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Thank you so much. I’ve talked with a therapist before, but she wasn’t even knowledgeable to the Bariatric issues I was facing months ago.

@ShoppGirl I hear you. Yes I saw the articles from HSS and a few others that quoted that amount, but I've found that sometimes things like this often become an echochamber, even among doctors and other healthcare professionals that should know better. All it takes for this to become the "standard", is for a 50 year old medical textbook or two to print this (based on old data or beliefs), and an entire generation of doctors come to accept it. Look no further than BMI as an example of a well meaning, but ultimately wrong calculation becoming the standard by which we judge obesity and you can see how this sort of thing may not be based on science, but on "generally accepted knowledge". Back to the subject at hand. We do know that RMR can and does increase during recovery, but the amount is not always the same and is highly dependent on both the injury/illness, as well as the individual themselves. As a general rule of thumb when talking about athletes like @AmberFL, the number of calories needed during recovery is typically a little higher than maintenance, but quite a bit lower than what they might have needed when working out. That said, we also need to recognize that Non-Exercise Energy Thermogenesis (NEAT) can vary by many hundreds of calories between individuals. This is important, because even though RMR may increase, it's logical to assume people will have a concomitant reduction in NEAT when ill or injured. The net effect of that may mean the calorie balance may not really change that much if at all. Here's an example: Let's use a 3 factor calorie model, meaning RMR, NEAT & Exercise. (I'm going to ignore TEF for now since it won't make a lot of difference here). Let's assume an RMR is 1500, since this is around the average for all humans. Let's also assume a NEAT of 600 for a total calorie burn before exercise of ~2100. I've selected this since it also is fairly close to the median. Obviously these are just averages and every individual will be different. At an RMR of 1500, if we use as an example a 25% increase due to illness/injury, that would mean the new RMR would be as much as 375 calories more. We would expect NEAT to drop in most people when ill or injured because they tend to sit/lie down a lot more, walk less, etc. Especially in people that have a high NEAT amount to begin with, a drop of 375 calories per day or more is easily within normal ranges when they don't feel good. The net result in our "average" person here is that while their RMR went up, their NEAT went down by the same amount, thus completely negating any need for additional calories. At the end of the day, like you pointed out, we all have to decide for ourselves what we believe and what we think is right. I'm certainly not opposed to anyone consulting with their doctor regarding nutritional needs, as long as you recognise that most doctors get, at best, a single course in nutrition in medical school. Many get even less. I'd tend to suggest a Registered Dietitian instead, especially when dealing with chronic or acute injury or illness. Full disclosure, my background in this area is in nutritional needs for athletes, not people that are unwell. The flip side of this is that I find there are very few RDs that have the requisite knowledge to properly coach athletes, since so much of their training goes into how to help with weight loss, or assist with the nutritional needs of diabetics, cancer patients and the like. We also know that there are some really lousy RDs out there as well, so caveat emptor. (Otherwise, why would we see some of them trying to get very active bariatric patients to stay on an 800kcal/d diet.). Any RD that does that is, i'm sorry to say, an idiot. I'll close by saying that I don't doubt you in the least that you needed to up your calories by a significant amount due to cancer and chemo. I'm sure you recognise that's really in a different league to what most people are going through when recovering from an injury/illness or even surgical procedure. In your case, you have both the fact that cancer cells are effectively using calories that should go toward healthy tissue, as well as the fact that chemo is incredibly destructive to the rest of your body. Best of luck.

