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Hello Kim, Ok I had my pre-op app yesterday,I met with paula, who took my weight( down 4lbs) and then met with dory who gave me the scprits i will for after surgery and also told me i need to get the optifast for the pre-op diet. I asked was there an alternative and she said Mary pat would offer some suggestions. I was going to purchase it but when she told me that they only had 1 case where someones liver was too big to do the operation i deceided to try to shrink my liver without using the optifast. I just think its too expensive. Mary Pat told me to use Carnation Instant Breakfast instead. ( no sugar). The first week you get to have 4-5 and a meat protien w/veggies. The second week is strickly shakes. So wish me luck mama...i am gonna need it.