Tiffykins

Since barium is NOT Water soluble, my surgeon doesn't use it. He uses gastrographin solution. If it would not have been for the leak test, my leak would have gone undetected. Grant it, I was a revision patient so my risk for a leak was quadrupled. There are several very experienced, well-known surgeons that only perform the one in the OR, and nothing post-op via a swallow test.

The upper GI also helps diagnose a pre-existing hiatal hernia which would need to be repaired while in there. This also looks for damage to the esophagus from reflux, or other issues with esophagus/stomach motility. I had to have labworks with all the bells and whistles, chest xray, eKg, and U/A for pre-op diagnostics. We had done u/s of my port, and band placement along with a fluoroscopy as well for my band.

This is just my experience: Most surgeons keep the same "rules" for all bariatric procedures be it VSG, RNY, or the band. It is still recommended to not use it excessively, nor take the NSAIDS on an empty stomach. I've been taking NSAIDS of all sorts since being around 6-7 weeks out without any issue. I always make sure I have something in my stomach be it some yogurt, or crackers with cheese. Something in there just as it's recommended when we have big stomachs. With the recent downgrade of max daily dose of Tylenol (Acetaminophen) from 8 pills to 6 pills per day due to liver issues, my main concern with Tylenol usage is that I can protect my stomach, I can't protect my liver. From the pioneers of VSG as a stand alone procedure who have been performing it the longest: Advantages and Disadvantages of Vertical Sleeve Gastrectomy Vertical Sleeve Gastrectomy Advantages Reduces stomach capacity but tends to allow the stomach to function normally so most food items can be consumed, albeit in small amounts. Eliminates the portion of the stomach that produces the hormones that stimulates hunger (Ghrelin). Dumping syndrome is avoided or minimized because the pylorus is preserved. Minimizes the chance of an ulcer occurring. By avoiding the intestinal bypass, almost eliminates the chance of intestinal obstruction (blockage), marginal ulcers, anemia, osteoporosis, Protein deficiency and Vitamin deficiency. Very effective as a first stage procedure for high BMI patients (BMI > 55 kg/m2). Limited results appear promising as a single stage procedure for low BMI patients (BMI 30-50 kg/m2). Appealing option for people who are concerned about the complications of intestinal bypass procedures or who have existing anemia, Crohn’s disease and numerous other conditions that make them too high risk for intestinal bypass procedures. Appealing option for people who are concerned about the foreign body aspect of Banding procedures. Can be done laparoscopically in patients weighing over 500 pounds, thereby providing all the advantages of minimally invasive surgery: fewer wound and lung problems, less pain, and faster recovery. Vertical Sleeve Gastrectomy Disadvantages Potential for inadequate weight loss or weight regain. While this is true for all procedures, it is theoretically more possible with procedures that do not have an intestinal bypass. Higher BMI patients will most likely need to have a second stage procedure later to help lose the rest of the weight. Remember, two stages may ultimately be safer and more effective than one operation for high BMI patients. This is an active point of discussion for bariatric surgeons. Soft calories such as ice cream, milk shakes, etc can be absorbed and may slow weight loss. This procedure does involve stomach stapling and therefore leaks and other complications related to stapling may occur. Because the stomach is removed, it is not reversible. It can be converted to almost any other weight loss procedure. Considered investigational by some surgeons and insurance companies. Next: >> Frequently Asked Questions About Vertical Sleeve Gastrectomy This information has been provided courtesy of Laparoscopic Associates of San Francisco (LAPSF). Please visit the Laparoscopic Associates of San Francisco. Alternative to a Roux-en-Y Gastric Bypass The Vertical Gastrectomy is a reasonable alternative to a Roux en Y Gastric Bypass for a number of reasons Because there is no intestinal bypass, the risk of malabsorptive complications such as vitamin deficiency and protein deficiency is minimal. There is no risk of marginal ulcer which occurs in over 2% of Roux en Y Gastric Bypass patients. The pylorus is preserved so dumping syndrome does not occur or is minimal. There is no intestinal obstruction since there is no intestinal bypass. It is relatively easy to modify to an alternative procedure should weight loss be inadequate or weight regain occur. The limited two year and 6 year weight loss data available to date is superior to current Banding and comparable to Gastric Bypass weight loss data(see Lee, Jossart, Cirangle Surgical Endoscopy 2007). First stage of a Duodenal Switch In 2001, Dr. Gagner performed the VSG laparoscopically in a group of very high BMI patients to try to reduce the overall risk of weight loss surgery. This was considered the ‘first stage’ of the Duodenal Switch procedure. Once a patient’s BMI goes above 60kg/m2, it