ouroborous

Oh yikes. That's good to know, before I have one glass of red wine and think "I'm okay to drive" (I actually don't drive after ANY alcohol, but still, good to know). As to your other post, that's me to a Tee: "no off switch." I don't obsess over food, in fact I can go long periods without any food whatsoever. It's just that when I DO eat, I can (and do) easily eat until I feel ill. There's never a "that's enough" stage! So hopefully lap sleeve is the perfect surgery for me, too (I'll know in about a month)! Edit: just did a little research, and it looks like the science proves you correct. I always thought that alcohol was absorbed by the stomach, but it appears that it's actually the small intestine where most is absorbed. Since lap sleeve doesn't affect that, and in fact increases the transfer rate from the stomach to the small intestine, alcohol could conceivably be MUCH quicker in effect. Source: http://www.intox.com/about_alcohol.asp

Okay, this is exactly what I'm hearing from all sources, so it rings true. 1-2% is not really something to worry about, since I think that's about the same as the general anesthesia complications rate. So if you're going to worry about THAT... Ahh, this makes sense. I was under the impression that real liver "shrinkage" just couldn't really happen in two weeks. The slippery liver thing makes more sense. Yeah, this will be the hard part for me! I'm naturally a worrier :lol0: Thanks for the info, as always!

Thanks for that, Tiffykins! This whole "20g of Protein max" thing had the smell of an urban legend about it. It's sad that doctors and nutritionists are repeating it, but even there I've found that not all medical practitioners keep up to date with the research. My primary care doctor pooh-poohed WLS because he said it had a very low success rate compared to diet and exercise (!)

Here's what Dr. Jossart had to say: Re: question about Protein The VSG does not have significant malabsorption and protein deficiency is essentially unheard of. Any Protein Drink will be fine. Make sure the carbohydrate count is low(usually less than 10gm) as you don't want to consume alot of sugar. Most health food stores sell good quality Protein drinks as well as grocery stores, etc. The general rule is more than 15gm of protein and less than 10 of carbs.

So, immediately after posting this, I found a LOT of articles on the net referencing Protein deficiencies after VSG. Deficiency due to restriction in intake makes sense, however my understanding is that stand-alone lap sleeve is NOT supposed to alter your basic metabolism. The only thing I can come up with to explain any supposed protein malabsorption would be if the increasingly rapid stomach emptying prevents sufficient pepsin secretion (and overall acid breakdown) for proper digestion. However, I believe that lap sleeve patients would be noticing this and having very noticeably difficult times digesting protein. One possible explanation for the "protein absorption" myth is that lap sleeve used to be just one part of a two part procedure -- and that procedure DID change absorption (of Proteins and other macro- and micronutrients). So perhaps what we're getting here is a confusion between the old procedure (which was malabsorptive) and the new procedure (which is not). Also, if the body could NEVER absorb more than 20g of protein at a time -- in other words, if this isn't something that changes w/lap sleeve, then that's another matter. However, I'm dubious of this. So, I believe that this may be something of a medical "urban legend." I'm STILL trying to track down ANY scholarly evidence that protein absorption changes in ANY way after lap sleeve. Since I'm about to get the surgery myself, it's kinda important to me (I want to be able to get enough protein to not only be healthy, but also build muscle).

