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My surgery is Oct 2nd 2019

My surgery is Oct 2nd, 2019

Hi All, I am having my surgery in 2 days (10/1/19) and just need to see some motivation to help me stop being so nervous. Can everyone just provide their first 6 month weight loss stats. Lbs down per month - month 1, 2, 3, etc...so I can be reminded of all the good things I have to look forward too! I am so excited but so scared and this simple thing will help me tremendously. Thanks!

Day 29 100 squats done so far!! My thighs are burning but looks good!![emoji106]looking streamlined [emoji28] Will complete 100 later on. Write down something good: I was just writing in my journal that I am gaining confidence in my ability to live this lifestyle longterm and for me this is a BIG deal!!! B side: I always find time to read!! No matter how busy! It's my way of decompressing after a long day! Even if for 10 minutes. Off to completing my squats🥵 Sent from my SM-N960U using BariatricPal mobile app

Some of you know I was interested in the IF topic but since I'm only 8 weeks out, it is probably not time for me to try to introduce that. As I am a super slow loser and am very metabolically challenged..I tend to opt for a keto based way of eating. Keeping carbs under 20 grams, etc. Keeping fat isolated to much less than the average 'keto WOL' and staying with the healthier fats. I've been stalled at the same weight for 10 days and I have been exercising during this time. Haven't noticed any new change in the way things fit (looking for non-scale victories, etc.)..and before that it took 2 to 3 weeks to lose 2 lbs. Was aiming for 800 calories or less with protein as highest macro followed by fat and then by carbs. When discussing IF on another thread, I posted what my dr recommended and it is based on 800 calories a day with 40% protein, 30% carbs, and 30% fat. I'm so nervous about changing my diet around, increasing carbs, etc. but at this point, I'm so frustrated with my slow losing pace and my stall, that I figure that I might as well try it. I've lost 32 lbs in 8.5 weeks which probably sounds ok to other slow losers but what bothers me is that in basically the last 3 wks of my 8.5 wk journey, I've lost roughly...2 lbs with the past 10 days at a big fat 0. I was ok with just losing 2 lbs a week..but i feel like my weight loss not only started slowing even more in the past several weeks, but it is now trickling to a standstill and I'm only 8 weeks out. I figured I'd see something like this starting maybe in month 4...definitely not month 2. I've tried to stay positive but that it is becoming harder and harder to do so...

Hi, I suggest opening up to your family and tell them how they are making you feel. It's your life and you are the one who has to live it. You are old enough to make your own decisions. If they cannot be happy for you and only bring negativity into your life you then you should pull away and do what's best for YOU and your family. I'm sorry you are going through this. I truly hope they realize how negative they are being.at the end of the day, your life is your business. 5'4" Starting weight 297 VSG on 7/31/19 Surgery wt: 266 CW 233 GW 135 Sent from my [samsung Galaxy] using BariatricPal mobile app

Last yr I bought a shirt from Target. It was an XL in women's. All women know how much it can suck to buy womens clothing. 9 times out of 10 a XL in one brand can be a M in another. This is why I generally just buy men's t-shirts. Though I know I wear an XL in Old Navy's women's shirts. That being said, I bought this shirt and when I got home it was about 3 sizes too small. I sadly shoved it in a drawer and forgot about it. I'm almost a mth out from my revision. My GERD is completely gone and the weightloss is a huge bonus. I found the shirt today and put it on. And it fit!

💜💜💜💜💜💜💜💜💜💜💜💜💜💜💜💜💜💜💜💜💜 ⚡⚡OCTOBER MOTIVATIONAL CHALLENGE⚡⚡ 📝📝📝📝📝📝📝📝📝📝📝📝📝📝📝📝📝📝📝📝📝 🍁🍁🍁🍁 FALL IN LOVE WITH EXERCISE 🍁🍁🍁🍁 Join in and enjoy motivation to reach your personal goals. Participate often, post daily, enjoy the conversations, ask questions, upload random pics and quotes, exercise (*accessibility accommodations made with couch abs routine because everyone deserves representation❤) Start by: 1. Posting your personal goal 2. Add your surgery type, status (pre/post op, losing/maintenance) 3. Weight and BMI (not necessary but encouraged) 4. Choose between the sofa or anywhere Ab routine 5. Show us your favorite sweater 🕒🕒🕒OFFICIALLY begins October 1, 2019🕒🕒🕒 💜💜💜💜💜💜💜💜💜💜💜💜💜💜💜💜💜💜💜💜💜 👏👏👏👏👏👏👏👏👏👏👏👏👏👏👏👏👏👏👏👏👏

