ouroborous

So those who've read my posts know that I asked a lot of questions before surgery about post-op depression, and have had a few struggles since my surgery with the problem. I've had a lifelong history with depression and anxiety, and have at various points in my life done therapy and been on just about every medication known. None of those things worked, long term. Note: some people do suffer real physiological depression post-op. It is well documented, and you should always talk to your doctor if you're struggling. I'm just posting my findings so that some of you might have a head start in unraveling this ball of twine. What I'm finding is that my depression is almost entirely related to physiological factors. In short, when I take care of my physical needs adequately, I'm not depressed or anxious. In fact, when I'm getting enough sleep, food (especially carbs -- yes, the evil carbs!), Water, and exercise, my mood is very, very good. When I AM taking care of myself, I'm calm (not anxious), hopeful, and generally a pleasant person. However, any of the following will QUICKLY put me into a tail spin: Not getting enough sleep. I don't know how many times I'm going to have to re-learn this lesson, but for posterity, here it is: if I don't get enough quality sleep, I'm a wreck. This is getting more pronounced as I get older, and has gotten dramatically more pronounced since the surgery. It used to be that it took a week or two of crappy sleep (or not enough sleep) to bring me down. Now a day or two and I'm a wreck. Not getting enough exercise. This is intimately tied in to sleep; when I am exercising regularly and vigorously, I sleep better. But even if you take sleep out of the picture, exercise has worked better for me than any antidepressant I've tried, and it has worked quicker. Don't get me wrong, I'm a big fan of better living through chemistry; if you need AD's, take them, but for me, exercise is much more effective. It can nip an anxiety attack in the bud, and 15 minutes of brisk walking in the sunshine (or even in the gray... come on, this is Seattle!) can prevent an entire day of blue moping. Not eating enough. If I don't eat enough food, or good enough food, I am a mess. I get wobbly and cranky and prone to irritability and depression. Worse, I tend to compensate-eat later, and eat far more calories (and far worse calories) than I would have if I'd just forced myself to eat properly to begin with. Also, I've noticed a strong correlation between mood and carbohydrate intake in particular. I guess it makes sense; taking in far fewer calories means I have far fewer reserves to spare, but quite often snapping out a blue funk is as easy as drinking a glass of skim milk (which has both Protein and milk sugar -- a win/win combination of carbs and protein, according to my nutritionist). Not drinking enough. This doesn't make me blue, but it makes me feel ill and grumpy, and that often leads to OTHER bad behaviors that precipitate blue-ness. Drinking too much caffeine. Of course, overindulgence in caffeine is always a shortcut to feeling icky, but since my surgery I've found that my tolerance is much, much lower. One big cup of coffee can make we wired and jittery for hours, followed by a deep crash of exhaustion and depression and anxiety. It's almost not worth it anymore. Drinking too much alcohol. Similarly, alcohol is a depressant so this shouldn't be that surprising. What's surprising is how much stronger the effects are now. Particularly, unfortunately, the negative effects -- two or three drinks and I'm hung over, moody and anxious the next day. Just like caffeine, it's to the point where the "fun" is almost not worth the cost. None of this means that I can avoid other good mental hygiene, like keeping social contacts strong and so forth. But ultimately, I find that simply taking care of my body -- doing the things I should be doing anyway -- is the most potent antidepressant available. It's as simple as this: when I take care of myself, I don't get anxious or blue. When I don't, I suffer.

So, nobody should take my posting as a recommendation to avoid meds. I am not anti-meds -- not at all. Better living through chemistry, baby (I mean, come on, I paid 20 grand out of pocket to have my stomach sliced up instead of "just" dieting and exercising; would someone who is anti-medicine do that?) I thought I was really clear about that, but I'll say it again: you really need to talk to your doctor about depression, and if you need meds take them. That being said, the point of my post was that, for me, taking meds has never been as effective as remembering to take care of my physical needs. I don't know how many people are like me, but I don't always "remember" to take care of myself, but I always, always always pay the price. So I have to consciously remember to get enough sleep, eat enough healthy food, drink enough Water, etc. And one of the prices I pay if I don't do those things is depression and/or anxiety. I suspect that for a lot of us, depression worsens after surgery. Not because of fear of mortality or anything deep and psychological like that, but simply because our brains are part of our bodies, and if we're not taking care of our bodies, we're not taking care of our brains! It's amazing how many people forget that they are a "part of" their physical selves and think that they can neglect their basic health and still keep firing on all cylinders, mentally and emotionally. I don't know about you guys, but I just don't work that way -- especially since the surgery. So, if you need meds, TAKE THEM. But also, try to take better care of yourself -- do all the things you know you're "supposed to" be doing -- and see if that doesn't help at least a little.

