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I think the amount you consume depends on how far out you are from surgery. I personally feel you must remove the triggers to get some kind of control. If you are truly hungry feed your body some type of protein- I have tried drinking skim milk and waiting to see if that helps. 3 meals is what my NUT told me to aim for- since grazing will lead to weight gain. As you can tell that hasn't been what I've done lately! On a good day a Protein shake made with milk for breakfast- lunch about 2oz chicken breast chopped up in lettuce tomato carrots, with regular salad dressing- dinner 3oz pork chop with green Beans and about 1/4c of mashed pot. If hungry in between some Greek yogurt! I think I feel hungry when I am truly just thirsty... I have read that if you have all of your protein in for the day and you still feel hungry, drinking something will help. Be prepared have high protein food in your house. So when you go for something it will satisfy you longer. The sugar craving are getting better for me with each day I avoid them!

16 December 2010 Suddenly, I'm one week away from undergoing a vertical sleeve gastrectomy. It is almost too much to digest that this truly is the beginning of the end of my 15-year battle of the bulge? The long-and-short of my story is that I was a chubby kid, athletic high-schooler, super-athletic collegiate (squash team) and, league player in my twenties and early thirties. A back injury (herniated disc) whilst training for a tournament spelt the end of competitive squash and any form of athletic activity. A job for a bachelor that involves numerous lunch meetings and after-hours cocktail functions is a recipe for disastrously rapid weight-gain. The trouble with athletes who suddenly quit working out is that they retain their appetites and eat with the same care-free abandon as they did when they were burning it up in the gym. Thus began my long addiction to food. A 10-year marriage-to-date to a wonderful wife and excellent cook fuelled the addiction. Despite sporadic forays into the gym and some tennis, I went from 85 kg (187 lbs) in my playing heyday to my current 160 kg (351 lbs). I've gained the equivalent in weight of another entire adult human being. Interspersed in this 15-year saga were numerous efforts to lose the weight, the likes of which are all too familiar: cabbage Soup, Exchange, Atkins, X-Diet, etc. There was one time that I managed to stick to a so-called 'detox' eating programme that caused me to lose weight possibly at the same rate as many bariatric post-ops. I actually fought through the back pain and starting playing squash again. It was tremendously gratifying to fit into my college clothing once more. The diet itself, though, was tantamount to starvation and led to my becoming incredibly sad. Although not diagnosed as such, I came about as close as I can imagine to being chemically depressed. It makes sense, I suppose, that if you deprive yourself of fat and not take supplements, plus cut out salt and sugar without electrolyte replacement, you're not going to absorb fat-soluble Vitamins which has to affect one's sense of well-being. Short-lived was my renewed thinness because at the end of the two-month crash diet, my resolve came crashing down too. So pleased was I with reaching my goal that I celebrated with a hearty double cheeseburger from the world's greatest supplier of lard disguised as food and have been supersizing ever since. Five years ago when my doctor noticed the increase in my blood sugar levels and expressed alarm at my increasing size, I took notice but was sure I had the strength of mind to return to my athletic ways. I didn't count on the severity of my backache nor the added damage that must have been caused to my back lugging all this weight around over the years. When he asked his assistant to find out who did bariatric surgery in Canada, I really froze in my tracks. A failed business contract, the commencement of accounting studies towards a different career and a home relocation found me in the offices of a new personal care provider. I discussed my weight with my new doctor and told him what the previous one had suggested. This time, I assured him, I wanted it too. That was two years ago. The wheels of the Canadian public healthcare system grind slowly. It took about a year to first see one of only three bariatric surgeons serving our entire province. At the time, the wait-list to have surgery here for free was around 3 years. I had two visits with the surgeon spaced six months apart. In that time, the only hospital where bariatric surgery is performed in our province announced a 60% cut in the budget for the procedure. This further clogged the bottleneck and increased the wait-time for surgery to 5 years. I couldn't afford to self-pay abroad so explored a not-so-well-published option of out-of-country-funding by our provincial health insurance for elective surgery. When I was approved, it felt like I had won the lottery (indeed I may have in terms of longevity). In fact, the first time I knew the outcome of my application was when I checked my voice-mail one evening early in November. There was a cheerful message from Virginia Mason Medical Center in Seattle regarding a referral. There was no mistaking then that funding had been approved. Until a few weeks ago, I was working nights as a security guard whilst studying accounting through night classes. I kept playing phone tag with the administrator of the bariatric office until we eventually connected and set the ball in motion. Since her first voice-mail on Nov 5, I have been scheduled for surgery on Dec 23 and am seeing my new, American surgeon for the first time this coming Monday. The pace of things South of the 49th parallel is at lightning speed by comparison. I had two final exams to distract me these past weeks but can now fully concentrate on preparing for surgery. I'm an irreligious, sceptical 46-year-old so there's some irony in getting a gift of sorts (we actually pay a sizable premium for health insurance so it's a right rather than privilege) when the rest of the Western world is exchanging trinkets and electronic gadgets in State-mandated spending sprees. I'm deliberately trivializing the arbitrary commercialization of the Winter solstice against what in my case will amount to better health and possibly, longer life. ------------------------------------------------------------------------------ 19 December 2010 With not a little trepidation, I pointed the car South and put pedal to the metal. It must have been the fatigue after a late night at Mark and Stacey's party rather than a hangover--I was careful not to overdo the Jägermeister and spiked punch--that made me want to get this journey over with. Testing a new pair of progressive lens glasses from behind the wheel for the first time, I made a beeline to Dave's house in Tacoma where I would be spending the night. Everything seemed a little clearer on the drive down. I have known Dave since I first started playing squash at the YMCA in the centre of Tacoma, WA. In 1990, I was wrapping up the penultimate year of my economics degree and Dave was a high-risk options broker. A substitute for one of two older brothers that I never had, Dave was a mentor and friend. In fact, it was on a trip that Dave sponsored to a squash tournament in Vancouver that sparked my love for the city that my wife and I now make our home. Cut back to a year earlier when I met fellow ex-South African, Claude where we played squash at the same club in Los Angeles. Claude had had his full of LA and when he heard that I was heading to the Pacific Northwest to complete my studies, he and his wife, Lynelle contemplated selling up and following suite. After a few visits to me in Tacoma, both were sold on the idea and moved. From being an only son with two sisters, I was privileged to now have two brothers in the same town. Needless to say, over the years, both these guys have watched anxiously as my weight practically doubled after my return to South Africa and subsequent emigration to Canada. They were always classy enough not to chide me but often asked how my squash was, as if to prod and propel me back onto the courts. Dave's wife, Rasha had prepared a magnificent prawn dinner with Pasta which we washed down with red wine followed by sliced kiwi fruit and pumpkin pie. Over several rounds of backgammon, we dissected and analysed the American economy. It was indeed a last supper of sorts. Having solved the problems of the world, we all turned in for the night. The next morning would be quite eventful for me. Dave had pancakes on the stove and heaps of bacon sizzling in a pan. The last Breakfast, he said. With a mouthful of pork, I told him this felt like taking a drink before meeting one's parole officer. When Dr. Jeffrey Hunter walked into the room with a beaming smile and firm handshake, I knew immediately that my surgery next Thursday would be in safe hands. During the 20-minute drive from Dave's house to the hospital, I didn't once doubt my decision to pursue the surgical path to wellness. This surgeon and his staff reinforced it. Everything at my first visit to the man who will next week be removing the greater curvature of my stomach, representing 85% of it's current size, went swimmingly. My visit included a lengthy stint with the nutritionist who walked me through the diet plan that will be the mantra that I chant over the next several weeks. With my sights set firmly on Protein shakes and lean cuts of meat with heaps of spinach leaves, I made tracks to Claude's in the hamlet of Woodinville a few kilometers Northeast of Seattle. Claude owns a house with a veritable park for a backyard complete with flowing stream all nestled amongst giant douglas firs. I love going there. With the clock ticking to get back to Canada to fetch Shamin at work, Claude and I barely had time to do a deep analysis of what Obama and the Democrats are doing to fix the problems of America before we spirited ourselves off to a Mexican restaurant. The last lunch, Claude called it. Faced with a two-hour drive, I declined any liquid nourishment and stuck to a black bean soup plus a quarter of Claude's chicken enchilada. Not only had my brothers treated me to some pretty amazing meals, but Shamin had ideas of her own when I fetched her. We made tracks to our favourite sushi spot in our hometown of White Rock and indulged as only convicts facing the gallows can, with the maki 18-piece combo, miso soup, agadashi tofu and mugs of green tea. Shamin said that this was our last supper. Since Saturday, I have had three last suppers, one last breakfast and one last lunch. And thanks to Mark and Stacey, one last party. -------------------------------------------------------------- 6 January 2011 It's 11h30 and two weeks to the hour that I was being wheeled into