ouroborous

Again, what people don't realize is that, while it is eminently possible to lose a great deal of weight "the old fashioned way," it is almost impossible to *keep it off* without surgery or some other kind of medical intervention. This has to do more with how our brains are wired than anything else.

100.3 isn't a huge concern in and of itself. However, if you present with vomiting or difficulty breathing then run, don't walk, to the ER.

From what I understand, it's a mechanical thing; if the NSAID pill pushes up against the wall of your stomach, particularly the staple line (which, being scar tissue, isn't lined with productive mucosa), you can ulcerate. So, as my surgeon recommended, it may be better to stack the decks: take a chewable, liquid, or sublingual preparation, where there isn't a risk of a pill lodging right up against the staple line for a period of time. Also, make sure you're on an acid blocker, and try to take it with food or Water (to increase overall gut motility). I am not a doctor, but the sense I get is that "once in a while" NSAID's are probably okay, but for regular use -- like arthritis, etc. -- you're probably better off with a non-NSAID, or at least a non-pill NSAID.

Thanks. I think I'm most excited about getting down to just one chin! Sadly, my belly is slower catching up than my face, but I'll get there. It's before and after pictures like this that remind me "yes, it IS working... you just have to be patient and 'keep on keeping on!'"

(Delayed response) This is useful information, particularly the higher numbers. I think it's very interesting that many doctors and nutritionists seem to take a "one size fits all" approach to nutrition. My suspicion is that my Protein needs are in the higher range, and I may need to drink one or more protein shakes a day to meet my needs. AFAIK, there isn't any real test for protein deficiency, right?

Danke schon!

I had this exact same thing: an on-again, off-again, low-grade fever for about 4-5 days. By the time I hit about a week out, it went away and stayed gone. My surgeon said it is very, very normal, and only to worry if it spiked over 101 and stayed there (or if I started vomiting/bleeding/passed out/etc.) Don't worry about it. Just take your pain meds, drink what Water you can (sip, sip, sip), walk as much as you can, and focus on getting better!

Thanks I live with myself every day, and I tend to downplay my gains (er, losses). But the truth is that when I look at that picture of my face compared to even the old one from here (which is me at around 285) or especially the one on my work badge (which is me at 330), I can see a HUGE difference. My face is much less round. I need to update my weight ticker, too. Tomorrow is weigh day, and I'm hoping to (finally) be under 270. You're looking great too! Looking at your albums, your "then and now" pictures show an incredible improvement! What a difference a few months make, eh?

First of all, I am *not* advocating going against your doctor's advice, for two reasons. 1. All else being equal, your doctor probably knows better than you do, and better than some yahoo on the internet. 2. I could get in legal trouble if I advocated you ignore your doctor! HOWEVER, that being said, we all have to make choices and live with the consequences. I think that it's a given that: 1. Tylenol (acetaminophen/paracetamol/etc.) CAN lead to liver toxicity. It's extremely unlikely to damage your liver unless you OD or run at chronically high doses, but it's still a non-zero risk. 2. A lot of the literature is confusing, as Tiffykins points out -- a lot of surgeons take a "better safe than sorry" attitude, and much of the information is stolen whole cloth from RNY documents. 3. Different surgeons and doctors/pharmacists give different advice. That all being taken into account, you have to use your own judgment about the risks vs. rewards. Nothing in life is perfectly safe. Edit: my doctor responded to an email about this issue. I've omitted his name/email, but here's his response, verbatim:

Well, my stall is officially over. At the 6 weeks point, I had two weeks where I lost zero pounds, and now I've lost 3 pounds a week for two weeks, finally putting me over the 50 pounds lost mark since this journey began. And for the record, I didn't change anything -- didn't change my carbs or my Protein, didn't change my quantities, I didn't do a pouch reset. I was just patient and reminded myself that I was doing all the right things and that eventually my body WOULD lose weight again (at <1000 cals a day, it HAD to!). And... it did. YAY! 250 lbs, here I come!