is increasingly difficult to safely perform a Roux-en-Y gastric bypass or a Duodenal Switch using the laparoscopic approach. Morbidly obese patients who undergo the laparoscopic approach do better overall in their recovery, while minimizing pain and wound complications, when compared to patients who undergo large, open incisions for surgery (Annals of Surgery, 234 (3): pp 279-291, 2001). In addition, the Roux-en-Y gastric bypass tends to yield inadequate weight loss for patients with a BMI greater than 55kg/m2 (Annals of Surgery, 231(4): pp 524-528. The Duodenal Switch is very effective for high BMI patients but unfortunately it can also be quite risky and may be safer if done open in these patients. The solution was to ‘stage’ the procedure for the high BMI patients. The VSG is a reasonable solution to this problem. It can usually be done laparoscopically even in patients weighing over 500 pounds. The stomach restriction that occurs allows these patients to lose more than 100 pounds. This dramatic weight loss allows significant improvement in health and resolution of associated medical problems such as diabetes and sleep apnea, and therefore effectively “downstages” a patient to a lower risk group. Once the patients BMI is lower (35-40) they can return to the operating room for the “second stage” of the procedure, which can either be the Duodenal Switch, Roux–en-Y gastric bypass or even a Lap-Band®. Current, but limited, data for this ‘two stage’ approach indicate adequate weight loss and fewer complications. Vertical Gastrectomy as an only stage procedure for Low BMI patients(alternative to Lap-Band®and Gastric Bypass) The Vertical Gastrectomy has proven to be quite safe and quite effective for individuals with a BMI in lower ranges. The following points are based on review of existing reports: Dr. Johnston in England, 10% of his patients did fail to achieve a BMI below 35 at 5 years and these tended to be the heavier individuals. The same ones we would expect to go through a second stage as noted above. The lower BMI patients had good weight loss (Obesity Surgery 2003). In San Francisco, Dr Lee, Jossart and Cirangle initiated this procedure for high risk and high BMI patients in 2002. The results have been very impressive. In more than 700 patients, there were no deaths, no conversions to open and a leak rate of less than 1%. The two year weight loss results are similar to the Roux en Y Gastric Bypass and the Duodenal Switch (81-86% Excess Weight Loss). Results comparing the first 216 patients are published in Surgical Endoscopy.. Earlier results were also presented at the American College of Surgeons National Meeting at a Plenary Session in October 2004 and can be found here: www.facs.org/education/gs2004/gs33lee.pdf. Dr Himpens and colleagues in Brussels have published 3 year results comparing 40 Lap-Band® patients to 40 Laparoscopic VSG patients. The VSG patients had a superior excess weight loss of 57% compared to 41% for the Lap-Band® group (Obesity Surgery, 16, 1450-1456, 2006). Low BMI individuals who should consider this procedure include: Those who are concerned about the potential long term side effects of an intestinal bypass such as intestinal obstruction, ulcers, anemia, osteoporosis, protein deficiency and vitamin deficiency. Those who are considering a Lap-Band® but are concerned about a foreign body or worried about frequent adjustments or finding a band adjustment physician. Those who have other medical problems that prevent them from having weight loss surgery such as anemia, Crohn’s disease, extensive prior surgery, severe asthma requiring frequent steroid use, and other complex medical conditions. People who need to take anti-inflammatory medications may also want to consider the Vertical Gastrectomy. Unlike the gastric bypass where these medications are associated with a very high incidence of ulcer, the VSG does not seem to have the same issues. Also, Lap-Band ® patients are at higher risks for complications from NSAID use. All surgical weight loss procedures have certain risks, complications and benefits. The ultimate result from weight loss surgery is dependent on the patients risk, how much education they receive from their surgeon, commitment to diet, establishing an exercise routine and the surgeons experience. As Dr. Jamieson summarized in 1993, “Given good motivation, a good operation technique and good education, patients can achieve weight loss comparable to that from more invasive procedures.”

I would recommend the 5 day pouch test (google it). Also, eating all the junk typically leads to more hunger. As for capacity, your anatomy could play a large role in that, or if you are eating/drinking simultaneously that's pretty much making the food go through faster. Pretty much everything you listed are slider foods for the most part. We can drink and eat at the same time, we just aren't supposed to do it. Just because we can, doesn't mean we should. And, unfortunately, there has to be some personal accountability when it comes to "what' we put in our mouths. I can eat quite a bit of food, nothing near 3 burgers, but I can eat more foods that are sliderish/mushy. Get your focus back on Protein dense foods.