surgery. What Shamin expected to be a 45-minute routine procedure like a visit to the dentist, an impression I had created, turned out to be a 2-hr major operation that resulted in yanking out 80% of my stomach. Mostly the upper curvature, the stretchy part of the stomach, was removed leaving me with a pouch about 4-6 oz in volume, the size of a small banana or 2/3 of a cup. This new pouch does not stretch. I chose this particular version of bariatric surgery to avoid some of the malabsorptive issues related to Roux n Y (a.k.a. RnY or gastric bypass), the current gold standard of WLS, and to be able to take anti-inflammatories as and when I become lighter on my feet and engage in more sport. The sleeve gastrectomy went quite well and there were no complications. My first night post-surgery though, was rough. I was in a lot of pain from the surgery and kept burping which caused quite a bit of discomfort. The staff at Virginia Mason Medical Center in Seattle is absolutely top-drawer and took excellent care of me. The next day, the barium drink during the x-ray in order to check for leaks and make sure that Fluid was passing through the stomach via. the pyloric valve into the small intestine, ranks amongst the most vile stuff I've ever drunk. It was all I could do to keep from throwing up. Isn't it remarkable how attuned you become to everyone's expressions when you're a patient? Why is the nurse frowning at my chart and how come the doctor is gesturing so animatedly? When the surgeon and the radiation team relaxed as the barium made it's way successfully through my tract, I also breathed a sigh of relief. Later, one of the nurses explained to me that they medicate the stomach to near-lifelessness in order to operate on it, then it becomes of paramount importance to revive it as soon as possible the next day. So they're constantly listening through the stethoscope for signs of activity. You'll never see from polite company or one's wife quite the kind of elation when you tell them that you've farted than erupts from the nursing staff when you inform them after bariatric surgery that you've passed gas. In fact, after your first bowel movement if indeed you have one, they're ready to hand you a trophy and send you home. Two days after surgery on the 2010th birthday of our lord Jesus, I was desperate for a shower. After I accidentally yanked out my glucose supply line, they deemed me fit to be discharged. Shamin helped me get my things back to the hotel room. No sooner did we set them down than we were in the car heading to Kirkland for lunch. Shamin drove. On the menu was medium rare sirloin, baked potato, crumbed shrimp and salad, with cheescake and chocolate for dessert. I pigged out on soup broth and sugar-free jelly. Wine flowed liberally so two days after surgery, high on oxycodon, it fell to me to drive back to the hotel. In fact, the next day, I took the wheel to blaze a trail out of Seattle and made it half-way back to Canada before succumbing to fatigue. Things went a little pear-shaped the next morning, my first back in Canada. I chewed on my gummy bear Multivitamin, followed by some flavoured Water with a crushed metformin. Later, a bit of cream of wheat fortified with whey protein isolate seemed to be competing for limited space. In the middle of a Skype chat with my sister in South Africa, the cream of wheat wanted out and I hurled for the first time. How on earth am I going to get in 70 - 100 g of protein with this little stomach volume? The summary of my food intake is protein and more protein, very, very little carbohydrates and almost no fats and sugars. I'm also on a cocktail of Multivitamins, Iron, B12 and Calcium supplements to compensate for the limitations of the new diet. Modern multivitamins and supplements are chewable and tasty so, incorporated as Snacks, you don't even feel like being medicated. Combating dehydration is now a way of life. I have to walk around with a bottle of water and sip constantly between meals. As it is early days yet and I'm only now graduating to pureed foods, I have to space out my spoonfuls in order to avoid an extreme sensation of fullness and subsequent pain. Recently, I was able to finish a whole cup of veggie soup over two hours whilst watching a movie. It now takes about 4-or-5 teaspoons of food to achieve a feeling of fullnes whereupon I start to belch. Any more hurts like hell. One more bite is like trying to stuff one more marble into an already full jar. There’s no give whatsoever. The greater curvature of the stomach is where your stretchy material resides. Mine has been removed and sealed shut with three lines of staples. My very compact stomach pouch has a valve on both it's entrance from the oesophagus and exit into the small intestine, respectively. Therefore, it is a closed container under pressure, implying no more fizzy drinks that could release carbon dioxide and cause immense discomfort. Adios beer, hello wine, vodka and whiskey on the rocks. I’m currently paying lip service to six meals a day; I can barely manage one, and two Protein Shakes. Yesterday morning, I bravely scrambled a single egg with a tiny amount of spinach and a sliver of cheese. I got through half of it, then ate the rest several hours later. Interspersed between meals, I’m supposed to sip about 2 litres of water. What a bloody joke! I’m averaging about a litre. The only things I’m making sure I consume are the multivitamins, iron supplement and chewable calcium sweets. They’re like dessert. Oh, I do get to enjoy as much sugar-free jelly that I can handle and I never seem to tire of it. Within a few weeks, there will be little external sign that I had any surgery. As the whole affair was done laparoscopically, I’m left with 5 little scars on my belly that is already mostly healed. Once fully-healed, I'm heading to the swimming pool to start exercising. I hate walking at the best of times. Oh yes, the million dollar question; I first met the surgeon on 13 Dec and went on a pre-op diet for 10 days. I lost 10 lbs (4.5 kg) in that time. In the 24 days since, I have shed a total of 36 lbs (16.3 kg). I have been told by my dietician that it is not unrealistic to expect to shed around 75% of my excess weight over the next six months. When I started out, I was 351 lbs (160 kg). I'm now 315 lbs (143 kg). The next milestone is to break the 300 lb mark, a weight I haven't been in over a decade. --------------------------------------------------------------------------- 13 January 2011 If there's one thing that I've discovered post-op, it is precisely that old habits can die easily and very, very quickly at that. There is nothing quite as drastic as once being able to virtually inhale a three-egg omelette with cheese, green pepper, mushroom and bacon and, sausage and hash browns on the side, followed by a cup of coffee, to hoping-upon-hope that the single boiled egg you're just about to tackle for breakfast won't fill you after just three bites. Such is the drastic nature of this procedure. The sense of fullness isn't the same satisfactory one as before. Rather, it takes you by surprise. One minute you're savouring the taste of just your third spoonful, then you feel a slight burp and know you ought to stop right there-and-then. But being a man, you bravely go for the fourth and the pain hits from nowhere. The tightness in your stomach is indescribable. It feels like your chest is going to explode and you wonder why-oh-why you were ever so greedy as to dare to eat a whole fourth spoonful. This surgery is like having an electric shock device around your ankle when you're on parole. Any deviance in the eating department and you're very quickly zapped into line. All went well the first two weeks post-op with a little heartburn to contend with. These past few days, I thought I was going to meet an untimely demise from acid reflux. How embarrassing is that? Even in my drinking heyday, I had never felt anything quite like this. Back in the day, you puked, you rinsed, you slept (not necessarily in that order) then got up, nursed the hangover and picked up where you left off. This time, the reflux was a whole new kettle of fish. Anything short of standing bolt upright had acid gurgling at the back of my throat. sleep was almost impossible. Yesterday, I finally collected from the pharmacist in capsule form a potent antacid which has proven to be the elixir for which I had been waiting. Last night for the first time in days, I got a full night's sleep and am feeling very refreshed finally. The surgery is doing its work. I have shed 17 kg in 30 days. The last three days, there's been a slight lull from my average loss of a pound-a-day. It might be because I have been struggling to get in the dietitian's requirement of 70 - 100 g of protein per day. A single egg has just 8 g of protein. Given the minimal volume of my stomach of around 130 ml, it would be impossible to meet the protein requirement from food consumption, the equivalent of 9 - 12 eggs. The solution to the dilemma is whey protein isolate shakes that body builders use. I mix it with something called enriched milk (skim milk fortified with powdered milk for the extra protein) and knock them back in 15 g slugs. Even that requires about 5 drinks a day. As tasty as vanilla and chocolate flavour is, after a while you just want to gag. Interspersed in all this protein intake is a requirement to rehydrate constantly. Water, jelly, electrolyte drinks and more water, 2 litres minimum of the stuff per day, is what is required. There just isn't enough room for it all. To combat the potential for malnutrition, for the rest of my life I have to take a multivitamin and iron supplement with breakfast, then three doses of calcium supplements the rest of the day. They're all in chewable form so it feels like snacking on sweets for dessert. Also, once-a-month, I have to get a Vitamin B-12 injection. On the plus side, I've kicked the type II diabetes that required two metformin pills a day. Which would one rather have, is the big question. There's no telling what the consequences of diabetes is, ranging anywhere from gangrene and the amputation of a foot to a stroke from high blood pressure. Yikes! By far, the nuances of bariatric surgery are a nuisance I'd rather have. --------------------------------------------- 13 February 2011 It has been so long ago that I was last under 300 lbs, I have kind of forgotten which era of my life that was. There is a selection of still-new clothing in my closet that is too tight for me so I obviously bought them when I was thinner than I am now. I have to try to recall when I bought--and almost immediately outgrew--them. Did I buy them in Canada at my favourite fashion store, Walmart, or in South Africa at my similarly popular source of bulk thread, Makro? If memory serves me right, I don't think I ever felt this 'trim' since arriving in Canada in 2004, and