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Sydney, When you say you put on weight, how much did you gain? My OB said that most of her patients deny weight gain but the pamphlet they gave me said that there is a chance for about a 2-3 pound weight gain.... I am supposed to have it put in Wednesday but I don't want to slow/stop my weight loss..... Katie

A little straight talking: Loose skin versus your health & well being? Personally, I think it’s a simple decision. I have glaucoma & the medication gives me dark, purple shadows under my eyes which nothing will cover (spent a fortune on different concealers). I’m very fair & it’s very obvious. People think I’m sick. But my choice is dark, purple shadows or my sight. Sight wins every day. How much loose skin you will have depends upon many factors like your age, general skin elasticity, where you carry your weight, how long you’ve been at your weight, your history of weight gain & loss, & how much you lose. I don’t have a lot of loose skin - just sort of droopy, loose, crepey bits on my inner thighs, inner upper arms & on my belly. A good pinch but not a handful. It all hides well in my clothes. I wear fitted knit dresses without any type of shape wear & even wear tops with wide straps - I just don’t wave my arms in the air lol. I’m not someone who’d have my body on display anyway - no shorty shorts, bikinis, plunging or strapless tops for me at any weight. 😁 So the loose skin doesn’t really impact my clothing choices at all. I was almost 54 when I had my surgery so I had age against me in regards to my skin bouncing back. Honestly, when I hit my goal I had very little loose skin - was pretty cocky about it too. But the extra 11 kg loss gave me what I have now. I’ve decided I won’t have any surgery to remove the excess skin. I earned that skin & a part of me, for good or bad, thinks I deserve it too. It’s a good reminder of where I was & where I am now. But it is your decision. We all have things that are personally important to us (for me it is my hair). I hope I haven’t belittled yours.

I had an identical experience to what you are describing after having an unfill, and then refills. When I asked my surgeon why we "refillers" seem to report a lack of being able to refind original sensations of fullness/lack of hunger between meals/restriction, he answered "We don't know." It's a drag, but it may be helpful to get in the mindset that your band ultimately doesn't do the bulk of the work after the initial, glorius first year (or so). Mine ran full power for the first year, making the weight drop off with little effort on my part, other than eating in a band-friendly way which was super easy due to my perfect restriction. Then I started having complications and a first unfill. I never found the original restriction once I was cleared to start refilling. As time went by, and my weight started slowly climbing, I told myself I had to throw out the fantasy that my band was going to do all the work for me. So I brought in my old tools (from my dieting years) and polished those off. The weight gain halted (I've been at the same weight for more than a year now--no losses, but no gains). I had to let go of feeling badly that I was "back to dieting" but you know what? At the end of the day, it still is easier, at least for me, to do this with a band (mine is now unfilled completely, due to other complications) than to do this as an unbanded person. In short, I understand and have lived exactly what you are experiencing. My only "tip" is to "live like you have an active band" even if you aren't feeling it. (I know, it's not as easy as when the band was indeed active.)

I told my husband, but do not plan to tell anyone else. I'm still trying to figure out exactly what to tell my boss. So far, I'm going with - I'll be out for a few days because I am having elective surgery for a minor medical issue. If pushed, I will say it is of a personal nature. Thoughts? Omar from Dr. Kelly's office just called me and was giving me pre-surgery instructions. My son overheard and asked - "Your having surgery? When were you going to tell me?" He's not great a keeping secrets, so I told him I just told him I was having surgery on my stomach. He kept pushing so I said the doctor was going to remove some things (non cancerous in nature). He kept pushing - so I said like cists and I added that they may be the cause of my weight gain. He's 15, so he was kidding around and said, "Eww. You have pimples in your stomach?" Oh well, I'm not sure if him telling people I have pimples in my stomach is that is much better than just telling people about the WLS

My Doc believes there are 2 groups of people. The sweet eaters and volume eaters. With past results she recommends the sleeve to volume eaters generally. One reason many slider foods (sweets) can be consumed with the sleeve and actual weight gain can be accomplished. With the other surgery you would have instant dumping syndrome from the sweets. One other item I myself looked at was the sleeve was a less invasive surgery compared to the other. Also, I am a volume eater so both myself and Doc agreed that would be the best route. I understand you have to decide but have you asked or considered your Docs recommendations?

if you follow all the rules you will reduce your chances of having complications however there is no guarantee. however with out the surgery you are almost promised continued weight gain and complications later on such as hbp high chol and diabetes as well and heart problems personally id rather take my chances with the surgery than face all the health issues that come from obesity. good luck to you

Have you tried metformin and Spironolactone for PCOS? That's what I'm on and balances out my hormones. I've been on both since I was 16 and diagnosed with pcos. These meds at the right dosages should help with any weight gain that's due to pcos. Metformin alone can do it. I just have the added spironolactone because I have high androgen with my pcos.

Also, you're supposed to double up on birth control the first 18-24 months. My surgeon strongly recommends a barrier method with pills/implant. However from personal experience, condoms and NuvaRing are tricky. Not hard, just tricky. And I had a friend with implanon that had seizures, weight gain, and pregnancy. It's all your choice though. Just remember to double up!

Ooh I don’t even want to think about this. I know if it causes weight gain in some it will cause it ten fold for me (like everything else does). I know that my mom stayed on birth control pills for years past the end of her cycle. I’m pretty sure it was to help with the symptoms of menopause. I wonder if it helps control menopause associated weight gain??

