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You will be fine...the rate of complications is so low. I will probably feel this way though before my surgery in two weeks. Just keep telling yourself why you are doing it

My surgery is on 1/22. I am so nervous but looking forward. It is the fear of complications or even dying.

It looks like you are a month post-op after RNY gastric bypass surgery. According to my meal plan, I was restricted to full liquids for the first 4 weeks after surgery and then pureed foods for the next four. It wasn't until week 9 that I was allowed to transition into solid foods. So when you said soft foods I am interpreting this as pureed foods, something with the consistency of mashed potatoes. I was given a detailed meal planning book that listed what foods were acceptable at this stage. The three most important elements after RNY gastric bypass surgery are to meet your daily protein, fluid and vitamin requirements. Food is secondary because your body is converting your stored fat into the energy that drives your body. Thus you lose weight. Weight loss is achieved after surgery through meal volume control. You begin at 2 ounces (1/4 cup) per meal and gradually over the next year and a half increase the volume to 1 cup per meal. With this minuscule amount of food, it is next to impossible to meet your protein daily requirements by food alone, so therefore you need to rely on supplements such as protein shakes. So make sure you are meeting your protein, fluid and vitamin daily requirements. If all is good at this point, then I would look for possible medical conditions. Generally they fall into 2 major areas: strictures and ulcers. According to the internet: Nausea and vomiting are the most common complaints after bariatric surgery, and they are typically associated with inappropriate diet and noncompliance with a gastroplasty diet (ie, eat undisturbed, chew meticulously, never drink with meals, and wait 2 hours before drinking after solid food is consumed). If these symptoms are associated with epigastric pain, significant dehydration, or not explained by dietary indiscretions, an alternative diagnosis must be explored. One of the most common complications causing nausea and vomiting in gastric bypass patients is anastomotic ulcers, with and without stomal stenosis. Ulceration or stenosis at the gastrojejunostomy of the gastric bypass has a reported incidence of 3% to 20%. Although no unifying explanation for the etiology of anastomotic ulcers exists, most experts agree that the pathogenesis is likely multifactorial. These ulcers are thought to be due to a combination of preserved acid secretion in the pouch, tension from the Roux limb, ischemia from the operation, nonsteroidal anti-inflammatory drug (NSAID) use, and perhaps Helicobacter pylori infection. Evidence suggests that little acid is secreted in the gastric bypass pouch; however, staple line dehiscence may lead to excessive acid bathing of the anastomosis. Treatment for both marginal ulcers and stomal ulcers should include avoidance of NSAIDs, antisecretory therapy with proton-pump inhibitors, and/or sucralfate. In addition, H pylori infection should be identified and treated, if present.

Hi everyone! I hope this message finds everyone well, So I’m starting my liquid diet tomorrow for my surgery next week! I’m super excited and very nervous at the same time. I been waiting for this moment for over 6 months. First thing first my stats I’m 5’5 and weigh 268 and unfortunately due to my weight I have some health complications. So my main reason for this VSG surgery is to become more healthy so I can live a healthy lifestyle not only for myself but for my family. Anyone one else getting surgery next week? And any advice from anyone on how you managed your nerves that has already had VSG would be great. Thanks in advance 💕

I'm not doing anything special until I go on the liquid diet two weeks before surgery (hopefully I get my date tomorrow!). The nutritionist provided a very complicated regimen that did include low-calorie/no sugar/no carb regular food, but it seemed like a bit too much work. I've decided to simply do protein shakes (Premium Protein) for those two weeks.

Like many others have said, my surgeon doesn't offer the band anymore, for the same reasons already stated. I was sleeved 11/6/18 and, also echoing the others again, only wish I had done it sooner! I'm losing slower than some people, I'm down 30lbs since surgery, 58lbs since starting pre-op diet, and 76lbs from highest weight. I am okay with slow and consistent, every body loses differently. But I FEEL great, I've had zero complications. I have no regrets at all about getting sleeved.

