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Researchers generally determine Protein quality by using the protein efficiency ratio (PER) or the protein digestibility corrected amino acid score (PDCAAS). They determine the PER by evaluating the weight gain in growing rats fed a particular protein compared with a standard protein, egg whites being the gold standard. The higher the PER value, the greater the protein quality. The PDCAAS was introduced as a more accurate way to evaluate protein quality for humans, because it uses human, not rat, amino acid requirements to calculate the amino acid score. It compares the amino acid profile of a protein with the essential amino acid requirements for humans according to The food and Agriculture Organization. When a protein meets this requirement, it gets a score of 1.0. PDCAAS has now been adopted as the official method by the World Health Organisation, the US Food and Drug Administration and the US Department of Agriculture. Although the PDCAAS method is the internationally recognised standard for comparing Proteins for human consumption, it does not allow for differentiation among proteins with a PDCAAS of 1.0, so proteins can have different PERs while still having a PDCAAS of 1.0. This is significant, because researchers are now exploring how variances in specific essential and/or conditionally essential amino acids, as well as the availability of various peptides and micronutrients, affect human physiology. Claims of consumer-relevant superiority or inferiority, when performance of physique modificaitons are concerned, have yet to be supported by population-specific evidence in humans. Protein PCDAAS PER Gelatin/collagen 0.08. -- Beef/poultry/fish 0.80-0.92. 2.0-2.3 Soy 1.00. 1.8-2.3 Ovalbumin (egg) 1.00. 2.8 Milk protein 1.00. 2.8 Casein 1.00 2.9 whey 1.00. 3.0-3.2 Bovine colostrum. 1.00. 3.0-3.2 Table 1 Table 1 (above) lists the PER and/or PDCAAS for the major types of protein used in nutritional supplements. The following discusses the relative strengths and weaknesses of these basic types of proteins that are often used as starting materials for nutritional supplements. Of course, adding deficient amino acids and other nutrients to these proteins may increase the PDCAAS, nutrient value and/or functionality of the protein. <><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><> As you can see above collagen/gelatin is nearly useless to the human body. This is what is in almost all protein shots. Always check the ingredients. Many makers of protien shots are giving them names that have Whey in their title but are still using collagen/gelatin as their primary protein source. Also keep in mind that ingredients on labels are listed in the order of amount used. So if collagen or Gelatin is listed first then it is the primary protein source for that product.

I have seen a few people post about significant regains on the Obesityhelp Revision Forum. I have also seen some posted on an Aussie sleeve forum where they have been doing vertical sleeves longer than in the U.S. A few of the ladies had significant regains after pregnancies which we all know could happen because pregnancy can obviously make people gain weight (although I know one lady who is about to have her 2nd post op baby and has remained slim throughout!!). Some of the people had simply not lost enough weight to get out of the obese or morbidly obese BMI range. And yes, some people had gone back to eating crap and gained weight back. Unfortunately it can happen with any surgery if you revert back to snacking on high carb foods especially like cookies or ice cream on a very regular basis. A couple of people experienced regains after going on a medication for an illness that causes weight gain. A few of them had been sleeved back when the stomachs were made quite a bit bigger than they are now and didn't remove all of the fundus like most surgeons do now. We always have to remain forever vigilant and learn the good habits after surgery. Not eating and drinking at the same time---protein first--things like that are big rules for a reason. Good luck everybody!

Chris, what an emotional and stressful year you and your wife have had! My first thought is thank goodness you both are sleeved because without it would be so easy to slip back into old habits and gain a ton of weight with all you've had going on! The first thing I say to your wife (after sending a big hug) is you are NOT A FAILURE!! You have been dealing with so much, caring for your parents, moving, working. I imagine there is little time left to think of yourself. I have a husband who has muscular dystrophy and is confined to a wheelchair. He is completely dependent on me for everything and unfortunately we do not have any help on that end, so I am pretty much on call 24 hours a day. I have two teenagers who are very active in school and sports, so on that end we are very busy too. So I know all too well how easy it is to put everyone else and their needs first and forget or run out of energy to take care of yourself. That being said, it is important that she take care of herself. The weight gain, the stress etc are all taking an emotional toll on her that is not good for her, you or her parents. If I were talking to her, I would say cut yourself a break. It has been an emotional and stressful year and things have gotten off track for you. It happens, but now is time to start taking back CONTROL and taking care of you. Go back to basics of when you first started this journey with being sleeved. Start with the pre-op diet of Protein shakes, and one meal of lean Protein and veggies for two weeks. This will clear any sugar and carbs out so any cravings that are creeping back in will be eliminated. Go back to tracking what you are eating. Focus on eating protein first, veggies second and sticking with only complex carbohydrates. You've done this once, you can do it again. Make time for yourself to excercise daily. You need it for the stress relief and some 'ME' time. If she cannot get out of the house long enough because of her parents, consider investing in some help if you can swing it, even if it's just hiring a neighbor to hang out at the house a few days a week for an hour while she exercises. Maybe her sisters can come for a couple hours, a few days a week. You mentioned they are ineffective (I am sure there is a whole story there) but maybe if they are asked to do one specific thing, for a specified period of time with a schedule you can all agree to, they can be of some help to you. Alternatively, you and she may need to work out a deal...she gets up early, gets to the gym or for a hike or ride before you go to work. Or you give her a chance to do what she needs after you get home. I feel for you guys. Things sound a bit overwhelming right now, to say the least. But now that you are getting settled, it is time to find a way to refocus some of your energy on taking care of each other. YOU BOTH CAN DO IT!! YOU ARE WORTH IT!

