing some testing to figure out what is going on. Honestly, some do struggle like this for a while. On occasion some end up with TPN for a while to help them get the nutrition they need. It sounds like you aren't quite at that point because you are keeping some foods down, but it is an option if you continue to struggle and end up in the hospital repeatedly for low vitamin levels. Some find a month or two of TPN can get them past the roughest part and then their systems are able to handle food and water without issue. It really depends on the person. But you don't want to go that route if you can avoid it... ❤️

Oh that's good!! I've seen some people set at that limit long term and I always feel bad for their bodies. LOL My partner really loves the libido side effects too. 😂 Yes, definitely talk to them!! Use them as the resource they are meant to be! My focus is health too so I try to make sure there is scientific data backing the advice I get from my clinic and if it doesn't work for my body I tell them so! A lot of people are afraid of challenging their doctors and dieticians. I outgrew that problem a long time ago thanks to major health issues. Nowadays people only get to stay on my care team if they are willing to work collaboratively with me for my best health!