Congrats on being 3 weeks PO! You’ve officially gotten through the worst of it. One thing I did today was 3 hours worth tough gardening. It’s in the 90’s still here and I was able to get through all of the bending, squatting, lifting, raking, and clean up without wanting to die. This week I hit 100 pounds lost (from pre-surgery weight) and it feels AMAZING now to move in my own body. Still have 10-15 pounds to go and I can’t imagine how much better yet that will feel

Yes! I don’t know what got me sick last weekend but I had okay nausea Sunday and Monday horrible. I had introduced canned chicken breast in water that weekend. I find I have to boil the chicken myself (a friend made me soup with chicken and veggies and I felt fine- reasoning on how I know). Because the nausea didn’t stop till Monday night I had to call my surgeons office and the prescribed me Zofran. I totally get where your coming from! I got sleeved 10 days after you

I am 3 weeks and 4 days post op. Just the last couple days I have started walking laps around our little lake. Each lap is close to a mile. First lap is starting to get easy. 2nd lap is a bit more work. If I walk beyond the two laps I am wiped out. I have also been cleaning around the house. I have to take frequent breaks. As for going back to the gym? Nowhere near ready. Plus my doc doesn't want me lifting anything over 10 pounds for a full 8 weeks. I mostly am following that rule, but with housework... sometimes stretching or raising my arms high (like to put something on a high shelf) cause pain at the main incision site still. I would love to do Pilates, but there is way too much I wouldn't be able to do yet. I AM considering trying water aerobics (at my own pace). I am off work for around 5 more weeks, and have never been able to go before. Not sure if I will be able for participate fully with that or not.

I hope your memory serves you correct and they don't hurt that much not that I have much of a choice. I have to do those for 10 days regardless. Thank you for your response 😊

OK ladies, some questions - may or may not be weight loss surgery related, but I figured there was a good group of ladies here who might have insight. I already have my yearly exam scheduled for later this month, but thought I'd see if anyone has any insight. And crowdsource questions I should ask my doc when I see her. Background: I'm 11 months out from surgery today. I'm in my early 40s. I hadn't had my period in months before surgery (and for about 2 years, it was very inconsistent - sometimes 2 weeks apart, sometimes 3 months). After surgery, I got my period back with a vengeance, but it was still inconsistent, anywhere from 2 weeks to 6 weeks apart. VERY heavy. I've had night sweats for years. Had my vitamins checked a month ago and everything looked fine (except cholesterol - which is weirdly higher than before surgery). Had my thyroid checked around April, and it was fine (I do have a history of hypothyroid). Current issue: About a month ago, I started getting what I think are hot flashes. But, really, I just am having a really hard time regulating my temperature. Sometimes I'm freezing cold, then I'll get astonishingly hot. Happens at least 5-10 times a day, and several times at night. Every day. Not at all connected to when/what I've eaten (and I got the sleeve, so the likelihood of it being dumping is fairly remote). Haven't had my period in 2 months, but, again, that's not super abnormal for me. But, last month when i was scheduled for my period, I did get my characteristic worsening of acne, just no actual period. From what I read, you can get hot flashes in perimenopause in your early 40s - but the literature says that they should be infrequent and typically right before your period when your hormones dip. That just isn't my experience - it is multiple times a day, every day. And I feel like I also get colder than most people. So, anyone have any advice on how to deal - or thoughts about what I need to discuss with my doc? Really appreciate it. Thanks!

Start by walking. It's the best way to get your endurance up. I was not allowed to lift more than 10 lbs for 8 weeks, but I was walking 10,000 steps a day by end of week one. That is very empowering. Hang in there.

UGH! I received another call from Sage Bariatric on 9/26/19. My pre-authorization has been approved, but still waiting on the approval for the predetermination. So I google BCBS pre-authorization and predetermination, because I was really confused. Pre-authorization or pre-notification, pre-certification confirms that a physicians’ plan of treatment meets medical necessity criteria under the applicable health benefit plan. A predetermination is a voluntary, written request by a provider to determine if a proposed treatment or service is covered under a patient’s health benefit plan. Predetermination approvals and denials are usually based on our medical policies. It has been two week and this waiting is really kicking my butt. But on the upside. I have gotten some much needed cleaning done trying to stay busy when i get off of work. I am so thankful i found this sight, I just really needed to think-out-loud.