LAPAROSCOPIC GASTRIC SLEEVE DIET Introduction The following information provides guidelines for you to follow before and after Gastric Sleeve Surgery and for the rest of your life. Gastric Sleeve Surgery is a weight loss tool. After surgery, you will be required to make lifelong changes in your eating habits and to exercise on a regular basis in order to achieve and maintain your weight loss goals. Gastric Sleeve Surgery reduces the size of the stomach which restricts the volume of food that you can consume at one time. This means that you will feel full after eating a small amount. The surgery also induces hormonal changes which help prevent you from feeling excessively hungry. You should avoid drinking liquids with meals. This is to prevent overfilling of the stomach. Frequent snacking or grazing must also be avoided as this contributes to excess calorie intake and can slow weight loss or cause you to gain weight. Exercise is an important component of weight loss success. Exercise is recommended before and after surgery in order to maximize the amount of weight that you lose and keep off. If you have not been an active exerciser, always consult with your physician for clearance and recommendations before beginning any exercise program. It is important to follow the lifetime Gastric Sleeve diet rules, supplement guidelines, and exercise recommendations in order to achieve and maintain optimum weight loss success. In order to begin preparing for surgery, start implementing the pre-surgery diet goals listed on the next page. 4 Pre-Surgery Diet Practice Tips 1. Choose low-fat foods, and avoid fried foods. 2. Stop using sugar. Use sugar substitutes such as Sweet & low, Equal, or Splenda. 3. Decrease intake of Desserts and candy. 4. Stop drinking sugar-sweetened beverages such as regular soda and sweetened Kool-Aid. 5. Start weaning off of caffeine and carbonated beverages. 6. Start cutting back on fast food and eating out. Begin making healthy meal choices when eating out and at home. 7. Eat 3 meals a day. Do not skip Breakfast. 8. Start decreasing portion sizes. 9. Eat more fruits and vegetables. 10. Practice drinking water and other fluids between meals, not with meals. 11. Drink 64 ounces Water a day. 12. Practice sipping liquids. 13. Avoid alcohol. 14. Begin some form of exercise. 15. Review the following information on the gastric sleeve diet. 16. Practice chewing foods thoroughly, 20 - 40 times or to paste consistency. 17. Purchase your protein drinks or supplements. 18. Purchase your vitamin and mineral supplements. 19. Begin planning a schedule for mealtime, fluids and Vitamin and mineral supplements. 5 Post Gastric Sleeve Surgery Diet Important Diet Guidelines: 1. Eat 3 meals per day. Avoid snacking and grazing. 2. Eat small amounts. Initial portion size should be no more than 1 - 2 ounces - approximately 2 - 4 Tablespoons - of food per meal for the first month. At first you may not be able to tolerate this amount. Over time, you will slowly tolerate more volume at each meal. Long term, the stomach will eventually hold about 4 - 8 ounces (1/2 - 1 cup) of food per meal. 3. Eat Protein foods first. 4. Do not try to eat food and drink liquid together. • Consume liquid 30 to 60 minutes before and/or 30 to 60 minutes after eating meals but not during meals. 5. You are required to take a multi-vitamin with minerals for the rest of your life. 6. Eat slowly! • Each meal should last 30minutes or longer. • Avoid gulping foods and drinks. • All foods must be well-chewed to a paste consistency. • Using a small fork or spoon (i.e. baby utensils) can help control portion sizes. • Have one place to eat (such as at the table) and avoid reading or watching TV while you eat. This helps you to enjoy your food, concentrate on eating slower and to realize when your stomach is full. 7. Drink plenty of calorie-free, non-carbonated, caffeine- free fluids between meals . • Drink slowly-sip fluids, never gulp. • Calorie-containing beverages should be limited to skim milk and Protein Drinks. • Limit juice to no more than 4oz. per day. • Consume zero-calorie beverages throughout the day. 6 Diet Progression After Surgery The diet after gastric sleeve surgery progresses through several stages. Your surgeon will let you know when it is okay to progress to the next stage. Day 1 - 2 after surgery: Clear Liquid Diet The clear liquid diet means fluids or foods that are liquid at body temperature and can almost be seen through. You will be on a clear liquid diet while you’re in the hospital. Examples of Clear Liquid Diet (No Added Sugar/ Sugar Free): • Clear (diluted) fruit juices without added sugar: apple, grape or white grape or diet cranberry • Sugar-free Crystal Light drink mix or popsicles, sugar-free Kool-Aid • Herbal tea, caffeine-free tea • flat soda • Sugar-free Popsicles • Sugar-free gelatin • Clear broth • Water ???? It is best to dilute juices by 50% with water. ???? Avoid citrus juices (orange/grapefruit) and tomato juice for the first three weeks. ???? Coffee and de-caffeinated coffee contain acids which are irritating to the stomach lining and should be avoided for the first few weeks for healing. Day 3 through Week 2: Full Liquid Diet The next stage is the full liquid diet which consists of sugar-free, low-fat milk products and the Clear Liquids listed above. You will need to supplement with protein (drinks or powder) after surgery. Remember to sip liquids, do not gulp. Examples of Full Liquid Diet (No Added Sugar/Sugar-Free, Low Fat): • Skim Milk or Lactaid milk • Soy Milk (non-fat) • Low fat, thin, strained cream Soup (smooth, no pieces of food) • Sugar-free instant breakfast • Protein drinks – Start daily when you get home from the hospital. (See section on protein and protein drinks) • Plain or “light” (no sugar added) yogurt with no fruit pieces • Sugar-free pudding or custard • Thinned cream of wheat or rice cereal 7 Week 3 through Week 8: Pureed Diet You may now begin a pureed diet. This includes all items listed for clear and full liquids, and the items listed for the pureed (blenderized) diet. • Eat PROTEIN foods first • Make sure foods are well blended. • Start slowly. If you do not tolerate pureed foods go back to the liquid diet and try again in a few days. • Remember to drink liquids between meals, not with meals. • Continue protein drinks or protein supplements every day. Examples for the Pureed Diet (Sugar-Free/No Sugar Added, Low Fat): Eggs Cheese Pureed or blenderized scrambled eggs or egg substitute or cheese omelet; melted low-fat cheese, low-fat or non-fat cream cheese, ricotta cheese, very smooth/mashed soft cheese such as mozzarella, string cheese, low-fat or non-fat smooth or small curd cottage cheese Meat, Fish, Poultry, Baby food meat or pureed meat or poultry moistened with broth or low-fat gravy Blenderized shrimp, scallops or fish Pureed tuna or salmon (canned in water) or pureed egg salad with low-fat or non-fat mayonnaise Potted meats thinned with broth; smooth deviled ham Starches Unsweetened instant oatmeal (strained), cream of wheat or rice cereal, mashed potatoes or sweet potatoes, smooth polenta, hummus, refried beans; low-fat or baked crackers or chips Vegetables Baby food vegetables or pureed cooked vegetables (no corn or peas) Mashed winter squash, tomato juice or sauce, pureed salsa, marinara Soup Strained, low-fat cream soup made with skim milk; fat-free broth Blenderized lentil or split pea soup or chili Fruit Baby food fruits (bananas, pears, applesauce, peaches, mango, etc) Unsweetened applesauce (smooth) Unsweetened canned fruit – blenderized Unsweetened fruit juice (diluted, no sugar added) Remember: IF YOU CAN CHEW IT, DON’T DO IT! 8 Tips to Get Started Everything that you eat on the pureed diet should be sugar-free or no sugar added, low fat and blended to the consistency of baby food or smooth applesauce. • You will need a blender or food processor or you can purchase baby food. • Start with 1 ounce (2 Tablespoon) portions - no more than 4 Tablespoons at the most. Listen to your body and stop eating as soon as you feel full. • Eat protein foods first. Then if you are not too full, try vegetables or fruits. • Continue protein supplements (80 g protein per day from supplement). Helpful Hints for Blenderizing • Cut foods into small pieces before putting into the blender or food processor. • Remove seeds, skins and fat. • Add liquid for ease of blending. Add enough liquid to cover the blades. Options include skim milk, broth, strained low-fat cream soup, low-fat gravy, low-fat or non-fat sour cream or fat-free half & half. • Blend the item to a smooth, applesauce consistency. • Make sure there are no particles, seeds or lumps remaining. If so put through a sieve or strainer. • If you have leftover blenderized foods, try freezing in single serving portions in ice cube trays and put the frozen cubes into plastic freezer bags. Meats – Very lean and dry meats puree better by adding a small amount of fat (margarine, oil, light mayonnaise, gravy, etc.) Fish also tends to be dry. Improve the texture by adding small amount of lemon juice, light mayonnaise or strained low-fat tartar sauce. Starches – Try pureed peas, canned Beans, sweet potatoes. Starches puree better when hot. Rice and potatoes tend to puree into a gummy paste and are not recommended. Substitute cream of rice Cereal prepared with a flavorful broth and seasoned with margarine. Pasta or noodles are not recommended as they are not well-tolerated. Vegetables – Cook vegetables until soft. If using canned vegetables, drain first. Add melted margarine and puree. Add a small amount of liquid until it reaches the smooth applesauce consistency. Fruit – If using canned fruit, drain first. Add a few drops of lemon juice to help prevent them from discoloring. Begin to take advantage of your favorite leftovers before surgery. Process these foods, and freeze them in an ice cube tray. (Each cube is approximately 1/2 to 1 ounce). When frozen, pop out into Zip-lock bag; label and date, and freeze cubes until needed. 9 Meal Guidelines for the Pureed Diet (See Sample Pureed Meals listed in the Appendix) Once you begin to eat pureed foods (which are considered solids) you will want to start differentiating between liquids and solids – meals should include pureed foods, and so liquids (including protein drinks) should be taken separately from your meals. • You should eat 3 meals a day with protein drinks between meals. • Protein drinks containing at least 20 grams of protein per serving should be consumed as needed to meet 80 g/day goal. • Start with a portion size of 1 to 2 tablespoons of pureed food for the first month. At first you may not be able to tolerate this amount. Eat your protein source first, and then if you have room a small amount of fruit, vegetables or other foods may be consumed. Hints for Measuring Foods: Liquids or soft/pureed foods are best measured in measuring cups or spoons; they can be measured in ounces, Tablespoons or mls. 1 cup 8 Fluid ounces 240 ml 16 tablespoons 3/4 cup 6 fluid ounces 180 ml 12 tablespoons 1/2 cup 4 fluid ounces 120 ml 8 tablespoons 1/4 cup 2 fluid ounces 60 ml 4 tablespoons 1/8 cup 1 fluid ounce 30 ml 2 tablespoons 1 Tablespoon = 3 teaspoons 1/2 Tablespoon = 1-1/2 teaspoons Week 9-12 After Surgery: Soft solid food Diet If you have been tolerating pureed foods, you may now begin a soft diet. This includes all items listed for clear and full liquids and pureed diets plus items listed for the soft diet. Try 1 to 2 new foods a day. This will help you to learn what foods you tolerate. • Remember your stomach pouch empties more slowly with more solid or dense foods than with liquids, so you will be able to tolerate a smaller quantity of food than you could with liquids . • Go slowly. If you do not tolerate the trial of soft foods, resume pureed foods and try again in a week. • Eat protein foods first • Avoid foods high in sugar and fat. • Space meals 4-5 hours apart • Continue your protein drinks between meals • Drink other fluids constantly between meals 10 Examples of Soft Diet (No Added Sugar/Sugar-Free, Low Fat): • Baked fish (no bones) • Imitation crab meat, baby shrimp • Bananas • Canned peaches or pears in water or juice • Well-cooked vegetables without seeds or skin (no corn or peas) • Scrambled, poached or hard boiled eggs • Tuna or egg salad (no onions, celery, pimientos, etc.) • Finely shaved deli meat • Baked, grilled or rotisserie chicken o Moist foods will be better tolerated. Moisten meats with broth, low fat mayonnaise, or low-fat gravy or sauce. o Fish and seafood Proteins are softer and easier to break down than poultry or red meat proteins. o Reheating foods tends to make them dry out and hard to tolerate. Common Problem Foods (Avoid for 3 months after surgery) • Red meat such as steak, roast beef, pork. Red meat is high in muscle Fiber, which is difficult to separate even with a great deal of chewing. Avoid hamburger for one month after surgery. • Un-toasted bread; rolls, biscuits. (Toasted bread may be better-tolerated.) • Pasta • Rice • Membrane of citrus fruits • Dried fruits, nuts, popcorn, coconut • Salads, fresh fruits (except banana) and fresh uncooked vegetables, potato skins. Month 4 After Surgery: Regular Diet • Problem foods as listed above can now be tried. • Rice, pasta and doughy bread may not be tolerated for 6 months or more. • Try fresh fruits without the skin first. If tolerated, the skin can be tried the next time. Salads are generally well-tolerated if chewed well. • Go slowly. Try a small amount to see how you feel. • Avoid high sugar and high fat foods to avoid a high calorie intake. 