ouroborous

It gets better over time, but my understanding is that it will be with you, occasionally, for life -- that tight feeling is your restriction! If it's excessively unpleasant, talk to your doc, but honestly I suspect that a certain amount of "lump in the chest" feeling is normal for all sleevers, and is part of re-learning how to eat.

Again, your mileage will vary. My nutritionist basically told me to not bother tracking carbs at all, but she did say the same thing the others here are repeating: eat your protein first, the vegetables (complex carbs), then anything else (including simple carbs -- rice, potatoes, sweets). If you follow this recommendation and stay within your calorie target, I suspect you'll lose weight regardless of how many total carb grams you consume.

So, I gotta say, I bought an OTC supplement to help that particular issue and... no help there (it was mostly lots of Zinc and Vitamin E... I was careful not to get toxic since these are fat soluble). Hopefully when I'm closer to my goal weight, this issue will resolve (cartoon image of a dust cloud coming out of... well, you get the picture).

It's bizarre how different everyone's advice is from their docs. My nutritionist specifically told me not to go longer than 2 hours between mini-meals. The only limitation is not to go over on my calories, and to make sure I get enough protein/water/vitamins.

I would highly recommend moving back to mushy/slushy foods, at least for now. I'm not a doctor, but 12 days to solids sounds scary to me. You may be setting yourself up for complications.

I second what Tiffykins wrote (as always!) Slider foods I can consume with almost no feeling of restriction whatsoever. Solid foods, on the other hand... my girlfriend and I went out for dinner at a local Mexican joint, and we split three tacos. I was able to eat 1/2 of one taco and a couple of tablespoons of black Beans and rice, over about 45 minutes. And I was STUFFED. Moral of the story: the density and consistency of the food make a HUGE difference.

food -- particularly carbohydrates -- is a powerful mood-altering substance. This isn't just the case for people with food addictions, it's at least partially how the body works. Carbs, for instance, have been shown to have strong connections with serotonin levels, and other foods (notably chocolate, but there's more... just can't remember them all) have strong affinities for dopamine. The bottom line is that going to food for comfort is very normal. Without this crutch it can be very difficult to self-soothe. Again, this isn't just "addictive behavior" -- anyone who is low-serotonin will feel stressed and anxious and blue. Tiffykins' recommendation to get a massage is spot-on; you have to find other behaviors that help to soothe you without being unhealthy. A hot bath and a glass of milk is another method; the heat relaxes your muscles and lets metabolism byproducts like lactic acid get released, and the milk is full of tryptophan, which is a natural serotonin precursor. Exercise is also a good choice -- exercise ALWAYS makes me feel better -- but you have to be careful not to overdo it, because if you're feeling stressed and anxious because of "low reserves," then burning up the LAST of your reserves with exercise isn't going to help. The best medicine is a good night's sleep! Protect your sleep time fiercely, because consistent sleep deprivation is an almost sure way to lapse into low-grade depression and anxiety. Mild exercise is good as a sleep aid, as are the relaxing effects of a hot bath or shower. Also, milk and its tryptophan-explosion. So maybe the ideal thing is: exercise mildly to moderately (around midday when it won't affect your sleep time). In the evening, drink a tall glass of nonfat milk and take a long, hot shower or bath. And then, sleep like a baby. The odds are that you'll wake up feeling right as rain! The thing to NOT do is to "relax" with something like alcohol or marijuana -- these things will further deplete neurotransmitter levels, and while you may feel better in the short term, over the long run you're just digging yourself in deeper!

I'm cleared to go back and hit the gym, and I'm so happy and excited. One nice thing about my genome is that I build muscle like CRAZY (despite being fairly low-testosterone... I shudder to think what I'd be built like if I had normal T levels for a male my age!). It only takes me a couple of weeks to lay on heavy slabs of muscle. Now that I'm losing fat (and I'm also keeping my Protein very high, watching my carbs a little, and tweaking all of the known bodybuilding micronutrients like arginine, carnitine, chromium, and so on), it should be a rocket sled! I have my age working against me, but everything else is in my favor. Right now, I'm DEPRESSINGLY weak and flabby from probably a year plus of almost no real workouts. So, while that's annoying, I know it'll come back quick, and I LOVE that sore muscle "I just worked out" feeling. I'm really excited! It's gonna be a great summer!