So when I went to my doctor the other day I was informed that when I am discharged from the hospital I will be sent home with 3 medications. One for pain, one for nausea and preloaded injections that I will have to give myself in my stomach to prevent blood clots for 10 days following surgery. Has anyone else had these injections?????? I'm freaking out since hearing that. I hate needles. Mind you I have several tattoos. Lol. Medical needles are just different especially if I have to give them to MYSELF.....😭😩🤯😱🤪

Hi everyone i had sleeve on 21 Sep 19 & was just wondering how much weight everyone is loosing early days 😊

Reading this has honestly lifted such a weight off of my shoulders because THIS WAS ME forever. I eat right avoid carbs, exercise , rarely go over 1000 cals a day _ pre op_ and I would never lose weight. Maybe the first week on a new diet Id drop 10 lbs and then NADA. At one point I worked out three hours a day and ate 900 cals a day and even after weeks I still would not lose weight and Drs and folks assume Im just pigging out on three pizzas and a gallon a soda a night. All I ever drank was water or coffee. I even went down to OMAD and I think because it affected my insulin levels it allowed me to lose 18lbs but then again- Stall no matter what I did. I have hypothyroidism, PCOS and endometriosis which means I also have too much estrogen and i always had this sense that that is why I never lost weight when i barely eat. I can relate to this thread so much and it is giving me hope that this surgery is going to work for me because going through all of this for it not to is beyond anything I can bear... I wish Drs would research more how hormones and PCOS and weight gain and inability to lose weight are all interrelated. Here is wishing us all luck that this works for us.

October 1 here. Getting scared...liquid diet is getting old.........Surgeon chastised me for only losing 19 lbs since April...what??! He said someone of your size should have lost more and is accusing me of cheating. grr.. I'm part of a whole fancy program at a local hospital and they are strict......I'm afraid of blood clots now....., and just 2nd guessing everything. Found out I will have 6 incisions....as opposed to 5..not sure why that's bugging me but it is lol. I think I'm just a nervous nelly....not packing much...iphone and chargers, and my flip flops. figure i'll wear their gowns.... my cough has now subsided and barely there but dr did say he would cancel the surgery if I had a cough....i even went to a fancy vitamin lounge yesterday and paid for a high dose of vitamin C. Sorry..just all over the place. I go from being excited and elated to doom and gloom.

I go in for the, gastro sleeve on Oct 14 2019 I am on my , liver shrinking diet Sent from my LGL164VL using BariatricPal mobile app

I'm happy to have this over 50 group. I'm 61 years old, scheduled for sleeve 11/7/19 surgery, going alone, no one knows except my daughter who just had sleeve surgery and having a very difficult time. I'm getting cold feet, feeling alone and did I mention I have HIV and can't find anyone else with HIV willing to share their experiences. Help! Sent from my LG-H872 using BariatricPal mobile app

Surgery date July 15,2019 Beginning weight 315 Current weight 267 I feel wonderful the best decision I could have ever made Sent from my SM-G950U using BariatricPal mobile app

I also had surgery on 9/3/19. I had rou-en-y. Sent from my moto e5 plus using BariatricPal mobile app

