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Chanelle, my heart is going out to you. On doing a cursory search of the academic medical journals on pregnancy after bariatric surgery (because as of yet, I have not found one which encompasses 'surgery whilst pregnant' and I concede the procedures documented do not encompass VSG), I found the following. Go straight to the abstracts/conclusions to get the gist of the research and findings. Sorry to everyone else for the information splat taking up your screens. This is clearly not merely an issue of the fetus being exposed to radiation through an x-ray or the impact of the anesthesia on the fetus during the VSG procedure (which is not to be overlooked and if you'd like me to send you a complete article privately, I can - 'cause it's very long to post here and you'd need to read all of it to get the baseline). It is also about the severe nutritional, Vitamin and mineral deficiencies present in the first weeks after the operation which appear to have a significant impact on the progress of the fetuses growth and development in utero. A point that would need significant evaluation, monitoring and intensive hands-on care. If you would like to ask any questions on the below, please do not hesitate to contact me. Much love x Analgesia, Anaesthesia and Pregnancy A Practical Guide 3rd Edition By Steve Yentis Chelsea and Westminster Hospital, London By Surbhi Malhotra St Mary’s Hospital, London Publisher: Cambridge University Press Print Publication Year:2012 Online Publication Date:December 2012 Online ISBN:9781139012966 Paperback ISBN:9781107601598 Book DOI: http://dx.doi.org/10.1017/CBO9781139012966 Subjects: Anesthesia, Intensive Care, Pain Management ,Obstetrics and Gynecology, Reproductive Medicine Chapter 3 Anaesthesia before conception or confirmation of pregnancy Many women will require anaesthesia when they are pregnant and many will be unaware that they are pregnant at the time of the anaesthetic, especially in the first 2–3 months of their pregnancy. The thalidomide catastrophe initiated the licensing arrangements for new drugs and their use in pregnancy; the current cautious stance of the pharmaceutical industry is reflected in the British National Formulary’s statement that no drug is safe beyond all doubt in early pregnancy. The anaesthetist should have a clear knowledge of the time scale of the developing fetus in order to balance the risks and benefits of any drug given to the mother. A teratogen is a substance that causes structural or functional abnormality in a fetus exposed to that substance. Problems/special considerations The possible effect of a drug can be considered against the stage of the developing fetus: Pre-embryonic phase (0–14 days post-conception): The fertilised egg is transported down the Fallopian tube and implantation occurs at around 7 days post-conception. The conceptus is a ball of undifferentiated dividing cells during this time and the effect of Downloaded from Cambridge books Online by IP 129.215.17.188 on Wed Jan 29 01:41:58 GMT 2014. http://dx.doi.org/10.1017/CBO9781139012966.004 Cambridge Books Online © Cambridge University Press, 2014 drugs on it appears to be an all-or-none phenomenon. Cell division may be slowed with no lasting effects or the conceptus will die, depending on the severity of the cell damage. Embryonic phase (3–8 weeks post-conception): Differentiation of cells into the organs and tissues occurs during this phase and drugs administered to the mother may cause considerable harm. The type of abnormality that is produced depends on the exact stage of organ and tissue development when the drug is given. Fetal phase (9 weeks to birth): At this stage, most organs are fully formed, although the cerebral cortex, cerebellum and urogenital tract are still developing. Drugs administered during this time may affect the growth of the fetus or the functional development within specific organs. Management options The anaesthetist should always consider the possibility of pregnancy in any woman of child- bearing age who presents for surgery, whether elective or emergency, and should specifically enquire in such cases. If there is doubt, a pregnancy test should be offered. If pregnancy is suspected, the use of nitrous oxide is now generally considered acceptable, despite its effects on methionine synthase and DNA metabolism, as there is little evidence that it is harmful clinically. Similarly, although the volatile agents have been implicated in impairing embryonic development, clinical evidence is lacking. Some drugs cross the placenta and exert their effect on the fetus, e.g. warfarin, which may cause bleeding in the fetus. Key points The possibility of pregnancy should be considered in any woman of childbearing age. No drug is safe beyond all doubt in pregnancy. Further reading Allaert SE, Carlier SP, Weyne LP, et al. First trimester anesthesia exposure and fetal outcome. A review. Acta Anaesthesiol Belg 2007; 58: 119–23. 