My husband is currently doing the HCG drops. He started when I got my surgery. It's kind of nice because we basically eat about the same amount of food!! He's dropped some weight. Who knows if he will keep it off. The drops mainly help you keep from getting too hungry. The weight loss is from the restricted diet. He adheres to it very well. He cheated this weekend when we went on vacation - and paid for it both in some weight gain and GI issues. He now knows it's not worth it to cheat.

You are awesome. The weight gain could be a combination of muscle gain and inflammation from using all those muscles that you have not been using for so long. Did you get yourself any kind of walking stick/hiking pole/cane? Not only will it help with balance but it will transfer the impact and strain of walking to your upper body muscles so your lower body muscles (and joints) will not get so fatigued. I noticed that even Walmart is selling the hiking poles now. They are right next to the tents in the sporting goods section. I am a firm believer in them. I don't hike without them. Keep up the great work. You are definitely my inspiration. I don't tell my wife much about what I read here on this forum but I have kept her up to date on this thread. It's a great story.

NSV Update ** I just wanted to let everyone know that I have gone a whole week WITHOUT using my wheelchair!!! I was having to use it after 7:30 - 8:00 pm but starting last week i decided it was time to take a stand... so as of last Monday ""no more wheelchair"" ... when i felt the nagging pains .... that use to make me get into my chair... I sat down on a chair or the couch for s few minutes... then got up and continued walking...I did have to buy some compression socks because of leg cramps... Next week, I will have my husband remove the motorized chair from the house... I gained weight (244 to 248) last week but I am to excited about not using the chair minutes, I don't care. Do you think maybe the weight gain is muscle?...((From all the walking))

These past five months have gone by fast...it seems like it was just a few days ago that I decided to start this journey... A gal at work got gastric bypass and was telling me about it. The WLS skeptic in me still thought "there's no way in hell I'd ever do that...I can lose the weight on my own..." I told the gal from work that there was no way I could fathom the idea of having my intestines rerouted and there was no way I was getting a band...all the complications and potential removal were just to much for me. She said "why don't you have the sleeve?" "the what? What the hell is the sleeve? Hmmm?" So I quickly googled the sleeve and if I were in a cartoon I would have had a damn lightbulb over my head...the sleeve sounded amazing to me...sure cut out a hunk of my stomach...it's only caused me more weight gain...no band, no port, no rerouting, no tiny stomach pouch! So I started my research and found NWWLS in Everett, Wa. It's a center of excellence and on my insurance. I called for a consult and got in to see Dr. Robert Michaelson. The staff that I met is great...most have bands/weight issues themselves and they make you feel comfortable, you aren't just the fat person in the waiting room. Dr. Michaelson is great...he said I'm the most informed patient he has had. (gotta love the medical assisting diploma and my yearning to be a nurse!) I wish that my family was more supportive. Some people just tell me I need to exercise more or eat better but it's hard...they have no idea. My mom lost 100 lbs but now she drinks...ALOT. It makes me sad when she harps on my weight and when I bring up her drinking its a different story. My sister in Las Vegas is supportive! Love you Ash! I don't really have a dad since he was abusive and I think he helped me become the obese individual that I am. Granted both my mom and dads sides have a high rate of obesity...he was an a*****e. Even when we were younger he would tell us we were fat and if we could pinch an inch we needed to lose weight. My mom was abused and she drowned her sorrow in food. My sisters and I learned the behavior and for me it all created a weight monster. When I started puberty I started getting boobs and hips and my dad called me fat even more. I decided to take matters into my own hands. When we were at the grocery store I secretly bought this weight loss book...you know the little ones by the checkout counter...and I had calories and fat content memorized...I barely ate. During 7th-10th grade I starved myself. I would do exercise in my room for a few hours and I would run down our road...I looked at other gals at school and was envious of how skinny they were...I saw a pic of myself that a friend posted on Facebook and I can't believe how tiny I was. I WAS one of those skinny girls. My collarbones were sticking out...I weighed less than 100 lbs and I was almost 5'4. I'm still 5'4 and often wonder if starving myself stunted my height...I guess I'll never know. I didn't eat Breakfast, for lunch I had a soft pretzel and a lemonade, for dinner I ate rice with some margarine on it. I would eat fruit in season. I think when I met my hubby I was probably 130-150 lbs...I was 19 and I think I ended up partying to that weight. Gradually I think I got comfortable with him and I started eating again. I think my body was in shock and kept on everything I ate...I'm now 319 lbs and ashamed of myself! I have a sedentary job...my boobs have always been huge so its truly hard to exercise!!! Even when I starved myself I wore 2 sports bras and it didn't help. I was the gal running in gym class with my arms up in front of me trying to stop the pain... I'm just so ready to start new!!! I want to have babies...2-4 I hope. I got pregnant when I was 23 and had a miscarriage. I tried after that but it never happened. I think I started eating more after that as well. The doctors I went to always told me it was my weight. So I'm hoping that I'll have babies soon! I have the symptoms of PCOS and my sister has it. I want to run marathons, get out and play games and sports with my friends and family, get my nursing degree and get a job where I'm not sitting all day. I want to... Ride on a plane without a seat belt extender Sky dive Bungee jump not get winded walking upstairs not have achy knees Have my boobs bigger than my stomach Wear regular sized clothes Buy clothes off the rack and not at a specialy shop Buy cute bras and undies Not be so self conscience about mysel Be happy Etc etc lol

That's correct, Pregnant not even 2 months after surgery. I see some threads but I'd just like an update of anyone that is going through this or went through it already... I was 300 pounds at my highest weight, now down to 240. I'm not even concerned as much about the weight gain as I am for my baby. I know this wasn't planned, but I'm already in love with my little pumpkin. The doctor that I saw at my nuchal screening told me that my weight and the fact that I became pregnant so soon after surgery makes me high risk, emphasizing preeclampsia, gestational diabetes and internal herniation. It's just all so much. I'm 25 and this is my first baby so anyone that can weigh in at all is appreciated. I've had terrible all day sickness and scared about nutrition and everything...