Look, what counts for grams of Protein is weight -- period. Volume is affected by density. Take a giant bag of popcorn, and you can lift it and throw it around easily. Take a giant bag of rocks -- same size, or volume -- and you can barely lift it. That's because there's a great deal more mass -- weight -- in the same volume. That means it's more dense. Weight -- or mass -- is a constant. There's a trick physics question which says "which is heavier, a pound of bricks or a pound of air?" It's a trick question because they both weigh a pound. Sure, a pound of air might fill a 55 gallon drum, whereas a pound of bricks might mean a half a brick, but they're still both a pound. That's why when measuring things like protein quantity, weight is everything. If you want to know how many grams of protein you're eating, the only reliable way to figure that out is to take the weight of the chicken (or whatever) you're eating, and multiply it by something (that "something" is the coefficient of chicken mass to protein mass). I'll say it again, when you're trying to figure out how many grams of protein that you're eating, mass (weight) is all that matters. Now, just because that's too simple, volume DOES matter, but for a different reason: we have tiny stomachs! Most of us can't eat more than 1/2 to 1/3 of a cup (a cup is a measure of volume, not weight) at a time. So we have to look at that 1/2 chicken breast, which maybe weighs 2 oz. cooked (56 grams, for about 15-20 grams of protein I'd guess), and see if it's more than 1/2 cup of volume. If it is, we may have to cut it into two meals, or get more protein in a different way (some Beans, maybe?) But if you really want to accurately measure your protein intake, you must use weight. That's because all of the measures are in weights, and if you start confusing weights and volumes, you'll get your numbers all wrong. I highly recommend you get an accurate (gram accurate) kitchen scale and weigh all your portions. Then use something like Livestrong (or whatever) to get your nutrition info from your portions (1 gram of chicken is not 1 gram of protein; you need a nutrition database to figure it out). I also recommend using metric measures :biggrin0: As you're already seeing, "Imperial" or standard weights and measures are needlessly complex. Almost all nutrition information is already in metric on most sites, so why not make the switch? Even if you don't have any conception of what a "gram" (a unit of weight) is, your scale will, and you won't be tempted to get it confused with say a cubic centimeter (cc, a unit of volume). I don't mean to be harsh to those replying otherwise, but this is basic physics -- basic weights and measures, really. Volume matters to sleevers because we have tiny stomachs. But if you're calculating nutrition, weight is king, baby. Edit: all this being said, it's probably a tempest in a teapot. I don't measure ANYTHING anymore, I just try to get "a lot" of protein and a fair amount of carbs, and I eyeball portion size. I think that honestly the payoff isn't worth the effort of religiously weighing portions. And yes, to avoid overeating, you should pay attention to volume, since that's what will plug you up, not weight. But still, I just wanted to point out that if you want to measure your nutrition, you must use weight. If you just want to eyeball it, then volume is probably fine.

Sounds like a little bit of dumping, mixed with some anxiety. Just chalk it up to experience; you'll be having a LOT of those "oops" experiences as you learn what you can and can't eat, going forward...

The gold standard for treatment of PF is cortisone shots -- in your heel! If that sounds painful (it did to me), you can try to: Do some stretches specifically designed to improve the pain (google it) Wear orthotic inserts (that's what worked for me, a sole insert called SuperFeet and my PF went away for good) Lose weight!

My guess is that you'll be a little more gassy, forever. Your stomach is tiny now, and there's just not as much room to fit food and liquid and gas. However, it should dramatically improve with time (it has for me). The feeling of pressure is probably a warning that you're eating too fast or taking too big of a bite. Slow down and savor it. You're not going to jeopardize yourself by eating less, or eating slower, so if you feel any discomfort, that should be your warning sign that you're going too fast. It's a common problem that a lot of us formerly heavy people have -- we tend to wolf our food down. I know I do!

Carbonation fears are overplayed. It's important to remember that doctors tend to play a "better safe than sorry" role, especially when it's regarding non-essential, empty calories like soda pop. But as Tiffy pointed out, the part of your stomach that's left is the least stretchy, most muscular bit. It's supposedly similar in texture to football leather (don't know if that's true, but it's what I've read) -- think about how many sodas you'd have to drink to seriously stretch a pigskin! I had a glass of beer at 3 months out. Aside from having almost zero capacity (I went from a "can down a six pack easy" guy to one glass and I'm DONE!) and burping a LOT, like every two sips, there was absolutely no pain or discomfort or problem.

Bottom line is that some pain is normal. If you are vomiting (or blood is coming out of ANYTHING), or you have difficulties breathing, that is a medical emergency. A little pain, however, is normal, and you should adopt more of a "wait and see" attitude. It COULD be a staple line leak, but it's fairly unlikely at two weeks out.

I think that over the short term (2-3 weeks tops), being a little short on protein isn't going to hurt you. But in the long term, it can lead to muscle wasting and all sorts of problems. I DO think you shouldn't stress about it, though, because unlike, for instance, water, you really can just try to "make it up" when you feel more like eating.