6 Section 1: Preconception and conception Pregnancy shortly after bariatric surgery. Transliterated Title: Svangerskap like etter fedmeoperasjon. Authors: Skogøy K; kristin.skogoy@nordlandssykehuset.no Laurini R Aasheim ET Source: Tidsskrift For Den Norske Lægeforening: Tidsskrift For Praktisk Medicin, Ny Række [Tidsskr Nor Laegeforen] 2009 Mar 12; Vol. 129 (6), pp. 534-6. Publication Type: Case Reports; English Abstract; Journal Article Language: Norwegian Journal Info: Publisher: Norske Laegeforening Country of Publication: Norway NLM ID: 0413423 Publication Model: Print Cited Medium: Internet ISSN: 0807-7096 (Electronic)Linking ISSN: 00292001 NLM ISO Abbreviation: Tidsskr. Nor. Laegeforen. Subsets: MEDLINE Imprint Name(s): Publication: Oslo : Norske Laegeforening Original Publication: Chistiania : Alb. Cammermeyer, 1880- MeSH Terms: Bariatric Surgery/*adverse effects Pregnancy Complications/*etiology Adult ; Bariatric Surgery/methods ; Duodenum/surgery ; Female ; Fetal Development ; HELLP Syndrome/etiology ; Humans ; Infant, Newborn ; Infant, Small for Gestational Age ; Obesity, Morbid/metabolism ; Obesity, Morbid/surgery ; Pregnancy ; Pregnancy Complications/metabolism ; Pregnancy Outcome ; Risk Factors; Time Factors ; Ultrasonography, Prenatal ; Weight Loss Abstract: Bariatric surgery is increasingly used to treat morbidly obese patients. Fertility in women may be enhanced after these procedures, owing to substantial weight loss and possibly a decreased absorption of oral contraceptives. We report a pregnancy that occurred two months after biliopancreatic diversion with duodenal switch in a 32-year-old woman. She subsequently developed haemolysis, elevated liver enzymes and low platelets count (HELLP) syndrome and had a weight loss of 43 kg (from the bariatric procedure) until the infant was delivered preterm by caesarean section (due to low activity). The infant was small in relation to the gestational age, with a weight of less than 50 % of the expected (780 g at 29.6 weeks). Histological examination demonstrated a small placenta with insufficient spiral artery trophoblast infiltration, possibly caused either by severe preeclampsia or by maternal nutritional deficiencies. Severe metabolic aberrations may complicate pregnancies after malabsorptive bariatric surgery. Patient preparations before weight-loss operations should include information on fertility and birth control in the postoperative period. Protocols for monitoring of patients that become pregnant after bariatric surgery are needed. Comments: Comment in: Tidsskr Nor Laegeforen. 2009 Mar 12;129(6):536-7. (PMID: 19291887) Entry Date(s): Date Created: 20090317 Date Completed: 20090319 Latest Revision: 20110330 Update Code: 20131125 DOI: 10.4045/tidsskr.09.34019 PMID: 19291886 Database: MEDLINE with Full Text The risk of adverse pregnancy outcome after bariatric surgery: a nationwide register-based matched cohort study Mette Mandrup Kjær, MD; Jeannet Lauenborg, MD, PhD; Birger Michael Breum, MD; Lisbeth Nilas, DMSc OBJECTIVE: The aim of this study was to describe the risk of adverse obstetric and neonatal outcome after bariatric surgery. STUDY DESIGN: Nationwide register-based matched cohort study of singleton deliveries after bariatric surgery during 2004-2010. Data were extracted from The Danish National Patient Registry and The Med- ical Birth Register. Each woman with bariatric surgery (exposed) was in- dividually matched with 4 women without bariatric surgery (unexposed) on body mass index, age, parity, and date of delivery. Continuous vari- ables were analyzed with the paired t test and binary outcomes were analyzed by logistic regression. RESULTS: We identied 339 women with a singleton delivery after bari- atric surgery (84.4% gastric bypass). They were matched to 1277 un- exposed women. Infants in the exposed group had shorter mean gesta- tional age (274 vs 278 days; P .001), lower mean birthweight (3312 vs 3585 g; P .001), lower risk of being large for gestational age (ad- justed odds ratio, 0.31; 95% condence interval, 0.15– 0.65), and higher risk of being small for gestational age (SGA) (adjusted odds ratio, 2.29; 95% condence interval, 1.32–3.96) compared with infants in the unexposed group. No statistically signicant difference was found between the groups regarding the risk of gestational diabetes mellitus, preeclampsia, labor