Obesity Surgery Springer Preventing Wernicke Encephalopathy After Bariatric Surgery Erik Oudman, Jan W. Wijnia, [...], and Albert Postma Additional article information Abstract Half a million bariatric procedures are performed annually worldwide. Our aim was to review the signs and symptoms of Wernicke’s encephalopathy (WE) after bariatric surgery. We included 118 WE cases. Descriptions involved gastric bypass (52%), but also newer procedures like the gastric sleeve. Bariatric WE patients were younger (median = 33 years) than those in a recent meta-analysis of medical procedures (mean = 39.5 years), and often presented with vomiting (87.3%), ataxia (84.7%), altered mental status (76.3%), and eye movement disorder (73.7%). Younger age seemed to protect against mental alterations and higher BMI against eye movement disorders. The WE treatment was often insufficient, specifically ignoring low parenteral thiamine levels (77.2%). In case of suspicion, thiamine levels should be tested and treated adequately with parenteral thiamine supplementation. Keywords: Clinical nutrition, Dietary, Bariatric, Gastric, Obesity, Wernicke’s encephalopathy, Thiamine Introduction The prevalence of morbid obesity has risen to global epidemic proportions and bariatric surgery has been shown to be the most effective treatment to achieve substantial and long-lasting weight loss for morbid obesity [1–3]. In the past decades, the number of bariatric procedures performed has increased exponentially. Currently, laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy are the most commonly performed bariatric procedures with more than 500,000 interventions worldwide per year [4–6]. Wernicke’s encephalopathy (WE) is an acute neuropsychiatric syndrome resulting from malnutrition and a possible adverse complication from bariatric operations. WE is characterized by the classic triad of ataxia, eye movement disorders, and mental status change. The prevalence rate of WE is 0.6–2% of the population, but the condition is often only discovered at autopsy [7]. Current guidelines for bariatric surgery suggest preventive thiamine suppletion (12 mg) in multivitamin treatment for all patients undergoing surgery, but higher doses for patients with suspicion for deficiency [8]. The aim of this paper is to review the clinical characteristics of WE after bariatric surgery, also referred to as “bariatric beriberi” [9] and to raise the clinician’s index of suspicion about this neuropsychiatric diagnosis and its preventability. Methods We searched MEDLINE, EMBASE, and Google Scholar, using MeSH terms (WE, Korsakoff syndrome, beriberi, restrictive weight loss surgery, gastrectomy). There were no language restrictions. Studies published from 1985 to 2017 on bariatric surgery with a diagnosis of WE were included. We reviewed the title and abstract of these articles, and indexed the data for year of publication, age, sex, BMI, onset duration and progression of symptoms, radiographic findings, treatment, and follow-up. All included studies were either case reports or case series, since information on the course of illness and symptomatology was often lacking in all group studies. The maximum number of represented case descriptions in one study was five [10]. One study reviewed four cases [11], three studies reviewed three cases [12–14], and eight cases reviewed two cases [15–23]. Cases were excluded if too little information was available to confirm a diagnosis of WE or no clinical characteristics regarding the patient or course of illness were available. Since the collected data is not a random sample of cases, and not likely to be normally distributed, nonparametric statistical procedures were applied (Mann-Whitney U test for comparison of two independent means, chi-square test for multiple means). The recorded data are either number of patients (percentage) or median (range) as appropriate. Results General Overview We identified 118 case descriptions in the published literature [9–101]. The most common bariatric procedure was Roux-en-Y gastric bypass [9–13, 15–18, 24–63], followed by sleeve gastrectomy [19, 64–85] (see Fig. 1 for an overview on the characteristics of the identified bariatric cases that subsequently developed WE). [https://www] Fig. 1 Bariatric procedure case descriptions (n = 118) leading to Wernicke’s encephalopathy (left), gender and age distribution of case descriptions on Wernicke’s encephalopathy after bariatric surgery (right, n = 113) ... Importantly, new cases of WE have continuously been published since the early beginning of weight loss surgery, and the total number of reported bariatric WE cases is growing per 2-year period (Fig. 2), suggesting that it is still relevant to review this differential diagnosis. Also, the total number of bariatric interventions (NHDS and NSAS databases (1993–2006) [102] and ASMBS database (2011–2016) [103]) has been rising each year [5], resulting in a relative decrease of WE cases per intervention (Fig. ​(Fig.22). [https://www] Fig. 2 Reported bariatric WE cases by 2-year period (left) and relative reported WE cases by 2-year period compared to general reference information from NHDS and NSAS databases (1993–2006) [23] and ASMBS (2011–2016) [102]. The red dotted line ... Descriptions of sleeve gastrectomy [19, 64–85] had a more recent publishing