11 Foods to Avoid : Hard/crunchy foods may always be poorly tolerated. Nuts and seeds are difficult to break down. Fried foods/greasy foods are hard to digest and are very high in calories. • Corn chips, potato chips, tortilla chips, hard taco shells • Nuts and seeds • Fried foods and greasy foods Points to Remember: • Solid foods will fill your stomach pouch more than liquids so you will be eating smaller quantities of foods versus liquids. • If you don’t tolerate a food the first time, wait a week and try again. • You may find that you tolerate a certain food one day and not the next. It is normal for this to happen. • If you don’t tolerate certain foods or notice nausea, vomiting or diarrhea during or after eating, ask yourself the following questions: o Did I chew to a paste consistency? o Did I eat too fast? o Did I eat too much volume? o Did I drink fluid with my real meal or too close to my meal? o Did I eat something high in sugar or fat? o Was the food moist or was it too dry? Steps for adding solid foods: • Try only 1 small bite of the new food and chew well. Wait awhile and if there are no problems, take another bite. • If at any time you feel too full, nauseated or vomit, stop eating and rest. Take only clear liquids at the next meal and add blended foods and liquids at the following meal. Try one solid food again the next day. 12 PROTEIN Protein is the most important nutrient to concentrate on when resuming your diet. Because the volume of your meals will be limited, you should aim for a minimum of 80 grams of protein per day – this needs to come from your protein supplement . Why is protein important? • Wound healing • Sparing loss of muscle • Minimizing hair loss • Preventing protein malnutrition Remember to eat protein foods first at each meal, followed by vegetables and fruit. These are some good sources of protein: Protein Sources Serving size Protein (g) Skim or 1% milk 1 cup 8 Evaporated skim milk (canned) 1 cup 19 Soy milk beverage 1 cup (8 ounces) 7 Non fat dry milk powder 1/3 cup powder 8 Nonfat, sugar free yogurt 1 cup (8 ounces) 8 Nonfat or low fat cottage cheese ½ cup (4 ounces) 14 Nonfat or low fat cheese slices String cheese *1 ounce/ 1 slice 6 LEAN meats – skinless chicken or turkey breast, fish, beef, ham, Deli meats *1 ounce 7 Egg or Egg substitute 1 egg or ¼ cup subst. 7 Peanut Butter (creamy) 1 Tablespoon 5 Tofu ¼ cup 5 Legumes; dried beans peas or lentils Chili, bean soup ½ cup cooked ½ cup 7-9 6-7 Soy/vegetable patty (like Gardenburger) 1 patty 8 - 10 Hummus ½ cup 6 Measuring Hints: *1 ounce of meat is equal to about 3 – 4 Tablespoons of chopped or ground meat. 1 ounce of grated or cottage cheese, tuna or egg salad is ~ 1/4 th cup (4 Tablespoons). A 3-ounce portion size of chicken or meat is about the size of a deck of cards. 13 High Protein Ideas Chicken or Turkey Pureed – Use baby food or make your own. Try mixing it into strained low-fat cream soup. Breast – baked or grilled Thin-sliced/shaved deli slices Ground – meatballs, meatloaf Canned – works great for chicken salad Strained out of canned soup – tends to be very moist Fish (avoid bones) Baked, broiled, poached, or grilled fish Shrimp Imitation or regular crab meat Fresh or canned salmon in water Canned tuna in water Sushi Beef or Veal (Extra Lean) Ground – meatballs, meatloaf Pork Shaved deli ham Eggs or Egg substitute Scrambled eggs or omelet Homemade eggnog made with skim milk, sugar-substitute Diet custard Egg salad Quiche or frittata Deviled eggs Low-fat Dairy Products Milk (skim or 1%) Yogurt (plain or no-sugar added) Low-fat cheeses including cottage cheese, string cheese, ricotta, or any other cheeses which are reduced-fat or non-fat. Legumes Peanut Butter – smooth Dried beans or lentils – or Soups, stews or chili made from these Hummus Vegetarian or fat-free refried beans Tofu 14 Protein Supplements ???? Because of the limited volume capacity of the stomach, it will be nearly impossible to meet your protein needs from food sources for up to a year after surgery. ???? You will need to consume a protein drinks to get a total of 80 g protein per day – This would be 2 protein drinks with 40 or more grams per serving, or 4 servings of a protein drink with 20 grams of protein per serving. ???? Once off of the liquid diet, it is best to consume your protein drinks between meals, rather than as a meal. How to choose a protein supplement: • Review the label to find a product that is high in protein, low in carbohydrate or sugar and low in fat. • Choose a product with at least 20 grams or more of protein per serving. • Whey protein is preferable, especially whey protein isolate. • Choose a product that is low-sugar or sugar-free and sweetened with sugarsubstitutes such as Nutrasweet (Aspartame) or Splenda (Sucralose) or Acesulfame K. The sugar content listed on the label should be no more than 6 grams per serving. • Avoid drinks such as Ensure, Boost, or Slim Fast. They tend to have a lot of carbohydrate and fat compared to pure Protein Powder mixed with skim milk or water. • Choose a product that is low fat: no more than 3 grams of fat per 100 calories. (For example, Atkins shakes tend to be too high in fat and are not recommended). Where to purchase protein drinks: • GNC • Super Supplements • Trader Joe’s • Fred Meyer • Wal-Mart • Rite-Aid • Walgreen’s • Grocery store pharmacies • On-line (www.Bariatriceating.com) 15 Commercial Protein Supplements Unjury (Flavored or Unflavored powder). 20 grams of protein per scoop. Mix with 6-8oz. skim milk, water, or yogurt Order at www.UNJURY.com or (800) 517-5111 or (703) 925-9390 Check the websites for recipes using Unflavored unjury protein powder. Optimum 100% Whey Protein 1 scoop powder = 24 grams protein Zero Carb Isopure 2 scoops powder = 50 grams protein Available at GNC Met-Rx Protein Plus Whey 2 scoops powder = 46 grams protein Designer Whey Protein Supplement 1 scoop powder = 17.5 grams protein Available at Rite-Aid, Super Supplements EAS 100% Whey Protein 2 scoops powder = 23 grams protein Zero Carb Isopure Ready to Drink 40 grams protein per 20 ounces serving Fruit flavors (clear liquid) EAS Myoplex Carb Sense Ready to Drink Liquid product 25 grams protein per serving MetRxUltra Pure Protein Shake (Ready to Drink) Liquid product 35 grams protein per 11 oz. Worldwide Pure Protein (Ready to Drink) Liquid product 35 g protein per 11 ounces (Available at Trader Joe’s, most large drugstore/pharmacies) Cytosport Protein Pure Performance Drink 40 g protein per 20 ounce bottle Tangerine and Watermelon flavors, clear liquid Available at NW Prescriptions 16 These products are available from Bariatriceating.com: (This website has a large selection of protein powders and ready to drink products. Check the website frequently for availability.) Micellar Milk Ready to Drink 40 g. protein in a 17 ounce serving New Whey Liquid Protein “Bullets” 3 ounce plastic container – 42 g protein, 2 g carbs Orange, Grape or Fruit Punch flavors AchievOne – Ready to drink (contains coffee) 20 g protein per 9 ounce serving Whey Gourmet 23 grams protein per scoop Comes in 12 flavors Nectar 23 grams protein per scoop Also available in single scoop packets Any Whey Tasteless Protein 17 grams protein per small scoop Add to soups, chili, eggs, etc. IsoFruit Delite Protein Cocktail Refreshing Cantaloupe or pineapple flavored 21 grams protein per scoop Matrix Protein 23 grams protein per scoop Elite 22 grams protein per scoop IDS 23 grams protein per scoop Protein Delite on the Go (plastic bottle with pre-filled powder) (contains dried fruit or chocolate bits) 25 grams protein in 8 ounces Additional ideas for adding protein to foods: 17 • Non-fat dry milk powder can be added to milk, hot cereal, cream soups, mashed potatoes, or casseroles – 1/3 cup powder = 8 g protein. • Egg white powder – can also be added to foods as listed above. Adds approximately 6 grams protein per 2 Tbsp. (check label protein content may vary by brand.) Sold at the grocery store (in the baking section). Hints to add variety to your protein drinks: • Flavor extracts or spices that do not contain sugar can be added to protein drinks for flavor. Examples: vanilla or almond extract, cinnamon or nutmeg. • Sugar-free cocoa powder can be added to provide a chocolate flavor. • Instant decaffeinated coffee can be added to drinks or yogurt for a flavor change. • Sugar-free Tang can be added to vanilla drinks to create an orange creamsicle flavor or try adding to an unflavored Protein Drink. • Sugar Free Kool-Aid or Crystal Light powder can be used to flavor protein drinks • Sugar-free syrups can be added to flavor protein drinks • If a drink tastes too thick or too sweet try adding more milk or water. • Mixing with milk provides additional protein and Calcium. • Try freezing your protein drinking after preparing. This can be consumed with a spoon as a frozen treat. Also can be made into “popsicles”. • Try adding ice to the prepared protein drink and blenderize to make a slushy. • Try mixing your protein powder with plain or sugar-free vanilla yogurt. • Try mixing protein powder into sugar-free Gelatin (before it is set). 18 Daily Vitamins and Minerals You are required to take the following vitamin and mineral supplements every day for the rest of your life. Taking a vitamin and mineral supplement is vital to maintain your nutritional health and prevent vitamin and mineral deficiencies. You are now at greater risk for decreased absorption of vitamins and minerals because you are eating a significantly smaller amount of food in a day. o All pills must be crushed, chewed or liquid for the first month after surgery or as directed by your physician. Multivitamin with Minerals (Start the first day that you get home from the hospital). First 6 weeks following surgery • 2 children’s complete chewable Multivitamins with minerals or 2 adult chewable multivitamin/mineral supplements to provide twice the adult RDA. • Take with meals, one in the morning and one in the evening. • Examples: One A Day Children’s Complete, Flintstones Complete. Centrum Children’s Complete, or Centrum Chewable for adults, Kirkland (Costco brand) chewable multivitamin Week 6 after surgery • Decrease to 1 multivitamin with minerals tablet daily for the rest of your life. • Take with a meal. • If the multi-vitamin/mineral supplement makes you nauseous, do not take it on an empty stomach—take it with food or at night. 19 Fluids • Do not drink liquids ½ - 1 hour before, during, or ½ - 1 hour after meals. Drinking liquids with meals or too close to mealtime may cause bloating, nausea, or vomiting. It is best to drink a lot of liquids between your meals • Fluid intake is very important for prevention of dehydration and constipation; adequate water is essential to help rid the body of waste, maintain proper muscle tone and prevent sagging skin. • Sip on water all day between meals. A water bottle with a sport top is a good way to get small sips of water and to avoid gulping. Sucking on ice will also help with fluid intake. • Your initial fluid goal should be a minimum of 4 cups (32 oz. or one quart) of caffeine-free, sugar-free fluid per day. At least half of this should be from water. You should be able to consume this amount within a few days after surgery. Gradually, you want to increase your fluid intake to at least 8 cups (64 oz.) a day. • Do not use a straw. This can cause your stomach to fill with air, causing distention, gas and bloating. • Try varying the temperature of liquids for variety and tolerance. • Most fluids should be non-caloric such as water, Crystal Light, sugar-free Kool- Aid, decaf coffee, unsweetened or artificially sweetened tea, or broth. Avoid all sugar-sweetened beverages. • Fruit juice should be 100% fruit juice with no sugar added. Limit to no more than 4 oz. per day and dilute with 4 ounces of water. • Limit caffeine to no more than 4 ounces per day. • Avoid carbonated beverages and sodas. Flat (diet) soda may be better tolerated. • Avoid alcoholic beverages. They do not have any nutritional value and may cause weight gain and/or liver damage. 