induction, cesarean section, postpartum hemor- rhage, Apgar score less than 7, admission to neonatal intensive care unit or perinatal death. CONCLUSION: Infants born after maternal bariatric surgery have lower birthweight, lower gestational age, 3.3-times lower risk of large for ges- tational age, and 2.3-times higher risk of SGA than infants born by a matched group of women without bariatric surgery. The impact on SGA was even higher in the subgroup with gastric bypass. Key words: adverse pregnancy outcome, bariatric surgery, gastric bypass, pregnancy Pregnancy after bariatric surgery: a current view of maternal, obstetrical and perinatal challenges Ronis Magdaleno Jr • Belmiro Gonc¸ alves Pereira • Elinton Adami Chaim • Egberto Ribeiro Turato Received: 6 May 2011 / Accepted: 14 December 2011 / Published online: 29 December 2011 Ó Springer-Verlag 2011 Abstract With the increase in the number of bariatric surgeries being performed in women of childbearing age, physicians must have concerns regarding the safety of pregnancy after bariatric surgery. The aim of this review is to summarize the literature reporting on maternal, obstet- rical and perinatal implications of pregnancy following BS. Methods English, Spanish and Portuguese-language arti- cles were identied in a PUBMED search from 2005 to February 2011 using the keywords for pregnancy and bariatric surgery or gastric bypass or gastric banding. Results The studies show improved fertility and a reduced risk of gestational diabetes, pregnancy-induced hypertension and pre-eclampsia, macrosomia in pregnant women after bariatric surgery. The incidence of intrauter- ine growth restriction and small for gestational age are increased. No conclusions can be drawn concerning the risk for cesarean delivery and the best surgery- to-conception interval. Deciencies in Iron, Vitamin A, vitamin B12, vitamin K, folate and Calcium can result in maternal and fetal complications. Conclusions Pregnancy outcome of women who deliv- ered after BS, as compared to obese populations, is better and safer and comparable to the general population. Close supervision before, during and after pregnancy following bariatric surgery and nutrient supplementation adapted to the patient’s individual requirements can prevent nutrition- related complications and improve maternal and fetal health. Keywords Bariatric surgery Pregnancy Pregnancy complications Morbid obesity Weight loss Vitamin A Deficiency in Pregnancy: Perspectives after Bariatric Surgery Cristiane Barbosa Chagas1, 2, Cláudia Saunders3, 4, 5, Silvia Pereira1, 6, 2, Jacqueline Silva7, 2,Carlos Saboya8, 9, 6, 2 and Andréa Ramalho3, 10, 11 (1)Clinical Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil (2)Center for Research on Micronutrients, Josué de Castro Institute of Nutrition, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil (3)FIOCRUZ, Rio de Janeiro, Brazil (4)Nutrition and Dietetics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil (5)Research Group in Maternal and Child Health (GPSMI), Josué de Castro Institute of Nutrition, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil (6)Clínica Cirúrgica Carlos Saboya, Rio de Janeiro, Brazil (7)Human Nutrition, Center for Research on Micronutrients, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil (8)Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil (9)Brazilian Society for Bariatric and Metabolic Surgery, São Paulo, Brazil (10)Social Applied Nutrition Department, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil (11)Instituto de Nutrição Josué de Castro, Centro de Ciências da Saúde, Universidade Federal do Rio de Janeiro, Av. Carlos Chagas Filho, 373. Edifício dos Institutos Bloco J, 2° andar, sala 26, Ilha do Fundão, 21941-590 Rio de Janeiro, Brazil Andréa Ramalho Email: aramalho.rj@gmail.com Published online: 12 December 2012 Abstract This study aims to describe the clinical consequences of vitamin A deficiency (VAD) in pregnant women after bariatric surgery. Included are studies on VAD during pregnancy and after bariatric surgery conducted in humans from 1993 to 2011. There are few investigations on the relationship between pregnancy and bariatric surgery and on the damage to the binomial mother–child resulting from VAD in this relationship. The high percentage of VAD in the postoperative period is a cause for concern, especially considering the function of this vitamin in certain biological moments and in moments of intense nutritional demand. This vitamin serum evaluation is recommended during the prenatal period. Keywords Pregnancy Vitamin A Vitamin A deficiency Obesity Bariatric surgery Retinol Beta carotene Night blindness