Focus foremost on Water at this point. Two reasons: it's more immediately dangerous to be dehydrated than it is to be low Protein, and two, mild dehydration can cause lightheadedness, especially with folks on BP medicine. And yes, I'd talk to the doc and get him/her to check your blood pressure regularly.

The first few days can be rough. I had some real issues with post-op fever -- it was mild; not an infection, but apparently a very normal post "trauma" thing your body does. The surgery itself is so easy, that I think we get blindsided when our bodies remind us that "hey, you did something pretty major down here!" Just focus on getting enough Water. That's really your number one goal in the first week. Then focus on Vitamins and Protein. Then, once you've got those licked, you can focus on everything else. Oh, and KEEP MOVING. I know that when you feel like crap the temptation is just to lie down and sleep, but trust me, walking and moving is a life saver.

Well, you're SUPPOSED to be eating small meals (100 calories or so) every 2 hours or so, so I'm not sure I see the problem! Just make sure you're making healthy eating choices, and your calories aren't going over, and otherwise listen to your body!

Absolutely; the depression HAS set in, but I'm trying to use it as motivation to make even healthier choices to "take care" of myself (and a lot of the depression, for me, may be a low-carb diet plus a bit of sleep deprivation from my apnea going haywire). And you're absolutely right; all of the habit changes the sleeve is requiring are changes I've been needing to make for years now. Change is never easy, and seldom pleasant. But it is necessary and inevitable, so I might as well be the one making the changes rather than the one who gets blindsided by them, right?

CARBS. You folks need carbs (complex carbs, not sugars or starch). Trust me on this. I think that a lot of folks on here are chronically carb-deprived because of the overall "carbs are evil" mentality. The reality is that without a readily-available source of blood sugar, you'll feel lethargic, blue, and tired. Don't believe me? Low carb and depression/anxiety: A Case of the Re-Emergence of Panic and Anxiety Symptoms After Initiation of a High-Protein, Very Low Carbohydrate Diet -- Ehrenreich 47 (2): 178 -- Psychosomatics Refuting the idea that you "have to be in ketosis" to lose weight with low-carb: Ketogenic low-carbohydrate diets have no metabolic advantage over nonketogenic low-carbohydrate diets -- Johnston et al. 83 (5): 1055 -- American Journal of Clinical Nutrition Ack, I'd post more, but I'm at work. Long story short: don't go crazy with the low-carb thing. Most studies have indicated that the primary benefit of low-carb diets is that they tend to be low calorie, too. So just watch your calories (and of course, follow your doc's guidelines) and you'll be good (and feel so much better if you don't cut out all of the carbs).

Highest wt: 330 lbs Surgery wt: 315 lbs Last Week: 291 lbs This Week: 286 lbs

Maybe one small regret: not being able to eat and drink like I used to. I mean, when I was thirsty, I would just drink before. Now I have to be mindful of when I last ate, how fast I'm drinking, and so on. It's mostly a positive change -- I'm being more mindful of everything I put in my body. But sometimes I have a twinge of wishing I could just gulp down what I need/want when I need/want it. Would I change my decision for this? No way in hell...

It is acid reflux, without doubt. You should be on a PPI and possibly a cytoprotectant like sucralfate.