20 Sugar and Fat Foods high in sugar and foods high in fat should be avoided due to the high caloric content. Consuming high calorie foods can slow weight loss and even cause weight gain. Be careful to avoid soft calories. Soft calories are foods or liquids that are high in calories and easily tolerated (soft or liquid). This includes items such as chocolate, ice cream and high calorie liquids such as milkshakes, regular soda or soft drinks, sweetened drinks, and alcoholic beverages. Avoid sugar (this also means honey, syrup, molasses and other caloric sweeteners), and foods high in sugar or with sugar added, such as candy and sweets; baked goods such as cookies, brownies, doughnuts, cake, pastries, pie, cobbler; frozen desserts such as ice cream, sherbet, sorbet, frozen yogurt, milkshakes; sweetened cereals; fruit canned in syrup; regular jams, jellies and preserves. Fats High fat foods should be avoided because they are very high in calories. • Avoid fried foods. Remove all visible fat and skin from meats and poultry. • Avoid fast foods. • Choose low fat or fat free products. • Avoid high fat dairy products such as whole milk, full fat cream, cheese or sauce. • Avoid high fat pastries, donuts and desserts. • Avoid high fat meats such as bacon, sausage and hot dogs. • Limit added fats such as butter, margarine, lard, regular mayonnaise or spreads, and regular salad dressing. Try the fat free or low fat alternatives. • Avoid “snack foods” such as potato chips, tortilla chips, cheese curls. You need to eat some “healthy fats” daily (for example, vegetable oils such as olive, canola or soybean; nuts or nut butter, or avocado). However, since they are so high in calories, they need to be limited to no more than 2 – 3 teaspoons total per day. 21 Possible Complications Nausea/Vomiting This is often caused by eating too much – taking too big of a bite, eating too fast, not chewing well enough or drinking liquids with solid foods. It can also be caused by lying down after meals, or eating foods that may not agree with you. Be sure to eat in a slow, calm manner. • Call your doctor if you are having frequent or persistent vomiting. Hair Loss Hair loss is a side effect of weight loss surgery. You may not see hair loss initially due to the time it takes hair to grow from the root. You will see hair loss or breakage as the hair grows through the scalp. Often it takes several months after surgery for hair loss to show; and several more months for you to see the hair start growing back. Hair loss can occur from a low protein and zinc intake, and a severe decrease in overall nutrition intake. You must take in a minimum of 70 grams of protein per day. Adequate protein intake may help reduce (but not prevent) hair loss. If protein intake is meeting the minimum recommended guidelines and hair loss continues to be bothersome, you can try supplementing with zinc (no more than 50 mg per day.) Ongoing hair loss can also be a sign of iron-deficiency anemia. Constipation Constipation after surgery is common, but can be prevented. It is usually due to a decreased intake of fiber-containing foods; also, Iron in the Multivitamin supplements can be constipating. Tips to prevent constipation • Drink plenty of fluid -- a minimum of 8 cups (64 ounces) per day. • Exercise regularly. • Try baby food prunes or unsweetened diluted prune juice or oatmeal. When you are allowed to resume regular foods, you can start eating high fiber foods such as high fiber cereals (3 or more grams of fiber per serving), fresh fruits, fresh vegetables and legumes. • Add high-fiber foods gradually • Chew all fiber-containing foods very well. • Drink plenty of fluids when increasing fiber in the diet. If constipation persists, try a daily fiber supplement. Inulin-based soluble fiber supplements such as Fiber Sure are less prone to cause bloating. * If constipation continues, call your doctor; do not take laxatives without consulting your doctor first. 22 Key Points to remember 1. You may never be able to eat the portions you consumed prior to surgery. 2. For a safe weight loss, you need to eat a healthy, well balanced diet. 3. Be sure to make healthy food choices to obtain the most nutrition per serving. 4. Choose low-calorie, nutrient-dense foods. 5. Be patient. At first, you will fill up after just a few bites. This is normal. Stop eating when you feel full. 6. Initial meal size should be approximately 1 – 2 oz. (2 - 4 Tbsp) per meal, 3 meals per day. Volume tolerance will increase after healing (usually about 2 to 4 ounces). Continue to eat slowly, chew foods thoroughly and drink in-between meals. 7. When you try a new food, take one bite to see if it is comfortable for you. 8. You must take the recommended multivitamin/mineral supplement every day for the rest of your life. 9. You should consume protein drinks or supplement with protein powder until your protein intake from foods is adequate. 10. Following the recommended diet rules will help you to lose weight and keep it off. 11. Your dedication to diet, exercise and lifestyle changes will dictate your success after surgery. 12. You can defeat the surgery, resulting in weight gain. 13. Grazing, drinking fluid with meals, or consuming high calorie foods or liquids are examples of ways that the surgery can be defeated. 14. Keep a food and exercise diary. Record the time of meals, food consumed, portion size and preparation method. (You may be asked to bring a food and exercise diary to your surgeon and/or dietitian visits.) 15. Attend Bariatric Support Group meetings on a regular basis before and after surgery. 16. Exercise regularly and follow your doctor’s orders or restrictions when exercising. Continue to follow the guidelines provided throughout this education packet. You have been provided the tools necessary to achieve and maintain a healthy weight loss. 23 Checklist : The following tasks should be completed before surgery: ___ Purchase supplements: ___Protein Supplements – try to have a variety of ones you like ___Multivitamin/mineral supplement ___Any needed equipment (see Equipment Checklist in Appendix) ___Any other foods and beverages you will need during the liquid and blenderized phases of the diet (Review diet sections) ___ Prepare some pureed foods to be used after surgery ___ Complete Meal, Supplement, and Exercise Schedule (see example in Appendix) ___ Keep working on these behaviors to make them become habits: • Practice eating meals without liquids • Practice taking small bites and chewing thoroughly • Pay attention to what you are doing while you are eating • Try to make your meals last at least 30 minutes • Sip fluids slowly – do not gulp! • Begin to wean yourself from caffeine • Find alternatives to coffee and sodas • Do not chew gum • Do not use straws • Find ways to incorporate 30 minutes of activity into your daily routine. Resources: The following websites are highly recommended: www.bariatriceating.com www.obesityhelp.com These books may be helpful: Exodus from Obesity – The Guide to Long-Term Success After Weight Loss Surgery by Paula F. Peck, RN Eating Well after Weight Loss Surgery by Patt Levine and Michele Bontempo-Saray Websites for calculating calorie and protein intake: www.fitday.com www.sparkpeople.com 24 Appendix: Equipment Check List The following is a list of helpful items to consider. For your Dining Pleasure: ___ Baby Spoon, Cocktail Fork (Helps you to take small bites) ___ Small Decorative Plates (Helps control portions and increases the eye appeal of the meal) ___ Insulated dish or warming plate (Helps keep food warm while you slowly enjoy your meal) ___ Sippy Cup (For those that have difficulty with gulping liquids) ___ Water bottles with a sports top (Re-use to carry other sugar free, non-carbonated beverages with you Other ideas – candles, new placemats, and fresh flowers to create a pleasurable eating experience at the table… For Meal Preparation These are vital pieces of equipment: ____ Mini food processor/food chopper ____ Hand Blender or the “Magic Bullet” (available at Walgreen’s) ____ Measuring spoons and cups ____ Small kitchen scale These are very helpful: ____ Extra ice Cube Trays ____ Small Freezer bags ____ Permanent Marker or freezer labels ____ Small plastic containers OR ____ The Food Saver (to vacuum pack foods) (A $100 investment, available at Wal-Mart) For Medications: ____ Pill Crusher ____ Pill Splitter ____ Large pill case (1 week’s worth) 25 Appendix: Pureed Diet Sample Meals: The following are ideas for pureed meals. Each meal consists of about ¼ cup. Use your own creativity to add variety to your diet. Spices and seasonings are not limited after surgery. Remember to make each of your 3 daily meals protein-based and include the essential fats (i.e., margarine, mayonnaise, oil) in your food preparation. Example 1: 2 Tbsp of a pureed cheese omelet made with Eggbeaters 1 Tbsp hot cereal 1 Tbsp sugar-free or plain yogurt Example 2: 2 Tbsp blended low fat cottage cheese 2 Tbsp pureed fruit (i.e., applesauce, peaches, pears or baby food fruit) Example 3: 1 Tbsp smooth peanut butter 2 saltine crackers 1 Tbsp pureed fruit (banana) Example 4: 2 Tbsp grated cheese 1 Tbsp polenta 1 Tbsp pureed roasted vegetables or marinara sauce Example 5: 2 Tbsp fat-free refried beans or hummus 2 baked tortilla chips 1 Tbsp grated cheese; garnish with pureed salsa and low-fat sour cream Example 6: 2 Tbsp mashed tuna or salmon salad made with 1 tsp light mayo 2 low-fat crackers 1 Tbsp pureed fruit or baby food fruit Example 7: 2 Tbsp mashed/smooth egg or chicken salad made with 1 tsp light mayo 2 low-fat crackers 1 TBS pureed fruit or diet pudding Example 8: 3 Tbsp ricotta cheese 1 Tbsp marinara sauce 1 Tbsp pureed roasted vegetables Example 9: 2 Tbsp pureed turkey or chicken with 1 tsp gravy or broth 1 Tbsp mashed potatoes or sweet potatoes 1 Tbsp pureed vegetable or fruit Example 10: 2 Tbsp pureed crab or lobster with 1 tsp light mayonnaise Sprinkle with Old Bay Seasoning 1 Tbsp pureed acorn squash 1 Tbsp pureed fruit Example 11: 2 Tbsp pureed chili 2 Low fat crackers 1 Tbsp diet pudding 26 Appendix: Meal Schedule Example Sample: Your Schedule: Time Meal/Supplement Or Vitamin Time Meal/Supplement or Vitamin 7:00 – 7:30 Meal 1 Multivitamin 8:15 Start Fluids 9:00 Walk 15 minutes 10:00 Protein Supplement 11:15 Stop Fluids 12:00 – 12:30 Meal 2 1:15 Start Fluids 3:00 Protein Supplement 4:15 Stop Fluids 5:00 – 5:30 Meal 3 Multivitamin 6:15 Start Fluids 7:00 Walk 15 minutes 8:00 Protein Supplement Daily Goals: Drink a minimum of 64 ounces of fluid. Sip fluids between meals Walk for 30 minutes Eat 3 meals and Protein Shakes to meet protein needs Supplements: Multivitamin – 2 chewables daily with meals (after 6 weeks, may use 1 tablet per day, cut small) Reminders: Meals should be 4 to 5 hours apart Do not drink 30 – 60 minutes before, during or 30 – 60 minutes after a meal No alcohol No carbonated beverages No caffeine No acidy or citrus juices/foods/beverages for first month 27 BEHAVIOR MODIFICATION TECHNIQUES 1. Don’t eat in front of the TV. 2. Don’t read while eating. 3. Pre-portion your food and put the box or package away. 4. Keep tempting foods out of the house. 5. Don’t go to the grocery store hungry. 6. Make a shopping list. 7. Use smaller plates and bowls. 8. Keep healthy foods available. 9. Focus on activities other than eating. 10. Brush your teeth after meals or if feeling the desire to eat. 11. Don’t eat standing up at parties or buffets. 12. Don’t stand at the food table at the parties. 13. Offer to bring a healthy food item to a party. 14. Park your car far away from your destination. 15. Get up to change the TV channel instead of using the remote control. 16. Take the stairs instead of the elevator. 17. Keep a food and exercise diary.