You won't be "full" anymore as you know it. Try and focus on being "satisfied". To do this you need the highest amount of protein for your buck. My bariatric center which is in our hospital sold me New Directions Protein Shakes but I think the Atkins Advantage brand at your local grocery store are a close alternative. Also, LOTS of water, tea, or other calorie free non-carbonated drinks in between keep you from feeling too hungry. I do still drink coffee also even though I have been recommended to be on a caffeine free diet as well, but that's my choice, not my advice!

I am so sorry. That is a hard blow when you are so close to and ready for a surgery you worked to get ready for. Hugs to you. It is time to use your frustration to find out what is going on. Your first step is to research your summary plan description from your insurer and your employer . This will give you a way to see the guidelines of your specific policy and what it says about bariatric surgery. Your next step is to go through the guidelines one by one and make sure you have met each requirement. If you have questions, please call your insurer customer service number on the back of your insurance card and ask every question you have. This is the only way to get to the answers you need. I know this set back is upsetting and you feel defeated. Please know we are here to support you. Please don't give up, be determined to find the answers you need. The denial may have been a mistake or may need to be appealed. I also wonder why the doctor's office didn't check into things further before scheduling surgery. My docs office won't schedule my last pre op surgeon visit, nor start my pre-op diet, nor even give me even an estimated date it when my surgery might be scheduled until they have an approval letter in hand from my insurer. Different strokes for different folks, I guess. Hang in there and find the answers you need!