Thanks for the responses. I'm pondering asking the doc to put me back on a low dose of Wellbutrin. I don't want to; it feels like admitting failure. My depression is mild, and mostly manifests as exhaustion. I had a little anxiety before the surgery; I know this isn't entirely due to the surgery, or I'd just ride it out. It's just gone up quite a bit since the surgery. I'm going to tweak my diet a bit first. I'm taking a chewable Omega 3 supplement (don't know what the ideal dosage is, I'm taking one 250 mg chewable per day). I also consume as much raw flax seed (high in O3FA's) as I can. I just really got started on solid foods, and my girlfriend and I have been grilling steaks and eating tiny steaks and salads, so I'm starting to get more complex carbs in my diet. I'm also a big fan of not ultra-low carb diets, but it's challenging to find carbs that I can eat that don't completely torpedo my weight loss. Tomorrow is my weigh-day. The blue, somewhat depressed side of my mind says I've probably gained weight; it will be interesting to see how that compares to reality.

...and it was delicious. This was my first weekend cleared for all food, and I was worried that meat wouldn't go down well. But it was well prepared, cut up small, and I chewed it like crazy, and it went down fine and tasted delicious. If only our Seattle weather would clear up, we'd be barbecuing every day!

So, I think I'm hovering riiiight at the edge of this post-sleeve depression. It's weird. Most days, especially days where I take care of my body and mind, I feel pretty good! I'm positive and upbeat about things like exercise and losing weight. I feel like I'm on the right track and things are mostly going well. But I also feel like I have no... reserves? I don't know how to explain it better than that. I feel like I used to be able to weather a day or three of not taking care of myself before I got down in the dumps. But now, it feels like ONE day of not eating properly or not getting enough sleep, and I'm miserable. It's not clinical depression (I know what that is, I've had it before). It's just a low feeling, feeling negative, slightly hopeless/pessimistic about the future. For instance, my girlfriend took some "six weeks post-op pictures" of me yesterday, and instead of seeing the good things -- my face looks much, much thinner, and my belly is sticking out WAY less -- all I saw were the negatives -- I'm STILL a fat, middle-aged man. That plus my mild, ongoing anxiety leads me to believe that I'm suffering from very mild depression. Again, I'm not willing to be medicated for something so mild; self-talk does wonders (for instance with the weight loss, I've lost 40 lbs, but I also had to remind myself that I technically have nearly 100 lbs to go, and it took me nearly 30 years to build up this blubber, I'm not going to lose it all in a day). Also, taking care of my needs (enough sleep, Water, exercise, etc.) really helps, as does simply not allowing myself to dwell on stuff. As I said, I've fought with the grey demon of depression before, and this is NOTHING compared to what I went through in my 20's. That being said, I was wondering if anyone knows of any nutritional (not herbal; I don't want to take St. John's Wort, which is just a poor man's MAOI) ways to improve the body's serotonin/dopamine output? What I figure is happening in my case is that my reserves really ARE low. Instead of my body being able to draw upon copious precursors to these neurotransmitters circulating in my blood from all the food I eat, it's having to work harder. Anyone know of what I can do to help it out? I think I read somewhere that L-tryptophan is a precursor to serotonin. Anyone know if tryptophan helps with mild depression?

LOL, I got a little... overeager, and slightly strained my left triceps. That'll learn me! I should be healed in a few days. In the mean time, I'm walking over 3 miles a day, at approximately 3.5 mph. VROOOOM!

MlkPas, you said exactly what I was thinking. I've read some of Jillian's posts and I'm very, very concerned for her. You can't just get this surgery and expect that magically nothing else will change, and you'll just get skinny. You can seriously hurt yourself that way. In fact, you can die that way. Jillian, I've been one of the "tough love" posters to you, and I completely agree that you need to completely change your mindset. With the sleeve surgery, you no longer have a choice, you have to start eating tiny, bird-like portions, and eating them very, very slowly. The acid reflux alone can lead to esophageal cancer (not to mention what it's doing to your poor sleeve incision). If you're willing to make the changes and get some counseling, the sleeve can be a great tool for weight loss. But it is not, by itself a magical fix for compulsive eating and bad habits. You have to work with it, not against it, or you're in for a world of hurt (figuratively and literally). Hopefully you've learned and are scared enough to make some necessary changes.