MeginNola, I had not thought of creating my own protein drink for myself. I think I might give that a try too as I have all of your suggested ingredients at home! I have been creating a protein shake on the recommendation of a coach for my son that he loves. It is milk, a little vanilla ice cream, peanut butter and banana. I would NEVER drink that of course, since it does not fit in with my nutrition goals, but for a football player who is working out all the time and trying to fuel his muscle and weight gain it is perfect, and much cheaper than my shake mix!

I'm 4 years out, 110 lbs lost but struggling with recent weight gain. Can't seem to find the green zone! It sounds like you are both too tight and could use an unfill. Just a little out can make a world of difference. Acid reflux is no fun and cause some serious damage. Good luck! Anita

I went for my check up and my doctor realized that after several blood tests over the last year that my TSH levels were high. I didn't know what that meant but I realized that I am almost 7 weeks out and I am so tired that I can't even get up and walk around without feeling like I did a 5K run. I know my vit-D levels are low. I now have to take a 50,000 IU's of Vit-D once a week. My B-12 came back up to normal, now I have to take a B-12 shot. I have to also continue to take Calcium and Iron and I still feel very week. I was put on an anti-depressant which helps a little. The doctor then checks my last blood test and said to me " I think you have a thyroid problem. I replied " I thought high levels of TSH means high functioning thyroid. However, high TSH means low functioning thyroid. After the doctor goes back into my record and realizes that all my blood test from last year showed a problem with my thyroid I had to take another blood test to see if the TSH levels are still high. High TSH levels leads to the following You may experience chilliness or sluggishness or feel weak, depressed and tired, symptoms often labeled as chronic fatigue syndrome. You may have problems thinking and with cognitive functions, have difficulty breathing or experience muscle cramps with vague or specific joint pain. You may be plagued with uncontrollable weight gain, dry skin, constipation, menstrual problems, hot flashes, PMS, increased menstrual flow or have a miscarriage or be diagnosed with infertility. The list of common symptoms of high TSH levels includes weakness, fatigue, difficulty waking up, difficulty losing weight and/or weight gain, roughening of the hair and skin, hair loss, a pale or yellow tinge to skin, brittle nails, intolerance to cold, constipation, depression, mood swings, abnormal menstruation, decreased sex drive and memory loss. High TSH levels can affect a person's overall outlook and mentality. I had all these problems pre surgery. Now I thinking did I have to do this surgery at all. I hope this test confirms my worst fears so I can finally feel normal again. I don't have any energy. Read more: Symptoms of High TSH Levels | eHow.com http://www.ehow.com/...l#ixzz23woxuHNH Read more: http://www.livestron.../#ixzz23woj9MJF

My sister and I are bestfriends. We get asked all the time if we're twins, and we always tell the person asking that we are. They also reply with "wow, you're identical"! It's always been fun because we'd share eachother's clothes, make jokes about our weight, fight over leftovers, cry over clothes shopping and embarresment of more weight gain, binge together, and confide in each other about how much it hurts to always be "the big girl" and never the pretty girl. Misery loves company, right? We did everything together, and understood each other in terms of the low self-esteem that comes with being a young adult...a fat young adult, at that. But this all changed 3 weeks ago and 38 pounds later. My sister just had vertical sleeve surgery. I watched her struggle with her approval. I even bothered her about it when I was jealous when I had no insurance and mentioned often to her it was the "easy way out". I was excited for her, but her journey seemed exhausting with all the hoops insurance threw at her, that I honestly never thought we'd see the day come. She (was) before the surgery 38 pounds heavier than me. I found a sort of consolation in that, as hard as that is for me to admit. Why? I'm not sure. I think I felt and do feel so lousy about myself that I tried to believe that it was okay, and that I'd always be smaller than her, and that I wouldn't be the biggest one on the family. Selfish and mean of me considering how much she means to me. And now the weight is flying off of her, and now we're the same exact weight, and I suddenly feel...alone. I'm ecstatic for her. Thrilled that she is happy. So excited to see her daily progress, and so excited to see her confidence already begin to blossom. She's showered in compliments and oohs and ahhs. I'm scared. I admit to myself that I'm alone in this right now. The comfort of having a "binging partner" the comfort of knowing we'd always be big and miserable TOGETHER and never alone, and now it's changed. Now she gets full off of two bites, and I stare at her in disbelief, in both happiness, and bitterness. Jealousy is such a horrible trait to carry around...especially when it comes to jealousy over loved ones. It's such a evil, sinnister, disgusting little tyrant that continues to drain. I hate that. I just know that I've now become the biggest one. She, as well as food, was our security blanket...and I'm sure I was hers as well. Food provides consolation and comfort and solace. Our relationship consisted of a shared common interest in junk food and a shared understanding of what it felt like to be fat and miserable. My sister is the happiest she's ever been. So where does that leave me? Well, I decided in late May early June once I got insurance, that I would join in on her journey and take "the easy way out". This journey has been anything but easy. I want to rekindle a relationship with her not based on food, but based on making health a priority and positive changes for us both. I want us both to feel good. I want to transition to a new life with her. Most of all, I'd like to bond over real interests...not just what type of fast food joint we hope to eat at next. I want the rest of this year to focus on transitioning and good, healthy, positive changes. For everyone.