Whew - you're going to have a tough time but try not to stress too much. It's hard enough to eat in the beginning months post op, and to add in a pregnancy (and the worries about eating for the baby) I'm sure can't help. Every single person and every single pregnancy is different. This time around the morning sickness was awful for me. It lasted until about four months, went away for just over a month and is back now that I'm in the third trimester. That's just me pregnant with this baby. I actually had an easier twin pregnancy than this single baby! You probably cannot eat much at a time. If you aren't already, you really, really need to find a Protein shake that you like that doesn't cause you problems. Dairy can be an issue, so if you don't like your shakes try mixing them with something else. Because you're expecting, I wouldn't go for the lowest carb and calorie shake you can find. Something I'd normally consider a splurge, like the BSN Syntha-6 brand, would be IDEAL for you right now. The higher calories are something you need because you're growing a baby and you're not going to be eating many of your calories. I'd pair a scoop of the Syntha-6 with a scoop or two of the Syntrax unflavored for a protein heavy shake that will help boost your caloric intake. I'd drink at least one a day, but I might try for two if you're really having trouble eating. You need to eat slowly, chew thoroughly and try a variety of different foods. Certain things do tend to feel like they get stuck in the beginning when your new sleeve is still swollen. I'm not saying you should live on mushies but you need to pace yourself and take it easy. eggs are a huge issue for a lot of people around this time, so if you find they aren't going down well, back off of them and try them again each week until you can tolerate them. It's the opposite of typical sleeve eating, but I found that the only thing I could really keep down with morning sickness were carbs. Small, thin slices of toast, crackers, grits, oatmeal, etc. You may find the same. The reality is that your priority just shifted - now your goal isn't to lose weight. Your priority now should be to heal and eat enough to have a healthy baby. You WILL lose this weight afterward. There isn't a magic window with the sleeve, and you'll find that your restriction is very much still there once baby arrives. I've gone back and forth during this pregnancy with restriction. At times I'm amazed because I can eat an entire sandwich and other times I can only manage a few bites before I'm stuffed. Oh, and watch that acid. I was off my PPI for years and now I'm back on it again. I could have sworn I was starving to death around the clock...and you'd think as a sleeve vet I'd know better ('specially since I'm always reminding people that are newly sleeved to take their PPI) but as soon as I hopped back on my omeprazole I felt so much relief. So make sure your OB knows you need a PPI and make sure you're taking one. As soon as I got on mine again the daily heartburn and around the clock stomach rumbling went away. Good luck to you, and to all the ladies here expecting! Oh, and since this is a thread about weight gain, I'm currently 27 weeks and I'm up 20 pounds. I'm not thrilled but I'm not worried, either. Compared to my past pregnancy gains (97 pounds for one girl, nearly 80 pounds with twins) I'm kicking butt this time around. ~Cheri