Well, it wasn’t exactly an AI generated recommendation. It was an AI generated summary of all the articles that applied to the question I asked Google. So basically One of the articles them gave that recommendation is below and you can read the full article of course and determine whether it’s a reputable source and applies to you. I agree with not going by a cookie cutter approach regardless of where it came from. Especially the Internet, but it logically does make sense to me so it would definitely be worth talking to your doctor about and asking for a specific plan for you. I know for me, my body is fighting cancer and processing chemo right now which both increase metabolism. Currently I’m logging like 1000-1500 cal more a day and still losing (albeit a little slower to appease my doctors). It changes your metabolism when your body is fighting something and it does burn more calories during times like this. How many that would be something your surgeon may be able to help you with a refer you to someone who can. I am very fortunate that I am at a big fancy breast center and they have an oncology dietitian that is helping me throughout all of my different treatments that I have in store for me over the next year to keep me on track for both that and my bariatric journey. i think the most important part would be to just be mindful of the fact that healing does require adequate nutrition and not to be at too much of a calorie deficit because yes, we will heal like we did from our bariatric surgery but that doesn’t necessarily mean it was the ideal circumstance or that we we’re healing as fast as we could have. I know you are itching to get out and back to your activity asap as I would be and good nutrition is very important for faster healing. I’m not saying that means you need to eat as much as you were eating when you were working out like crazy, but if it was me, I would focus primarily on fueling my body to get better faster, without gaining of course, and really focus on the weight loss once I was back on track (it won’t be that long). I mean if you can lose a bit great but if your body is screaming out for nutritious food it’s probable that there is a reason. The nutritionist that I am working with would not give me a specific calorie amount instead she told me to still try to avoid cookies and chips, but to eat when my body was craving nutritious food and she checks in with me every week to see how I am doing and make tweaks Does your surgeon have a nurse practitioner that you could talk to if you give them a call? Or was your dietician from pre surgery very helpful (mine was worthless 😂). Maybe you would get a more in-depth response from them than your surgeon who’s always super busy.

@AmberFL I must have missed that you are recovering from surgery. While I probably wouldn't recommend a significant fat loss diet while healing, I'd also be a bit cautious about using Google AI recommendations. The idea that you need 15-20 calories per pound of current body weight to heal just doesn't pass the smell test. If this were true, none of us would have properly healed from our bariatric surgery. Keep in mind that 15-20 pounds for you right now would be roughly 2500 to 3400 calories. At your starting weight, that would have been about 4500 to almost 6000 calories a day! Looking through the scientific literature, I couldn't find a single reference that this level of calories was needed to promote healing after surgery. There were some references to additional calories being helpful in the event of significant wounds, thus your calorie needs may be somewhat higher for more involved surgeries vs simple ones. I apologise, but I have no idea what "PS surgery" is, so that doesn't really help narrow things down. I think my recommendation would be to base this more on feel. If you are feeling really rundown, that's probably a good indication you may need to up your calories. You're always going to feel somewhat tired after any major surgery, so I'm talking about feeling excessively tired. If you do feel the need to add more, my recommendations above regarding macros still stand. We do know that wound healing requires adequate protein (thus 1.6g/kg is a good minimum target). We also want to make sure you're getting adequate essential fats, so shooting for a minimum of 50g is still good advice. If you are more like 70 to 80g, especially when not on a fat loss diet, that's just fine. I wouldn't necessarily recommend going much higher that that on fats because if you do, if will mean you would likely be subtracting calories from carbs. Good whole food sources of carbs like whole grains, vegetables and fruit have tons of nutritive value that you really shouldn't be skipping right now. In short, protein first, essential fats next, and carbs for the rest of the diet.

You have been tracking your macros and measuring activity far longer than me but from my little bit of experience and what the nurse practitioner told me I would basically just cut out your extra carbs while you are being less active to maintain and then decrease your calories a bit to lose but I wouldn’t cut too too much. Your body is healing so just don’t be in too much of a hurry and be at a significant calorie deficit. We had no choice with the bariatric surgery because we had to protect our healing, intestines and stomachs with the tiny portions during recovery but it is not ideal to recover from a surgery at a such a calorie deficit. Our bodies actually need extra calories and protein for wound healing so you may actually find that your body is burning more calories than you would be if you were just being a couch potato for no reason. Just something to consider or do a little research on. The reason I say just decrease the extra carbs is because before my activity, I was eating a certain way, and then the nurse practitioner learned how active I was being from my activity logs and she told me I just needed to increase my carbs to sustain that level of activity and decrease it if I slowed down and it has worked like a charm. So basically just reversing that is what I would do if I were in your situation. You could also reach out to your dietitian or nutritionist who gave you your original macro guidelines if that is the plan that has been working for you and ask him or her what they would change given your much lower activity for the time being.