Today i got on the scale and i gained 6 lbs from the last time i weighed myself, but i gained 9lbs since the last time i went to the doctor 2 months ago. Sometimes i get discouraged when i see the scale go up and down. I dont feel like im losing weight but today my co worker said he can tell that i have lost weight. He also told me that youve been working out alot so the weight gain could be the fat turning into muscle and muscle weighs more than fat. When i see the scale go up and down it makes me nervous to weigh myself at home and even more nervous when they weigh me in the doctors office.

I made my decision in April to start the journey to Gastric Bypass. I made my surgeons appointment and started my 6m monitored weigh-ins. Surgeon requires clearances from cardiologist as well as pulmonologist. I called those offices to make appointments and both required referrals from the Dr requiring the clearances. I naturally called the surgeons office, they informed me they do not submit referrals, that it was up to my PCP to refer. Fine. Called my PCP, they flat out refused. Said they "have no reason to refer you". Return call to surgeons office with tears of desperation, managed to get the PA to "see what she can do". Woo-hoo! Got the cardiology and pulmonology appointments! Went to my 4th month weigh-in at 4lbs up, uggh! how did that happen?!?!?! Called surgeons office to see if I would have to start over, or if a little flub is still ok, the PA (again, love her!) said the only insurance she knows of that gives grief over weight gain in those 6m is Gateway, and I don't have Gateway. Whewf!!!! *sidenote* Still totally working on getting those 4lb gone by next weigh-in!! My next appointment with surgeon is on Aug 31st, at that point I figure, I will have 5m weigh-ins, cardio clearance, pulm clearance, bloodwork and psych eval done, we will probably be submitting to insurance. The insurance coordinator told me I need to have a letter from my Dr's on their letterhead, with the years and my weights on them for the last 5 years. Now I already had these Dr's fax over my medical records and they did, so now I need to ask them for more? OK fine. I called my OB's office (because I have seen them consistently, whereas the family Dr I hadn't seen in 3 years previous to my 1st weigh-in) asking them for this letter, was told "No. We faxed them all the records, they have it. They are just being lazy and do not want to organize the paperwork themselves and are passing the buck" Really? Ok maybe. But really? I'm afraid to even call my PCP to ask, in fear they will tell me the same thing, especially considering they were the ones to refuse my referrals. UGGGGHHHH!!! Are the stars against me for this surgery?!?!?! I know, in the scheme of things, these are not horrible setbacks, but nonetheless, should I take them as an omen that I shouldn't have the surgery. Or listen to my husband and say, they are hurdles to jump to make me sure I really want this surgery. I DO! I DO! I DO!! Please, tell me I'm an idiot and just being over scared. Or tell me to turn and run and never look at surgery again. Sincerely, The worry-wart LOL

I went to the info session last night at the U of PA to learn about my options for weight loss surgery. I was suprised to hear the surgeon poo-poo banding in general. He said they are doing less of them now due to instances of re-surgery, complications, weight gain of patients and the wearing out of the band. I was shocked! I went in there having almost made my up mind that the band was for me. He was very much for gastric bypass. Have others experienced this? Is there merit to what he is saying, or do the surgeons have a motive for wanting to do gastric over banding? Appreciate any thoughts!

I just had my 4 year anniversary in July. When I had my surgery I was young and it was two weeks after my Dad died. I also went though a divorce within 6 months of having the surgery. I am not making excuses but I can honestly say now that I want in the right mindset for the surgery. I am now 37lbs heavier than my lowest. And I cannot seem to get the weight to come off. I am very discouraged.