I copied this post from an old post I found on the site from 2013. What do you think? I kind of a long read, but I has a lot of good information I thought. I was most interested about the parts that talk about the importance of making the most in the first 6 months and not to take them for granted. I am 4 1/2 month out, so It has given me a renewed sense of urgency to make the most of my "honeymoon" period. As my weight loss starts to slow more, the more worried I get about actually meeting my goal. Pouch Rules for Dummies INTRODUCTION: A common misunderstanding of gastric bypass surgery is that the pouch causes weight loss because it is so small, the patient eats less. Although that is true for the first six months, that is not how it works. Some doctors have assumed that poor weight loss in some patients is because they aren’t really trying to lose weight. The truth is it may be because they haven’t learned how to get the satisfied feeling of being full to last long enough. HYPOTHESIS OF POUCH FUNCTION: We have four educated guesses as to how the pouch works: 1. Weight loss occurs by actually slightly stretching the pouch with food at each meal or; 2. Weight loss occurs by keeping the pouch tiny through never ever overstuffing or; 3. Weight loss occurs until the pouch gets worn out and regular eating begins or; 4 Weight loss occurs with education on the use of the pouch. PUBLISHED DATA: How does the pouch make you feel full? The nerves tell the brain the pouch is distended and that cuts off hunger with a feeling of fullness. What is the fate of the pouch? Does it enlarge? If it does, is it because the operation was bad, or the patient is overstuffing themselves, or does the pouch actually re-grow in a healing attempt to get back to normal? For ten years, I had patients eat until full with cottage cheese every three months, and report the amount of cottage cheese they were able to eat before feeling full. This gave me an idea of the size of their pouch at three month intervals. I found there was a regular growth in the amount of intake of every single pouch. The average date the pouch stopped growing was two years. After the second year, all pouches stopped growing. Most pouches ended at 6 oz., with some as large at 9-10 ozs. We then compared the weight loss of people with the known pouch size of each person, to see if the pouch size made a difference. In comparing the large pouches to the small pouches, THERE WAS NO DIFFERENCE IN PERCENTAGE OF WEIGHT LOSS AMONG THE PATIENTS. This important fact essentially shows that it is NOT the size of the pouch but how it is used that makes weight loss maintenance possible. OBSERVATIONAL BASED MEDICINE: The information here is taken from surgeon’s “observations” as opposed to “blind” or “double blind” studies, but it IS based on 33 years of physician observation. Due to lack of insurance coverage for WLS, what originally seemed like a serious lack of patients to observe, turned into an advantage as I was able to follow my patients closely. The following are what I found to effect how the pouch works: 1. Getting a sense of fullness is the basis of successful WLS. 2. Success requires that a small pouch is created with a small outlet. 3. Regular meals larger than 1 � cups will result in eventual weight gain. 4. Using the thick, hard to stretch part of the stomach in making the pouch is important. 5. By lightly stretching the pouch with each meal, the pouch send signals to the brain that you need no more food. 6. Maintaining that feeling of fullness requires keeping the pouch stretched for awhile. 7. Almost all patients always feel full 24/7 for the first months, then that feeling disappears. 8. Incredible hunger will develop if there is no food or drink for eight hours. 9. After 1 year, heavier food makes the feeling of fullness last longer. 10. By drinking Water as much as possible as fast as possible (“water loading”), the patient will get a feeling of fullness that lasts 15-25 minutes. 11. By eating “soft foods” patients will get hungry too soon and be hungry before their next meal, which can cause snacking, thus poor weight loss or weight gain. 12. The patients that follow “the rules of the pouch” lose their extra weight and keep it off. 13. The patients that lose too much weight can maintain their weight by doing the reverse of the “rules of the pouch.” HOW DO WE INTERPRET THESE OBSERVATIONS? POUCH SIZE: By following the “rules of the pouch”, it doesn’t matter what size the pouch ends up. The feeling of fullness with 1 � cups of food can be achieved. OUTLET SIZE: Regardless of the outlet size, liquidy foods empty faster than solid foods. High calorie liquids will create weight gain. EARLY PROFOUND SATIETY: Before six months, patients much sip water constantly to get in enough water each day, which causes them to always feel full. After six months, about 2/3 of the pouch has grown larger due to the natural healing process. At this time, the patient can drink 1 cup of water at a time. OPTIMUM MATURE POUCH: The pouch works best when the outlet is not too small or too large and the pouch itself holds about 1 � cups at a time. IDEAL MEAL PROCESS (rules of the pouch): 1. The patient must time meals five hours apart or the patient will get too hungry in between. 2. The patient needs to eat finely cut meat and raw or slightly cooked veggies with each meal. 3. The patient must eat the entire meal in 5-15 minutes. A 30-45 minute meal will cause failure. 4. No liquids for 1 � hours to 2 hours after each meal. 5. After 1 � to 2 hours, begin sipping water and over the next three hours slowly increase water intake. 6. 3 hours after last meal, begin drinking LOTS of water/fluids. 7. 