So I met with the nutritionist today, and much of the talk was about carbs. Specifically, she told me to not worry about carbs, because sleevers simply can't get in enough food for the carbs to be an issue (as long as you stick to complex carbs from vegetables or whole fruits, not sugar/flour/etc.) In fact, she specifically suspected that my icky feelings (wobbly, nauseous) were due to mild hypoglycemia from not eating enough carbs, and not eating them regularly enough. Just to be thorough, I asked "so 80-100 grams of carbs a day isn't a problem?" and her response was "oh no, not at all. As long as you're sticking to the calorie total, you're going to lose weight. Just make sure you're getting enough Protein, but otherwise don't worry so much about restricting carbs." As usual, your doctor/nutritionist/mileage may vary, but from what I'm hearing from the "experts" (as opposed to internet folklore), I really don't think I'm going to worry about carbs at all. One benefit of more carbs (when on whole foods) is that they tend to contain more Fiber -- helping with any bathroom issues you might be having (and which I definitely have been having). So that's one less thing to worry about. Don't worry about the carbs... just the protein, Water, and Vitamins. I mean, I've been averaging 100 g of carbs/day and I'm STILL losing about 1 lb/day.

So, does acid reflux get worse after surgery? I know that obesity can cause acid reflux, and I have it. According to the endoscope, I don't have a hiatal hernia. Is my reflux likely to get worse after the surgery?

It's something folks swear by to break stalls. Basically you re-run yourself through all of the early eating stages (liquid, full liquid, mushy, regular, etc.). Honestly, I think it's just a way to feel like you're DOING something while time passes -- the body is complicated, and stalls will eventually end (if you're doing the right thing).

Yeah, that 6-8 week stall was a killer for me, but just have a little faith in the process, and your body will start burning the fat again. Oh and don't forget to drink lots of Water, eat enough Protein, exercise, and get lots of rest (as if you didn't have anything ELSE to worry about

You beat me to it... I'm pretty sure that the muscle teardown/repair/rebuild cycle requires you to retain water for a few days. Even when I wasn't losing weight, I was losing inches; I started this wearing 48 inch waistband jeans, and now I'm wearing 40 inch waistband shorts (they're elastic in the waist, so that's probably like a 42 inch jean, but still). For reference, in my 20's when I was working at a very physically demanding job (UPS, unloading boxes, 6 hours of dripping sweat every day), I was wearing 38 inch jeans, so I'm getting within sight of being near or at the lowest weight I've had in my adult life (which is sorta sad at 276 pounds, but still!) I haven't started going to the gym yet (I got overeager a few weeks back and pulled a triceps, but I think that's healed), but I think now it's time!

So from last week to this week, I lost -- nothing. It's very frustrating, because even when I'm NOT tracking my calories, I'm still eating less than half of what I used to eat. I know, I know, it could be a plateau, it could be Water weight, weekly weigh-ins are probably still too frequent. What makes it more frustrating is that I've been feeling really sick lately. There's something... off... about my food schedule. Some of you may know that I had been really tired and a little depressed, and complaining about that. I even got the doc to prescribe an antidepressant. But I never took it because I am still sort of convinced that the problem is sleep-related (my apnea is acting up) or nutritional, NOT general depression. Yesterday, I discovered that it is definitely nutritional. I've been trying to go about 2-3 hours between eating, but I discovered that when I do that, especially by the end of the day, I get sort of lethargic, sleepy, and blue! However, if I eat every hour or so, I feel much, much better. My girlfriend even commented that it was like turning on a switch... I was tired and grumpy and unpleasant, and then I had some apple slices with Peanut Butter, and woke right up to my normal chipper self. So SOMETHING is amiss nutritionally. But that's frustrating, because I'm not losing weight! It's not like I'm pigging out. Even if I don't track my calories at all, because of the sleeve's restriction there's no way I could eat more than 1200-1300 calories per day (and that would be really pushing it, it's probably closer to 1000-1100). Most days last week, at work, I stayed at 600-800 net calories. For reference, before my SWAG is that I was eating around 3000-3500 calories per day, and maintaining around 330 lbs. Now, at "only" 48 lbs down, apparently I'm maintaining at significantly less than half those calories. It's just not fair! So now I'm stuck, not losing weight, and discovering that in order to not feel sick and lethargic and sluggish, I have to eat more. ARGH! I want to at LEAST cross the 50 lbs mark. Is that too much to ask for a guy who was technically at least 130 lbs. overweight? Can you tell how frustrating this is for me? Edit: I'm about 7 weeks postop. I don't know when the usual "stalls" happen...