I'm so grateful to have found this site and have read a number of stories that made me feel less alone in my own struggle. Here is my story: March of 2008 I saw a weight loss surgeon who said all the right things to convince me I was too fat to lose weight on my own and the only way to have lifelong success was to sign up for WLS which required a thousand dollar deposit. I weighed 265 lbs at the time and in my late 30s was far too tired to try another diet and exercise program that would inevitably result in another 10lb weight gain. January of 2008 my employer switched to a new insurance carrier, I submitted paperwork in March for coverage for WLS and eventually got the definitive "no" in November 2008. Fast forward to October 2009, same doctor, same spiel, weight now 295lbs and co-morbidities presented to insurance carrier requesting coverage- denied. Februaury 2011, made a "lets just see" call to insurance carrier to find out if requirements were met........found out that one more year of a documented weight and BMI over 40 and the coverage would be extended! I put my ducks in a row and within 2 weeks of my initial doctors visit in February 2012 I was able to schedule my surgery for mid March. I was shocked to find my weight ballooned to 347lbs but thrilled when I lost 16 lbs pre-surgery in a short 12 days. I took 5 days off work, gave away all the food in my pantry and bought the cutest pajamas I could find for my 3 day hospital stay. I packed my bag on Sunday and even though I was nervous and exited I slept until 5am when I took a luxurious bubble bath and set out for the hospital @ 7am. In pre-op my precious daughter sat and prayed with me, my anesthesiologist joked about just turning the big 40 too, my surgeon came in and smiled, answered my questions, quelled my fears and prayed with my daughter and I. Nothing but blackness. I barely woke to find myself in PACU alone and asked for my daughter to be allowed in.."sure honey, which one is she?"..."hmm, oh, she's the one with pink hair!". My sweet daughter came in and praised God with me that I was breathing and everything seemed fine. Fade to black again. I'm in a private room now and my daughter is sleeping on the sofa. The nurse comes in, the IV is checked, "here's your button for the morphine pump. Any time you feel pain coming on you press it." I'm not in pain, I feel my stomach and it feels flat already, stupid, it must be the drugs. My surgeon comes in with his PA and he looks flushed, sweaty and triumphant, "eveything went wonderful! no problems, a textbook case if there ever was one." we smile and I joke about calling What Not To Wear to get a new wardrobe. I get up to the bathjroom as soon as I can. I'm anxious to see how I look and change out of the hospital gown. It's been 3hrs since surgery and i'm in my pajamas, robe and snuggly slippers and my daughter takes my arm and we begin our walk around the unit. I walk and walk, smiling and thinking what a good patient I am, no DVTs for me. My stay is uneventful, day 3 my surgeon smiles and says "time to go home!" I fill my prescriptions but I haven't touched the pain medicine and feel so powerful that I drive myself home. Then the horror begins. The first noght i'm home I wind up in the bathroom with forceful diarhea that comes in waves of gut wrenching spasms. Over and over again, just foul smelling liquid, I sit there too long and now i'm sick, I pull the trash can over and vomit clear liquid until I think i'm going to pass out. My daughter gets me to bed, time to take the meds and not try to do it on my own, I slump back and its daytime now. My head is spinning and the spasms come again, diarhea, vomit.... I step on the scale, smile in a drug haze and think wow i've lost 2 more lbs! Nothing is clear anymore, what day is it? what time is it? did I take my pills? was it a dream or did I really eat a piece of chicken from the refrigerator? why won't the nausea stop? why do the Protein shakes suddenly taste like dog butt? I can't get anything in, i'm trying to force 2oz popsicles down but when I finish one its back to the bathroom with waves of diarhea and vomiting. Day 6 post-op, I manage to take a shower with my daughter holding me up, pack 2 Protein Shakes and my giant Water bottle and trot off to work. I make it 2hrs into a ten hour shift and spend most of it in the bathroom vomiting blood...time to call the doctor. I talk to the nurse who tellls me to drink as much water as I can. I can't. I call and talk to another nurse who says to try a different Protein shake. I'm weak and sick and starting to lose it...I scream at my daughter "why won't you help me?". I call the nurse again, the PA calls me back "have you been able to take your meds and get some water in?" no, NO! It's been 11 days since surgery and now we're worried for some reason and my daughter has my bag packed and we're back at the hospital where they have my room ready and they put me back in a hospital gown. I don't see my doctor until Monday but Fri, Sat and Sun a variety of PAs mand other surgeons from the office come in and tell me things and they'll support me and some people have a harder time and just give it time, time time. Monday the first of many PICC lines come and the tests start. In 3 days I blew 11 IV lines. The PICC line sounds wonderful but they hit my ulnar nerve and the vein occluded and I went back to my room with an open hole in my arm, a second PICC and a gown covered in blood..how did that happen with a sterile drape? So I can't eat but they think I won't and they tell me all the reasons I need to and they threaten if I don't its time for TPN. I try, I puke. I try everything, Unjury- ick, water-gross, eggs-vomit, pudding, ice cream, sherbet, yogurt, Jello... the nausea wells up from my toes and never ends. The TPN starts on Tuesday, I leave the hospital 13 days later, Maundy Thursday, I beg because tomorrow its Good Friday and I can't bear to be away from daughter on Easter. Monday after Easter I have lost 8 lbs in the 4 days i've been home, somethings wrong. The doctor says to get a liter of Fluid and some Vitamins, it'll be ok, it's not. Friday the nurses come and set up the home TPN and show me how to do IV push meds, the saline, phenergen, saline, heparin, again, the zofran, again, 8 times a day. My house becomes and infirmary, boxes and boxes of supplies, dressings, medicine, saline, alcohol swabs, heparin. The dog can't be out when the dressing is changed, the TPN bag is changed once a day, add the vitamins, push the medicine. It takes a few weeks and the meds are doubled, the nausea just won't fricking stop. The TPN is my savior. another month, double the meds again, brief periods of relief, my weight stabilizes @ 317....I had WLS for this? I can't work, i'm constantly sick and besides I have a doctors appointment every week and another test, EGD, swallowing, emptying studies, another EGD, but nothing is wrong "everything is fine, it may just take time for you. You might be on liquids for 6 months" my doctor says... liquids? it's been 3 months and I can drink about 12 oz a day... liquids? i'm still on TPN?! It's been 4 months, I can't stand the TPN, we decrease the time and I try to eat what I can when I can. My weight is 318, d?