date (median 2014) than papers on Roux-en-Y gastric bypass [9–13, 15–18, 24–63] (median 2006) (U (85) = 301.5, p  [https://www] Fig. 3 Months after bariatric procedure, Wernicke’s encephalopathy was diagnosed per surgical procedure (n = 115) Vomiting We further analyzed the symptomatology in all case descriptions. Vomiting was the most frequently described presenting symptom (103 cases, 87.3%) and could be seen as the most relevant precursor of WE. From the literature, it is known that vomiting can also be a major complication in bariatric surgery and is one of the most frequent causes of postoperative readmissions [104]. Severe vomiting is not a normal situation after bariatric surgery and therefore further investigation in cases with frequent vomiting is indicated. In the present sample, non-vomiting cases were distributed throughout all onsets post-surgery, but only 5 out of 15 case descriptions were after the first year, suggesting that other causes than vomiting are likely to cause WE later post-surgery. Alcohol abuse (2 cases), a malabsorptive bariatric procedure (2 cases), and a new operation for hernia (1 case) could explain the late onset in non-vomiting WE presentations, suggesting other factors that negatively affected vitamin B1 storage. Importantly, severe infections, such as postoperative intra-abdominal abscesses leading to thiamine deficiency [78], are also a common presenting feature of WE and are likely to relate to an adverse outcome of WE [105]. Wernicke Encephalopathy: Presenting Characteristics The most profound characteristic of WE in the reviewed case descriptions was ataxia (84.7%, 100 cases), presenting itself as gait abnormalities up to the full inability to walk or move. The second characteristic was an altered mental status (76.3%, 90 cases), presenting itself as delirium, confusion, and problems in alertness or cognition. The third characteristic was eye movement disorders (73.7%, 87 cases), such as nystagmus and ophthalmoplegia, resulting from extraocular muscle weakness. The full triad was present in 54.2% (64 cases), a percentage much higher than the originally reported 16% of patients that present themselves with the full triad in literature in post-mortem case descriptions of WE in alcoholics [105]. Post hoc analysis in the reviewed sample shows that patients presenting themselves with mental status change were older (median 36 years) than patients without mental status change (median 25.5 years) (U (66) = 262, p Moreover, patients with eye movement disorders had a lower BMI (median 45.6 kg/m2) than patients without eye movement disorders (median 52.1 kg/m2), suggesting that a higher BMI can protect against this symptom of WE in bariatric cases. Male patients that did not present themselves with eye movement disorders had a later onset of symptoms (median 24.0) than male patients that did have eye movement disorders (median 3.5) (U (33) = 49, p  Imaging CT scans of the brain did not reveal any significant radiological finding in all cases undergoing this procedure (13 cases), suggesting that CT imaging is not the most suitable imaging technique to detect WE. In 65.6% of the case descriptions where an MRI was performed (40 cases) the procedure revealed radiological alterations. This percentage is somewhat higher than the reported sensitivity of 53% in an earlier study on WE [106]. Of interest, positive MRI results were more frequently associated with mental status change (χ2 (1) = 3.9, p  Treatment: Too Little Too Late According to the European Federation of Neurological Societies and the Royal College of Physicians, 500 mg of parenteral thiamine should be given three times daily until symptoms of acute WE resolute. The treatment is lifesaving and has the potential to reverse this acute neuropsychiatric syndrome [107]. A total of 57 (47.5%) case descriptions were reported in detail on the treatment of WE symptoms. Suboptimal treatment, with relatively low doses of parenteral thiamine (Importantly, a progressive clinical course was visible in 31.6% of the patients (37 cases), resulting in post-acute deterioration of neuropsychiatric and neurological symptoms. This suggests that the diagnosis was easily missed, resulting in a lower likelihood of full recovery. Moreover, the detrimental effect of not treating WE promptly is visible in Fig. 4 showing that many of the patients who developed more than one acute symptom later progressed into chronic Korsakoff’s syndrome. This neuropsychiatric disorder is characterized by severe amnesia, executive problems, and confabulations, leading to lifelong impairment [108]. Patients that developed Korsakoff’s syndrome had significantly more acute symptoms (median 3 symptoms) than patients that did not develop Korsakoff’s syndrome (median 2 symptoms) (U (99) = 703.5, p  [https://www] Fig. 4 Long-term cognitive outcome related to number of acute symptoms (left), MRI outcome (middle, n = 55), and too low levels of thiamine treatment (right, n = 52) Although this finding was not significant, in the group that presented themselves with acute MRI abnormalities, more cases later developed Korsakoff’s syndrome (Fig. ​(Fig.4).4). Also, too low dose of a dose of thiamine suppletion therapy resulted in more cases of KS despite the lack of significance. Non-compliance Of interest, in 10.3% of