15 minutes before the next meal, drink as much as possible as fast as possible. This is called “water loading.” IF YOU HAVEN’T BEEN DRINKING OVER THE LAST FEW HOURS, THIS ‘WATER LOADING’ WILL NOT WORK. 8. You can water load at any time 2-3 hours before your next meal if you get hungry, which will cause a strong feeling of fullness. THE MANAGEMENT OF PATIENT TEACHING AND TRAINING: You must provide information to the patient pre-operatively regarding the fact that the pouch is only a tool: a tool is something that is used to perform a task but is useless if left on a shelf unused. Practice working with a tool makes the tool more effective. NECESSITY FOR LONG TERM FOLLOW-UP: Trying to practice the “rules of the pouch” before six to 12 months is a waste. Learning how to delay hunger if the patient is never hungry just doesn’t work. The real work of learning the “rules of the pouch” begins after healing has caused hunger to return. PREVENTION OF VOMITING: Vomiting should be prevented as much as possible. Right after surgery, the patient should sip out of 1 oz cups and only 1/3 of that cup at a time until the patient learns the size of his/her pouch to avoid being sick. It is extremely difficult to learn to deal with a small pouch. For the first 6 months, the patient’s mouth will literally be bigger than his/her stomach, which does not exist in any living animal on earth. In the first six weeks the patient should slowly transfer from a liquid diet to a blenderized or soft food diet only, to reduce the chance of vomiting. Vomiting will occur only after eating of solid foods begins. Rice, Pasta, granola, etc. will swell in time and overload the pouch, which will cause vomiting. If the patient is having trouble with vomiting, he/she needs to get 1 oz cups and literally eat 1 oz of food at a time and wait a few minutes before eating another 1 oz of food. Stop when “comfortably satisfied,” until the patient learns the size of his/her pouch. SIX WEEKS After six weeks, the patient can move from soft foods to heavy solids. At this time, they should use three or more different types of foods at each sitting. Each bite should be no larger than the size of a pinkie fingernail bed. The patient should choose a different food with each bite to prevent the same solids from lumping together. No liquids 15 minutes before or 1 � hours after meals. REASSURANCE OF ADEQUATE NUTRITION By taking Vitamins everyday, the patient has no reason to worry about getting enough nutrition. Focus should be on Proteins and vegetables at each meal. MEAL SKIPPING Regardless of lack of hunger, patient should eat three meals a day. In the beginning, one half or more of each meal should be Protein, until the patient can eat at least two oz of protein at each meal. ARTIFICIAL SWEETENERS In our study, we noticed some patients had intense hunger cravings which stopped when they eliminated artificial sweeteners from their diets. AVOIDING ABSOLUTES Rules are made to be broken. No biggie if the patient drinks with one meal – as long as the patient knows he/she is breaking a rule and will get hungry early. Also if the patient pigs out at a party – that’s OK because before surgery, the patient would have pigged on 3000 to 5000 calories and with the pouch, the patient can only pig on 600-1000 calories max. The patient needs to just get back to the rules and not beat him/herself up. THREE MONTHS At three months, the patient needs to become aware of the calories per gram of different foods to be aware of “the cost” of each gram. (cheddar cheese is 16 cal/gram; Peanut Butter is 24 cals/gram). As soon as hunger returns between three to six months, begin water loading procedures. THREE PRINCIPLES FOR GAINING AND MAINTAINING SATIETY 1. Fill pouch full quickly at each meal. 2. Stay full by slowing the emptying of the pouch. (Eat solids. No liquids 15 minutes before and none until 1 � hours after the meal). A scientific test showed that a meal of egg/toast/milk had almost all emptied out of the pouch after 45 minutes. Without milk, just egg and toast, more than � of the meal still remained in the pouch after 1 � hours. 3. Protein, protein, protein. Three meals a day. No high calorie liquids. Fluid LOADING Fluid loading is drinking water/liquids as quickly as possible to fill the pouch which provides the feeling of fullness for about 15 to 25 minutes. The patient needs to gulp about 80% of his/her maximum amount of liquid in 15 to 30 SECONDS. Then just take swallows until fullness is reached. The patient will quickly learn his/her maximum tolerance, which is usually between 8-12 oz. Fluid loading works because the roux limb of the intestine swells up, contracting and backing up any future food to come into the pouch. The pouch is very sensitive to this and the feeling of fullness will last much longer than the reality of how long the pouch was actually full. Fluid load before each meal to prevent thirst after the meal as well as to create that feeling of fullness whenever suddenly hungry before meal time. POST PRANDIAL THIRST It is important that the patient be filled with water before his/her next meal as the meal will come with salt and will cause thirst afterwards. Being too thirsty, just like being too hungry will make a patient nauseous. While the pouch is still real small, it won’t make sense to the patient to do this because salt intake will be low, but it is a good habit to get into because it will make all the difference once the pouch begins to regrow. URGENCY The first six months is the fastest, easiest time to lose weight. By the end of the six months, 2/3 of the regrowth of the pouch will have been done. That means that each present day, after surgery you will be satisfied with less calories than you will the very next day. Another way to put it is that every day that you are healing, you will be able to eat more. So exercise as much as you can during that first six months as you will never be able to lose weight as fast as you can during this time. SIX MONTHS Around this time, our patients begin to get hungry between meals. THEY NEED TO BATTLE THE EXTRA SALT INTAKE WITH DRINKING LOTS OF FLUIDS IN THE TWO TO THREE HOURS BEFORE THEIR NEXT MEAL. Their pouch needs to be well watered before they do the last gulping of water as fast as possible to fill the pouch 15 minutes before they eat. INTAKE INFORMATION SHEET AS A TEACHING TOOL I have found that having the patients fill out a quiz every time they visit reminds them of the rules of the pouch and helps to get them “back on track.” Most patients have no problems with the rules, some patients really struggle to follow