@$ WLS! We double the meds, the phenergen is 4 times the dose it was when I had surgery, does anyone know this causes heart problems? We decrease the TPN, I can only eat right after I push the meds and I do it again right afterwards, then I pass out... weight loss is tough work, I manage to get down to 314. Somethings wrong, I feel sick, sicker than usual haha...my daughter is talking to the nurse at the ER, "no she feels really sick, her heart is skipping beats maybe? her blood pressure is up. look at her arm, do you think it's swollen? what's that black mark?" They tell me I have a UTI and send me home, its Monday. I can't breathe, i'm having a heart attack, I know it, its Wednesday and we're back at the ER, the doctor smiles and says its anxiety, take some Ativan and keep taking your antibiotic...are you kidding? I throw up the antibiotic, it stinks, I crush the Ativan and sleep for days. Its Friday and the nurse calls, "how are you" my arm hurts and its swollen, "GO BACK TO THE ER" I can't, I fall back asleep. Its Saturday and I can't find my wrist, my arm is a thick puffy balloon like they use to make balloon animals. My fingers won't bend, doesn't matter cause I can't feel them anyway, i'm sick, I vomit and try to push my meds, I get in 2ccs of saline and it feels like my arm is a water balloon...I push a cc and I think I see it literally filling up, theres a black gnarled line around my upper arm, looks like a barbed wire tattoo, thank God for WLS. I'm at the ER again, its Saturday night and i'm sure they'll admit me, they HAVE to pull the PICC and give me a new one, surely they'll see that, I can't breathe, please give me some Ativan and phenergan, i'm gonna puke again. A nurse comes in and says he's from Interventional radiology, doesn't even touch my arm but smiles and leaves, we hear him outside the door "you've gotta pull that PICC, it's really bad!" a tech comes in with an ultrasound machine and pushes on the outer part of my arm, over and over, slimy gel, pushing harder, my arm isn't quite so numb now, its killing me on the underside, my armpit aches and the inner portion of my upper arm feels like someone is firing a gun into it every time they touch me. "Good news!" the ER doc smiles and tells me its just a little superficlal blood clot...yay! all we need to do is apply warm compresses and it will go away, have some noroc for the pain...great, more crap I can't swallow. "What should I do if it gets worse? what if it swells up more?" don't worry "It's fine, no need to come back even if it gets bigger, warm compresses and you'll feel alot better" It's Monday and the weekend went by in a drug induced haze. I can't use my PICC, I crush the norco and ativan and try to stay asleep, no not asleep, blacked out, like anesthesia until the doctors office opens Monday. I tell the nurse, she sets up an appointment at Interventional Radiology for them to pull and replace the PICC on Tuesday, good, hopefully i'll die by then. Its 6pm Monday and I can't take it, I might be hallucinating, I know i'm dying, I moan and rock, i'm in the car, off to the ER again. I wait for hours while people scream and cry, everybody is taken before me, I pull my sweatshirt and cover my head, I moan and lick the blood from cracked lips, I can't even stand up to go to the bathroom and vomit, 4 hours later and they wheel me back. Nurse after nurse comes in to try to start an IV, "she's dehydrated and a tough poke" "I KNOW! she's so ill tho, what are we supposed to do???" check her feet, no veins, we're gonna have to go in thru the femoral.....God no, I can't remember if I have underwear on and they're gonna cut into my groan to find a vein. "Great news!" we found a cluster of blood clots under your arm, no not one, there are several vericose veins bulging out of your arm, the PICC went bad and they strangulated and now they have clots in them. You're gonna die if you throw one to your heart or lungs, we're starting the lovanox, you're gonna be fine. 3 days of terror, I'm admitted to the hospital and the doc upstairs decides she knows what I need, they pull the PICC from my grossly swollen arm and I beg for some dilauded "this isn't a painful procedure, you don't need anything for pain." and she teaches the student nurse how to yak=nk 4 feet of tubing and wire from my arm while I sob, my daughter cries and starts to yell. The doctor leaves, she won't come back or write orders, i'm sick, no pain meds or nausea meds, try some tylenol, f**** you. I cry and demand to see another doctor, I call my doctor and the oncall doctor screams at the charge nurse...they give me ativan and phenergan, my daughter yells and threatens, the nurses hate to come in my room. Wednesday morning is the first and last time I see my surgeon, he pops his head in and smiles "so your PICC is gone now, thats what happens" when you screw up and get a blood clot is what he doesn't say. I'll see you in my office next week and we'll talk about a feeding tube. What? I had WLS 4 and a half months ago... I cry and turn and face the window, I keep the shades down. I'm sick of this, I finally get to leave @ noon on Wednesday. I have a script for Warfarin and an order to have my blood drawn every day, I have no PICC line, no IV push meds, no TPN and my arm looks like I was going for a Popeye look. I sob on the ride home. When I go to the lab the next morning they stick me 6 times and still don't get enough to run the PT/INR to check my clotting times. I fall out of the car as I try to go inside, I just sit on the grass and contemplate throwing up on the lawn, I see the neighbor and when she waves I think I should strip off my clothes and just run shrieking down the street... I need a laugh, otherwise I just cry. I'm so depressed, I see my primary doc, he orders me oral nausea meds, a compression sleeve for my arm and listens to me cry. I tell him my heart is skipping a beat, he says "phenergan can cause permanent heart damage" f*** phenergan. It's 12 days since I left the hospital without a PICC. The last thing my surgeon said was that they couldn't find a reason for my symptoms, he even asked the doctors at a seminar in California and they were all puzzled, oh well, too bad for me. My weight is down to 300 lbs now, it was 312 when I left the hospital. I made the mistake of going back to the ER last week Tuesday because my chest hurt and I was coughing and that same shortness of breath and heart thing came back. they said I was fine and were sending me home when I looked the ER doc right in the eye and said "with all due respect, the last time you said I was fine I had a blood clot that almosgt killed me, please, can you just check everything to make sure i'm ok?" tears in my eyes, he smiles, lets run another test. Theres a shadow in my lung, likely pneumonia but we can't be sure the clots haven't moved. We'll keep you for observation but we won't admit you, you're probably fine buit we'll do some IV fluids and antibiotics to be sure. They take me upstairs, I know whats coming next, nurse after nurse tries to start the IV, IM pain meds, I ask for nausea meds at 6:30 am and by 2pm I still haven't gotten any. I can't stand it so I leave, they chase me and try to make me sign something saying if I die its my own fault. I get home and chew a phenergan, drink some lortab and pass out. My primary doc said he would figure out how to get me seen by a specialist, I won't return the calls from my surgeons office, if I could put a stop payment on his check I would but insurance has already paid his fee. Maybe he's right, there's nothing to explain my symptoms, I doubt that, my skin is grey and I look like a chemo patient because my long thick brown hair has fallen out in Patches and I have a kind of crazy eyed look to me. I'm hungry and thirsty, I think I look like I could be a victim of starvation but then I laugh because i'm still so fat. I knew the risks of the surgery, pulmonary embolism, DVT, sleeve leak, infection. I was a nurse for 10 years and took care of hospice patients who looked better than me. I signed on for a magic pill, a fantastic surgery that would finally help me get to a healthy weight so I could see my daughter graduate from medical school, get married and hold my grandchildren. I wanted to avoid diabetes and stop heart disease, funny how it all worked out. If you have experienced any of the pain, nausea, depression, sadness, fear, frustration, anger or disgust like I have, tell me your story and let me know i'm not alone, i'm not crazy and it does get better. :-)