I certainly had one hell of a paunch during my wedding in 2000, so we may well be looking at the late 90's. I would be lying if I didn't admit that my latest stall was getting the psychological better of me. I mean, here I am post-major-surgical-procedure to lose weight, barely able to imbibe half-a-cup of food per meal that fills me for hours, and getting nowhere near the required amount of protein, only to hover tantalizingly above 300 lbs for the last few weeks. Like everyone, I went dramatically from 351 lbs pre-op to around 305 lbs. The expectation that this kind of rate would be sustainable is rich to say the least, yet it becomes a pipe-dream for the morbidly obese. Luckily, I didn't go into the kind of depression that resulted in starvation to achieve this milestone. I stuck with the programme, sucked down protein shakes to make up the deficit, ate the soy sausages and even relished the chocolate-coated Protein Bars that 10 years ago would have made me gag. My exercise regimen has included some very basic exercises because I still feel a little too weak to go for lengthy walks, let alone jog or play squash. I timed my exercise routine. It took me exactly 13 minutes (12h00 to 12h13) to do 20 reps each of the following: squats (feet shoulder-width apart, only squatted as far as was comfortable) crunches (lying on back, hands clasped behind head, tried bringing up head to knees, could barely get my head off the ground) leg lifts (lying on back, palms face down under buttocks, just lift feet off ground) cheat pushups (on my knees instead of the traditional way) left bicep curl (using a shopping bag filled with our new duvet as a weight) right bicep curl (ditto) left tricep extension (ditto) right tricep extension (ditto) bench press (lay on bed and pushed the 'weight' towards the ceiling) shoulder press (shopping bag as weight, standing legs slightly apart, raised 'weight' to ceiling) left side bends (standing feet slightly apart, hands clasped behind head, lean twice to the left, then back upright, will use make-shift weight in future) right side bends I did these 12 exercises (so a little over a minute each on average) on a mat in the small space between the bed and the wall. My gym outfit was my boxer shorts and I went barefeet. I will continue to use my make-shift dumbbell until we find that ideal duvet cover. Who needs a gym, eh? It has now taken me longer to describe my exercise than the workout itself took. How did I find the excuses to avoid exercise in the past? Which brings me to the topic of constipation. What is up with that? I guess the minimal food intake is as much to blame as the lack of hydration. I have struggled to drink the suggested amount of water and am hoping that the protein shakes count as both nutrition and fluids. No doubt, the body tries to absorb as much of whatever little it is now getting and often tempers the metabolism in anticipation of famine rather than feast. So, as much as toilet humour provides endless hours of mirth in slapstick comedy, it is a serious topic when it comes to diet and weight-loss. Not having a bowel movement for two-to-three days is discomforting to say the least. The medical team knows about this and is ready to prescribe suitable 'stool softeners'. Instead, I've re-discovered prune juice. "What does all this have to do with the scale," one wonders? Well, when you're desperate to reach certain weight milestones, like lose 50 lbs or 100 lbs, or achieve a specific weight, 300 lbs in my case, you start to become very particular about what exactly it is that you're weighing. In my mind, any food or liquid in my intestine is not part of my body weight, hence has to be expunged before the weigh-in. How ridiculous is it that I was careful not to swallow any water whilst brushing my teeth in the morning? Sometimes, the mind concocts ideas that descend rapidly from the sublime to ridiculous. To cut to the chase, after yet another morning leaving the toilet tissue undisturbed, I stepped trepidly onto the scale and weighed in at 298.4 lbs. The sensation was overwhelming. For all intents and purposes at 05h30 on a Sunday morning, I ought still to have been in bed. But an early night and a full bladder resulted in an early morning and my usual interlude with the scale. My wife was still fast asleep so it took enormous restraint to squelch my desire to yelp. With an enormous weight off my shoulders, no pun intended, I have a spring in my step today. At last it feels like the programme is on track again. I have regained all of the confidence in the surgical procedure that I had going into it. The overwehlming evidence of its effectiveness just from the experiences of its alumni should have been convincing enough. However, it still requires one's own adventure with it to fully come to terms with its benefits. I look forward now to tackling the next 100 lbs. -------------------------------------------------------------- Tuesday, 22 March 2011 I love numbers because, unless manipulated by accountants and politicians, they tend not to lie (a bold statement from a would-be-accountant). When I first started exploring bariatric surgery as a solution to my morbid obesity, one of its wilder claims that attracted me to it was that a person could lose 75% of his excess weight within 6 months. At the time, I was 351 lb (160 kg) and felt that I needed to get down to 220 lb (100 kg). In total, that would imply a loss of 131 lb (60 kg). 3/4 of that is 98 lb (45 kg). Could I really lose 45 kg in 6 months, in other words, 7.5 kg per month? It seemed too good to be true. A 45 kg loss in weight would put me at 115 kg, a weight at which I once used to play a half-way decent game of league-level squash. As I read more about the effectiveness of the surgery, I became giddy in anticipation of becoming a veritable gazelle within just six months. At the 3 month mark since my vertical sleeve gastrectomy, I weigh 280.4 lb (127.5 kg). I have lost a whopping 71 lb (32 kg). This implies a rate of loss of just over 22 lb (10 kg) per month. If this is sustainable for another three months, I'm on track to blitz right past the projected 6-month, 45 kg loss. It even tickles a tantalizing fantasy of shedding the entire 60 kg within 6 months. Reality dictates otherwise, however, because the initial rate of loss post-op is staggeringly high versus what it's become, hence a much larger drop in weight immediately post-op. Still, a gander at my weight graph in the health tracker shows a fairly straight line with a constant slope. With some hesitation, I'm tempted to adjust downward my overall weight-loss expectation to around 187 lb (85 kg). Before my op, I asked the surgeon whether this was feasible and he said it certainly was. At the time I didn't believe him but now I'm not so sure. I remember very well when I was last 85 kg. It was in 1991 when I was at my fittest ever and about to play in the B Divison at the US Open Squash Tournament in Portland, OR. In the second round, I lost a 5-game marathon to the top-seed and shed 8 lbs of water weight for my effort. Back then, I was a fairly well-oiled machine and knew intimately the effects of food on my body. A diet on a student budget, comprising instant noodles with broccoli, tuna, pinto Beans and chicken kept me in trim. Toasted sandwiches with hotdogs, cheese and mayo inevitably translated into an upward tick of the scale. -------------------------------------------------------------- Sunday, 27 March 2011 More on the numbers, this time regarding my recent lab tests. In summary, they're all good and a reversal of where they've been the past decade. I've moved into the normal range in just about all the important categories. Even going back 10 years to my mid-30's, my blood sugar levels--as measured by Hemoglobin A1C and Fasting Glucose--were always a couple of points above normal though nothing worth calling out the cavalry for. Even the Urine Albumin or ACR (Albumin/Creatinine Ratio) which is a gage of the level of functioning of the kidneys, was just above normal. When my personal care physician (PCP) a.k.a. family doctor diagnosed me with Type II Diabetes, it was almost tongue-in-cheek. He said that each measure, on its own, was not worth a diagnosis of diabetes but, together, ooh, aah, maybe, why not? "Diabetes! Take a couple of Metformin daily and see me again in three months." At the time, it sounded more like he was obliged for ethical and liability reasons to come to a conclusion of diabetes rather than any concrete proof of the disease. Thus began three-monthly visits to the labs to test these two variables, as well as an annual visit to the optometrist to photograph the back of my eye. This was to see if excess blood sugar was causing the rupture of capillaries back there. The eyesight of diabetics deteriorates for this reason rather than from the normal decline around middle-age from retinal mal-function. Another ominous feature of my blood was elevated pressure and high levels of cholesterol, especially the abnormally high ratio of total cholesterol to bad (LDL) cholesterol. Neither was ever high-enough to warrant medication but required a change in diet that favoured fish and chicken over red meat and, an increase in leafy greens. My dietary approach was to ignore the advice. The PCP was vindicated in his diagnosis of diabetes. While the ocular capillaries were always intact, the blood sugar levels were not. I initially avoided the Metformin like the plague and it showed in the tests. As soon as I started taking them, the numbers came down though never into the normal range. It was plainly obvious that my body was not processing sugars normally. In fact, the endocrinologist to which my first bariatric surgeon had referred me emphatically increased my Metformin dosage from two- to three-a-day. There must have been something more compelling in the numbers that he saw leaving me feeling a little disingenuous for doubting my PCP. It's a coincidence that my three-monthly lab date was just before my VSG. It meant that I had fresh numbers for comparison and could attribute any changes in my digits directly to both the surgery and post-op dietary changes. Prior to those pre-op labs, I had been on a high-protein, leafy-green diet to shed some weight, get my body into ketosis mode and, reduce the size of the liver and rid it of fats and sugars. Despite that, my numbers were still off the charts. A tabular summary of the results are: Normal Early Immediately Post-op Range Dec '10 Pre-op Mar 2011 Glucose 3.6-5.5 mmol/l 7 (high) 6.4 (high) 5.3 (normal) A1C 4.8-6.2% 6.8 (high) 6.6 (high) 6.0 (normal) ACR < 2.0 2.1 (high) 0.8 (normal) Chol. 2.0-5.2 mmol/l 4.6 (normal) LDL 1.5-3.4 mmol/l 3.3 (normal) HDL >0.9 mmol/l 0.9 (low) Chol/HDL <5.0 5.1 (high) Triglyc. <2.3 mmol/l 0.9 (normal) BP 120/80 120/80 (normal) I'm reasonably pleased with the results though everything could come down