I don't think carbs are "bad". I think I have a problem with carbs, I know I gain weight with carbs, and do not have room for Protein when I eat carbs. I know that I feel lethargic/listless when I eat carbs, and I don't care if it's "good, complex, healthy" carbs, my body is carb sensitive. I don't care what anyone else does with their body or how they choose to eat post-op. I do know what has worked beautifully for me, and I don't plan on changing it. If I worked out more, would this equation change? Probably. If I had room for more healthy carbs over protein, would I eat more? Probably. But, I do what is best for my body, and for how I need to maintain. I did what I needed to do to get to goal, and figure out the rest later. Eating a balanced diet was pretty difficult for me during my losing stage. I simply did not have room for more than what I could consume from protein dense foods. It just wasn't physically possible. I'm a meat eater, very carnivorous, more so than many of my female friends. I like it better than whole grains and even veggies. I love carbs, but I don't like the way they make me feel, and definitely do not like the added bloating, and capacity issues that I run into when trying to eat more carbs. Women, especially those with PCOS, are specifically told to avoid carbs of all sorts because they are metabolically challenged. When we were looking into seeing the reproductive endocrinologist, I was advised to go back to low carbing even though I've never been diagnosed with PCOS. I honestly think people need to do it how they need do it. Also, some people struggle with making the best choice, or have food issues. Justifying eating healthy carbs in my mind is no different than justifying eating all those extra points on Weight Watchers. I remember telling myself "Oh I'll just eat this because I have 30 extra points for the week". Unfortunately, that justification led me to making bad decision the following week. We all have our own individual struggles, and issues with eating. I picked my battles, and my battle was carbs and justification. Everyone here knows I do not diet, deprive myself or forbid any foods in maintenance, but for me to instill better behaviors and really learn to listen to my body, I had to cut carbs, and focus on what would work for ME.

As soon as I was able to get in my 64oz of clear fluids, I could add back in a cup of coffee. I've been drinking coffee daily since about 6 weeks out.

Most insurance companies take your first weigh in weight as your submitting and approval criteria. You might want to check with the insurance coordinator with your surgeon's office to clarify and confirm this information.

Nope, and I rarely ate that many carbs in maintenance, and only force myself to eat that many because I'm pregnant. Fat burned turns to energy, and the liver breaks it down properly. I know, I know every person is different, we all lose at different rates, but there is NO way even if I wanted to do so, I could NOT eat that much food, and well wouldn't do it because I know my body is carb sensitive, and I didn't want to take too long to achieve my weight goals. For me, I got the same "rule", and that rule in my opinion is set for people with normal stomachs, and are not morbidly to super morbidly obese with 50-60% body fat percentages. It'd be different if I had normal human stomach capacity, worked out on a daily basis and wasn't already immensely fat.

Thought I should edit: If you are only a few days out, I would not touch spicy stuff especially anything that has a lot of vinegar or an acidic base. Your stomach staple line is still fresh and healing. BUT, check with your doc. I did not notice your surgery date before my previous comments.

I've been eating spicy food since hitting mushies with zero issues. That was around 5-7 weeks out for me. I have had zero issues eating spicy food, and I eat some variety, be it Mexican, Thai, Japanese, Korean, whatever a couple times a week!

Nope, I feel the same way. But, do not be surprised if you find that skinny nuts are just giving out textbook "diet plans" for people with altered bodies that are geared toward people with only 30-40lbs to lose. I have the same issue with Dr. Phil and Oprah blabbering on about obesity. I wanna scream "HI POT, MEET KETTLE"!

I've order from High Plains Bison. Google them, they have great customer service.

Cook on low for about 5 hours. I wouldn't add any sauce to the top of it until the last hour or so because the intense heat build up will make the sauce too runny. At the 4 hour mark, slice the meatloaf in half and check the doneness. Ground meat can cook faster in a crock pot but I would say from my other recipes, I usually do 4-5 hours on low for ground meats.

I never found obese/overweight men attractive either, and didn't date fat men. It's a preference just like race, ethnicity, or religion. Heck, you've seen pics of my husband, he's has a rockin' body, and it was brought up on OH a couple of days ago in a topic about leaving your spouse if they became overweight/obese. My honest answer is YES, I would leave him because it's typically the behaviors that lead to obesity. It's a cause and effect situation. Which is vastly different from him being permanently injured from a combat wound, or an suffering a traumatic injury that left him disabled/handicapped. Those were not caused by his behaviors or habits that he allowed himself to get into. Just like I'd leave him if he became an alcoholic or drug addict. Fat is a symptom of behaviors and habits, and I couldn't be with someone that chose that self-destructive path. Especially now, that I have lost weight, changed my relationship with food, and refuse to go back to where I was in the weight department.

