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No judgement here. I'm sorry to hear about all your struggles. I agree with @Ed_NW. You may want to look at all the other types of bariatric surgery options. Talk it over with your surgeon. Do what's best for you and your health.

If I did that, then all the info would get mixed up and off on a tangent. I keep track of all the threads I start. Plus you get Bariatric Pal Store points for each thread you created and reply to. I've gotten a ton of stuff free or close to it

To all my bariatric friends/pals thank you all so much for your nice thoughts to me and my family. Andrew is (i don't like the words was) a wonderful, wonderful grand-son. i will always love him forever and forever. Life sadly must/will go on without him - but my memories will always be in my heart. kathy

I am in the same boat. I am going in next Tuesday. I have my bariatric pantry with all my protein and bone broth soups etc. I am going to get all my vitamins organized and medications all together. I have to make a daily chart which I'll be checking off water intake, protein and medication since there is SO much to track. I dont have any idea how people go back to work right away. I need to choose a few more books on Audible and have those ready to go. I really didnt want to make too many pureed soups etc because I have no idea what I'll tolerate and dont want to have gallons of pureed soup I dont like. I guess I could do a few. I need to be careful not to read too many people's experiences as it just ramps up my anxiety (what if that happens to me). I am a major control freak and it's very very hard for me not to know what to expect!! Hang in there. Pretty soon we'll be looking back on these posts as a distant memory!

Bariatrics gave your life now a blank canvas; So please now go through life painting yourself a true masterpiece!

I'm obsessing over this right now. I've had a first doctor visit Jan 10th and did an overnight oximetry test last night at home. On Jan 29th I have 3 appointments. First is a consult with the surgeon and metabolic testing. Second is a DXA scan and third is a nutrition consult. At the first appointment I had, I expressed my hope to get this done ASAP since my line of work gets extremely busy after March. I called my insurance Co. (Capital Blue/BCBS) and asked two different times to find out if there was a 6 month medically documented weight loss needed and I was told both times that it didn't appear so and that it depends on the surgeon. I feel like it could go either way based on the wording in my policy. This is snipped directly from my policy: "The patient must have documented failure to respond to >6 months of conservative measures for weight reduction prior to consideration of bariatric surgery, and these attempts must be reviewed by the practitioner prior to seeking approval for the surgical procedure. Some centers require active participation in a formal weight reduction program that includes frequent documentation of weight, dietary regimen, and exercise." I have almost 2 years of documented weight loss attempts and a whole list of things I've tried. I'm crossing my fingers and toes that it's enough, but won't be shocked if it's not.

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

Has anyone tried recipes form Fresh Start: Bariatric Cookbook by Sarah Kent? Are the recipes good?

to all my bariatric pals thanx to all who are thinking of me and my family i feel all your arms hugging me in support thank you kathy

This is how much I take and how I've been instructed to split them up. I take the Bariatric Advantage chewy ones and they're basically candy so I like taking them.

If you just got VSG, you can take normal centrum multivitamin! That’s what my doctor said. I use the swallowable ones. I hated chewing those stupid, expensive Bariatric ones!

Well welcome to you. Raven you're about the weight I was at my surgery 4 months ago and I have lost 50 pounds, I am also 5ft8in but a whole lot older. I turned 73 the Day after Christmas, so just about the oldest on Bariatric Pal, makes not much difference, because I have all the joys and much of the trials of everyone else. I am a RnY bypass but I know a lot of the other procedures, especially the VSG and ESG. Is there any questions you would answered, anything I can help with? I had a very good surgery and wish that for everyone else. I live in Central Ohio, about 50 miles NE of the hospital where I had my surgery.

Will do! Yeah it could probably be shorter, but I have no idea where or who it came from or why it was written. Sounds like it was written by a doctor summarizing all the things he/she can think of when it comes to being successful with bypass and what they notice are the causes behind failures. It reads very much like it was an outline for a presentation, maybe for something like a bariatric conference *shrug*. I'm a reading nut, so I dig the 10 pages it turned into when I pasted it into Word

If you have any kind of sense of smell stay away from the Bariatric Advantage chewable. They smell like an actual peed in diaper that was left sitting out. Vomitous. The taste is not great and they are huge but the smell is the worst thing. I told the nutritionist and she said yeah I think they are gross too. I had some on my table laid out a few days post surgery (because my place said to get going on vitamins right away) and my daughter sat next to me and said ew what is that smell, it smells like a pee diaper?! I could smell it on my fingers long after I chewed them. I still have a nearly full bottle and I'd rather lose the $ than open the bottle and smell it again.