a notch, especially the cholesterol level. -------------------------------------------------------------- Tuesday, 24 May 2011 Almost 21 weeks since surgery, I find myself still picking from the hors d'oeuvres or soup section of the menu while my short, slightly-built wife has her pick of the Entrees. It's an ironic reversal that is actually working quite well for our appetites and budget. For the wait staff, however, it's enormously confusing. The order taker has to first scowl at me for declining anything to drink, not even water, then frown harder at my minimal order. I don't always feel that it's necessary for me to explain why I cannot drink 30 minutes before a meal. There is usually a progression from amusement to bewilderment as the paltriness of the order registers. "Are you sure that would be all?" I get asked whilst being physically sized up against my order. As he turns to leave, you can almost read the, "What a cheapskate!" facial expression. Initially it might be understandable that I'm too cheap to order a beer or glass of wine. But for such a big fellow to cut costs with just the cup (not even the main-course-sized alternative) of clam chowder while the lady chooses the lamb shank with potatoes and gravy is just wrong. It doesn't end there. If a different person actually brings the meal to the table from the kitchen, there is the almost mandatory politically correct query about which meal is for whom. To avoid any question of ridicule as it's obvious that the mountainous lamb shank is for the big chap and the lady is watching her figure, I find the main course heading my way. At least the order taker had time to digest the information; this poor character shakes his head almost as if we the customer got our own order wrong. ------------------------------------------------------ Thursday, 26 May 2011 The converse of the non-surgical victory (NSV), something with which bariatric post-ops become quite familiar even only a few months post-op, has to be the non-surgical disappointment (NSD). In the wake of the breakneck speed at which we lose weight, start fitting into old clothes, get compliments from people and become more active, we run the danger of expecting too much too soon. Coupled with a stall at the 22-week mark, I experienced my first NSD when my scuba wetsuit proved two inches too tight. If you know these infernal things, the zipper is at the back, like those embarrassing surgical gowns. I guess if it had been wet which is when it is more stretchy, I might have been able to squeeze it shut until my blood stopped flowing. So rather than pass out, I go it the heck off and resolved to be patient a few more weeks. -------------------------------------------------------------- Thursday, 23 June 2011 Today is a weight-loss surgery (WLS) milestone for me. Exactly 6 months ago to the hour, I was in my ward at the Virginia Mason Medical Center in Seattle, WA recovering from my vertical sleeve gastrectomy earlier that morning. The six-month post-op period is significant in the WLS context because it is considered the 'honeymoon' period during which the most rapid rate of loss occurs, as much as 75% of the total weight needed to be reduced. Of the 70 kg (154 lb) that I needed to shed at surgery, I have kissed 49% away so my experience has been closer to average. I'm half-way there with the rest expected to take another year to come off. As a matter of fact, I reached my current weight about a month ago so my honeymoon may have ended prematurely. I seem to have entered the dreaded post honeymoon stall that is experienced by many WLS recipients. This is not the end of the loss because my caloric intake is still miniscule. It may be the body's response to what is essentially starvation (in relative terms, of course) in which it hangs on to whatever it is fed. That's all well-and-good and I'm not panicking. I continue to get full on tiny portions. I have pushed the envelope on a few occasions with one bite too many, and paid the price in the form of extreme pain and discomfort. It's a vast change in psyche compared to the heyday of binging with a stretchable stomach. That was when I could eat through any sensation of fullness whereas now I'm alert to any signal of fullness. Around three bites into a meal, I start to notice a slight churning in my stomach accompanied often by a tiny belch. Of course, this sensation is commonplace to anyone who hasn't had surgery. It is only unusual in my case because it occurs so much earlier. At that point, most normal people would be exlaiming that they have left just enough place for dessert. I, on the other hand am good for just one more bite which, if I reserved for dessert, would be depriving myself of a crucial opportunity to ingest protein. Most of this description in any event is pertinent to meals of dense protein comprising fish, chicken, red meat or soya. A small bag of popcorn goes a longer way in which I have to allocate an entire segment of about 3 hours to indulge. Cynics may be critical of the fear-driven disincentive to eat and they would be right. You should not be averse to food and certainly not terrified of getting full. That kind of mentality coupled with societal pressure to conform aesthetically spawns a whole range of eating disorders that include bulimia and anorexia. Overweight people such as I are often like petulant children who want our cake and want to eat it. The surgery is just the wooden spoon of discipline. So wish me luck as I tackle the next 50% over 12 months. -------------------------------------------------------------- Sunday, 26 June 2011 The irony of getting a question in a letter from someone named Ruth was enough to send me into paroxysms of laughter. She's not Dr. Ruth, just my friend's daughter whom I've known since the mid-80's. She wrote: "Wow, Neeven, you look so great! You must feel really good too! How has your weight loss changed your life? Ruth". To this I replied simply (yeah, right!), "Dear Ruth Thanks so much for the compliment. Indeed I feel good courtesy of numerous changes to my life, both psychological and physical. The most important of these has been a more optimistic outlook despite bleak circumstances. Just being able to leap out of bed with ten times more energy rather than dragging myself from under the covers is testimony to that. My mobility is vastly improved. I am walking everywhere now, back on the tennis courts with a vengeance and, after a few more lost pounds, even contemplating a squash membership. I played tennis this morning against a chap who 24 years ago used to play competitively. He tired after the first set while I was still good to go. It was a big boost to my confidence that my fitness has improved so much. I was chasing balls that I used to let fly past and taking the extra steps to better position myself without the fear of exhaustion. It is easier to get in-and-out of cars. I no longer have to shuffle in the aisles between restaurant tables and risk knocking over some poor diner’s beverage. I can see my shoelaces again and even bend down to tie them without needing a respirator afterward. From opting for the stairs, to sharing a bench with someone, to stepping aside in an elevator to allow one more person in, I’m considerably more self-confident. It’s taking some getting used to the attention I’m receiving from friends who are noticing the difference. Those who have been with me from the beginning have continued to be tremendously encouraging and supportive. Others who see me after a very long interval struggle with the awkwardness of commenting on my physique. They want to gush at how ‘good’ I now look but suddenly hesitate at the implied suggestion that I used to be a slob. Yesterday, at Shamin’s company’s annual Summer picnic, most of her colleagues had last seen me mere weeks before I had the surgery, squeezed into my suit and wolfing down chow at the Christmas function. This time, many targeted me for conversation to inquire how I felt, what I was eating and whether I had struggled. I’ve never been coy about talking about the surgery (and neither is Shamin at work, it appears) so I was flattered that they wanted to chat and heap praise on me. I soaked it all up Stephen Colbert style, like a seasoned celebrity. I made the mistake of not logging my body-dimensions pre-op but I guess my loosening clothing is measure-enough of what used to be. I say that tenuously because a lot of what is now too big for me, was actually once very tight for me. I used to bulge out of my jeans so my girth must have been a lot larger than the diameter of the trousers. Near the end, I couldn’t button my suit coat and the ski jacket that I wore during my Dec. ’09 visit to New York shows evidence of strain on more than a few seams. From shirt collars that used to choke me, to button holes that protested, to belts that didn’t even fit but now need new holes, there’s no shortage of evidence of my shrinkage in my wardrobe. Heck, even my feet slip into my shoes more comfortably. By far the biggest compliment I get is from Shamin who is highly critical of my aversion to spending instead of splurging on a few pants, shirts and jackets that actually fit. I sometimes catch her giggling at how much of a clown I look like in jeans with a crotch that hangs too low, or a favorite sweater that now reveals my clavicle. My logic is that I’m just a few inches from fitting into four brand new trousers that I outgrew the instant I bought them years ago. The reality is that as good as it has been, I’m only half-way down this journey with another 80 lb of loss still to navigate. I’m going to get much smaller (how many guys actually say that with a straight face?). It will now fall off slower but fall it will (hello, still talking about the weight here...!), so I’m biding my time before incurring the expense. We’re saving in other ways. I select from the appetizer section of restaurant menus and my share of the consumption of household groceries is negligible. That is partially offset by the introduction of pricey protein shakes, protein bars and a cocktail of nutritional supplements to the grocery list though there’s a net saving against breakfast Cereal, candy, soda and potato chips. My life was worsened for the sudden development of GERD post-op which persists intermittently but guaranteed to flare up by my favorite, curries. We used to prepare it spicily-enough to remove paint from a ship’s hull, whereas I can barely handle black pepper on my 4 oz steak now. I have become partial to fat-free, white-sauced foods rather than their tomato-based alternatives and, in general, just a whole lot more finicky about meals. I approach every meal with a certain trepidation. This selective eating is a two-edged sword that deprives me of the tastes I once savored, but further promotes my weight-loss. Now do you regret asking a simple question? Your friend Neeven"