You are killing it! Your point about calories is really on point as well. I recommend any bariatric surgery patient read up on Relative Energy Deficiency in Sport (RED-S). The simple explanation is that if you work out a lot, you need to eat more. If you don't, then you are a lot more likely to start having a hard time with things like fatigue, various injuries, getting sick a lot, lack of concentration and depression. At its worst, you can get really sick, leading to heart issues and worse. My personal experience is that women tend to struggle with this more, though anyone can be impacted. Some people here might think it doesn't affect them because they don't consider themselves athletes, but if you are working out multiple days a week, it is a risk, especially considering how hard it can be for us to get more calories in. Over time, you'll hopefully learn where your personal limits are. For example, I've found that right now I can maintain my weight reasonably well up to about 30 miles a week, but beyond that I lose weight whether I want to or not.

Hello everyone. I'm 2 years post-op and was sleeved on 01/06/2023. I'm at goal and have been for awhile. I just wanted to pop in and say that I have no regrets. For the first time in 20 years, I am HEALTHY. Bariatric surgery is just a tool though, you have to follow your plan to see results and you HAVE to work on the "head hunger" because that doesn't go away with surgery. However, if you do your part. You will be pleased with the results. It feels wonderful to be on the "other side" of weight loss and maintaining. Best of luck!

I think you have to first understand what these medicines do. They stimulate insulin production. This may or may not be important to you depending on if you are diabetic. They slow gastric emptying, meaning you'll feel full longer They may suppress hunger signals. Interestingly, researchers don't fully understand why all of this occurs. My personal take in your case is that if you are still steadily losing and are not feeling overly hungry yet (most people don't feel a lot of hunger 4 months post op), then I personally don't see the need to use this medication. I doubt it will do a ton, and might even make it hard to get adequate protein intake. If on the other hand, you are already feeling a lot of hunger and are struggling, then these might help. A few other things to think about: For most people in the US, these medicines can be VERY expensive, even if you have good insurance. If you don't have good insurance, then I hope you're independently wealthy because they can be several thousand dollars a month. Most of the pharmaceutical companies that sell these drugs do have some sort of savings card to make them SIGNIFICANTLY more affordable. Keep in mind that most of those are only good for up to one year. That means you could be back to looking at thousands of dollars a month to continue the medication after the savings card runs out. There are companies that are selling compounded versions of many of the GLP-1 agonists and they sell these for a lot less (typically hundreds of dollars a month rather than thousands). Bariatric Pal is even doing this. These companies can do this because the FDA has special rules for drugs in short supply that allows companies to make them to help fill demand. The issue is that you may or may not be getting what you think. See this link for more info: https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/fdas-concerns-unapproved-glp-1-drugs-used-weight-loss While some companies are certainly reputable and selling you what they say they are, others just are not. It's a little like the wild west right now when it comes to compounded GLP-1 agonists. There is a percentage of people that don't seem to respond to these medications. It's about 15% for semaglutide and a bit less for some of the others. I mention this since some people get really disappointed when this happens, so it would be good to be aware of this possibility ahead of time. These drugs (like most any drug), can have side effects that make then not worth taking for some people. There's really no way to know ahead of time if you will have this sort of problem. Generally speaking, most people that stop using these medicines tend to gain weight back pretty quickly, since the hunger will kick back in. As such, most doctors and pharmacists recommend staying on these for life. It's best to be prepared for this now, vs. thinking you're going to get away with just taking it temporarily.