them and need a lot of support to “get it”, and a small percentage never quite understand these rules, even though they are quite intelligent people. HONEYMOON SYNDROME The lack of hunger and quick weight loss patients have in the first six months sometimes leads them to think they don’t need to exercise as much and can eat treats and extra calories as they still lose weight anyway. We call this the “honeymoon syndrome” and they need to be counseled that this is the only time they will lose this much weight this fast and this easy and not to waste it by losing less than they actually could. If the patient’s weight loss slows in the first six months, remind them of the rules of water intake and encourage them to increase their exercise and drink more water. You can compare their weight loss to a graph showing the average drop of weight if it will help them to get back on track. EXERCISE In addition to exercise helping to increase the weight loss, it is important for the patient to understand that exercise is a natural antidepressant and will help them from falling into a depression cycle. In addition, exercise jacks up their metabolic rate during a time when their metabolism after the shock of surgery tends to want to slow down. THE IDEAL MEAL FOR WEIGHT LOSS The ideal meal is one that is made up of the following: � of your meal to be low fat protein, � of your meal low starch vegetables and � of your meal solid fruits. This type of meal will stay in your pouch a long time and is good for your health. VOLUME VS. CALORIES The gastric bypass patient needs to be aware of the length of time it takes to digest different foods and to focus on those that take up the most space and take time to digest so as to stay in the pouch the longest, don’t worry about calories. This is the easiest way to “count your calories.” For example, a regular stomach person could gag down two whole sticks of butter at one sitting and be starved all day long, although they more than have enough calories for the day. But you take the same amount of calories in vegetables, and that same person simply would not be able to eat that much food at three sittings – it would stuff them way too much. ISSUES FOR LONG TERM WEIGHT MAINTENANCE Although everything stated in this report deals with the first year after surgery, it should be a lifestyle that will benefit the gastric bypass patient for years to come, and help keep the extra weight off. COUNTER-INTUITIVENESS OF FLUID MANAGEMENT I admit that avoiding fluids at meal time and then pushing hard to drink fluids between meals is against everything normal in nature and not a natural thing to be doing. Regardless of that fact, it is the best way to stay full the longest between meals and not accidentally create a “soup” in the stomach that is easily digested. SUPPORT GROUPS It is natural for quite a few people to use the rules of the pouch and then to tire of it and stop going by the rules. Others “get it” and adhere to the rules as a way of life to avoid ever regaining extra weight. Having a support group makes all the difference to help those that go astray to be reminded of the importance of the rules of the pouch and to get back on track and keep that extra weight off. Support groups create a “peer pressure” to stick to the rules that the staff at the physician’s office simply can’t create. TEETER TOTTER EFFECT Think of a teeter totter suspended in mid air in front of you. Now on the left end is exercise that you do and the right end is the foods that you eat. The more exercise you do on the left, the less you need to worry about the amount of foods you eat on the right. In exact reverse, the more you worry about the foods you eat and keep it healthy on the right, the less exercise you need on the left. Now if you don’t concern yourself with either side, the higher the teeter totter goes, which is your weight. The more you focus on one side or the other, or even both sides of the teeter totter, the lower it goes, and the less you weigh. TOO MUCH WEIGHT LOSS I have found that about 15% of the patients which exercise well and had between 100 to 150 lbs to lose, begin to lose way too much weight. I encourage them to keep up the exercise (which is great for their health) and to essentially “break the rules” of the pouch. Drink with meals so they can eat Snacks between without feeling full and increase their fat content as well take a longer time to eat at meals, thus taking in more calories. A small but significant amount of gastric bypass patients actually go underweight because they have experienced (as all of our patients have experienced) the ravenous hunger after being on a diet with an out of control appetite once the diet is broken. They are afraid of eating again. They don’t “get” that this situation is literally, physically different and that they can control their appetite this time by using the rules of the pouch to eliminate hunger. BARIATRIC MEDICINE A much more common problem is patients who after a year or two plateau at a level above their goal weight and don’t lose as much weight as they want. Be careful that they are not given the “regular” advice given to any average overweight individual. Several small meals or skipping a meal with a Liquid Protein substitute is not the way to go for gastric bypass patients. They must follow the rules, fill themselves quickly with hard to digest foods, water load between, increase their exercise and the weight should come off much easier than with regular people diets. SUMMARY 1. The patient needs to understand how the new pouch physically works. 2. The patient needs to be able to evaluate their use of the tool, compare it to the ideal and see where they need to make changes. 3. Instruct your patient in all ways (through their eyes with visual aids, ears with lectures and emotions with stories and feelings) not only on how but why they need to learn to use their pouch. The goal is for the patient to become an expert on how to use the pouch. EVALUATION FOR WEIGHT LOSS FAILURE The first thing that needs to be ruled out in patients who regain their weight is how the pouch is set up. 1. the staple line needs to be intact; 2. same with the outlet and; 3. the pouch is reasonably small. 