SHe announced today that she would not return for the fall season. She was told in March or April that her contract would not be renewed. They said that people didn't trust her anymore. After the way she did with the wedding and the non-discussed weightloss. There was "different feeling" at the table. Here is the yahoo story link http://news.yahoo.com/s/ap/20060628/ap_on_en_tv/tv_the_view_reynolds What do you all think? I know she has been a hot topic here before and thought I would see what the opinion was here. ~Mandy

I agree. Even our family Dr overrode our bariatric Dr on our frequency of eating and I agreed with him. There's been a few unrealistic "rules" our bariatric Dr tells his patients that are against common sense even. We no longer go to him, for those and other major reasons. Like I said, I drink less air with a straw than I do just drinking out of a cup. To each his/her own.

@@JamieLogical I went home on full liquids- after 2 weeks I'm on purreed. So easily! Do you know there are a growing number of bariatric programs where they send people home on SOFT foods? Every program is different. So chicken and tuna go down very easily. Never had a problem with getting anything down, food or liquids. Not from the very first day in the hopsital.

Megan, We have the same insurance...and yes they pay 100% as long as the doctor is in Network. So far, I've only been responsible for a co-pay to see the WLS and my PCP, other than those two, I haven't spent a dime at all..and it's a blessing to have such great insurance with no Bariatric exclusion. I'm also at the finish line and hoping for an October surgery. Oh and one other thing, I'm not sure if you know or even if it applies to your coverage but BCBS requires three visits to the doctor's office in three separate months. By that I mean, it used to be you had to go through a 6 month supervised diet program, but they've since made it much easier. Now it's only 3 months.. so for me, my doctor's appointment in Aug counts as 1 visit, then my appts with the psch or Nut will in Sept counts as number 2 and then my 2nd appt with the NUT in Oct will count as my third consecutive month of appointments...then I will be able to get surgery. Anyway...Best of luck!

It may work differently. I had my reg Dr. refer me to the bariatric center. There I saw a surgeon, a few nutritionist visits, psych exam, which was all covered by my insurance from the referral of my primary care physician. Once that was done, the bariatric center sent to my insurance to get approval for my surgery.

I am still waiting for the insurance company to approve my surgery but I understand what you are going through. My husband who is very supportive on whatever I decide to do, told my mom that I had a referral to see a bariatric surgeon. He did not know I did not tell her, so she went off. She said there are to many things that can go wrong and so on and so on. I have not told her that I am following through and getting banded. I want to but I do not want to hear the negative stuff that she will say. My friends are very supportive though and I am thankful for that. I have only told one of my brothers and his wife and thats it. I am at a cross to tell the rest of my family or not. I do not want the negative that you have received. Also I have not started my pre-op diet so I cannot answer you question on that. Good Luck!

I'm going to a Bariatric Surgery Seminar tomorrow night and am excited, nervous, anxious, but ready to do this. I grew up as an overweight child and have always been an obese adult. I think my anxiety is due to the fact that I will look different, but will I really be different or is it possible to stay the same inside, just with a different shell? I know this is a question I need to address during my psych consult, but I'm wondering how many others felt this way prior to surgery. Thanks, and good luck to everyone! :wub:

You are funny about keeping your stomach in a jar. The only thing that would do for me is keep me from eating even more. That does not appeal to me at all! I've never heard of having a recording of your procedure. Here in America everyone is so afraid of lawsuits, they probably don't allow video taping--at least not to give to the patients. My insurance will not pay for the procedure unless it is done at a "Bariatric Surgery Center of Excellence" meaning they have to have certain standards and certain programs in place. I will only be in the hospital for two days, though. They send you home early in the US--too expensive to keep you longer. I have been dealing with hair loss for quite a while myself as I have been having thyroid issues. Even though I see alot of hair in the shower and bathroom sink, and I have less volume, I still have quite a bit left--no bald spots or anything. I did start to take biotin (I was told to get a high dose (500mg, I think) and I have seen an improvement. I wish I knew where my grandmother was from. A cousin did some geneolgy research a few years ago, but I don't believe she went back as far as that. Let me know how things go for you! Anne

Check out a product called ageLOC. A friend of mine recommended it to me, though she hasn't had any bariatric surgery, she says she can tell a difference.

No matter which surgery you get.. you will experience some of the same things. I put this information out there to let people know they are not alone and you may not receive the support from your family/friends. You will receive 100% support from the bariatric community. Losing the weight is easy, but their is no way to truly prepare for the mental challenges ahead of you. Keep in mind that we all go through the same challenges and we are all fighting obesity together. Best of luck to you! And Congratulations on getting your surgery date!