I have 8 days to go until my GS and am beginning to really struggle with headaches, tension, dizzyness and flushes. I have called the NHS hospital that I going to's bariatric ward, but no response to my message... I am really finding 2 litres of milk a day + 1 litre of water (coffee!) hard. I never drank much before and this is a quantum shift for me, never mind the grumbly tummy

I was on tricare for a short time years ago but didn’t have it for my bariatric surgeries. But after dealing with the revision process with any insurance I I learned that them covering it for GERD would be far more likely than just for weight regain. GERD it would be repairing a complication or side effect of surgery instead of just doing another bariatric surgery. They consider that more of a medical necessity If that makes any sense.

That’s awesome. I have been very pleased with my revision to SADI. My surgeon didn’t mention the intestine length thing but he did have me do the barium swallow, an endoscopy and a gastric emptying study before saying that the SADI would be an option as well as the bypass and it was up to me which I wanted to do. There are pros and cons to the SADI revision. statistically (which by definition means there are outliers that are more or less) but the majority of people lose faster and the loss is more durable which got my attention but the possibility of bathroom issues is significant (fortunately I didn’t have this at all until I recently started chemo but I don’t think it has anything to do with the surgery). One con though of SADI is that many doctors have never heard of it. From my family Dr, to the urgent care, ER physicians, gyno, radiologies, breast surgeon, etc. Even the gastro dr who will be doing an endoscopy and colonoscopy on me Monday has never heard of the SADI but my bariatric doctor said he will explain my anatomy to her and it will be fine. I always tell them it’s a modified version of the Duodenal Switch with one anastomosis instead of two and if they still look confused I tell them it’s not exactly but kinda like a bypass and a sleeve combined. But obviously I need the person putting a camera in there to understand better than that. I think you will be very pleased with your results from either one but another thing to consider is if you have a complication or need revision to the SADI how many doctors are able to operate on you. My surgeon told me that if I had a complication he would stabilize me but he would send me to a nearby hospital if I needed any type of revision. I appreciated that he was willing to admit his limits and I was okay with that but I guess it is a risk you may want to ask about. Your surgeon may very well have done lots of these but mine had not. Also, not a lot of doctors will do a revision to the SADI just because of regain. You would be more likely to find someone to revise a bypass. Not that we are hoping to need a third surgery but obesity is complex and a lifelong struggle so it’s something to think about. I wish you the best of luck. And hope to hear about your surgery date soon.

Thank you so much for your response. It’s perfect timing that I saw this as I just left the Bariatric surgeon’s office. My experience with GLP-1s was quite discouraging. I was just about ready to give up trying to lose the weight I regained. However, my appointment with the Bariatric surgeon was quite encouraging. He agrees that I qualify for a revision surgery. He laid out the revision surgery options: Bypass, SADI-S or SIPS. Apparently the final revision surgery method will be determined during the surgery when he is able to assess my intestine length for the bypass/malabsorption effect. So for now, I’m going to focus on completing the program steps (Barium swallow, Psych appointment, Nutrition appt, support group, etc) so they can submit the PA for revision surgery. So I’m going to focus on completing the insurance requirements

Glad you're doing well! Don't hesitate to ask for help here if you run into any issues. Sometimes the answer will be talk to your surgical team, especially if it's a medical question, but often the experts here are happy to share what's worked for them. This is just such a fantastic resource for Bariatric Surgery patients!