the case descriptions (12 cases), non-compliance to the medication and follow-up medical regimen was reported. A lack of insight into a given situation is a relatively common sign of the acute and chronic phase of WE [105]. The patients did not follow their follow-up, did not take prescribed drugs, or discharged themselves from the hospital against advice, leading to adverse outcomes. Because of the severity of the syndrome, this aspect requires specific attention in the treatment of WE patients, and at risk bariatric patients. Discussion Persistent vomiting is a common symptom suggesting a complication after bariatric surgery [109]. Nausea, vomiting, and a loss of appetite are also common, non-specific symptoms of thiamine deficiency [8]. Ultimately, vomiting and a loss of appetite are also a preventable cause of thiamine deficiency [110], leading to Wernicke’s encephalopathy (WE) in the majority of bariatric case reports. Adequate, timely, prophylactic, and substantial thiamine treatment in all patients undergoing bariatric surgery is required to prevent the development of WE, which is a rare but severe complication. The present review highlights that current treatment was neither prophylactic, adequate, timely, nor substantial in the majority of cases, leading to worsening of WE symptoms, the development of additional WE symptoms, and ultimately chronic Korsakoff’s syndrome. One of the most remarkable findings in the present review is that the initial symptoms of WE are often not recognized as such, leading to a prolonged state of emergent WE. In 31.6% of the cases, the initial symptoms progressed into more severe symptoms, ultimately leading to chronic Korsakoff’s syndrome. Prompt treatment of the first symptoms suggestive of WE with high doses of parenteral thiamine replacement therapy is necessary to prevent further damage [110]. According to the European Federation of Neurological Societies and the Royal College of Physicians, 500 mg of parenteral thiamine should be given three times daily until symptoms of acute WE resolve [107]. Interestingly, guidelines for treating WE suggest that patients suspected of WE should already be treated as such [107, 111]. Additionally, prophylaxis of WE following early signs and symptoms is only achieved by use of parenteral vitamin supplements, since oral supplements are not absorbed in significant amounts [111]. Moreover, in bariatric surgery, it is always relevant to give prophylactic vitamin therapy, according to international guidelines, to prevent patients from WE. Of interest, newer methods for bariatric surgery such as sleeve gastrectomy and intragastric ballooning still can lead to WE, despite their relative benefits for the patient. Recently, Armstrong–Javors (2016) pointed out that new techniques lead to the primary risk factor of WE, namely vomiting, despite a theoretical advantage by reducing the stomach volume without bypassing the duodenum [112]. Suspicion for WE should therefore be equally high in more traditional surgical procedures and newer procedures. Also, the risk of developing WE due to vitamin B1 deficiency is not restricted to the first half year after surgery but appears to be lifelong, given other factors such as new infections, insufficient meals, or alcohol consumption [110, 113, 114]. Preventive education on the necessity of sufficient vitamin intake should be given before bariatric surgery is performed and is relevant in long-term follow-up. Bariatric patients in their teens or twenties are likely to be more protected for mental status change in the course of WE than patients in their thirties or older, as reflected in a younger age of non-mental status change patients. This finding is in line with earlier reports showing that age is the strongest predictor for postoperative delirium [115, 116]. Importantly, pediatric patients and young adults undergoing bariatric surgery therefore require more attention for sensorimotor problems, such as ataxia and eye movement disorders, besides prophylactic parenteral thiamine treatment. In this specific group, more attention to lifestyle training should be an essential element of treatment, since non-compliance is relatively higher [50]. Relatively more cognitive reserve in combination with non-compliance can leave symptoms of WE unnoticed for a longer period. Although eye movement disorders such as nystagmus and ophthalmoplegia were much more common in bariatric cases than those in the general WE population [113], a higher preoperational BMI was predictive for fewer eye movement disorders. Additionally, male subjects with longer post-bariatric onsets often had no eye movement disorders as a presenting characteristic of WE. It is likely that eye movement disorders represent the most severe form of thiamine deficiency, since it is also the least common phenomenon of the WE triad. Moreover, females are at greater risk for full thiamine depletion than males [8]. A possible mechanism of action explaining the protective effect of higher weight is a greater storing reserve of thiamine in severely obese patients in comparison with less severely obese patients. This mechanism of action has been referred to as “preferential intracellular thiamine recycling” [116], leading to relatively less thiamine depletion in patients with higher body weight. Often, cases