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Why Does It Matter? Support during your Weight Loss Surgery journey can help you succeed. It is motivating to know that the people who love you are on your side. Through the long days of diet restrictions and dramatic lifestyle changes, your journey will be easier if your family members and friends pitch in however they can, whether with verbal encouragement or concrete changes such as avoiding eating off-limits foods in front of you. Still, it is important to remember that you CAN succeed, whether or not you get the support you hope for. Get to the Heart of the Matter First, make sure you know why they are against your weight loss surgery. It is often because they are afraid for your safety. They may know people – or know people who know people who know people – who had complications from Weight Loss Surgery. You can talk to them about the real risks of surgery – using statistics rather than hearsay – compared to the risks of remaining overweight. Still, do not assume that your safety is why they are negative about your decision. It is important to let them express their concerns and to address them directly. These are some other common reasons why your family and friends might have a negative gut reaction to your exciting news. They may be worried that you won’t be able to stick to the Weight Loss Surgery diet, and that you’ll be disappointed with the results. They may think you don’t need it. A lot of family members have trouble seeing how overweight you are, and understanding how much it interferes with your life and health. They may feel insulted. Parents especially may feel as though they have failed if they see you, their child, opt for surgery. They may feel threatened. Your significant other, for example, may be comfortable in the relationship you have had for years, and may worry that the way you feel about him/her will change as you lose weight. They may not know what it means for them. Friends may worry that you won’t want to hang out with them anymore, especially if your time together tends to revolve around food or if they think of you as their dependable “fat friend.” Whatever the true concern is, address it directly. Reassure your friends and family that you are doing this for you, and that you will not become a different person. Offer Them a Role Some friends and family members may feel overwhelmed by your news of Weight Loss Surgery, and that can lead to their negative response. Surprisingly, offering them ways to be more involved in the experience can actually help change their minds. They may feel better about your WLS once you tell them the details about the prep, procedure, and diet, and may even be grateful if you let them know specifically what they can do to help. Address Meal Times Directly Food is central to relationships at home and in social settings, so it is understandable if your loved ones are worried about how your upcoming Weight Loss Surgery will affect the time you spend together. If you think this may be a concern, discuss meals at home and in restaurants with your friends and family. Let them know that you will still be present at the table and interested in being good company, even if you are not eating as much as them or ordering the exact foods that they are. If you are comfortable with the situation, they are more likely to be. Agree to Disagree In most cases, family members mean well. It may be hard to remember or see in the heat of the moment, but they often do genuinely want the very best for you. If you have already tried your hardest to convince them to support your Weight Loss Surgery decision and they are not ready to do so, your next hope is to keep them as an ally in other aspects of your life. Hopefully, you and they can agree to disagree about your Weight Loss Surgery. You can let them know that you respect their opinion and will not be pressuring them to support your WLS. In exchange, you can ask them to continue to be your friend regardless of whether you are a bariatric surgery patient. Be Patient Sometimes, it just takes time. Your own Weight Loss Surgery success may be the best argument for why your loved ones should support you. It may take weeks, months, or a year, but they may come around as they see how happy you are, and as they realize how much they miss you. Bariatric surgery is a lot easier when everyone you love supports your decision, but that’s not always the case. Don’t let resistance from family members and friends get you down, though. They’re probably trying to act in your best interest, and in most cases, you can still get Weight Loss Surgery while keeping strong relationships with them.

Great pics Renewed! I can tell you were working hard to cross that finish line, and that's all that counts! I can not for the life of me get the Rocky song out of my head now. I've been humming it since you mentioned it, lol. Be sure to take pictures of the next one too.

Hi guys! I just got home and I thought I would update about Renewed. I talked with her DH about an hour ago and she was still in surgery. They decided to do the 360 degree lift, all the way around the tummy and back, and that's probably why it's taking a little longer than expected. He's going to call me when she is out of surgery, but I'm going to have to leave in just a bit, so it may be a little while before I can post again. Keep sending up your prayers and positive thoughts. I'll update again as soon as I can.

Just getting in the door from yet another busy day. Renewed - I am so glad to know that you are doing well. It seems like you are making a little progress everyday. I get my fill tomorrow. My SIL is going with me to Roanoke, VA. We are going to do a little shopping before my appt. Yippee!!!

WTG Leslie! That first run was the hardest for me... Well, I did day one of week one again this evening. I am completely pooped. It was a little strange....it felt harder than it did on Saturday. I've been on the go all day today and I don't think I ate enough. I did eat a few triscuits about an hour before my run but I just ran out of fuel today. I did it though! I struggled on the last interval a little but I made it through. Keep up the good work everyone!! Renewed~ You are turning into a running machine!! You go!!

Renewed~ I hope it doesn't get bad where you live. We got quite a bit of wind and rain from Faye. Lots of tornado watches and a couple of warnings around us. I really don't like bad weather, especially the wind. Be safe and keep us updated if you can. Tootie, I hope you are doing okay...

renewed - I hope ya'll have a good time tonight. I think all parents need their own time every now and then. Your DH sounds like a keeper!!! DH and I also have "date night"...lol It really helps us. We realised after having some problems last year that we have to work on our marriage as well as our family. We'd quit doing anything together, we focused 100% on the kids. We're doing great now and are closer than ever. On a side note - I lost 2 pounds this week. I literally jumped up and down in the doctor's office today. I am now truly addicted to C25K!!!