Oh, one other thing. WRT to carbs, I've been eating 80g-100g all along. My stall right now has nothing to do with increased carb intake, since my carb intake has been pretty steady for the entire time since surgery, including some weeks when I lost 7-10 pounds in a single week. Basically, the idea that I'll speed up my weight loss by eating less carbs just makes no sense, when you look at the evidence. This is just my experience... you all should listen to your doctors, not me, of course. But I think that the moral of the story is that I'm going to try to "lighten up" and not weigh myself as frequently, and eat more carbs (good, healthy, complex carbs) and eat them more frequently (rather than a single carb-heavy meal, eat little Snacks of Protein and carbs on a regular basis... which, incidentally is what my nutritionist told me to do last time... I should listen to the "experts" instead of making it up as I go along -- I'm not always the brightest bulb in the batch!)

Again, not to be confrontational, but there's a lot of science indicating that carb restriction can lead to depression and lethargy. Additionally, although simple carbs can lead to insulin spikes/troughs, we're not talking about simple carbs here (I don't eat sugar and white flour anymore, pretty much at all, and my fructose intake is always in the form of whole fruit). I think we have to remember that what applies to the general population isn't always going to be applicable to WLS patients, because our nutritional needs and intake are very different (even our metabolism is slightly different if we're digesting in a less acid-rich environment). The bottom line is that a 6'1, 280 lb. man who's taking in 1000-1200 calories a day (which is, again, 50% more calories than my nutritionist recommends, but I'm using it as a "high Water mark" of my cheatiest of cheat days) is going to lose weight, given enough time. I don't recommend skimping on any other essential nutrient, of course, but I think that extreme carb restriction is not going to net gains (losses) as impressive as claimed (in fact, I've yet to see a study that shows that carb-restricted patients do better than non carb-restricted patients post WLS). And what I do know is that it will make you feel miserable. Well, maybe not you, but it does for me. I can literally feel the difference within minutes of eating a few grapes (ooh, scary, complex carbs!) And the real bottom line, of course, is that I'm going to listen to my nutritionist and doctor -- this is ultimately what we should all be doing, listening to our doctors. And she's telling me to eat more carbs and trim my Protein down slightly. Edit: thinking about this, I really should have chosen a different thread title. I'm ultimately less concerned with stalls (which I KNOW will happen and are inevitable -- the body has a billion homeostatic mechanisms designed to prevent rapid weight loss; we're literally fighting a million years of evolution when we try to shed pounds rapidly) than I am with feeling crappy all the time. I'll happily accept a slightly slower weight loss if I feel good. My girlfriend is the example I should have been paying attention to; she happily munches on wheat crackers (in moderation) and fruit and vegetables and mashed potatoes and rice (all in moderation), and has been steadily losing weight for 8 months now. And her mood and energy level have been great and getting better every day. Basically she never watches her carbs, only her calories and exercise, and she's doing great. So again, I'm sorry if I come off as confrontational, but it's really starting to dawn on me that everyone is in agreement -- my surgeon, my nutritionist, my girlfriend's experience, and my own body and instincts. The only reason I've been trying to limit carbs is because (again, sorry, but let's be honest...) "some people on the internet" told me to. I should learn my lesson! Also, I think I'm going to start weighing myself every other week or once a month or so. I know I'll lose the weight, and if I stop anxiously hovering over the scale I won't stress out so much about the inevitable plateaus.

Thanks for the reply! But nope, it was nutritional. I wasn't eating enough carbs. I think I'm going to stop listening to the folks here who say "ohhhh noooo, 60g of carbs! You're going to get fat!" and start listening to my nutritionist who keeps telling me "don't worry about carbs -- stick to your Protein, Water, calorie, and exercise goals, and you WILL lose weight, and feel so much better while you're doing it!"