Mindy, I dont nmind helping folks on an individual basis.... I am not interested in educating the "shady coordinators"... I give my work phone number and my work email (and it's my personal as well) so that it IS understood that I am someone that works in this field. Not only that, I feel that if I wanted to be shady I would do a better job at disguises... and use the username msfluffbunny or something non-related.... Oh to address your first question.... I dont work for "a" doctor... I work with several docs in Mexico and the states.... What I do with absolutely no $$ in my pocket, is help people that are having problems...regardless of who did their surgery, help those who DONT have the $$ find a way (in the states and in Mexico), and if someone is just plain scared I dont mind talking with them and encouraging folks.... Not everyone that is here to help... has their hand out. I have come on here more in 2 days then I have in 2 years just defending myself with all of crazy paranoia that seems to be present. I want thank those who sent an email thanking me for the explanations on wanting to help.... I hope maybe... everyone will do things in the way they wish... and allow others to have the freedom to share in the way they are most comfortable. I personally like to help a peron on an individual basis.... That is my choice and if I can be of assistance from someone that NEEDS to share or have questions about any of the bariatric procedures... I am happy to share what I have learned.... Anyone can write to me individually at bandinfo@verizon.net

Hi Marty, I agree with everyone else. You are human...we succeed, we fail and we get back up and try again! You will be successful again and this is a great forum to come to for support. The people here are non-judgemental, truthful and inspirational! Good luck as you renew your committment to this journey!!!

Welcome and here: BariatricEating.com Health & Nutrition - Bariatric Recipes Someone posted that the other day. You'll never need another recipe.

oh my goodness....i just replied to ur other thread...but i know see ur problem.....have u tried going to a major hospital in AZ and visiting their bariatrics division or something....im assuming if its a major hospital...they wont deny u of assistance regardless if they did ur surgery or not.......u definitely need to take action asap!! sounds like u been dealing with the pain for almost 5 mnths now.

Hey All - Well, some of you know that I've been sick since I started the pre-op diet (think that's probably coincidental). Anyway, ended up with bronchitis and a double ear infection this week. Called my surgeon today and they said I need to finish my antibiotics before they can do surgery, so surgery moved from Monday August 3rd to Friday August 7th. Funny thing is that my surgeon is doing a workshop for other doctors that day, so my surgery will be recorded and shown via satellite to other bariatric surgeons. I was fine with that for two reasons 1) they don't show my face and 2) I figure he's gotta be on his "a" game right?? So, bummed that I have to live on liquids for yet another week, but feel better that at least I'll be healthy for surgery. Jen

Has anyone gone to Bailey Bariatrics in Owasso, Ok for their lap band surgery? If so, what was your experience? Thanks...

Jong, I buy it at Walmart. It's called Body Fortess super advanced whey protein, I get it in chocolate & vanilla. Then I buy my unflavored from GNC and it's for Bariatric patients

You are doing great! It could be a little water retention. I buy those little crystal light drops and love them. Its ok to have that. There is no calories. The other thing I just got which might help you for when you get through surgery is NutriWise Protein drink enhancers. They are powder that you put in your water. 15 grams of protein so when you don't want a thing but have to get your liquid in - they are a life saver. I bought the Lemon Razzy and it was really good. I also purchased Bariatric Choice drink enhancers. The blue raspberry wasn't so good but the berry was really good. Also 15 grams of protein. I hope they help you. I bought them on Amazon. Can't wait to hear your good news - you're almost there!

I had my initial meeting with my surgeon and he told me I would only lose 40-50lbs with lapband, he was trying to encourage me to have gastric bypass. He has only done 30 some lb surgeries and the other surgeons at this hospital have also only done 30 some. This hospital just started doing surgeries last Dec. I know the lb is just a tool, I get it, I understand that. But could someone give me hope that I will lose more? I am at 243 now, was at 250 at my 1st visit the bariatric center. Thanks for all of your help!