What does everyone mean by supervised weight loss ?? I have to be weighed for 4 consecutive months with no weight gain , I can lose but not significantly. Is this considered my supervised weight loss ? I am required to meet with a nutritionist for clearance. Or is the nutritionist my supervised weight loss ? Sent from my iPhone using the BariatricPal App

Surgery was 4/23. I gained 18 pounds in 3 days while still in the hospital after my sleeve. I was readmitted to the hospital 8 hours after my initial discharge after it was found I had lost blood flow to 20% of my spleen, presumably from a blood clot. I received a large amount of IV fluid in that time which resulted in those 18 pounds. I lost that in 5 days plus an additional 9 pounds since, but to me, those 18 pounds of fluid "don't count". I was just wondering if anyone else had a large weight gain immediately post-op.

I have Anthem BC/BS. Our plan is called a POS (point of service) Don't know how that differs from PPO or HMO. I am in the early stages of this process. My doctor did a referral in Jan. and I will see the surgeon for the 1st time on March 13. Because I have read about such a variety of experiences w/ BC/BS I did a little investigating in regards to the policy I have through my employer. What I found is copied below. The caveat is that this is specific to the policy my employer subscribes to. If you go to the Anthem site (http://www.anthem.com/ ) and look up your state, you may be able to find out what the policy is re: WLS based upon the plan you subscribe to. Medical Policy Subject:Surgery for Clinically Severe ObesityPolicy #: SURG.00024Current Effective Date: 04/16/2008Status:RevisedLast Review Date: 02/21/2008 Description/Scope Clinically severe obesity is a result of persistent and uncontrollable weight gain that constitutes a present or potential threat to life. There are a variety of surgical procedures intended for the treatment of clinically severe obesity. This document addresses those procedures. Policy Statement Medically Necessary: Gastric bypass and gastric restrictive procedures with a Roux-en-Y procedure up to 150 cm, laparoscopic adjustable gastric banding (for example the Lap-Band® System or the REALIZE™ Adjustable Gastric Band), vertical banded gastroplasty, or biliopancreatic bypass with duodenal switch as a single surgery, is considered medically necessary for the treatment of clinically severe obesity for selected adults (18 years and older) who meet ALL the following criteria: BMI of 40 or greater, or BMI of 35 or greater with co-morbid conditions including, but not limited to, life threatening cardio-pulmonary problems (severe sleep apnea, Pickwickian syndrome and obesity related cardiomyopathy), diabetes mellitus, cardiovascular disease or hypertension; AND The patient must have actively participated in non-surgical methods of weight reduction; these efforts must be fully appraised by the physician requesting authorization for surgery; AND The physician requesting authorization for the surgery must confirm the following: The patient's psychiatric profile is such that the patient is able to understand, tolerate and comply with all phases of care and is committed to long-term follow-up requirements; and The patient's post-operative expectations have been addressed; and The patient has undergone a preoperative medical consultation and is felt to be an acceptable surgical candidate; and The patient has undergone a preoperative mental health assessment and is felt to be an acceptable candidate; and The patient has received a thorough explanation of the risks, benefits, and uncertainties of the procedure; and The patient's treatment plan includes pre- and post-operative dietary evaluations and nutritional counseling; and The patient's treatment plan includes counseling regarding exercise, psychological issues and the availability of supportive resources when needed. Surgical repair following gastric bypass and gastric restrictive procedures is considered medically necessary when there is documentation of a surgical complication related to the original surgery, such as a fistula, obstruction, erosion, disruption/leakage of a suture/staple line, band hermiation, or pouch enlargement due to vomiting. Not Medically Necessary: Stretching of a stomach pouch formed by a previous gastric bypass/restrictive surgery, due to the patient overeating, does not constitute a surgical complication and the revision of this condition is considered not medically necessary.

