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It took me a full week to get rid of the weight gained from surgery. It took 2 weeks to get rid of all extra gas. Sent from my iPhone using the BariatricPal App

hair loss that begins a year after surgery(or later) is caused by nutrient issues or some other condition, not the normal side effect of surgery. Have you had blood work? I have had weight gains and losses that don't make sense but I think if you journal your food, for at least a month it will help you pinpoint the problem.

I have had PCOS for so long...when I was originally diagnosed it was called Stein-Leventhal Syndrome. I struggled 20 YEARS with it. Every single symptom, I have/had. Wls saved my life. I went from 6 insulin injections a day, to nothing. My PCOS helped me get high lipids, battle diabetes, high blood pressure, hair loss on my head, excessive hair growth everywhere else, extreme weight gain...I could go on and on. 2 years post vsg, my ONLY regret: that I didn't do the surgery sooner! 2 years post op, 188 pounds down, healthy, and 10 weeks pregnant!

Sherri- My heart goes out to you!! My sister just went through this same thing about 1 year ago. She had been married for 7 years, 3 small children and had no idea her hubby was on his way out. He was wonderful for the first few years but then when he turned 29 it got really bad. He complained about what he had in life and didn't have, weight gain and losing his hair (mind you he was only 29....good grief!!!) Anyway, he went to work one Friday and didn't come home after work, somewhat had become the norm. He would go out with guys and they would set up and drink all night but he would usually come home by 3-4 am. This night in particular he didn't come home until 9:30 the next morning. Had every excuse in the world. My sister loving him ever so faithfully, let it go. She didn't believe him but she let it drop for the day. That night we had a family function for a wedding reception with dance. They got there about 6 and he told her they had to go at 7:45. Said he was tired and wanted to go home. Went home, dropped her off. She asked where are you going and he said where ever I want. I will be back. He came home the next morning at 10AM (mother's day last year) and said I am moving out I have found someone else. Walked out and didn't give her a cent. 10 months later he had a baby with 'the other women'. The divorce wasn't even final yet. The family pitched in and helped her but I tell ya we were all soooo worried about her. Now she is 57 lbs lighter, is socialiing with friends again and has a life. She hasn't been like she is now since before she got with him. She is doing so much better and just the other day we were talking about the whole thing. He has bothered her a few times since leaving with one day he wants her back and the next she is worthless. She fell for this a long time. Then we talked her into counseling. It has done her womnders and given her life back. She had stayed home for so many years and done everything for him and now she is living for her daughters and herself. He still gets angry because she doesn't take anything from him now. She has her own life and if he doesn't like something......TOO BAD!! I know what you are going through right now. I too was married before. He cheated on me in the very beginning and even after 10 years of marriage it still hadn't gone away. I honestly don't think that is something people can get past. Good luck to you. You are NOT asking for sympathy. Just compassion. We all need that. Exspecially at times like these. It may seem like you can't do it without him but believe me you can. I am now remarried but I am also a very INDEPENDENT women now. My new hubby and I have the problem that he feels that I don't 'need' him. I do....but I can also take care of myself. Good luck and I hope things work out for you. Come here and talk anytime. We will listen!

All of what your experiencing Rebecca is normal. so don't get frustrated, your body is still adapting to the foreign object inside you, your metabolisim is also adjusting , you will have flux in weight gain & loss as you start,but once you move to solid foods your stabilize and loss will come, i know we all want instant results, but your doing great , congrats to you and hang in there like you said your frustrated but refuse to give up. Slow & steady wins every time. GOOD LUCK & CONGRATS! Steve

Last year when I started to see my weight plumage! My body for years was getting too comfortable with being in the 280's for decades! But when I hit 304, then 310 and jumped right into 367 I knew something was wrong. I wasn't feeling right. sleeping a lot, the weight gain, swelling. My thyroid was a little off and I am being treated for that. Not to mention, I have degenerative hips (one replaced several years ago), I couldn't walk. Today, I can walk so much better, move around faster, more agility. Best decision I ever made for myself. Yes, I wish I took control a very long time ago before it got out of hand with my health. Better late than never.....

I knew you meant one week per stage. U might need longer... They took me off the combination blood pressure pill so I no longer have the diuretic aspect... just in a regular bp pill that doesn't cause weight gain..first change my gp made Seeing endocrinologist is a great idea to rule out medical problems. I keep thinking there is a test that can show if your sleeve is still correctly done....?? I hope you keep or kept logs if your diet reset and weight numbers to show the Dr. They love stuff like that pkus when we're re fat, ppl don't likely give us the benefit of a doubt when we say, the diet isn't working or related!!

Yeah even the people I know supporting the program, after a couple of years, what is the point in going back? Pay extra money and only have a couple or one day open to me, I may or may not see the surgeon, and if it is a COE, I have to wonder that it isn't for their ASMBS records. They do nothing for those who are farther out having weight gain except to say pay more $$$ to join their non surgery weight loss program. Then there are other places you can go and compare what you get. I've seen the surgeries and done the investigation: what a racket. I'm getting ready to do a blog post. The surgeon's office I had? They asked for people to give them recipes that they'll publish and SELL a book for. Now why would I want to give my recipes up for free so THEY can make $$ off of it and possibly have the copyright too? Who's making $$$ off me? Is this how you want to be treated by your surgeon's office?