1) Use thick barium to confirm the staple line is intact. If it isn’t, then the food will go into the large stomach, from there into the intestines and the patient will be hungry all the time. Check for a little ulcer at the staple line. A tiny ulcer may occur with no real opening at the line, which can be dealt with as you would any ulcer. Sometimes, though, the ulcer is there because of a break in the staple line. This will cause pain for the patient after the patient has eaten because the food rubs the little opening of the ulcer. If there is a tiny opening at the staple line, then a reoperation must be done to actually separate the pouch and the stomach completely and seal each shut. 2) If the outlet is smaller than 7-8 mill, the patient will have problems eating solid foods and will little by little begin eating only easy-to-digest foods, which we call “soft calorie syndrome.” This causes frequent hunger and grazing, which leads to weight regain. 3) To assess pouch volume, an upper GI doesn’t work as it is a liquid. The cottage cheese test is useful – eating as much cottage cheese as possible in five to 15 minutes to find out how much food the pouch will hold. It shouldn’t be able to hold more than 1 � cups in 5 – 15 minutes of quick eating. If everything is intact then there are four problems that it may be: 1) The patient has never been taught the rules; 2) The patient is depressed; 3) The patient has a loss of peer support and eventual forgetting of rules, or 4) The patient simply refuses to follow the rules. LACK OF TEACHING An excellent example is a female patient who is 62 years old. She had the operation when she was 47 years old. She had a total regain of her weight. She stated that she had not seen her surgeon after the six week follow up 15 years ago. She never knew of the rules of the pouch. She had initially lost 50 lbs and then with a commercial weight program lost another 40 lbs. After that, she yo-yoed up and down, each time gaining a little more back. She then developed a disease (with no connection to bariatric surgery) which weakened her muscles, at which time she gained all of her weight back. At the time she came to me, she was treated for her disease, which helped her to begin walking one mile per day. I checked her pouch with barium and the cottage cheese test which showed the pouch to be a small size and that there was no leakage. She was then given the rules of the pouch. She has begun an impressive and continuing weight loss, and is not focused on food as she was, and feeling the best she has felt since the first months after her operation 15 years ago. DEPRESSION Depression is a strong force for stopping weight loss or causing weight gain. A small number of patients, who do well at the beginning, disappear for awhile only to return having gained a lot of weight. It seems that they almost on purpose do exactly opposite of everything they have learned about their pouch: they graze during the day, drink high calorie beverages, drink with meals and stop exercising, even though they know exercise helps stop depression. A 46 year-old woman, one year out of her surgery had been doing fine when her life was turned upside down with divorce and severe teenager behavior problems. Her weight skyrocketed. Once she got her depression under control and began refocusing on the rules of the pouch, added a little exercise, the weight came off quickly. If your patient begins weight gain due to depression, get him/her into counseling quickly. Encourage your patient to refocus on the pouch rules and try to add a little exercise every day. Reassure your patient that he/she did not ruin the pouch, that it is still there, waiting to be used to help with weight control. When they are ready the pouch can be used once again to lose weight without being hungry. EROSION OF THE USE OF PRINCIPLES: Some patients who are compliant, who are not depressed and have intact pouches, will begin to gain weight. These patients are struggling with their weight, have usually stopped connecting with their support groups, and have begun living their “new” life surrounded by those who have not had bariatric surgery. Everything around them encourages them to live life “normal” like their new peers: they begin taking little sips with their meals, and eating quick and easy-to-eat foods. The patient will not usually call their physician’s office because they KNOW what they are doing is wrong and KNOW that they just need to get back on track. Even if you offer “refresher courses” for your patients on a yearly basis, they may not attend because they KNOW what the course is going to say, they know the rules and how they are breaking them. You need to identify these patients and somehow get them back into your office or back to interacting with their support group again. Once these patients return to their support group, and keep in contact with their WLS peers, it makes it much easier to return to the rules of the pouch and get their weight under control once again. TRUE NON-COMPLIANCE: The most difficult problem is a patient who is truly non-compliant. This patient usually leaves your care, complains that there is no ‘connection’ between your staff and themselves and that they were not given the time and attention they needed. Most of the time, it is depression underlying the non-compliance that causes this attitude. A truly non-compliant patient will usually end up with revisions and/or reversal of the surgery due to weight gain or complications. This patient is usually quite resistant to counseling. There is not a whole lot that can be done for these patients as they will find a reason to be unhappy with their situation. It is easier to identify these patients BEFORE surgery than to help them afterwards, although I really haven’t figured out how to do that yet… Besides having a psychological exam done before surgery, there is no real way to find them before surgery and I usually tend toward the side of offering patients the surgery with education in hopes they can live a good and healthy life.