bless your heart! I can totally relate with you though! I am out now 2 years and when i hit 200 that was it, never made it to onederland, but whatever. . . at least i don't weigh 350 lbs! and i think that once we hit a certain place, our bodies do stop everything. The weight gain is only 5 lbs, could be water weight too, mine usually is. . . i don't exercise and that is now my news years resolution. . . i eat everything there is too (except lettuce, that hurts a lot) just be really careful with the goodies. Christmas time is a very very junk filled season. . . hopefully after the holidays you'll get back into the swing of things. . . we all get that blahhh feeling and just are tired. . you'll be ok, your human and just look how far you have come. . . you lost a whooping 124 lbs! that is a hugh accomplishment. . . you have a great tool to help you and you'll do fine. . . just rest for now, maybe that is all you really need. . .

I am psyched for this and can't wait for surgery so I can put the last 15 years of see-sawing weight gain behind me. Now just turned 41, I know I won't ever get back to that 25 year old fit footy player but I am very excited about making permanent changes that WILL have results. My dream is to be able to buy clothes from a 'regular' menswear store instead of having to find "high and mighty" (big men) stores. Currently 130kgs (286 pounds) I am hoping to lose 35kgs (77 pounds) but most of all being able to run around the park with my daughter climb rocks with her and race her in the pool etc. I can't wait for the change. I have already given away drinking in preparation (losing 3 kgs/6.5lbs) in a short time. I meet with the Dietician next week and then on to the 2 week pre-op diet before surgery on June 3 with Dr Copp here in Brisbane. Happy days ahead!!:confused:

I had an increase in my menopausal symptoms after I had my gall removed in 2921. We increased my dosage but nothing changed (except a small weight gain) until my GP wondered if I wasn't absorbing them well anymore since the issue started after the gall surgery which also caused a protein absorption issue. She put me on a HRT patch as a trial. Well, she was right. The symptoms are gone & I’m only on a low dose HRT again. Malabsorption can be a concern with bypass so maybe ask your doctor if the absorption of your HRT could be being affected. Bonus of the patch is no pills - yay. Just replace the patch every 3.5 days. Oh, & I’ve slowly lost some of the weight I’d gained.

Thanks for that share. I was a normal weight child before I started school. My first grade teacher would not let me leave the lunchroom until I finished my food. She would leave me alone sometimes until the bell rang to go home. I didn't know how to tell my mother and started gaining weight to not get left in the lunchroom. I gained 30 pounds that year and that is a lot for a little kid. I remained the biggest kid in the class until after the sixth grade. I got my beloved horse and she helped me slim down. It was after my dad died in 1992 that my weight problems started again. I was the apple of his eye and it devastated me. In August 2011 I had gastric sleeve surgery. I started at 269 and had lost to 185 in August 2012. I was out of work from January 2012 to August. I think going back to work that August contributed to my current weight of 220. I have been out of work again since the end of December and can't get this weight off no matter what I do. I am starting back to work this Monday July 13 and I am terrified this is going to cause more weight gain. I have done nothing but Protein and a couple of cantaloupe slices this week and lost 3 pounds. My injuries from a car accident and chronic anemia (it is genetic, not Iron low) prevents me exercising enough to help add muscle and burn some fat. Sorry I got off topic but I needed to rant.

Were you worried at all that your insurance would deny you because of weight gain? I'm a little worried if my clinic weights me in the will not do the surgery. I finished the 3 month trial and I'm tentatively scheduled for June 9th; just waiting on BCBS insurance approval.

I'm Anna, married, and the mother of three grown daughters, and one twelve-year-old son. I'm also the grandmother of two. I've been trying to qualify for my surgery for five years, and I finally have a date! October 26th. When I started out, I needed six months of medically supervised diet. I did that, only to have our insurance change before my surgery could be scheduled. Then the new insurance said my BMI was not high enough without two or more co-morbidities, and I only had one. Then I developed breast cancer and uterine issues. Resolving all that took another two and a half years. I developed the second and third co-morbidites, and managed to stay at the required BMI long enough to qualify. My main purpose for choosing RYGB is to resolve my Type 2 diabetes. The weight loss is a good thing, and will help my arthritis and high blood pressure, but if I can even just achieve a 10-15 year remission, I'll be thrilled. My husband has been through this, and I was with him every step of the way. His results were great at first, then he had some weight gain. That makes me nervous--I don't want to go through this only to regain weight, but he assures me I have more resolve than he. (I'm not so sure of that.) I'll be honest. The surgery itself doesn't scare me (not after everything I've been through), it's the post-op life. I wonder what that will all be like, how well I'll negotiate it, what the changes will be like. I've always been overweight. The goal they have me at was my weight in junior high school. I don't even remember what it looked like. I'm afraid of dumping, constipation, etc. My family and friends expect me to be tough--just like I've been in the past--but well, let's just say we'll see how tough I really am. I feel like a marshmallow on the inside. Am I the only one who is thinking about all the things I'll never eat again? And how silly that is? I'm supposed to be thinking about all the advantages I'll have. Anyway, I'm looking forward to talking with folks who are going through this as well. Anna