Take it easy and follow all the doctor's orders. You'll do great!

You're right, everyone heals differently. But given the OP's symptoms, I'd be willing to bet that she's eating too much, too fast. Not to be mean, but I suspect that she either didn't get adequate post-op guidance, or isn't being compliant with the post-op guidelines. Oh yes, I COULD eat a Greek yogurt in 10 minutes. But it would make me have reflux (sore throat, some pain in my chest), it might make my stomach hurt, and it would be a bad idea. Could and should are very different, in this case. Before I slowed down on the Water, I could drink way more than 100 oz per day. According to my nutritionist, I should be drinking 60-80 oz tops, and slowly.

Edit: I should reiterate that I'm not a doctor. The meds I recommend are just the ones that have worked for me. Obviously, you should be under the care of a doctor; if you can't access your sleeve surgeon, at LEAST talk to your primary care/family doctor and explain what's going on. You don't want to add prescription med interactions to the mess that's already going on inside your stomach... So, someone's gotta lay some tough love on you here. First, STOP THE NIGHTTIME SNACKING. I strongly doubt you're experiencing real hunger at this point. It's head hunger from bad habits (or it's a symptom of reflux; see below). It is time to break those habits, for good. You should have been ready to change those habits before getting the sleeve, but now it's too late -- you have to change your habits, and you have to do it now. Not only will the late night eating sabotage your weight loss, it will really dial your acid reflux up to 11. Stop eating and drinking an hour before bedtime. If you're super thirsty, you can take a tiny, tiny sip of Water at night. I do this with no problems. But it wasn't until I stopped eating an hour before bedtime that my acid reflux really calmed down, post-op. Second, your reflux sounds out of control. Are you on a PPI (proton pump inhibitor -- acid blocker, like Prilosec or Protonix, or generic equivalents)? If not, WHY THE HECK NOT? At a month or so out, I'd recommend 40 mg of omeprazole (generic Prilosec) per day (20 mg taken twice, once in the morning and once in the early evening) and possibly something like Carafate to prevent damage to your sleeve and esophagus from all the acid. Both are available in very cheap generic formulations, and you can even buy the omeprazole OTC at costco, etc. For the Carafate, get a prescription -- if you can't see the surgeon, talk to your primary care doc, but I recommend it. It's a cytoprotectant that really helps prevent the acid from doing serious damage (or so my surgeon told me). Third, just from everything I've read, you are eating too much and likely too fast. At a month out, it takes me 25-30 minutes to consume one small Greek yogurt, and even then I'm probably going too fast. Also, make sure to separate eating and drinking by at least 15 minutes, probably more like 20-30. Even with water, take small sips -- don't gulp. I know that drinking water is instinctive if your throat is raw and sore from reflux, but drinking too much water too fast can actually make reflux worse (trust me, I went through this... it wasn't until I started drinking less water -- while still making sure I got 64oz+ per day -- that my reflux got under control). Finally, I highly recommend sleeping propped up until your reflux is under control. Acid reflux is serious business. You must control it, and to do that, you need to follow my other guidelines. I am not a doctor, so obviously you should be under the care of a surgeon and nutritionist, if possible, and follow their advice. But even not being a doctor, I'm very worried for you -- it sounds like you're on the road to serious, long-term complications, and you need to course-correct... now.

I second (fifth?) all of the recommendations. Attempt to get ahold of Dr. A, but if you can't, and the pain continues, seriously consider going to the ER. Explain in the ER that you are a vertical sleeve gastrectomy patient and when you had your surgery. Today, I would limit anything you consume (if you consume anything at all) to Water and liquids (not solids, not slushy, but liquids only). Consume them very slowly and in moderation (making sure to get enough water). I second Mini-ME: you ate way, way too much, and probably too fast. Hopefully you didn't damage your sleeve. I hope you feel better soon.