Dr. Wiljon Beltrè is the go to guy for surgery in Central Florida. He cares about his patients "beyond the knife". His patients have a high success rate and few complications and weight gain, IF, you commit and follow the plan. Sent from my XT1097 using BariatricPal mobile app

@anl1990 Don't let the above post get you down. I happen to disagree with it. I'm a sleeve. got to goal in "six months" transitioned to maintaining in six months. I'm maintaining four 1/2 years out. I would have been fine if it took me a year or more. I'm also not the only sleeve that contradicts @James Marusek opinion. What do all surgery types have in common? Does not matter what type of bariatric surgery you have. We all lose at different rates. Anyone of us can experience weight gain. Surgery success depends on following plan and changing old behaviors.

EGD - esophagogastroduodenoscopy Former medical transcriptionist here. LOL. Haven't worked for two years though....had to retire due to disability (arthritis). Sitting at a desk for 20 years transcribing and then 13 more years at home at a computer makes for a lot of weight gain and ultimately contributed to the arthritis.

Hi Jackie, I really don't know how it eroded and never even heard of a lap band erosion. I lived in California and moved to Knoxville, Tn. I didn't realize that if a doctor did not do your procedure, he will not give you any fills. So no doctor in this area would even consider me. After a couple of years and 25lbs weight gain later I found a doctor in New Orleans which is actually from TJ that flies in every three months to give fills to their patients. I drove all the way to New Orleans all excited to get a fill and on my way of losing some weight! I have the 10cc Inamed band. He said okay you are going to feel some pressure as he is filling my band to the full 10cc and got no restriction and that is when I found out it was eroded. Went locally and had an Endoscopy to confirm it. I would use my credit card if it was not maxed out! I had a great job. It was only a 2 year temporarily project and after the 2 years was up it was the worst time to get a job during recession. Which forced me to start my own business that is doing great but I have everything invested into it. I will be able to have the band removed in a year but I was hoping sooner than later! I do have some good days when I say I can live with this a bit longer but on my bad days when I have a lot of pain I want it removed yesterday! I guess i gave tmi but that is my story and it feels good to let it all out! I'm glad to see you are doing good with your lap band and I wish you lots of luck and will power to make it to your goal weight!

What should I be feeling when I am full with the band. I know this feeling may be specific to each person, but I need to know what you guys felt when you were full. As for me instead of just feeling full I feel pain, and I have spasms all the way up my neck. I havent had a choking feeling or anything, but I definately feel a pain in my throat. I have also noticed that my stomach growls and bubbles a lot. Is that normal? And my hunger has come back as well. I am 12 days post op and I have no gas pains or any pain near or around my port or any of my incisions, the only pain I have is when I am guessing I am full. Even though the scale says different I feel like I have gained all of my pre op weight back. I was down to 274 and now I am back up to 278 which really makes me angry. I have read on here that the hunger will return as you heal after surgery so I kinda understand the weight gain. I just hope I dont have to wait much longer on my first fill. I would imagine I'll have to wait until my incisions are completely healed up. My Doc said that by the #rd of July which is my next appt. with him, I should be eating fish and today I ate two pieces of fish from Captain D's so I guess thats following the Doc's orders. Anyways, what I am trying to say is that I feel like I have taken a step back instead of forwards with this weight gain. And I so dislike seeing the hunger return. Although I have enjoyed being able to eat somewhat solid foods I would rather the hunger stay away. Any advice would be greatly appreciated. Thanks.,

My family and a few others know I' had the lapband in 2007. Of course they noticed I lost weight (75lbs) but never got to goal. They never said anything negative and I was happy being 75 lbs down amd not really stressing about weight loss anymore....just coasting. 18 months ago starting to have problems...had upper GI and Endo 3 months ago and found....dilation of esophagus, prolasp of my stomach through the band. Port had flipped because of adhesions...my symptoms were extreme weight loss for 3 months then weight gain with nausea. And just feeling...not right. None of my family knew any of this except my husband. Now ..I'm telling some of my family since I'm having surgery to let them know....we're a close family. I'm really having a hard time explaining why I'm having the band out and going to a sleeve...since nothing really shows on the outside except I'm gaining weight because I can't keep solid Protein down and eat more slider foods. My siblings are asking why I don't just see if I can unfill and let it all go back like before...and they say surgery is dangerous. I'm just second guessing myself all over again. Maybe I want someone to tell me I can wait and everything will be fine....then I wonder how much damage waiting longer will do. I'm soooo feeakimg confused and scared of making the wrong decision like I did with the band..even though I thought amd was told it was the best thing out there for PERMANENT weight loss. My surgery date is Feb. 28th, 2013. Thanks for listening to my crazy ramblimgs.

My husband has been on Omeprazole for a long time . No weight gain to speak of. His surgery was 3 years ago. Mine was Sept 6th. I have lost only 16lbs so far, but I am not worried. It will happen.