Great idea to speak with your bariatric doctor but discuss the Wegovy with them as well. I have not discussed Wegovy with the bariatric surgeon post surgery but I mentioned it to the PA as a possibility if I am to gain during my cancer treatment over this year if that would be an option and he say it may. I mean he could have assumed that I just meant any GLP-1 and assumed either would do but he didn’t say that Wegovy was not okay for me and I had sleeve prior to my revision to SADI and my surgeon leaves the sleeve as is and does the bypass portion to make up the modified duodenal switch surgery (SADI). Also, post sleeve but pre SADI, I discussed GLP-1 as an option for regain and he said it was a serious contender in terms of what he thought would work for me but the insurance coverage was the issue. I went with the revision and it’s been night and day In terms of the surgery being a better fit for me so I’m not trying to deter you, but maybe the redo was all I needed because I wasn’t mentally ready with the sleeve. I guess I honestly can’t say 100% for certain. Either way, don’t give up. The bariatric doctors won’t give up on you either, together you will find what works for you. Consider what your coverage is and what the cost will be long term though and whether your team will keep prescribing it as a maintenance thing or what happens when you get to goal too because there are pros and cons with both. I mean Wegovy is not surgery and that’s a pro anytime you can avoid surgery but the cost, long term side effects of the shot and regain stats are all things that I would be asking about.

This is my current situation except I’ve been on Wegovy for only 3 months. I haven’t lost any weight. The food noise is there and I don’t feel I’m eating less. I tried to get Zepbound (my insurance will cover it) but I haven’t been able to find a doctor who will prescribe it (because of my previous VSG surgery). I’m planning to meet with a Bariatric surgeon this week to discuss a possible revision surgery.

A typical pre-op is dependent on your insurance and your surgeon, but most require things like: A series of monthly visits with a dietitian. 3 to 6 monthly visits are fairly common A visit with a psychiatrist or psychologist. Depending on the outcome, you may need to undergo treatment for an undiagnosed eating disorder One or more education sessions typically done over a series of weeks. This is to better prepare you for both the immediate post-op diet, as well as long term expectations. These are sometimes, but not always done together with the dietitian visits. Clearance from your primary care doctor and depending on your health history, clearances from other doctors such as a cardiologist or endocrinologist. Numerous blood tests, both to look for potential problems and to set a baseline. Again depending on your health history and your surgeons preferences, you might need to have things such as an endoscopy and/or a swallow study done. Some people may even need additional imaging done such as CT or MRI scans. As a diabetic, they may require your A1C to be below a prescribed value. This is for your safety. Honestly I'm probably forgetting some stuff. If so, I'm sure others here can chime in. In terms of lifetime changes to your eating patterns, you need to make sure you're prepared to make better food choices for life. It's a sad fact, but a pretty high number of people that have weight loss surgery eventually gain the weight back. This can be avoided by learning how to make better food choices now, so you don't fall back into old habits once the stomach restriction eases off. It's often misunderstood by those not familiar with bariatric surgery that weight loss post surgery is "easy". Yes, the initial loss can be easier that it would have been otherwise, but keeping the weight off is just as hard, if not harder that it would have been had you not had the surgery. This is why learning how to eat better is so important. People that lose weight naturally and keep it off do so through repeatedly making good food choices and strict discipline. That knowledge carries over really well to long term weight maintenance. The people that fail weight loss surgery often found initial weight loss easy, but sometimes really struggle once they get to maintenance since they don't know how to eat like a "normal" person. Add in the fact that a formerly obese person trying to maintain weight typically can't eat as much food as someone that was never overweight even if they are the exact same body size, and you can see why retraining yourself here is critical. Throw in the fact that (at least in my opinion), most obese people either have an eating disorder, or at least suffer from disordered eating, and it's obvious that the surgery is just a small component to overall success. TL;DR: IMO, It's better to take your time and do it right.