There is always the exception, and I guess I'm it.... To me, it is a lifestyle.....NOT a diet. I have plenty of friends who are skinny, and probably never been overweight in their life. I follow their lead....you will never see them eating like a pig...always small portions. At parties, you hardly see them eating at all but engaged in conversation..... They do it out of good lifestyle, I do it because the band will not let me be a pig..CANNOT overat.... 2nd, what food they do eat is HEALTHY....you will never see them counting calories. They simply know what is good and what is not good for their bodies.....it's not rocket science and I don't need MFP to tell me. That is what I do...since myl food portions are so small, thanks to the band, I have educated myself to be a Health Nut.....I only eat the best foods, stay away from junk, choose organis when possible.. I have not eaten red meat in 18 months.....no flour products, no sugar, no salt, soda, milk, etc. to some that may be a diet, to me that's a healthy lifestyle. 3rd, my skinny friends are all active, involved in something like running clubs, cross country biking, etc. I too have elected to to be the same way.....even after having one heart attack with cardiac surgery, I am more active now than I was 30 years younger....which included 2 tours of Vietnam.... So, I do not think about calories, just eating healthy... Being banded, my portions are totally in control, cannot overeat even if I wanted to..and I have tried and learned my lessons well.... Most days, I do not even think about being banded at all....it is as though I had surgery once, I'm healed and cured, and life goes on..... However it goes on with a NEW NORMAL.... I have not gained, nor lost any significant weight in over a year. I see my bariatric surgeon every 3 months....he cannot be more pleasd because I make him look good....has had me at a few of his seminars..... He once said he wished all his patients had my attitude towards living a new life...... These forums are a place where no one is right, and no one is wrong....but it is a place where people who have been banded share their personal stories. I am shocked at what some people tell other people what they should or should not do.... I have been in the profession for over 30 years and , well, I'll leave it at that..... I have reached my goal, completed the journey....this is now my NEW NORMAL LIFE! Set free from dieting, calorie counting, etc.....and it is all easy and normal behavior for me.