with WE following anorexia nervosa present themselves first with eye movement disorders [117], suggesting that this symptom is likely to be the result of full thiamine depletion. This suggests that both patients with lower body weight, and female patients are at greater risk for developing WE, and should guide clinicians in preventive thiamine therapy [1–4, 118]. Radiologic imaging can be employed to support the diagnosis of WE, but is not always sensitive to WE symptomatology. Often, hyperintensities were visible in the thalamic region, the mammillary bodies, and the region around the third and fourth ventricle, in line with previous research on WE [7]. Our results show that MRI alterations are frequently associated with mental status change, but not the motoric aspects of WE. This finding is relevant, because it suggests that specifically in bariatric patients with motoric problems, such as ataxia or eye movement disorders, WE should be treated despite the outcome of an MRI. Non-compliance is common in WE patients following bariatric surgery (10.3%) and could be viewed as a more discrete symptom of the disorder. Patients with WE lack insight into their situation, due to the severity of the neurological problems [108, 110]. Education on the direct adverse consequences of malnourishment should be incorporated into the provision of information before surgery. After surgery, more automated checks on vomiting are relevant. A limitation of the present review is that we only reviewed case descriptions. Therefore, predictive information regarding prevalence rates and incidence rates is limited. Despite this limitation, the level of detail in the reviewed case studies leads to new insights into WE following bariatric surgery. Recently published studies on treatment perspectives of WE in general and psychiatric hospitals are alarming: European as well as American studies demonstrated that most patients did not receive thiamine at all or only received it orally in low doses [119, 120]. Both types of treatment lead to unnecessary cases of chronic Korsakoff’s syndrome characterized by severe amnesia, executive problems, and confabulations, leading to lifelong impairment [108]. It is therefore important to highlight the clinical signs of symptoms in this specific condition. In conclusion, there is a growing number of bariatric patients worldwide. Malnourishment-related WE is a rare but severe and preventable consequence of bariatric surgery that warrants attention given its rapid onset and detrimental course. All bariatric procedures can lead to deficiencies and therefore to WE. WE can be fully prevented by supplying prophylactic thiamine given either parenterally in vomiting patients or orally in non-vomiting patients. Mental confusion, eye movement disorders, and ataxia are often missed as crucial symptoms of WE. After the initial onset of symptoms, rapid treatment with high doses of thiamine is still a life-saving measure, directly ameliorating the core symptoms of WE. The large distribution of WE onsets suggests that bariatric patients remain more vulnerable to vitamin B1 deficiency for life, and therefore require lifelong routine follow-up on their B1 status. Acknowledgements We thank Topcare for supporting excellence of long-term care. We also thank Misha Oey for her advice, and textual suggestions. Compliance with Ethical Standards This review was conducted in compliance with the ethical standards. Conflict of Interest The authors declare that they have no conflict of interest. Ethical Approval Statement This article does not contain any studies with human participants or animals performed by the authors. Informed Consent Statement Informed Consent statement does not apply. Article information Obes Surg. 2018; 28(7): 2060–2068. Published online 2018 Apr 24. doi: 10.1007/s11695-018-3262-4 PMCID: PMC6018594 PMID: 29693218 Erik Oudman,[https://www]1,2 Jan W. Wijnia,1,2 Mirjam van Dam,1,2 Laser Ulas Biter,3 and Albert Postma1,2 1Experimental Psychology, Helmholtz Institute, Utrecht University, Heidelberglaan 1, 3584 CS Utrecht, The Netherlands 2Korsakoff Center Slingedael, Lelie Care Group, Rotterdam, The Netherlands 3Department of Bariatric Surgery, Franciscus Gasthuis, Rotterdam, The Netherlands Erik Oudman, Email: ln.uu@namduo.a.f. [https://www]Corresponding author. Copyright [emoji767] The Author(s) 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. References 1. Sjostrom L, Narbro K, Sjostrom CD, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357(8):741–752. [PubMed] [Google Scholar] 2. Colquitt JL, Picot J, Loveman E, Clegg AJ. Surgery for obesity. Cochrane Database Syst Rev 2009 (2):CD003641. [PubMed] 3. Buchwald H, Estok R, Fahrbach K, Banel D, Jensen MD, Pories WJ, Bantle JP, Sledge I. Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med. 2009;122(3):248–256.e5. [PubMed] [Google Scholar] 4. 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Hey all, I had gastric sleeve surgery on 9/24 as well. My doctor said 7 to 10 days on full liquid. I'll see him on Monday and will let you all know if he says I can switch. After training myself on the liquids I'm looking forward to the pureed food. I think I'm going to start with baby food. Are you keeping your liquids down comfortably? Sent from my SM-N950U using BariatricPal mobile app