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I just had my first adjustment this morning (under a fluoroscope/xray). My doctor injected some local anesthesia, and then he pulled out a loooong needle! Man, I was scared at first, but the pain was not that bad. He put 3cc initially, and I will need to come back after 2 weeks for a follow-up.
By the way, 35 pounds lost already. So I am averaging 5-8 pounds a week, which he said is normal for a guy my size (started at 471lbs). He said we tend to lose way faster than others.