See you on the other side! Hope you have a safe surgery with no complications.

Hello everyone! I finally had my surgery on January 9th! Everything went very well, no complications...no nausea, no real pain other than the expected gas discomfort. Spent one night in the hospital and home the next day. Within a couple days time I started feeling anxious about what I just did to my body 😞 and could not stop thinking about food! I got to thinking that I'm never going to be able to eat my favorite meals again which caused me to get all worked up. I then started fearing that I'm going to be a failure at this 😢 I did 3 days of clear liquids post op and I am now on full liquids for 10 to 14 days. Please tell me these feelings are normal 😩

Humor is a good friend to take with you before, during and after your surgery. My surgery ended up being around 5pm. The patient before me had unexpected complications and her surgery lasted 6 hours instead of 2. At least your laundry will be done when you get back home. And Netflix will be waiting too. Isn't it amazing how a good (or even a not so good) movie can help you cope with nervous tension? I don't know you, but I'll be wishing you... and the other poster on this thread... the very best tomorrow. Promise to update us as soon as you feel able. OK?

Would pancreatic surgery at a weight of 320ish be all that more dangerous than if you were at 180, assuming you aren't 4'6"? I would do a consult with a bariatric surgeon (keeping in mind they want you to be their client most likely) to see if it would complicate a treatment/surgery protocol for cancer. I've had a couple of health issues pop up just after surgery (not related to surgery) and I find that non-bariatric medical folks are unclear about the new way my body works. Such as drinking a big-to-me bottle of contrast dye before a ct scan etc. Or not producing a big cup of urine on demand for testing. That being said I have some wonky boobs that may or may not decide to go cancer that I have to have scanned every 6 months and those folks totally encouraged me to have the fastest weight loss possible to make detection and treatment easier. (And they weren't ginormous to begin with.)

Sorry if the lede was misleading--long intro thread, unrelated to the surgeon in GA, a former poster in the Lap-Band forum, or a grocer who sold toilet tissue. Also not a BM discussion, although I gather those are popular 'round these parts. Hello, all. Apologies for the length; maybe the info or discussions will help some in the future. Like many here, I’ve battled obesity my entire life, from Husky-sized jeans to a HW of 453 in 2017. Through a counselor, I connected with a weight loss PCP, and by working with him and a NUT have lost 130 lbs in 2 years. I was content with this method and pace, but circumstances had other plans. This past summer, I presented with symptoms consistent with gallstones. After an external ultrasound showed nothing, PCP ordered an EUS. Surprise, pancreatic neuroendocrine tumor (PNET), on my birthday, no less! Consults with surgical and medical oncologists ensued, and while I have the kind of cancer that killed Steve Jobs, as long as I don’t treat it with carrot juice and happy thoughts, it probably won’t kill me tomorrow. That’s good, since as a husband and father, I want to stick around. The (hopefully not) killer, though, is that my cancer doesn’t show up on bloodwork or CT, and only marginally on PET. Med and surg onc, per secondary and tertiary opinions, concur that the best treatment plan is to cut it out. What has this to do with WLS, you ask? As I wrote above, I was happy to keep losing my 5 lbs/month, see where I landed, and make further lifestyle changes when I plateaued. However, the cancer I have, according to World-Class Oncologists ™, can flip a switch any time and go from not-a-problem to Patrick Swayze-level, and nobody understands exactly why or how. WLS enters the picture as a catalyst to accelerate treatment. The thinking is that VSG (my recommended procedure, based on my initial consult with Dr. Hussain and the bariatric team at UC) will drastically en-rapidate my weight loss, possibly helping me drop as much as 70-90% of my excess body weight in the next 9-12 months. In that way, the surg onc should be able to operate on a healthier patient with fewer complications, especially if, as seems likely, he has to pivot to what would be, at worst, a laparoscopic Whipple procedure. Being a lesser man at the time of that surgery should make the whole process less risky overall, but that’s just one of the questions for the surgical team that I’ll begin to firm up once I start the formal pre-op process. I’ve been assessed as a near-ideal bariatric candidate by psych based on my previous work, and by NUT based on the low-carb high-protein changes we’ve institutionalized in our family lifestyle. We even gave the NUT two recipes she said she’d share with her patients! I have concerns in both areas, though, that I’m working to get a handle on—psych, given my history with depression, and nutrition, since some of the strategies I’ve used to be successful up to now might not be compatible with VSG. Anyway, thanks for letting me introduce myself and overshare. If you have any relevant thoughts or experience on the above, especially if you have had, or know anyone who has had, a Whipple procedure after a VSG, I’d REALLY like to hear from you, since there’s not much in the open literature on it. I’ll maybe post more details, questions, etc., in the relevant sub-forums if I can’t find something through search, but again, thanks for letting me vent and share.