I am not a doctor, but from my understanding, Protein is not absorbed by the stomach, period. It is broken down by the stomach and bile acids, and absorbed in the small intestine. Protein (nutrient) - Wikipedia, the free encyclopedia "Digestion typically begins in the stomach when pepsinogen is converted to pepsin by the action of hydrochloric acid, and continued by trypsin and chymotrypsin in the intestine. The amino acids and their derivatives into which dietary protein is degraded are then absorbed by the gastrointestinal tract. The absorption rates of individual amino acids are highly dependent on the protein source; for example, the digestibilities of many amino acids in humans differ between soy and milk Proteins[6] and between individual milk proteins, beta-lactoglobulin and casein.[7] For milk proteins, about 50% of the ingested protein is absorbed between the stomach and the jejunum and 90% is absorbed by the time the digested food reaches the ileum.[8] Biological value (BV) is a measure of the proportion of absorbed protein from a food which becomes incorporated into the proteins of the organism's body." Note the phrasing: "between the stomach and the jejunum." This jibes from what I remember of my physiology classes: the stomach is NOT primarily an absorptive organ; instead, its job is to churn up food and mix it with acid and enzymes for absorption in the intestines (primarily the small intestine for nutrients). As another case in point, consider that lap sleeve is considered a restrictive, but not malabsorptive procedure. The duodenal switch, on the other hand, is a malabsorptive procedure. All of this goes to my (educated) guess that the figures about how much protein you can "absorb" in one sitting after lap sleeve being bunk. It's not so much how much you can absorb, because that hasn't changed. Instead, it's literally about how much you can consume -- that's the only thing that's changed (unless you also had your gallbladder out, which DOES affect protein digestion, to an extent).

Will this change w/time? Broccoli is about the most "good for me" vegetable that I actually LIKE. I think eggplant and squash are disgusting. Hopefully this is just a temporary thing! Or maybe I can put it in a blender...

Actually, from what I understand, up to 30% of people who have WLS (or, in general, lose lots of weight fast) get gallstones. That's effectively 1 in 3, so it's pretty common. I'm not sure about the stats on pancreatitis.

I wasn't aware that I would have to be catheterized... ugh.

"you know most people gain all their weight back plus some" "why take the dangerous road...just eat right and exercise" "if you've never lost more than 20 lbs on a diet, then YOU are the reason why...not the diet...what makes you think you can stick to this?" This is just dead wrong. They are right about one aspect: most people who lose weight with diet and exercise alone gain it back, and more. But the whole point of weight loss surgery is durable weight loss. It is MORE of a "dangerous road" to just eat right and exercise, because the odds are 95% that you'll fail with that route, and the dangers of obesity are FAR greater than the dangers of the lap sleeve (when performed by a competent surgeon, and with patient compliance). The reason you'll be able to "stick with" this is that the sleeve is specifically designed to limit the amount you can eat at one sitting, and to limit your hunger. Thus, it is a tool designed to augment your "willpower." I think you should realize that your family is afraid for you; be touched by their concern, but still be aware that you are making the right choice.

Excellent points. I also wonder if the sleeve wouldn't help alcoholics as well -- from what I understand, you'd be hard pressed to consume enough volume of alcohol to get really blotto. Two birds (addictions) with one stone, for those who are addicted to both?

I don't usually get into belief vs. non-belief arguments. Having a mother who's fairly devout has taught me that when I answer that my non-belief is as heartfelt as her belief, I only get blank stares. So I've learned to just live and let live and accept that 95% of the rest of the population doesn't share my beliefs (errrr, non-beliefs ) and, that's perfectly okay.

Does anyone know what the mean excess weight loss percentage is for VSG as a primary procedure? The ASMBS paper shows a 60% mean EWL, but from what I can tell, that's for the Magenstrasse and Mill procedure, which does not include the resection that removes the ghrelin-secreting fundus of the stomach. So it's possible that the "real" mean EWL for lap sleeve is higher than 60%, but I can't find hard figures on it. Anyone know?

Indeed. One fact that most people overlook is that losing weight is EASY. I can lose 10-30 pounds without even working too hard. A lot of it is switching to lower carbs and watching what I eat. The problem is that keeping the weight off is next to impossible. That's what's so great about the sleeve; not only do you lose an amazing amount of weight amazingly fast (although TBH, I'd be very happy to lose it slower), the sleeve gives you a great set of tools for keeping the weight off. By changing your hormonal chemistry, by producing a restrictive (but not malabsorptive) anorexia, and by avoiding all of the foreign body complications of the lap band, the VSG provides a near-ideal tool for losing the weight and keeping it off long-term. It's still too new to tell for sure, but many bariatric surgeons are calling the lap sleeve the new "gold standard" for weight loss surgery. Honestly, I wish the "weight loss industry" would go away, and be replaced by the "avoiding weight regain" industry. That would be more honest, and more healthy for all of us.