Actually, Protein is measured by weight, not volume. Your target is 60-100g a day -- grams, which are a measure of weight. If you take 60g of protein and then only take what fits in 2/3 of a cup, that is less than 60g of protein. I'm sorry, but if your nutritionist said that you could eat less than 60g of protein (which you would be doing if you only took 1/2 or 2/3 of it) and still be eating at least 60g of protein, that's just wrong. It's basic weights and measures. That being said, I don't think we should freak out if we don't hit the target once in a while, and remember that there are other forms of protein that are easier to get down -- whole black Beans, for instance, are very protein dense, and chili or black bean Soup is relatively easy to get down. And of course there are Protein shakes.

Make sure that you're taking care of yourself -- in particular, getting enough Water, Vitamins, and Protein (you ARE seeing a nutritionist, right?), and getting enough sleep and exercise. If all of these things are in order, it's likely just normal post-operative "shock." If you get dizzy or have trouble breathing or begin vomiting (or a bunch of other potential issues including severe pain, high fever, yellow eyes, swollen abdomen), run to your doctor immediately. But if you're just run down and you're doing all the things you're supposed to do, that's pretty normal.

Um. You guys know that severe ketosis can ruin your kidneys, right? I worry about this sort of advice. A lot. Seriously, focus on limiting your calories to the target range (600-800/day, adjusted by exercise), keep carbs in a "reasonable" range, drink lots of Water, take your Vitamins, and exercise. That's ALL you need to do. Honest! That and a little patience and the pounds will just melt off. From the AAKP (American Association of Kidney Patients) website:

Don't worry too much about Protein, especially in the first week or two. You're not going to become seriously ill even if you're protein deficient for days on end. The only thing to be really careful about, especially in the first week, is Water. THAT can get you into trouble rapidly. If you were just sleeved on 8/9, focus on sipping water and walking as much as you can. The rest will take care of itself, trust me.

Actually, according to my surgeon, it IS possible to feel physiological hunger after lap sleeve. The mechanisms are complex, but apparently we shouldn't expect to "never feel hungry again." Some people are lucky and don't ever feel hungry again, but Dr. L said that "most people do regain some sensation of hunger, although much less strong than before."

It's really, really important not to compare your process with others, as that will just discourage you. Make sure that you're losing, but over the long term -- don't weigh yourself ANY more frequently than once a week, and even that is pushing it (every other week or once a month would be better). Water weight gains can easily swallow week-to-week fluctuations. In the end, just focus on the fact that you ARE losing and it's a healthy loss. You'll get there, even if it's not right this instant.

I'm with the crowd. I've had a few drinks since my surgery (three months out). It affected me a lot faster, and differently. There's no way to drink enough volume to become really intoxicated (which is probably a good thing) unless you're drinking hard liquor. Plus, the two or three drinks that I did have made me mildly hungover the next day, which is a first (given my weight before surgery, I could have easily downed a six pack and not felt a thing the next day and only felt mildly tipsy at the time). All things considered, it's just not that much fun any more. Which, again, is probably a good thing.

Here's what three months looks like: 330 lbs to 270 lbs. 60 more lbs to go!

I've been exercising -- as in cardio exercise, walking -- since day 2, at the doctor's recommendation, so obviously that's not off limits. From what I can tell, it's only resistance training (weight lifting, machines, etc.) that's off limits. My post-op pamphelet says to avoid lifting more than 15 lbs for two weeks post-op. I've also heard four weeks, and six weeks. I know the surgeon is the final arbiter, and I'm going to see and ask him on Thursday, but in the interim I'm curious: when did you guys start working out (for reals, not just walking) after your surgery?

Dr. Jossart, there's a pretty strong current of belief around here that after lap sleeve, it's "impossible" to absorb more than 20g of Protein at a time. This is often used to say that high-Protein shakes, for instance -- say 50g or 60g of protein -- are a waste of money. Many people claim that their doctors and nutritionists gave them this fact. Also, I DO find some reference to protein malabsorption on the net -- for instance, a consent form I found referenced it. However, I searched the medical databases and couldn't find ANY reference to lap sleeve significantly altering protein metabolism (intake, yes, but not basic metabolism). From what I understand, one of the primary "selling points" of the lap sleeve is that it is not malabsorptive. I guess if the smaller, scarred stomach is unable to produce sufficient gastric acids or pepsin or whatever, protein metabolism might be challenging, but that seems a stretch (and I believe it would be noted in literature). I'm starting to think that the "20 grams of protein in a sitting" meme is an urban legend. One possibility is that since the lap sleeve used to be just part of the lap sleeve plus DS procedure, which unless I'm mistaken IS malabsorptive, there may be old data floating around masquerading as current truth. I'd appreciate it if you could shed any light on this, because a lot of people are giving a lot of other people a lot of potentially incorrect advice :lol0:

I can't see anything specifically about helium that would be contraindicated for lap sleevers. That being said, hypoxia -- lack of oxygen, which helium inhalation can bring about -- can be fatal, so I'd still avoid inhaling too much of the stuff.

Look, let's be honest. It's not without challenges. But the fact is that there is simply no way that I could have lost 60 lbs and kept it off before surgery. Just losing 60 lbs has probably already added 10 years to my life. So, despite my griping and kvetching, would I do it over again? In a heartbeat.