Look into the health issues caused by most artificial sweeteners, including weight gain and insulin response. Organic stevia seems to be the safest out there. Sweet and lo, Equal and Splenda have been linked to cancer, parkinson's, alzheimer's, dementia, and lots of auto-immune disorders. I feel we should avoid the chemicals because we want to lose weight and be healthy too - not trade obesity for some other horrible disease. It's so hard to avoid the chemicals in low sugar "diet" pre-packaged items, like Protein bars. I do eat them when I need protein, but try not to have the chemicals in coffee, diet drinks, and processed stuff. I found a Protein powder (Jay Robb egg protein) that was approved by my NUT because I have a dairy and soy allergy. It is sweetened with stevia. Good luck to you!

New to the board and find the information very helpful. I had my VG lapband removed (after 2 years) on October 19, 2010. Had major slippage with 40% of stomach going through-band. The band had only a small fill may have had something to do with it? No erosion or complications during removal. (Glad it is out - knew it was not the long term answer). I did well with the band losing most all desired weight but feel as though I need to move forward with VSG too not allow any weight gain. I want to get VSG but have been told to wait 6 weeks - 3 months. What have you been told or what is most common in this scenario? In advance thank you for the input. I am also considering Dr. Rod or Dr. Aceves for VSG - they both seem to have a good reputation. Thoughts???

Hello friends! I'm feeling a bit devastated this morning. I just went to my fifth of six required appointments for my insurance. I had gained four pounds 😭. I am two days from "that time of the month" and am SUPER bloated. I can go up 7-10lbs this week of the month easily due to bloat. My previous few appts had been phone visits, so this is my first recorded weight in the office since Feb. I asked the doctor if she thinks I will get denied by insurance. She said maybe. She said she does see them take into account the final weigh in and compare it to the first, but they could deny me for this one weigh-in. She did note that my weight on my scale at home was lower than theirs and I was bloated. She said she couldn't make any promises. Don't get me wrong, I do blame myself 100% for this. I am just frustrated because I have been making positive changes. I have been being careful about not overeating and choosing healthier foods, I walk 15-30 mins each day and have been tracking about half the time (I need to work on this). I've been cooking healthier dishes, swapped to a smaller plate and utensils, dropped almost all of the sugar out of my diet, but the scale just doesn't like to move for me unless I go to extreme measures. This has always been the case for me. I have been making food and non-food changes to set myself up for success - ex. - I recently changed jobs to take a less stressful position because I recognized my previous job was allowing no time to think/act on healthier changes (was working 60 r weeks). I am in the second week of this new job. So, I am just feeling incredibly disappointed in myself and really sad that all of this work the last five months may come down to these stupid four pounds. Again, I own it - I'm not blaming anyone but myself. This is just hard. And it SUCKS. So, I've cried my eyeballs out and now am trying to move forward and make this last month really count. I am determined to drop 10-15lbs before my next appt. Has anyone else gone through this? I have Premera BCBS through Amazon. I am in NC. If my end weight is lower than the first do you think I will get denied? Come hell or high water I WILL weigh less next month! Thanks for listening ❤️

I am really glad to hear you're going to be able to do this. Good luck to you. :cool: I've heard from people who had tummy tucks that generally even if they had more weight gain/loss after the tuck that their tummy still looked better than it did before the plastic surgery...so I think it's probably well worth it even if you need touch up work later. A tummy tuck is the one plastic surgery procedure I would dearly love to have. I haven't had any kids (or any other abdominal procedures) but my panniculus is about a "grade 2" also. Everyone thought my skin would snap back from the weight loss because I'm relatively young (I'm 21) but I have a lot of stretch marks on my tummy and I think it was just stretched beyond the point of return at my highest weight. It's bad enough that I had a lady I was helping at work ask me if I was pregnant! Agh! (By the way, for those who don't already realize it, it's NEVER a good idea to ask a woman if she's pregnant unless you already know the answer - both of us felt bad after I had to tell her, no, I'm not pregnant :cool: ) I would LOVE to be able to get a tummy tuck right now but haven't really pursued it because I thought that the surgeons would surely decline to do it until I'm at goal. It gives me hope that you have found surgeons who are willing to do it.

I had my inner thighs operated on in October of 2005. It is a painfull surgery and the scars are not all that attractive, but the results in rewarding. I have had a breast reduction, liposuction, tummy tuck and the inner thighs. The thighs were the most difficult. Would I do it again? Yes At least in my clothes I look soooo much better and my legs do not rub together like they did. They have always rubbed, even as a teenager ( and I was not heavy), but after so much weight gain they were painful. Much better now.:whoo:

Thank you very much jachut. I mean really I am a little ahead of myself here I mean I haven't even gotten my surgery yet, but I am hopeful and with hopefulness comes a million differant idea's in my head. I truly do want to wear a two piece not a tankini a two peice again in my life, and since i have know what my stomach looks like when I'm a size 5 after all the damage my weight gain and loss has done to me I know for me to feel truly comfortable in one or even to be truly comfortable naked a tummy tuck is my only option I just don't want to spend all that money just to ruin it once I do decide to have children. But then again I am going through all this now for health but also because I want to be and feel sexy and attractive. So I may as well do it all.

Hey ya’all. I am 3 days post op from a lap band revision to the RNY bypass. It wasn’t the smoothest of recoveries. I was sick for almost 2 days. Vomiting more than I was taking in. Also I got Crepitus from my breast to my eyes and it swelled up my left side of the face. That has subsided a bit but still painful in the neck and it rubs on the inside so I get terrible chest and upper back pain. Now my abdomen on the left is so swollen than my left upper this is swollen. Feel like a fatty. The worse of it all is that i gained 22 pounds in the hospital and I ate barely anything. I just about lost it when I got home. But since I couldn’t eat anything they continuously pumped in fluids. Anyone else out there he any of these problems and relate and help me through this “scary phase” of healing? Otherwise I am pretty excited I had it done. I was able to drink a crystal light tonight and not get heart burn like I would have with the band so i was excited about that.

Does anybody remember a few decades ago the conventional wisdom about fat cells? Once added by weight gain, they never go away? Even with dramatic weight loss, those shriveled up fat cells remain in the body just waiting to pounce on calories and plump themselves up again? That mental image has never left me. It makes me so mad that these skinny shriveled cells are just lying in wait. I think it was actually what the liposuction industry used to convince us that lipo was a way to solve that. Actually remove the skinny shriveled fat cells along with plump fat cells once and for all. Not saying it's true. Just saying it stuck with me. Kinda like these fat cells.