That's a great story! Just one thing... I wish we were all more willing to say "I had surgery" when people asked us how we lost the weight. If we could all have the courage to say that, it might start to take the stigma away from WLS. As long as we hide the fact, I think we're still buying into the idea that weight loss is a matter of courage and determination, and not what it really is -- a medical issue.

For those debating whether or not to pursue weight loss surgery, or which procedure is right for you, I highly recommend reading studies and peer-reviewed publications on the topic. They can be daunting since they're all in medicalese and science jargon, but they are (or attempt to be) an unbiased view of the subject. I did my own research, and quickly came to the conclusion that just trying to "do it the old fashioned way" was likely a recipe for failure, and that my risks of doing nothing and remaining obese were much higher than my tiny risks from weight loss surgery. For those committed to WLS and the VSG in specific and trying to choose a doctor, that's more difficult. Even here in the States, I've had a really hard time finding concrete stats on my surgeon. I BELIEVE that his stats are really good, but I don't have access to any hard data on him. I can only imagine how difficult that would be if he were in another country with different reporting standards. This is not an attempt to slander non-US doctors, but I would believe that doing "hard numbers" type research might be more challenging. Of course, you can just call the doctor and ASK, but if you don't trust them to begin with (and of course, they'll all say "trust me!"), why would you trust their statistics? Ultimately I wish there were publicly-available statistics on morbidity and mortality for all licensed medical practitioners. Not everyone has the time or money (or knowledge) to track this down on their own.

I strongly, STRONGLY recommend that people follow the doctor's guidelines to the letter. This is a major surgery; just read the stories of those with leaks (or worse), and you'll realize that the potential consequences of not doing what you're supposed to do far outweigh the little surge of pride from "I'm tough! I can eat a whole loaf of bread 2 days post-op!" Bottom line is, you've only got one body. Treat it right -- do what the doctor says!

I think that stretching (medicalese: "redilatation") is an "unknown" for VSG. However, it's less likely than things like bypass, where it is basically just a matter of when it happens, not if.

Weird question, since people keep mentioning the gas post-op. Since that's in your abdominal cavity (right?) and not your digestive tract... how does it... er... get out?

Interesting. This doesn't sound like my experience at all. I have consumed various things in my life -- food, alcohol, drugs -- that were very unhealthy for me, but there was nothing that I couldn't "put down" and nothing that I ever "obsessed over." Mostly I have bad habits and get into trouble when I'm bored! Thanks for the input. It's always interesting to me to understand how other people "experience life" (if that makes any sense).

These are all great ideas! To inject one small word of caution into the narrative though, please be careful to use correct form, especially when dealing with heavy weights. I don't want to imagine what it would be like to get a sleeve and be all excited about getting fit and muscular, and then getting a hernia or a ruptured disk. Otherwise, exercise safe, and (most important) have FUN!

Well, you're not really supposed to have carbonated beverages due to the carbonation. I haven't heard anything about avoiding acid. As Dr. Jossert (sp?) said, this is not a procedure that leads to ulcers. Things might be a little different for band-to-sleeve revisions, but my doc has said I can have pretty much whatever I want, once my sleeve is healed. Just in smaller portions.

Thanks for the replies. The followup from my EGD is that it looks like I won't need to have ANYTHING done aside from the sleeve itself (which, on a virgin stomach, should be a breeze). As long as I can follow the pre-op diet rigorously and shrink my fatty liver, the odds are that I should be in good shape!

Hello, one quick question: I was under the impression that a gallbladder removal could happen during the same surgery as the VSG. In fact, I vaguely recall my surgeon mentioning that he wanted to do this because it was safer. However, the surgical center staff now claims that it can't be done during the same op. I'm not sure if this is an administrative issue or a surgical limitation.