There are quite a few with a VSG too, maybe not lightning strikes but definitely rumbling thunder possibly building to thunder claps! https://www.verywellhealth.com/long-term-complications-after-gastric-sleeve-surgery-4158320

lol Sorry for causing confusion, elcee. For some reason, that's just how I think of the later complications. With sleeve, complications other than GERD tend to happen peripoperatively and not years later, but certain risks with RNY are ongoing and there are small chances of complications even many years later (e.g. ulcers, internal hernias, bowel obstruction). Even if the risks were equal, this sorta freaks me out a bit since I hope to travel places that might not have the best medical care in the future. I liked the idea of there being a point in time a couple of months after surgery when I could relax a bit and think, "Well, if something bad was gonna happen, it probably would have happened already" if that makes sense.

Lightning strike complications, what the heck are they? I have 2 days to go to my revision to RNY and thought I was well educated and well prepared but I haven’t seen lightning strike complications in anything I have read! I still don’t understand why people fear RNY with its rerouting that technically can be reversed if it has to be but they don’t fear having most of their stomach chopped off and thrown in the bin never to be seen again! I wouldn’t have a sleeve if I had Reflux. It is fairly common knowledge now that the sleeve is not a cure for Reflux and can exacerbate it if you already have it.

I'm 5 years out RNY. I also had Gerd pre-op and my doctor would only do RNY. I haven't had any complications, strictures, hernias or anything of the sort. I stay pretty active and hike often. I think better time is spent researching your surgeon and their rates of complication. That has a much greater effect on your personal outcome than overall averages. If you're confident in your surgeon, I'd say go with the sleeve but be open to revision if necessary. Good luck on your surgery. HW 314 SW 296 GW 177 CW 169

i had some mild heartburn pre Gastric sleeve back in 2015. Nothing I would ever classify as terrible - I and my doctor attributed it to a side effect of carrying so much extra weight. Fast forward to today. I have major GERD, all the makings of Barretts, a healthy hernia I've named Herbert and reflux levels off the charts. I am going in for a revision from sleeve to RNY on Wednesday. My surgeon (same for both procedures) wishes he had gone with his gut and ordered the EGD before surgery last time as his method may have changed. I dont blame him one bit, however, and we're both pretty sure it came about as a result of the sleeve- both are known complications, unfortunately Whatever you decide is best for you - I wish you all the luck in the world!

I'm new here and haven't even introduced myself yet, so forgive me for skipping that part and jumping straight in with a question, but my surgery is scheduled for exactly 1 week from today and I'm feeling the need to get a decision made quickly. I've been in preparations for bariatric surgery for a year now. The plan was always for sleeve. The intestinal rerouting thing just scares the bejeezus out of me, but it's really the rates of longterm complications that scare me the most about RNY, especially the "lightning strike" complications like internal hernia that can pop up unexpectedly years down the road, probably when you're hiking and about 100 miles from any decent hospital if you have my luck. I was much more comfortable with the idea of VSG. However... I have a long history of GERD. It's milder when I lose weight but still there, and I had to switch from ranitidine to a daily PPI (omeprazole 20 mg) several months ago because the ranitidine just wasn't doing it for me anymore. Even with the PPI, I've sometimes had breakthrough heartburn and admit I've taken a second omeprazole later in the day every now and then for it. I figured I'd just have to stay on a PPI after surgery and convinced myself that would be a better option than taking on the added risks of RNY, but my pre-op EGD this morning showed LA grade A esophagitis (i.e. mild esophagitis) and a small hiatal hernia. Those were just the initial impressions and the final report and biopsy results aren't in yet, but the surgeon showed me about how big the hernia is and I'd guess it's 2-3 cm. He says no problem, it can be fixed during surgery and we can treat GERD with medications or, eventually, even LINX if needed, but I'm concerned for a few reasons. It seems ominous to me that I have even mild esophagitis after several months adherence to a PPI regimen that's supposed to heal acid damage. I'm thinking that means I'd have to be bumped up to a higher/more frequent PPI dose after surgery just to keep things stable if I'm lucky. I'm a research person, so I've reviewed most of the recent research regarding GERD and the sleeve, and it looks like there is a large chance of the esophagitis worsening in grade after VSG. It also looks like there's a huge chance of recurrent hernia despite repair and as much as a 1 in 8 chance (according to one small study) of needing revision to RNY later. With that factored in, my chances of needing additional surgery after a sleeve actually appear to be the same or higher than my chances of needing additional surgery after RNY. I also wouldn't look forward to having to pay for EGDs every year to reassure myself that my esophagitis hasn't turned into Barrett's. The general consensus of everything I've read leans toward RNY over sleeve for preexisting GERD, but this doesn't match my surgeon's encouragement to go with sleeve. Then again, he might have that can-do attitude because he knows how much I originally wanted the sleeve? I don't know. Anyway, needless to say, I'm having major second thoughts about the sleeve, but I have so little time left to decide and I'm worried about making the wrong decision. I was hoping my EGD results would give more clarity, but they just seem to have made the waters even murkier. If you made it through that longgg post, I guess my question for you guys is: Am I being overdramatic about a little heartburn? Did any of you have esophagitis on your pre-op EGD? Which surgery did you choose and how did it work out? All opinions and anecdotes welcome and thank you in advance!