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

What a Jerk Face! Bands aren't dying out. My doctor does more bands then bypasses. Also...You are only suppose to loose up to 70% of your excess weight in 5 years. So if you are a 100 over you are expected to loose 70lbs in 5 years. Be proud of your accomplishments. You are truely an inspiration to everyone. I have been banded for almost 2 years and I had a horrible weight gain and my doctor keeps pushing me. KEEP GOING BE PROUD!

Welcome jen!!!!! In my opinion, (I am 2.5 years out) and was heavy my whole life...... the sleeve is the best thing that ever happened to me. Could I have lost more weight? yes. The sleeve seems to work varrying degrees for people. Some people lose all their excess weight, some 30lbs. It depends on what you put in, and what you want. Post-op life is so much better (weight gain is not like before when dieting) but there is a risk of going back. I see the scale go up a few pounds then I blow an imaginary horn in my head. I can eat entire small box of cheezits in a few hours. I also can only eat 3 oz of steak and a few bites of veggies. It all depends of choices. What I am getting at is the sleeve is amazing but it is not guarantee to be thin for the rest of your life... (although I wish it was)

http://www.bariatric-surgery-source.com/weight-gain-after-gastric-bypass.html

Congrats on six years out. You are not alone in having a weight gain. Many of us working them off. Here is a link to the vegan/vegetarian bariatric forum. Hope this helps. https://www.bariatricpal.com/forum/1101-vegetarian-or-vegan-eating/

Coco, I concur with Alex. I am 2 years and 5 months out. Despite losing so much, having plastic surgery and all the hard work, I am also having trouble with some weight gain. I am stable at the moment, but cant seem to lose anymore and even gained 10 pounds I havent been able to lose since I quit smoking. Its hard, but you have to go back to the basics of what made you successful in the first place. It makes you realize how much of the weight loss was in your court and what you really need to do to continue to be successful. Thats really the best advice I can give you is to start again and follow the rules. Babs in TX 334/18-/170 -154

Thanks for the feedback everyone. I had my bat wings, moobs, and tummy tuck all in one go. I'm now 19 days post-op. I had 6 JP drains. The 2 in my arms and the 2 in my chest came out after a week. The 5th one in my groin got clogged somewhere around 2 weeks, so it was removed. The last one is still draining about 85cc / day of a slightly yellow, mostly clear liquid, so I really doubt it'll come out at today's visit. The day after surgery, they tried to stand me up. I passed out, probably because of low blood volume. Because of that, I spent a total of 3 days in the hospital, but by the end I was doing laps around the nurses' station. I had a button for pain meds & an IV antibiotic while I was in the hospital, plus Norco (hydrocodone + tylenol 5-325). A Norco every 4 hours actually worked better for me than the button, and that's exactly what my doctor prescribed for me to use at home. I also tried 500mg tylenol to see if I could get off the harder stuff sooner, but nope. I went from Norco every 4-6 hours down to just a Norco at night, down to nothing. I've been off all pain meds since day 15. The scale numbers are just plain depressing with all the fluids (and probably weight gain from being out of the gym),. My shirt size is now a men's medium! I was somewhere between a large / XL. I started working from home at day 14. I'll start going back in to the office on a regular basis once this last drain is out. Here's some tips I learned: You need lanyards for the JP drains. The nurses will pin them to your hospital gown, but once you start showering, that does you no good. Amazon sells a box of 25 for under $10. Use Glad Cling-wrap once you've only have a drain or two to keep dry but have otherwise healed up enough to shower. Don't be afraid to cut a hole in the butt of your compression garment for #2. My particular compression garment looks like a men's one-piece swimsuit from the 1920s. It has clasps and a zipper down the front. It also has a hole in the front for #1, but no flap in the back for #2. Especially with drains in your arms, it'll be hard to get in and out of the garment to use the toilet. The compression garment I got tended to roll up my thigh and cut off the flow, so my thighs collected a lot of fluid. A bed wedge or pillow + workout tights under the garment worked wonders for this. I wish I had a tip for getting rid of the glue from all the bandages. Nothing worked. I tried water, soap, ice, oil, and rubbing alcohol. I had to scrape it off with my fingernail.

I know the men may hate me for this but there is always the option of a vasectomy if it’s a long term choice to not have children. Obviously this wouldn’t be a solution for the OP for just dating but for those who are married reading this, the absorption and weight gain concerns are real and it may be time for the men to step up. At least it’s worth considering.

I have confirmation from a barium swallow that I have a big slip. I have chronic heartburn and weight gain :thumbup: They are unfilling my band tomorrow to see if that will correct the slip, if not, they will have to surgically correct. Just be aware, symptoms can be so different from person to person. If you don't feel right, call your doc.

Most doctors recommend a year after placement of the band. The reason is because you need time to be healthy, establish new eating/cooking habits, etc. Not only that, but the weight gain from becoming pregnant can mess with a newly banded person's mind. Talk to your surgeon first since you're wanting it to happen so quickly.