I guess I have a couple of things for you to think about: Many insurance companies don't cover weight loss surgery. Those that do, typically have very specific requirements that take months to accomplish. Do you know for sure this would be covered, or are you prepared to pay out of pocket? Most bariatric surgeons have their own set of requirements from patients aside from those that the insurance company requires. These too can take weeks to accomplish. If your surgeon does not have any requirements, this would go against best practices. Do you really want a surgeon willing to take shortcuts? Most bariatric surgeons want to have you do a pre-op diet of 2-4 weeks. There are multiple reasons, but the most important is to shrink your liver to make the surgery safer. Are you okay with extra risk just to get the surgery ASAP? Most bariatric surgery is done by a specialised bariatric surgeon, not a general surgeon. I'm not sure I'd even want a general surgeon to do the bariatric surgery even if they say they could do it. Remember, experience here is highly predictive of positive outcomes. Are you sure about the experience of the surgeon what would be performing the surgery? Long term success from weight loss surgery is a lot more than just having the surgery done. Are you mentally ready for a lifetime of changes to how you eat? Do you really know that VSG is the right surgery for you? Gastric bypass is typically recommended for larger people with more weight to lose, especially if they have comorbidities like diabetes. I think it's worth taking your time to research and discuss various surgical options before jumping straight into this. On a more practical level, even if you could overcome all of the above, most surgeons and surgical suites are scheduled based on the length of the planned surgery. I can't imagine either of them changing this on short notice. Overall, while I think bariatric surgery is a fantastic, life-changing choice, it's not for everyone. Take your time and go through the process to mentally and physically prepare yourself before jumping in.

Thats just wonderful to hear because bariatric surgery, unfortunatley does not work for everyone. You are getting there. Be proud you were brave enough to go and get the extra help

You're right. Since I was tracking i saw myself behaving haha. I probably eat way more but panicked when saw it on paper. Today I'll be more honest hopefully but I am still preplabbing my protien intakes .. I've been going to the usual classes but I did a few challenge classes which were amazing. I realzied I really do enjoy circuit training or crrossfit so I'll look into it. My fancy gym membership is ending on 24th if this month and I don't think I'll renew it now as Ramadhan is coming (holy month for muslims) so I'll be fasting from dawn to dusk so I will probably fit in some cardio for that month. Let's see how it goes! Your classes sound fun especially that there's for beginners so u don't push urself too hard. I am glad u r still in the zone!

That looks delish. Maybe you could do a bariatric food blog or something.

Well my bariatric surgeon is a general surgeon so when the oncologist asked if I had a surgeon I said yes so she called him and he also installed my chemo port two days later (thank god). Well my body “spit a stitch” which is not uncommon but the Oncology PA said it could cause infection and obviously that is my lifeline right now and requiring another surgery would delay my treatment so I wanted it looked at by the surgeon office. I seen the surgical PA. He took it out and it’s fine but it also gave me a chance to talk to him about my fitness and nutrition. He said that I am so dedicated and I have been doing so great that he is not worried about me. He said I shouldn’t be trying to run at a huge deficit right now though because the cancer actually burns carbs and so does the chemo so my body may need them right now. He said it’s more important to fuel my body to keep up being active since active people are proven to have better outcomes. I have to admit that I’ve been pretty fortunate so far with the side effects of the chemo at least 🤷‍♀️ . Anyways, I told him that since that low Fiber aka high carb diet I have been craving sugar a lot. I told him I am trying to satisfy it with veggies and fruits but I’m not 100%. He said that great try to have my sugar wrapped in fiber and not plastic. He said that he has no doubt that once this is behind me that they can get me back on track. i told him that my next phase requires really high steroids to be infused weekly and the oncologist said most people gain but they are able to lose it. I said she must not have had a patient like me. I asked if I’m having a real hard time since I will be past the honeymoon period if we could use like Wegovy to get me back on track and he said that’s an option. I told him that I think I may only need it for like a month to detox from these carbs because they really are like a drug to me and I feel like I need like 30 day rehab and then I can do it. He said that they will not abandon me and we will figure out whatever it takes to get me to my goal after I beat this. That made me feel really hopeful that I will still be able to pick this back up. I was worried that I would have to gain a lot back before anyone would give me Wegovy if I need it, but it sounds like it could be an option sooner (I’m guessing I will have to pay OOP but hopefully only for a few doses to get to the regular dose).