I have never had any kind of surgery before, nor have I gone under anaesthesia, and I am freaking out! I have severe anxiety and panic attacks, and I'm trying not to use any medication to stave them off, but it's increasingly getting harder as the time comes. Does anyone here know if the doctors will provide a calming agent of any kind? I'm afraid of taking a benzo (which I use for my panic attacks, diazepam) because it might cause issues with the surgery or medications that they give in the IV? I just generally have fear of the surgery as well, of not waking up, of blood clots and complications, etc. Gah! I keep fretting as well that I have some kind of blood disorder (or clotting disorder) since I bruise really easily, and there's bruises on my belly already and legs that just show up out of nowhere. This post is rambly, so my apologies, but that's how my mind gets when I'm panicked! I'm just super nervous and scared, but also excited and hopeful that everything will work out okay! This past month on the pre-op diet has been really difficult as well, and I'm afraid my liver won't have shrunk enough or some other complication might arise. (Also my throat has been scratchy and sore off and on for days.) Anyone else here having surgery on the 15th also?

OhioSparkle - you indicated that you had RNY gastric bypass but posted this in the sleeve section. The following response is provided assuming you are RNY: The three most important elements after RNY gastric bypass surgery are to meet your daily protein, fluid and vitamin requirements. Food is secondary because your body is converting your stored fat into the energy that drives your body. Thus you lose weight. Weight loss is achieved after surgery through meal volume control. You begin at 2 ounces (1/4 cup) per meal and gradually over the next year and a half increase the volume to 1 cup per meal. With this minuscule amount of food, it is next to impossible to meet your protein daily requirements by food alone, so therefore you need to rely on supplements such as protein shakes. So I would recommend you first verify that you are meeting your daily protein, fluid and vitamin requirements. Some members on this board have noted that for RNY gastric bypass surgery, they have entered a stall by eating too little. That may be what is happening in your case. When you eat too little it throws your body into a starvation mode and your body holds onto every calorie as if it is their last - thus no weight loss. So make sure that you are following your daily meal plan volume. You must eat the recommended amount. Also the meal plan is based on volume not calories. If you are looking at calories make sure you are including your protein shakes into the calorie numbers. If eating causes nausea, it may be due to a complication such as a stricture or an ulcer. The transition to solid foods can be difficult on your stomach. I found softer foods such as chili and soups went down much easier than harder foods such as steak and chicken. Therefore I relied on these to a great extend. I provided some recipes at the end of the following article. http://www.breadandbutterscience.com/Surgery.pdf

I feel some sadness because the only person I have in my life is my mother and every complication I've had, she just says "I have nothing supportive to say because I told you so" to and from the hospital. And she told me last week she was MAD I needed my gallbladder removed, even though it started going bad years ago. She told me she is convinced it is all related and I can't tell her otherwise. I don't have anyone in my life who supported this choice, so every time something bad happens, I just feel worse. Sent from my SM-G930R4 using BariatricPal mobile app

Oh my lord. I am so sorry. That sounds terrible. I’m so glad you are doing good now. Unfortunately I didn’t have any complications so far. Just an occasional diaphragm spasm from swelling but comes and go super quickly. I really wish you the best now that the worst appears to be over 🙂

I am 2.5 months out and still really struggling with sadness at not being the weight I expected to be. Yes yes, "what did you expect, to lose 100lbs in 3 months?" I don't know... maybe deep down inside I had hoped I would. I can't get over my impatience. I always want instantaneous results with everything. I know and knew going into this that that wouldn't be the case here. But I still end up crying and upset since I feel like I've gone through a lot of BS since surgery and I'm not happy with the results I am getting. In this particular moment, I just feel really depressed. I feel like I have such a long road before I lose another 100lbs and then so much more pain and money with all the plastics I want. And at this point I just anticipate endless complications. It just feels like a neverending road of pain and disappointment. Sorry, feeling bleak today and just needed to get it out. Sent from my SM-G930R4 using BariatricPal mobile app

I had the sleeve. I,like many people am sorry I didn't do it sooner. It's the best thing I could have done for myself. I had surgery in July of 2017 and I have lost 202 pounds. I couldn't be happier. My surgeon doesn't even do band surgery anymore. She said she does a lot of band removals because people have complications or they want them out because they do not work.

That’s awesome ❤️ my dietician’s full-time job is working with folks that have had major complications after WLS. She’s definitely a diamond in the rough. Very sweet, helpful and knowledgeable. Even though we only meet once a month we actually email and text frequently. She told me I have unlimited coverage for our visits pre-op and post-op with my new insurance which I’m so thankful for BUT I told her to brace herself because I’m a question-asking machine. She may want to kill me before my 6 months are over! LOLOLOL