Carol, Carbs started to creep back in to my eating, and I'm learning quickly that if I don't stop it, it quickly leads to weight gain, not just a stall. The further out I am from surgery, the easier such things to down - my smaller stomach does not help me here. Fortunately, I learned during the pre-op diet that getting the carb count VERY low for a few days completely kicks the cravings and makes it much easier for me to stay on track. So, when I get into trouble, I have to white-knuckle it through about three days, and then it tends to be smooth sailing. I'm afraid I'm coming to the conclusion there are some foods I just have to say goodbye to if I want to keep my weight off. I'm not an "everything in moderation" kind of girl. Happily, I'm learning to find substitutes I enjoy, and am discovering a world of low-carb, sugar free baking options for those times I just have to have a treat. See if you can go "cold turkey" for about 3 days, it might be all you need to get back on track.

140 g of protein per day? That seems quite high! I am currently in the 250 lb range and I'm getting between 60-80 g a day and even that is challenging without drinking shakes or eating Protein Bars every day. Naturally sourced protein for me seems to work better and I enjoy it more. But as it stands, I'm eating mostly protein every day and still not really getting more than 80 g. I also wanted to point out that you should double check with your surgeon that those high protein numbers are what he is advising. High levels of protein put extra strain on the kidneys. That is not a problem in the short term if your kidney function is healthy, but can become problematic in the long term. Also, high levels of protein require greater hydration (at least 1/2 gallon of fluids for every 100 g of protein), and you must be sure to make room in your calorie food intake for other vital nutrients. Protein is great but not at the expense of everything else your body requires! Carbs are "the devil", but your body needs "good carbs". These include fruits, vegetables, Beans, and whole grains. They deliver essential Vitamins and minerals, Fiber, and a host of important phytonutrients. I try to keep my carbs below 40 per day (occasionally higher or lower). Especially once you begin more strenuous exercise, the carbs are a vital part of your energy stores during exercise, as well as your post-exercise recovery. Common symptoms of excess protein in your diet include: - Weight gain (probably not an issue for VSG patients, but may be contributing to stalls) - Intestinal irritation - Dehydration - Seizures (a rare and extreme symptom!) - Increase in liver enzymes - Nutritional deficiencies - Risk of heart disease (with long-term excess protein intake) - Kidney problems Again, I want to reiterate, if your medical team is advising you to have 120-140 g of protein per day, you should follow their direction. I simply wanted to put "the word" out that this is quite a bit higher than what I have seen others discussing here on VST and is approx. 2x the amount my medical team has advised me to consume.

That was me, when... 8.15.12 It has been 4 months since I posted my first blog entry. I am happy to write that this week - Monday, August 13, 2012 - I was officially approved for surgery by Cigna. My surgery date is scheduled for September 9th. I am very excited and know the next 20 days will fly by! I've waited so long for this that it almost doesn't feel real. I guess as I have my pre-op visit and do the pre-op diet it will seem more real. When the coordinator called me I was ecstatic. I can still hear her voice telling me I was approved! The insurance process was so long and drawn out for me it was a dream come true to be approved. Right now I am struggling with a weird guilt. I can't articulate exactly how I feel but *guilt* is the best word I can come up with. I think part of it is that I am a low BMI'er and not as deserving ? Maybe, I can't tell for sure. I can say that I've always had issues with being overweight. I yo-yo and have gotten slim and then put all the weight back on quickly. I worry that I am putting myself in harms way and at risk because I have no self control or will power and almost like I don't deserve the surgery. Its odd, hard to explain. Add that to my excitement and you have my current frame of mind. I worry about being a good example for my daughters and wonder if this is setting a bad example for them. Hey, if you can't control yourself then just have surgery like me. Ugh... I have Rheumatoid Arthritis and that is a real struggle for me and the main cause of the weight gain over the past 3 years. I know if I get my weight under control the joints and body would feel so much better. I know I need to do this and I should do it but I almost feel like I need to make myself suffer for being heavy. I have this stigma that this is what I deserve for not being good enough like *regular* people that can control their weight. You know this fat girl guilt. Well, just wanted to get an entry out that reflected how I was feeling right at this moment. I can't wait to look back at this entry a few weeks from now and smile because everything has worked itself out and I am post op and feeling good.