The sugar alcohols used in many artificial sweeteners cause problems for many people: diarrhoea, bloating, discomfort, … Personally I try to avoid or reduce as many artificial sweeteners, sugar alternatives & sugar as I can. It’s hard because it’s in almost everything you buy. I did it to kill my sugar craving - it has. (Artificial sweeteners & sugar alternatives still feed your desire for sweet.). Also there is a lot of research being done into how artificial sweeteners still lead to weight gain, affect your immune system, etc. But this has been a personal choice for me. Generally if I want something sweet I’ll eat some fruit. But again it’s been my choice to do this. I have made chia seed pudding & used vanilla extract as flavour. There is natural & added sugar in it but it’s very little. Also added milk powder which gave some sweetness (& extra protein) & a natural sugar. What about a fruit crumble? Cook up apple, berries, rhubarb or other fruit & sprinkle the top with a mix of rolled oats, coconut, nuts, a little plain flour, cinnamon a little butter & bake until golden. Use a little monk fruit for a touch of sweetness if the fruit is a little tart & in the crumble topping. Congratulations on your daughter’s weight loss. So wonderful she’s been inspired by you to make changes in her life too.

I spoke with my doctor this morning. She said my thyroid is fine and that she's checked that evertime I've done blood which was done late September and we do it almost every other month. Doc says the weight gain is most likely from the limited mobility due to my fibromyalgia. I've definitely slowed down a lot...Ive never been an over eater, I just wasn't eating the proper foods and that coupled with lack of exercise and late night dinners has made me this way. My hate for food may be why I chose to eat less, I always knew it wasn't good food goin in so I never ate a lot.. For all those that say I'm not being honest with myself, understand this, I am not here to give a false image, I'm looking for advice and encouragement. Whatever u did to gain weight is what u did, I know how I got here...lets stop insinuating I am a liar. Thanks for all the advice. I now know its not my thyroid. My doc says that since I've started my meds for the fibromyalgia, it will allow me over time to be able to work out and that mixed with the surery and my new eating habits will help me get my life back..I jus hope she's right. Also it will prevent my family history diseases, and assist with infertility issues..weight loss is the cure for way too many things..lol.