Yep, and it's because they stand it in for hours on end, day after day. Soda doesn't linger in the body. I'm not arguing, I'm not saying that it can't be harsh on a stomach, but there is a vast difference in standing in an acidic environment with rubber shoes vs. sipping a soda that goes through the body. Soda also leaches Calcium from our bones, weakens the enamel of our teeth etc etc. I'm not saying it's the best option, and there aren't some drawbacks to soda.

Or, drinking through a straw will make your stomach expand to the point of exploding internally! ! ! I really want to shake people that make these comments LOL.

I honestly don't see the world any differently. Call it cold, brash, whatever, but it's NOT my place, or my responsibility to reach out to other people who I think would benefit from WLS. However, I have been approached, and asked "how'd you do it, what did you have done?" and at that point, I've been very open about it. I know several people who look at obese people with disgust, can't stand to watch them eat, and for me, that's just absurd. I don't watch other people eat. I didn't pre-op, and it surely didn't change after I lost weight. I just don't pay attention to other people that closely. The only time that I've had a different perspective is now that I am pregnant as a skinny woman, my heart breaks for women who are obese/morbidly obese and pregnant. They look miserable, they have difficulty moving around. Hell, I have trouble moving around and I'm a stinkin' size 4/6 in maternity clothes. I was obese when I was pregnant with my 13 yr old son, and I remember how miserable I was during that pregnancy. It's not that I want to tell them there is an option for them to lose weight, but my heart does hurt for them because I know how difficult pregnancy is at any weight, but add an extra 100lbs, and it's downright misery. The world does not revolve me, and my world doesn't revolve other people. So, I pay little to zero attention to what other people are doing with their bodies. This mindset didn't change post-op. Maybe I'm just too self-centered to worry about other people that I do not know, or have some sort of relationship with on a personal level. I have been asked to speak at the informational seminars, and at support group meetings. I always decline because I'm a bit too abrasive, and do not coddle people. I don't think I'd be well received in a group of pre-op/post-ops who believe surgery is going to fix their food issues, or those that whine about not losing weight while they shovel in cheesecake and hos hos for Snacks.

I'm over 2 years out, and still take Nexium. I probably won't go off of it anytime soon. I know a lot of people can and do wean off of it successfully, but I've had reflux in the pregnancy, and I have zero desire to ever feel that way if I can prevent it.

I'm over 2 years out and still can't comfortably eat scrambled eggs so I can't help you with that one. Are you still on a PPI/acid reducer? If not you could be experiencing swelling, and irritation from acid. If you're on a PPI, you might to try a different regimen. My main recommendation is to get to your doc, and find out if they can do a scope. I had a case of severe gastritis that caused pain when eating. It resolved when I was switched from Prilosec to Nexium. Also, pain with eating solid foods happened when I started having gallbladder problems. I'm just throwing out some ideas for you and what I've experienced. As for liquids, see if you can just go back to mushy/super soft solids, and cut fat and any extra sauces/condiments for a few days to see if this helps. Try a bland diet, and maybe some Probiotics. The Tender Iron from Vitalady.com is awesome!

I don't explain it. I don't tell them that I had surgery. I refuse to use that little card to get a discounted meal. A to-go box, and a " oh the meal was great, thank you so much, I can't wait to have the rest of it for dinner tonight." End of story. Period. No other questions have ever been asked.

It depends on how far out from surgery you're wondering about. At 2 years out, I can eat 2 donuts without issue! As for McDonalds hamburgers, I can eat 1 of the regular, value dollar burgers without the top bun, if and only if I eat it super slow. usually I get in only about 3/4 of it before I decide it's just not worth it. I shared this a couple of weeks ago: I get a lot of messages from people just getting started, or just getting to normal food, and I remember being there. I remember never believing that I would be able to eat something decent. Well, here's a little nugget for everyone, and for me, seeing what others were eating really helped me wrap my head around all of it. Everyone wants to know what eating postop equals or they need visuals for reference. Tiff's lunch for today. 5 tortilla chips with salsa, 1fajita w/ 2tbsp of refried Beans,1tbsp sour cream, 4 small strips of grilled chicken breast meat & lots of sauteed onions!!! I tear off the majority of the tortilla. 2 years out, I could technically fit more in if I wanted or really ate super slow, but this is my standard lunch portion size. I'm completely satisfied and really love the restriction. Pretty mushy meal when all factors are considered, but here's proof life post vsg is very doable and normal food is possible! I can eat half of an 8oz sirloin steak from Logan's cooked medium with steak sauce. If I mix some of the sides, mushy food with it, and extend my meal a little more than 20-30 minutes I can fit in a few more bites.