Use bariatric vitamins. They have doses that are tailored for us bariatric patients. I use a multi w/iron I bought from Amazon. The brand is ProCare Health and it's a chewable. I was also told to take Vitamin B complex w/50 mg of thiamine. A probiotic with 10 strains. 10 Billion of something which is a lot! LOL Two hours later I can take a 1200-1500 mg chewable calcium citrate w/vitamin D3 and chew another one 3 or 4 hrs later. Iron has to be separated from calcium by 2 hours. I'm looking forward to just swallowing my vitamins because in my opinion, they're all gross. I have to finish my current supply of chewables first. Good luck on your WLS journey!

Has anyone been directed to take 1500mg of calcium daily (divided into 3 doses at least an hour apart and of course away from other vitamins)? My pcp seems to think it's excessive but I don't wanna diiiiie! Lol. I also take a bariatric multi and a biotin and once in awhile a dropperful of liquid b. I loathe the 3 doses of calcium.

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

Currently, I take a gummy calcium plus D3 in the morning and a regular One-A-Day for Women's caplet plus an iron tablet in the evening. I say "currently" because my vitamin regime has changed several times since being sleeved. In the first 2 or 3 months, it took me a LONG time to figure out what worked for me. I developed a reaction to the adhesive of patches. Every time I took my multi, I'd get nauseated. I tried chalky chewables, soft chewables, bariatric capsules, and finally settled on SF gummies. By the time I ran out of my super-store size gummies, I felt ready to try regular vitamins and had the One-A-Day still on hand from before surgery (also super-store sized). For me, the timing of the vitamins was more important than the method. I always take with food or shortly after eating. If I don't take with food either I get nauseated or I burp up "vitamin" burps for about an hour. to answer your questions about gummies: yes, I find them much easier. I was able to find sugar free ones and didn't feel guilty about it at all. I still do calcium gummies because my tummy is a little sensitive in the morning and I look forward to the small treat after breakfast.

I take bariatric fusion chewable multi. My doc/nut says 4/day covers everything I need. So I don’t have to remember a bunch of different vitamins. They have various flavors and you can get a sample pack to see if any work for you.

kygirl - absolutely love your graphic icon! Hang in there - it WILL get better! Your feelings are totally understandable and normal. Give your new tummy/stomach grace as it needs to heal from the trauma and all liquids is soothing and key internally. You are in the most daunting phases, no doubt. It was in those times I'd review my bullet list reasons for having surgery. And, when your eating phase does progress - cottage cheese never tasted better! ;] Another hope and promise, at least for me, was to purchase two excellent, quality food bariatric cookbooks by Sarah Kent. I hated all the artificial tasting liquids from too sweet, bland or chalky. It gave a glimpse into favorite dishes edited for the new sleeve tummy. I have used her cookbooks through-out all phases which made things bearable. I am currently in week 5 of soft foods which I and my husband (fit and lean) are enjoying together. I am only able to eat ¼ cup at each meal, but again understanding the healing process of this vital organ while encouraging it to slowly regain its' function to digest + absorb solid foods for caloric health and well being. kygirl, I have found that this surgery is not for the faint hearted. It requires much grace toward your body and a determined kind of patience. Ergo, be good to yourself and pace accordingly. Tomorrow and the future will indeed take care of itself. You can do this! It will get better...

Hi, I am new to the sleeve group and 5 weeks post surgery. I feel honored and privileged to learn more about the bariatric pal community and the courage, resolve and authenticity you regularly share. While very much a rookie in all this... I do hope, I too, can be of value and an encouragement to others. Question: I continue to experience an odd sensation upon my shoulders, especially when preparing meals, walking any distance or i.e. wrapping a present yesterday on the kitchen island. It feels like a ton of pressure weighing down on my entire body. I did have tremendous pain in the left shoulder from the drainage tube days after surgery. It was not gas. I never had any shoulder or back issues previous to surgery. Any thoughts on this?

Warning, do NOT get the Baiatric Pal version. My only,disappointment. from Bariatric Pal Store. I think I got some of the sf cheesecake from Hello at my local Krogers and they may have some in stock at Wally World. Worth a look-see.

And my friend@ RnyBeyhive had her surgery with Dr Miller on September 17th, she was still active on Bariatric Pal in December2018, maybe if she sees this she will say HI.!

Here's a link to mine. Compared to others on here, my hospital seems to move at a snail's pace, but it worked out well for me. https://www.urmc.rochester.edu/highland/bariatric-surgery-center/life-after-surgery/bariatric-diets.aspx

For food ideas this is my bariatric dietician recipe website. http://insidekarenskitchen.com/bariatric-friendly-recipes/