superfatty, your last comment is not just comical but reflects some fundamental misunderstandings. I didn't get fat because of overeating. And no one gets fat if they are able to listen to their inner guidance and follow it, not from overeating. Do you read any scientific studies about obesity? Increasingly medical science is proving, through random-access controlled studies, the kind that meet the top industry standards, that obesity is rarely the result of pigging out o food. That is such an outdated attitude. Obesity is increasingly seen as an illness in and of itself. I know some morbidly obese people eat copious volumes of food but not all that many. And why do they? Increasingly SCIENCE is revealing that folks who compulsively overeat do so because of underlying health reasons. Sure some of it is in the head and if that belief works for you, stick with it, honey. But increasingly obesity is being understood as the result of underlying, untreated, unrecognized health issues. I didn't get fat by pigging out on food. I got fat by taking several medications for over ten years that have now been shown to damage the body's metabolism and cause rapid weight gain. AS I watched myself morph from a normal sized thirty-something to a morbidly obese person, I wondered what the heck was I doing? Did I get up in the night and binge eat while sleepwalking? Did I go into psychotic trances and swing by fast food joints? Cause I never pigged out. Have you ever eaten a whole pint of ice cream in one sitting? I have. My first time was when I was in my fifties and my skinny close friend showed me she filld her freezer with pints of fancy ice cream to eat for dinner when her husband traveled. Until that moment, it had never occurred to me to eat more than a modest serving of ice cream. And I was the only adult in the house when I packed on the drug-influenced rapid weight gain so that meant only I bought the food in. I wasn't unconscoiusly binge eating. I packed on weight because the drugs I took damaged my metabolism. Gosh, what unenlightened thinking to believe people only get fat from pigging out. And if you think I am making up my science: three of the drugs I took have had class action law suits against them, and the plaintiffs (the victims) won. They couldn't sue for weight gain because fat is not a protected class in this country (i am a lawyer so if I sound like one, that's why) but they sued because each of these three drugs, in addition to damaging the metabolism and causing weight gain also tended to cause the onset of diabetes. And guess what? I developed diabetes, and not Type II but Type I. Type I's are usually skinny but those cursed drugs made me fat. Not every fat person pigs out. In fact, relatively few do. Cling to that if you must. And yes, it is about our heads as much as our bodies. Which is why I still say to Ms Kee Kee: trust yourself. Anyone that doesn't trust themselves, I feel sorry for them. Maybe some obese people did not always trust themselves but two weeks before bariatric surgery is a good time to start. How are you going to change the head game if you don't trust yourself? I won't give my power over to health care professionals. Sure I want their advice but I don't just see allopathic doctors. If I have the surgery, still an if for me, for I have lost 90 pounds on my own -- altho that could simply be the result of my Type I diabetes and I just think it is all the changes I have made in what I eat. Did you read the post about the gal whose own doctor said if she didn't eat anything she's gain because of her hypothyroidism? Hypothyroidism is real. There are a million stories in the naked city, and in the land of fat people. Don't assume everyone got fat the way you did. And I am not even assuming how you got fat altho you seem to suggest you pigged out. I didn't. I have never eaten immodestly and I have always swum laps at least five times a week for decades as well as other exercise. I got fat because of health conditions. You just watch. In the future, obesity is going to be given respect as a medical condition and not stigmatied as fatties pigging out. You stigmatize yourself that way.

Hi Again: Leatha: Thanks for the positive words. I am more afraid to take the anti depressants because of weight gain at this stage. Unfortunately, I can't change schools for my son. He is extremely gifted and the school he goes to is for kids at his IQ range. This is one of 8 schools in the country that handle what they call "duel exceptionality" which is gifted coupled with some other issues like ADD spectrum, emotional immaturity, social integration for the gifted etc... There are only 22 kids that his school and it is run by a doctor and his wife. They have what they call an 'autonomous learning model" which works well for kids like my son. Thats why we are selling the house and moving closer! Theresa: I have found that blood tests dont mean anything to test for certain deficiencies. My blood tests came back normal months ago and I know I eat better now than I have before. I have a list here on my desk that outlines what kind of tests to ask for to make sure that they dont waste my time checking for the wrong things. Atkay: Thanks. I am sure that I dont have Alopecia. I am not losing in Patches. (Thank God!). I believe my problem has to be hormonal or Vitamin related. I know it will grow back, but watching gobs fall out is scary. I am losing more in the front, but all over evenly. I still have hair and luckily my hair is very thick to start with. I am feeling a lot better today know that I am taking action! Babs in TX 334/188/170 -146 6/23/03

omg, you are me. i am a very well educated and professional individual. i too struggle with the whole house thing because of my perfectionism. i don't like to 1/2 clean and if i can't do it right, forget it. my closets are mostly empty and the stuff is cluttered all over the house because...i'm not shoving it in the closet. How insane is that? Clean, mostly empty closets and clutter everywhere. i'm not sure how this would apply to my weight gain history though. I think mine is for different reasons other than perfectionism. Anyway, glad to hear that there is someone out there who feels the same way as I do about having two selves.

Hey Jessica. We were banded the same day! I have lost 16 pounds pre-op and as of today...3 since surgery. I was also told that weight gain/loss is not important right now. Healing and getting our protein and water in are!! I wish you all the best!

WARNING: I tend to ramble! :confused: My name is Amy, am 40 years old, married with two furry feline babies. My husband and I own a tanning salon in Little Rock, Arkansas. My struggles with weight started about 3rd grade, I remember having to shop at Sears in the "chubby sized section" (yes, it did say that on the signs) I remember watching my mom and grandmother constantly fight with their weight. When mom was on a diet, so was I - which I needed, but as soon as I was out of her sight, straight for the donut shop! In high school, I pretty much starved myself down to 125 lbs and can distinctly remember passing out in the shower several times because my blood sugar was so low. After one year in college, the weight came back in spades!! I have been over 200 lbs since 1989, which led to poor self image and self esteem, which led to bad relationships, which led to more weight gain. I'm happier in my life than I've ever been and it's time for me to get out of this fat body suit I've been wearing for 25 years. It took me until I reached 40 years old and having a wonderful husband to realize that I am worth it, dammit! I'm excited, nervous, scared, motivated, committed, fearful of failure all rolled into one. Anyone else with me? :ohmy:

I'm 3 years post surgery. I've recently been able to eat whatever I want and I have no will power! I've gained 12 lbs in one month. Anyone have suggestions? Advice? I've heard some pills can be taken. Sent from my iPhone using the BariatricPal App

I'm 5 weeks postop I've lost up to 46lbs since surgery. Since this weekend I've gained like 5 lbs out of nowhere. Have not cheated and have almost had to force myself to eat because I'm not really hungry and exercised every day. Feeling frustrated. I know I should be grateful for what I've lost but irritated at the gain.

I have pizza all the time. It's just not pizza from a restaurant. I do a "skillet" version, using a cast Iron skillet, a carb master tortilla, organic/low carb marinara sauce, turkey pepperoni, with pizza cheese and veggies. They are about the size of a personal pan pizza, have a thin crispy crust and are lovely when you finish them up in the oven under a broiler so the cheese gets all bubbly and gets those little bits of brown. I can eat half at a meal and it's under 300 calories and low carb to boot, with some decent Protein. You can have all the things you used to love eventually. Just better (healthy) versions, or in smaller quantities/much less often. And the big thing to realize - you may not even want most of the really bad for you foods once you relearn how to eat healthy foods, and feel and look better overall. food issues that lead to obesity usually aren't just because a person is hungry; overeating or eating crap foods to the point of serious weight gain. Most of us have other reasons to medicate with food - low self esteem, fear, depression, using food as a reward/comfort/distraction. You're focusing on food obsession and fears and worrying over changing something that has been a huge part of your life, but likely has caused you more grief than happiness. No matter what, change is hard and can be scary. But if you are a candidate for WLS, then you either have serious health issues exacerbated by the weight, or high enough weight alone where the doctor feels that this is the best path for you to regain your health and give you a fighting chance to relearn how to eat properly - it will give you the time to regain control so you can start over with your relationship with food. .