A testimonial from the website of the hospital I will be banded..... insipires me whenever I feel like I need a pick-me-up... just wanted to share. I have found that there are certain "stones" that you must claim as your own and use with almost religious zeal to keep the tool of bariatric surgery sharp and effective. I think every person who has this surgery builds their own cairn out of the stones that they discover work best to encourage them. So here are a few of mine. Stone #1—Quiet Reflection This one takes different forms for different people—prayer and meditation, transcendental sauntering, yoga, sitting quietly, being. Take your pick, but this is an important discipline as it keeps the bariatric patient in touch with the one thing that our weight and former dependence on food distanced us from—our feelings. You must think about how you feel, stay aware of how you feel and set your compass each and every day to make all of the choices that keep you feeling good, feeling lean, and feeling in control. Stone #2—Meaningful Movement Do something. For me the compliance to this particular "stone" is profoundly personal and it took me almost four years to figure out that I would exercise far more consistently if I would work out early in the morning versus in the evening when I almost always had a conflict or flagging motivation. Committing to a time that no person or event could challenge and making it virtually impenetrable from interlopers made this one of the most significant assurances for me. If I start with this stone on the cairn—even if it is just a 45 minute energetic walk—everything else seems to fall in place. Put simply, if I even reluctantly walk over and pick up this stone (no matter how heavy) and carry it to my weight loss cairn each morning, I know that I will virtually run and, with little effort, pick up the rest of the stones that day and stack them on the monument of the day's success. Make this stone anything you like—for me it is walking, rowing, dancing, or maybe a touch of light weightlifting that I should actually do more often. Stone #3—Liturgical Vitamin Ceremonies My vitamin consumption has become an almost holy symbol of my intent to honor the body this surgery gave me. I bought a tea box (a wooden box with 12 square compartments) that sits next to my favorite chair. Every morning and night I open it up to behold the vitamin selection that assures my good health. There they all are—the multi vitamin, the Co-Q10, the calcium, the Colace (still needed from time to time). I take vitamins several times a day, and each time I take one, I whisper "I am good to me." Stone #4—The Security of Staples Always, always, always have the staples you need to stay the course for good health. This takes discipline and a list (laminated and always with you). For me, the staples are hard boiled eggs, fat free cottage cheese, Montreal steak spice, Lite Havarti cheese, apples, blueberries, fat-free yogurt, and Crystal Light. These must be in my reach at almost all times or I will most assuredly make the same bad choices that caused my weight gain. Make your own list and carry a small cooler in your car everyday if you must—and I have—so that you have no excuse. Never, never go home without knowing that you have the staples you need there. I do better without too much choice. An important related "stone" to this one was a hard one for me to acknowledge and eventually convince the rest of my family to join me in honoring. I cannot have any food in my house that is not desirable for a weight-loss patient to consume. Once that first year of no appetite passes and hunger makes its inevitable return, the same temptations you once knew will be back. Even though you will feel rotten if you succumb, it is just too tempting. I find the de-temptation of the home environment and replacing it with staples (symbols of on-going health) is critical for me. Any family member frustrated by this strategy can find plenty of excuses to sneak out of the house for a non-healthy treat. Stone #5—Surround Yourself with Stone Masons This has to do with the ongoing support we all need in life to achieve any of the goals we set before us, particularly the goal of good health after weight-loss surgery. For some, this may mean participating in support groups. I have had a mixed reaction to formal groups for bariatric patients. Prior to surgery, I found the groups to be absolutely inspiring with so many stories of success transformation. They were a remarkable source of hope during a time of despair. However, not long after my surgery, I found that most support groups were negative. The participants focused on what wasn't working, what they couldn't eat, or what they didn't like. Since I had been totally prepared for the changes that my surgery was intended to bring, I did not find what I wanted in a group. Look intentionally for a support group that absolutely encourages the excitement (and yes, reality) of a body that has been readjusted completely to bring about a transformation. Yes, our cups may now be literally half full, but our lives and futures are virtually overflowing. Surround yourself with people who see it that way and, do as I did, select your own personal support team. The people on that team are your stone masons who will help you set the stones you choose in place and secure them for life. Stone #6—Celebrate and Play At least once a quarter, take a day to do nothing but celebrate. Keep a list of the things that you always said that you would do when you lost the weight—take a hike, ride a horse, go to a concert, climb a mountain, go sit on the beach and watch a sunset, shop, etc. Write down everything you can imagine and, like a bucket list, do them one by one. Plan these important days, give them to yourself and review the stones in your weight-loss structure. If you can, take the day off on your surgery anniversary and honor your good health. Stone #7—Share the Joy Take some of the new energy of life that is most certainly one of the extraordinary benefits of weight-loss surgery and give it away to somebody who needs it. Do this in whatever way the world calls you to give something back. People carry "weight" in very many ways and I think we end up with an obligation once ours is gone, to help others carry their own or lose it as the case may be. Stone #8—Lighten Up and Face the Facts The reality of my numbers is as follows. The last time I weighed prior to surgery, I was a precious but substantial 327 pounds. I would lose a total of 167 pounds, 18 of which have found their way back. Of course, this predictable weight gain is a fact that strikes sheer terror in the heart of any person who has struggled with weight loss and knows how easy and devious the return of pounds can be. However, using the stone stacking method described here, I have discovered how to maintain my weight within about a two-pound fluctuation over the past year. Put simply, the balance of stones and habits for me that I have in place right now will accommodate maintenance. What I also know is that if I want to be as lean as I have been (which I very much would), I will have to exercise a bit more and trim some additional calories out of my diet to create that outcome. These are facts, not magic and not a failure of the surgery. Just a reminder that I will have to continue to use my stones in different ways everyday for the rest of my life to sharpen the tool of my surgery and create the monument to good health that I want my cairn to be .

I think the answer is no, but I'd like to get thoughts from folks. I'm 3 days post-op and on full liquid protein at the moment. On my list of approved foods are things like: protein shakes, jello, pudding, etc. I found this awesome bariatric protein recipe site and was SO EXCITED to try the pistachio mint protein shake. Two tsp in it was amazing until I realized that pistachio pudding mix has those itty-bitty chunks of pistachio in it. I stopped right then and moved onto something I know to be completely smooth but I can't help wondering, how at-risk am I from those little chunks I may have consumed?