@Jessica - the high risk is probably why. I don't have any children and have never been pregnant. PCOS is diagnosed through various test. From what I've read there is no one specific method used by all doctors. For me it was my history of missed periods, extra hair growth, and constant weight gain that caused my doctor to order a lot of blood work. Once that was complete he sent me to get sonograms based on the unbalance of my hormones. The sono nailed the diagnosis in because I have all of these tiny cysts all over my ovaries. So the cysts combined with the hormone levels is what finalized my diagnosis. Once diagnosed, I had more test, biopsies, and then was put on medications.

As a lot of people here my weight as ALWAYS been an issue for me. I am at a raw emotional state right now that I can't take on this weight anymore! I am going thru the approval process for the 2nd time (first time didn't fully qualify weight/co-morbidies so the Dr. office wouldn't file for the pre-approval.) My weight is spiraling out of control. I'm not happy, kids driving me nuts, they need to go back to school and I have a husband that says he understands and is just trying to support me in this but just keeps throwing it in my face that I can do it on my own and have before and that getting this band is not going to be a miracle! 1) I know this won't be a miracle it's a tool!! I said this now and before, its something to hold me to it, so when it comes off I can't say hand me the snickers and I pack it back on. 2) I've committed to exercises before and stuck to it....the difference I could never loose more than 30lbs so I would get discouraged, pissed and quit...it all comes back, then I'm pissed I have to start all over again. I am tired, tried of this cycle. I just turned 29---I'm done having kids, have 3 boys. I just want to live the rest of my life in peace knowing that this time when it comes off, I have no choice but to put the right stuff in my mouth or risk horrible things happening to me and my stomach, not just having to worry about the weight coming back. I know this. He wants to compare my life, mentally and physical challenges of this weight to his weight gain since high school! Sorry pal---this is just not weight gained like you from going super athletic to sit on your ass and still thinking you can eat whatever you want. You fully did that on your own! He doesn't get that!! Mine has always been there!! My dad use to make comments to me about my weight, like peer pressure wasn't enough, went almost an entire year only eating a sandwhich a day to loose the weight. That got me to 140 when I was 15---then meet my now husband and got pregnant with my son. Of course he would say you were small when I meet you I was freaking 15!!!! And what I did the year prior to just get to that weight was ridiculous!! Then after you add 3 pregnancies on top of that!! I'm done! I swear I should be on that damn slimquick commercial how it's comparing the woman and man! It's true! He said I should take a hot bath after workouts helps shed the extra pounds!! Really! I proved my point to him. He did that got in weighed himself when done lost 2lbs...I gained 2lbs!!! I am over this right now. I am doing everything again I can to get this band on!! I feel like running and hiding on a island on my own right now. I have 1 person that is truly supportive of this idea because she knows what is like, his aunt of all people. I want to be happy for once in my life! I'm tired of walking in the stores liking a shirt that would be more age appropriate and them not having my size. I want to be normal, whatever that is I don't know anymore. I just know that this is not! I'm almost at 240 an all time high when not pregnant and I don't like this! Thanks for listening, hope I got all of this out I feel like my veins are popping out of my head right now. (Maybe I should go to the Dr to have them record a high blood pressure for today :/ to add that to my list to help me get approved!!)

I was banded the 13th also. I actually felt pretty good on day 2, but now that I'm home (day 2 at noon) the gas is getting worse. I'm sure it's because I'm moving around alot more. Right now my stomach is taut as a drum. Plus, while I know it is all iv fliuds and not real weight gain but I went up 6 pounds from the morning of surgery till this morning. I'm sure once that starts to leave I'll feel better. I just went over all my food options for today and am thrilled that I can have my tea with skimmed milk in it! It is steeping as I type!

I was banded right before thanksgiving too, in 09. It went much easier than I thought it would. I was on mushies and knew I had to do the right thing for my band to heal. The next thanksgiving I did ok, ate mashed potatoes and stuffing with my turkey but no pies. Last year, ate whatever I wanted. There is deffinately a progression there lol. I have actually already been thinking about this year the last few days. I have struggled with some weight gain and am finally back to excersise and a low carb diet. My whole family gets together for 4-5 days, including my grandma and uncle from Illinois (I live in Florida). Anway, lots of big meals starting with breakfast. My mom always makes my favorites. I have come up with a plan, one cheat day on Thanksgiving, including a special breakfast. No left overs the rest of the visit. I will bring food that is on my plan. I am going to ask my mom to stick to breakfast items I won't find too hard to resist. I think starting off the day right is a good thing. I will focus on enjoying the company of my family- including 2 nieces and 2 nephews I love playing with. Back to the topic of how to handle these once a week pig outs- why not bring a think or 2 on your plan so you will have band friendly food available. Good luck!