Hi y’all! Fair warning, I’m posting PUI (posting under the influence) right now! 😳🥳🤩🤪🥰😂🤣😅😇 Seems I had a serious case of the fomos this week with @GreenTealael having her upcoming VSG to RNY surgery for GERD and @Alex Brecher having his RNY reversal for bowel obstructions/necrosis. I just had to wrap up a pending tri-fecta! LOL What I thought was a serious case of food poisoning — or as I like to say, “When good refrigerator roulette goes bad”...was actually a sudden onset of internal hernia with twisted gut. It came on so quickly Sunday night and by Tuesday I couldn’t eat. And Wednesday ended up curled up on a cold tile (filthy) floor in the ER convinced I was dying, moaning, sweating profusely and making quite a spectacle! My only regret is I didn’t have a tip jar handy to earn a few quarters!! It’s a risk of WLS that is part of less than 3% total for complications after surgery—so no need to fear complications from WLS. To put in perspective that 3% is lower than the national averages for all sorts of surgeries!!! I’m 17 months out from RNY and was just so super surprised by this new development! But initial surgery went very well! I went into surgery at 12 midnight and was back in my room after recovery by 3:45am! Woot! I have a rockstar surgeon and team who were able to do it all laporoscopically! She said if I play my cards right and am able to eat something later today and get my walking in that I can probably go home late this afternoon! Yeah, baybee!!! Now I just have to proactively start medicating to guard against having a Rosemary’s Baby sort of post op poo! 😞😥 i’m so grateful to everyone and for our Bariatric Pal Family! Thanks Alex for creating such a special place! (Oh and I don’t recommend doing it this way, but this morning was back to being only 3.4lbs away from final Goal #3 of 130lbs!!! Woohoo! With my post op plan progression in place I expect to shed this post surgical fluid weight gain in a couple of weeks and reach Goal #3!)

I've had many, many Ah-ha's over the years, but I guess the most serious one was in 2000 when my mother was felled by a stroke, brought on by her diabetes and lifetime of obesity. I spent a couple of weeks down in La. helping my dad adjust to her being bedridden. It was entirely too sobering to realize that even after having lost 100 lbs a decade earlier, it still took two or three people to roll her over to change her bedding. And that they did not make Depends large enough to fit her. I went home and told my husband, "I have seen my future and I do NOT want to go there." I immediately started trying to get approved for bypass, but failed to accomplish that (Not enough documentation, the ins.co. said!). Had some moderate success with WW, but eventually gained that all back. Then in Dec. 2006 I had an episode with my heart and was diagnosed with diabetes. The meds for both added to my weight gain and made me SO lethargic. I literally felt like I was dying a little each day. My cardiologist shocked me when he said, "It would take you two to three years to lose the weight you need to "IF" you could do it and your history does not make that look likely -- Simply put, you don't HAVE two to three years!" He referred me to Dr. Miranda, who's office staff was AWESOME and they did all the tough, insurance stuff FOR me. Here I am a year after my first consultation, banded, down 72 lbs and off of 8 out of 9 meds I took before surgery!

I gained about 12 pounds in the 6 month "Physician assisted" weight loss attempt. My surgeon doesn't submit paperwork till you've completed this step. I was close as far as qualifying BMI wise at 36 (35 with co-morbidities was the cut off), when I started the 6 months so losing before I qualified wasn't an option, AND my PCP had just started me on a statin, which can cause weight gain. No one cared. What my surgeon DID care about was AFTER I was submitted I did have to lose 10 pounds for liver shrink within the 4 weeks before surgery. I dropped 13.

Anyone out there that's had weight gain struggles post gastric bypass? I had my surgery back in 2009, did excellent with weight loss but over the past year I have put weight back on. I'm currently getting back on track and losing the weight but I'd like the support of a buddy who's gone down the same road.

Well this is a hit in the head. Lost 12# one week post op. Next 2 days, I have gained 1 1/2 #. Getting 90% of water, 100% protein, and about 500 calories what with skim milk and protein mix. Anyone else had this happen?

I think the 10 pgs. is way too much information. Stick to the facts, list diets you have been on steady weight gain, list all the medical conditions you have from the excess weight. The only letter I had to provide was one that my suregon suggested my primary doctor write. The letter was a draft of what my primary should say. The draft letter was what the insurance companies want to hear and is what I listed above. Insurance companies only want what effects you medicaly.

That was the biggest surprise of my life. I had to undergo more than a year of fertility treatment and artificial insemination to have my daughter and now, when I least expecetd, I got this blessing. I am 3 month post VSG and almost 6 weeks pregant. I am still afraid, concerned about the nutrition of the fetus, weight gain, breatsfeeding ... finances... and all those things... but I am sooooo HAPPY about this baby. May God bring him/her in good health! I will keep you all posted.

When I was still eating at McD's, I remember telling someone, "I don't even like it!" And yet, there I was - eating it again and again even though there were consequences (weight gain and bad feelings) for doing it. As a general thing - people don't like to give things up unless they have something to replace those things. Drive-thrus offer that immediate gratification. How else can you get that? The other thing that has worked for me is setting rules about those kinds of places. For example, at McD's - no more fries, remove the bun from any burgers. With enough rules in place - it just wasn't worth it to go there anymore - and now I don't.

In your position, I would want another band too - or another surgery. But on an ecouraging note, i was devastated to learn I'd have to unfill my band for a major surgery, and that it would need to remain unfilled for up to six months as I have to have a second follow up surgery. So far its been over 2 months, I've actually LOST weight and that's without hardship. All I've done is log my 2000 maintenance calories a day and exercise like I always did (which is why I can eat so many calories). I have enough for three good meals, the occasional treat, and a "bank" throughout the week as I hardly ever eat the entire 2000 so that I can go out and have a bigger meal without guilt or repercussion. Seriously, its been easy and sooooo enjoyable to have bread, salads and red meat again. I will not fill again unless weight gain occurs, but truly, I am now confident I can maintain my weight, as long as I keep up my running.

Globe, most insurance will cover Mirena. I have Tricare Prime Overseas and they did it with no problem. Tricare is usually behind the rest of the insurance plans as far as coverage. The way Mirena works is still really unknown. It does release birth control (levonorgestrel, as a previous poster mentioned) which is used in birth control pills. The device itself is supposed to also thin the uterine lining, making implantation much more difficult. If you remove the device to conceive, most doctors will tell you to wait for two cycles before trying again, because the uterine lining might be too thin to sustain a pregnancy. The questionable aspect for many people is that nobody is really sure if Mirena stops sperm from reaching the egg or if it simply prevents a fertilized egg from implanting. What a lot of people don't understand is that most women wouldn't conceive every month anyway - or even every year. So assuming that each month an egg is released and then fertilized, resulting in a spontaneous abortion is a bit much. It can happen, though, so for that reason many Catholics and other religious groups are completely against the use of the device, even more so than other forms of contraception. In my case, I opted for Mirena solely for control of my endometriosis. In that respect, it's the ideal treatment. My husband has infertility, and even if he didn't, I have no religious beliefs that would cause me to question the use of the IUD. The only side effect I could possibly say that I experienced *might* be a slower weight loss. But I can't be sure. I'm still losing, and still at a very good rate, so it might just be a natural slowdown as I get closer to goal. I have had none of the awful side effects I had with pills in the past - acne, moodiness, depression, weight gain and constant cravings for junk food - so for me, it's a great option. Another choice, if your insurance covers it, is the Nuva ring. Again, some people love it and some people hate it. I loved it, again, for endometriosis control (I left it in an entire month and went right to the next ring with no break). It simply isn't available in remote overseas locations, however, so I had to go with a different option. Best of luck to you. But check with your insurance, Globetrotter. I'd be willing to be they cover it already. ~Cheri