There also should be a thread for people having surgery in January if you haven’t found that yet search January in the search bar and it should pop up. Lots of people with the same nervous feelings that you have. Also, if you really have a lot of anxiety, I made lists and organized everything. I mean down to a tea. I got out my book that the surgeon gave me. I read it covered to cover and I made a schedule for two days before surgery. I mean every little thing I planned out. I have an anxiety disorder, so a lot of therapy has taught me to control what I can when I feel like something is out of control. Yours will be different because every surgeon is different, but here’s a copy of mine. I just found it in my phone. I shaved two days before because they don’t want you to have any fresh cuts because of infection and I’m a model patient because of my anxiety. 😆 I left my crochet bag in the car for my husband to bring up after I had a room and he seen if I was feeling up to it or not. I also had a second bag at home packed with things I would want if I was staying more than one night which was a good thing because I did stay longer. Anyways, some of these things may not even matter to you, but for me just planning it out so that I knew that I wouldn’t forget anything made me feel more in control of my part so once I got to the hospital, I was able to turn it over to them to do what they do every single day because I had done my part already. Also from my list anything that needed to be at an exact time, I set alarms in my phone and labeled them with what I was supposed to do like take that nausea pill or stop drinking liquids or whatever. Review Sunday night Two Days Before (Mon) Switch to the liquid diet. SHAVE, drop off donations and pick up Walmart order, Wash Comforters. 2:00 Therapy on Zoom Pack other bag for 2nd night (move my one rx tonight so I don’t forget and take it in the morning) The Day before: (Tues) Skip that one medication starting this morning, Pack hospital bag and crochet bag switch from full to clear liquid this evening, remove rings, change sheets, take my shower with the special soap, take the nausea pill at bedtime and of course nothing at all after midnight. Surgery Day: (Wed) Wake up at 3:30am and take my allowed meds with 12oz of regular sugar Gatorade- finishing everything before 4:30, (don’t pee) take my second shower with the special soap, toss towels in wash, brush teeth and get dressed (nothing on my body or hair at all except clothes). Then head to the hospital at 5:15. Also remember not to pee after that Gatorade because they need a pregnancy test shortly after I arrive at 5:30. *Bring bag, phone, bariatric book with questions, will, DL and ID. (Remind Hubby to bring a sweater) Surgery scheduled for 7:30am 🤞

I cancelled my gym membership in the month I had my surgery since I wasn't going to be able to exercise for 6 weeks after the surgery and I would be away for another 4 weeks and Christmas was coming up and didn't want to waste the money (month to month membership). I need to get back into the gym, but I've not been in months so I'm going back to complete novice stage. But I have been cycling so that's at least something. I want to make going to the gym a habit again. I haven't renewed my membership yet because it will be too crowded with all they "new year, new me" types who use the gym in January for two weeks and then never again.

I'm not a medical professional, but I will say there are some scientific studies that show many drugs are metabolized differently in bariatric surgery patients. Some you don't metabolize as well and some are much more bioavailable. I'm really just guessing here, but it's highly likely that the codeine was metabolized very quickly and more completely than it would have been in a person with a normal GI tract. In effect, you sort of overdosed on codeine. After all, 60 mg of codeine is a pretty big dose to start with. Considering your altered anatomy (and lower weight), it was probably just too much.

Bile reflux tended to be the biggie problem with the MGB back in the day. When my wife and I first started looking into WLS almost 25 years ago, the MGB was a proposed alternate to the incumbent bands and RNY but it never gained traction with the ASBS (precursor to today's ASMBS). In the meantime, both the BPD/DS and the VSG (and more recently the SIPS/SADI) have gained acceptance in the US bariatric (and insurance) industry. There are reportedly some techniques that have been developed to mitigate the bile problem, and there may be something to that, and why it may have been accepted elsewhere; but in the US, it's time has passed.