Okay, I just heard back from the nutritionist (I'm so lucky to have highly-skilled nutritionists who actually answer their email). She told me to eat more carbs. Basically, we need carbs for energy, mood regulation, and all kinds of stuff. Basically at >100g of Protein per day, I'm not leaving enough calories in my calorie budget for carbs. So she told me to eat less protein, and eat more carbs. I'm putting this in bold because so much of the "folklore" that circulates around here is that "carbs are bad." However, my own experience is that long-term, very low-carb diets can be hazardous to your well-being! She also responded that it's not as important to be low-carb as it is to be low-calorie. With regards to the plateau I'm experiencing, she said what you all are saying: plateaus happen, and as long as I'm doing all the exercise and stuff I'm supposed to be doing (I am), I will eventually start losing weight again (I asked her about the "sleeve/pouch reset" and it was her opinion that this is basically just a placebo that keeps you occupied during the time that it normally takes for you to get out of a plateau -- in other words, it just keeps you busy, it doesn't actually DO anything as long as the calories are the same). But with regards to feeling blue, down, lethargic, sleepy, and low energy, she was very emphatic that I need to eat more carbs, more complex carbs, and restrict my protein if necessary to do so. So to anyone who's going through this same thing, post-sleeve blues, talk to your doc or nutritionist, but please don't just buy into the common folklore that "carbs are bad." Maybe for some people, maybe sometimes, but for the rest of us, carbs are important for maintaining mood and energy. And as we all know, when you're too exhausted to go to the gym or make good food choices, your weight loss will suffer. (Note: if you couldn't tell, I feel better while writing this. I ate some grapes -- again... evil, evil carbs!)

Yeah, I've considered that. My next bloodwork isn't scheduled for a month (actually it'll be close to two months before I get the results). When you're feeling cruddy, two months is a long time! Here's what I do know. Before the surgery, my bloodwork showed that nutritionally I was fine in almost every area. My folate and Iron were a little high, but that was about it. Because my iron was high, the nut. recommended that I not supplement with iron, however since I was nervous about going to basically zero iron, I'm taking one bariatric iron chewable per week. I talked to the nut. about that and she's fine with it. I am not diabetic, nor have I ever been. I was worried about it (my dad has diabetes, under control, and given my weight it was just a matter of time), so I bought a blood sugar tester, but my sugar has never even been close to bad. My doctor's bloodwork confirms this. So I'm definitely not diabetic; however, that doesn't mean I can't be temporarily hypoglycemic or whatever. Every day I take two Bariatric Advantage chewable multis (morning/night), one sublingual B12 (don't know dosage), one 1000 IU Vitamin D (hmm, just realized, I've cut my D in half since the surgery, maybe I should add another D in the evening), four 250 mg chewable Calcium citrates (split over the day), and four 125 mg chewable Omega 3's (split over the day). I also take a male support supplement that contains some herbs and basically lots of zinc and Vitamin E (not toxic doses, but high doses). I take 40 mg of omeprazole per day, and some antacids as needed. My eating is sporadic, I know that. During the work day, my schedule is much more structured. On the weekends, I can go 3-4 hours (or longer!) between meals. It's not wise, I know, but I forget. Also lately I've been sort of neglectful of my Water. I don't think I'm dehydrated, but I have had a few days where I've only gotten about 20-40 oz of water in. I've been good on Protein, usually 90-100 g per day. Carbs have averaged around 80-100 g per day (per the nut. I shouldn't bother counting them, but still, LiveStrong counts them for me). Calories during the work week are pretty constant, from 600-800 net calories per day (800-1000 gross, but my nut. says to subtract out my exercise calories, so I do). On the weekend, calories vary wildly, from maybe as low as 400 if I forget to eat, to 1200 or so if my girlfriend and I go out for dinner. I'm not feeling nauseous or anything. I get a little dizzy when I stand up, but I think my blood pressure is MUCH much lower than before my sleeve (I used to run a resting BP of around 130/90, now it's about 120/70, and my resting heart rate has gone from about 90 bpm to about 60 bpm (!)). The feeling I get is just sort of run down. I feel tired -- physically tired... fall asleep in the chair tired -- in the middle of the day. I never used to have that happen. I also get blue and depressed, but it tracks *exactly* with my fatigue; if I eat and the fatigue goes away, the blues go away instantly (which is why I'm not taking the antidepressants; I'm not convinced that general depression is the root problem, and I don't want to sign on for a six month course of Wellbutrin if this is just a nutritional thing). My sleep is okay, but not great. My sleep doc has prescribed a new auto-titrating CPAP that should be better able to track my pressure needs so that I shouldn't have to get a new sleep study every month. I will pick that up tomorrow. Because I'm a sorta geeky guy, I purchased a recording SpO2 meter (the finger clip thing that measures your blood oxygen; it's a cheap way to look for apneas/hypopneas during the night). During my tests so far, my O2 sat hasn't dropped below 92-95% (which is fine), and my pulse rate never spiked above 80 bpm during the night. An apnea attack would show elevated pulse rate with oxygen desaturation, so I don't think I'm having clinically significant apnea (of course, this doesn't mean I'm getting restful sleep; you can have "partial arousals" that don't much spike your BPM/SpO2 numbers, but which still ruin your REM sleep). We'll see if the new fancy auto CPAP machine helps. I'm somewhat at a loss. I'm going to email the nutritionist and see what she thinks. I'm seeing her in a week, but I feel crappy NOW, and I'm not losing weight NOW, so I'm hoping for answers... I'm convinced that ultimately this is nutritional. I just don't know what it is that I'm missing. My suspicion right now hovers around carbs; I know that everyone on here afears the carbs, but I'm noticing that eating carbs (especially complex, good carbs -- fruits, whole wheat crackers, etc.) seems to help a lot. I think I have to switch away from such a protein-heavy diet and start incorporating more fruits and whole grains in my diet.