Many congrats on the pregnancy ! ! ! The main issues is that you can NOT continue to eat low carb. Ketosis causes fetal brain damage so GO EAT A SANDWICH, if you are still low carbing it. Honestly, VSG has not complicated my pregnancy. The biggest challenge has been the inevitable weight gain, but you might not have as much as I have. I've gained a solid 20lbs at 29 weeks pregnant and even though that is perfectly on target, it's mindbending for me to gain weight. I have struggled with the physical changes, my ever expanding belly, and the fact that I'm 34 doesn't help! This is also my 2nd pregnancy, and higher numbers on the scale are expected with a 2nd pregnancy. So, my recommendation is to get to your ob, you shouldn't have to take any additional Vitamins, but make sure they monitor your B12 and Folate on a regular basis. If you aren't taking anything, start now. Folic acid and B12, Iron are the ones we need the most. My labs have remained stellar through my pregnancy. All you'll need is a prenatal with a sublingual b12. If you have worked out through your journey, keep working out. I admittedly didn't work out, and haven't in the pregnancy. I know that has contributed to my weight gain. Depending on your starting pregnancy weight, will determine your pregnancy calorie/protein/carb goals. I'm to eat 1700-1800 calories, 100gr of Protein 100gr of carbs, and 100oz of clear fluids per day. Yes, it's challenging, and I drink some calorie-filled drinks because I simply can not eat all my calories. Grape juice helps tremendously. Again, many congrats, and if you need anything, feel free to shoot me a message!

I know stalls suck. BUT, I really think everyone needs to be realistic and logical. Your body has been put through hell. Pumped full of fluids, anesthesia, meds, sleep deprivation, overridden with hormones, and we expect to just drop weight magically. Your body is so confused, and overwhelmed. Your liver is processing everything that was put in there. I know we all want to see big numbers the first couple of weeks, to the first month, sadly our bodies need time to adjust and try to figure out everything that is going on. Take measurements, keep following your plan, and please, allow your body to recover. And, as difficult as it is, try not to compare your numbers on the scale to others. I don't know how much you have to lose, or how much you might have lost on the pre-op, but all of these factors contribute to how you will lose through the first year. From what I can tell, you've lost 65lbs pre-op so that in itself is a huge accomplishment. The biggest issue right now is that your body is just trying to figure out what the hell you've done to it.

My thought process on any bariatric surgery is that if you put in the work, not just the physical changes, but the behavioral/mental work, surgery will work. Identifying, and resolving your own food issues will serve you well long term. That means not just cutting calories, watching carbs, exercising, it means true behavioral changes that revolve around your own personal eating habits and behaviors. It's been well established that the sleeve works, but patient compliance is the highest contributor to long term success. I really had to face the facts when it came to what contributed to my obesity. I was not an emotional eater, nor did I have compulsive tendencies. BUT, I love food, all foods, and none of that has changed in maintenance. I still love food, I love going out to eat, I love social events that revolve around food, and the only thing that keeps me in check is the fear of getting fat again. I tow a thin line of "normalcy" and life post-VSG. I do eat anything and everything I want. However, I still eat Protein first 85-90% of the time. I have indulgences, but I keep them in moderation. It's something that I'll have to do to maintain my loss. The restriction of the sleeve is still very present to this day, but I can eat around my sleeve. I've found this to be true since being maintenance. Since being pregnant, I have to eat more calories/carbs/protein than I ate in maintenance, and for me to hit those goals, I have to eat more frequently, and cheat the sleeve to some extent. In the beginning, I never allowed any doubts stand in my way. I wasn't willing to accept failure again. So, I pushed out all the negative thoughts, stuck to my plan, and was hellbent on achieving my goals.

I've drank soda since being below goal, and it has done nothing to change my sleeve capacity. I typically do not drink diet. I stick with gingerale or orange/strawberry sodas that are caffeine free, and I have experienced zero negative issues with having a soda here and there. There is zero scientific evidence that soda causes sleeve stretching, and for that matter, no scientific evidence exists that soda stretches RNY pouches. It's not like soda sits in there brewing for hours, it hits the pyloric valve and empties into the intestine just like any other Fluid. As for cravings for things because of my soda consumption, I have not experienced this at all either.