The gurgling is just a side effect of the mechanical restriction. Your stomach is tiny now, and from the surgery it is probably practically swollen shut. The gurgling sounds are very, very normal at first and some amount of gurgling will persist, probably forever. Some folks have suggested warm/hot beverages relax the sleeve a little bit. Try a cup of hot chamomile or spearmint tea; it used to really help me relax my sleeve! The good news is that now, about six weeks out, most of those issues are behind me. It doesn't last forever!

Congratulations! Even when you trim down, expect your head to take a long time to catch up. I'm about 50 pounds down now, and my head STILL hasn't caught up, even though my clothes are just falling off me.

I think that pre-op jitters are very normal, especially considering that this surgery is irreversible. However, I take comfort in facts and statistics: the data on this procedure, as new as it is, shows that it is an extremely safe and extremely effective to lose weight. And it's "durable" weight loss -- which is medical jargon for "the weight comes off and stays off." That's the magic -- that's why we get ourselves "mutilated" and remove 3/4 of our stomachs instead of just doing diet and exercise; diet and exercise can and do lead to weight loss, but almost nobody -- literally 5% -- can keep the weight off. And each cycle of loss and regain is very hard on your body. And all this time of diet and exercise and deprivation and shame and discomfort is precious days and years of your life that you'll never get back. As to being on medicine for life -- aside from possibly an acid blocker, you'll be on far, far fewer medications post-sleeve than you would be as an obese person. Trust me. And most of the "medications" we take are Vitamins. Who do you know who doesn't pop a Multivitamin? So how come when we have to take vitamins it's shameful? These are some of the questions I've had to ask myself. With the sleeve, yes, you do something irreversible. But that's half of the appeal. You can never go back to eating enormous portions. You can never go back to wolfing your food down. And if you listen to your doctor, and follow some simple directions, the weight will never come back. That's why we do this. To me, when I looked at it like this, it was crazier to not get the surgery than to get it. Edit: I should add one more thing. Almost every single person I've talked to who's had the lap sleeve done has said that it was the best decision they'd ever made, and that they would do it again in a heartbeat. Now, that's not scientific, but to me it was pretty impressive. I can't think of many other elective surgeries with a customer satisfaction rate that high...