I am currently in therapy. I continued with my therapist who completed my psych evaluation. And the plus with this counselor is that he is a certified bariatric counselor. He is able to address my current weight loss journey that my previous counselor sorta did not have a clue. I am a stress eater, so we mainly talk about life issues that stress me. And this strategy helps because I feel like I can decompress every week.

I am new to Bariatric Pal and am currently 391. My goal is to have vsg surgery in January 2020, my goal weight is 225. I was recently diagnosed with severe arthritis in my right hip and that I will need a hip replacement within the next year or two. I am even more anxious to have my sleeve surgery, feeling frustrated that I still have three months of required appointments before I have surgery.

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

Hi, I'm new here and not sure how to post either. I'm from Burlington and have just been approved for the VSG surgery. I am having my surgery on Aug. 28th. Dr. Wasserman, South Jersey Surgical Group will be performing my surgery at Virtua Center for Bariatrics. I am nervous about the diet changes and I need as much info as I can get. How does everyone handle the menu planning when you still have to prepare meals for your family?

Date of Surgery: 12/16 Dr Ariel Ortiz HW 280 SW 262 CW 188 TPL 92 TGP 130 This is quite an interesting journey! The thing that has surprised me most is the energy I have. I'm doing 2.5 hours zumba, 2 hours of strength training per week and I just started C25K (3 half hour running sessions per week). I'd like to do a 5K in October. I used to be quite fond of coming home from work and spending the evening in the recliner. Not any more, I can't sit still for that long! My eating is pretty good, but it is not perfect. I would say I'm "behaved" but not deprived 95% of the time and throw caution to the wind the other 5% usually on a weekend day. This past weekend I had cake AND about 10 skittles. The cake nauseated me a little because frankly the piece I had was probably too much. It had whip cream in the frosting and foods that have air in them tend to bother me, anyone else have that problem? I'm also back to having some dizzy spells when I stand. I've increased my water and my protein to try to figure out why that is. I've also stopped taking a bariatric vitamin and moved to a whole foods based vitamin with iron. So fun to watch everyone's progress!

Hi. I have been researching bariatric procedures for weight loss for a few years. I'm 45 year old woman whose weight fluctuates between 170-190 lbs. I have met with a couple of bariatric surgeons to explore the balloon and lap band. I'm not impressed with the balloon, and the complications associated with the lap band scares me. The ESG seems like a good fit for me, however, there are no long term studies to prove it's effectiveness and safety. My body over produces scar tissue, so that is my biggest concern with any surgical procedure. I have been struggling with an autoimmune disease which is exacerbated by my weight and poor food choices. I need to lose weight and I'm unable to do it on my own. In 2005 I was able to get down to 120 lbs and maintain it until 2011 with the help of phentermine. I was buying it online and the formula was very strong. I maintained the weight loss until the online phentermine was discontinued. The phentermine prescription I now receive from my doctor must be formulated differently because it has little effect. I want to lose weight and get off the medication. In 2011 I began suffering from various immune related ailments. The doctor's believe it is Burchett's disease. I'm prone to illness and infection. The foods I eat and extra weight I carry is literally killing me. I'm a single mom of two girls, ages 13 and 16. I need to be the healthiest I can be for them . I'm desperate and scared. I have a consultation next week with Dr. Reem Sharaiha at The Center for Advanced Digestive Care at NewYork-Presbyterian/Weill Cornell Medical Center. I will continue to post my experience through this journey to help those researching procedures. Thanks for all who share, it has been immensely helpful to read the process others have experienced.

For the record, I'm careful with EVERYTHING I read on the internet! :-) What I liked about the video is that he reinforces what actually is VERY common science/research -- weight loss is achieved through diet, not exercise, and therefore you have to get your head and your diet straight as your top priorities during the early stages after bariatric surgery. And then when you do start exercising, most obese people are de-conditioned and are gonna need the help of trained professionals to guide you in the early stages. Those are the messages he promotes in this video, and they make perfect sense to me. Have you actually watched the video? I watched another of his videos this morning out of curiosity (and will watch more) and he had the highly UN-debunkable position that your success or failure largely lies with the choices you make.

My weight loss surgery story actually started back in early 2019, but I chickened out before my first appointment because I was worried that I would have postop complications and the cost would go beyond the base rate. I gave up on the idea of weight loss surgery at that time, and decided that I would do it on my own. I think everybody here knows how well that went. At the end of the year I found out my husband‘s job would be ending, and we took that as an opportunity to try to find a job where he would have insurance that I could go on that would cover weight loss surgery. He got a job that covered it, and I joined his insurance plan, and within the month I was set up with my first appointment. my first appointment ended up being converted to telemedicine because of Covid, but that actually worked out great for me because my doctors office is two hours away. We had a six month waiting period, and for the first two months I will be honest I was working from home in quarantine, and I made absolutely no effort to lose weight and I did not make any progress. My third appointment was going to an in person appointment and the Bariatric class, and I was terrified that I would be up in weight and be disqualified. So for 2 weeks prior to that I went on a low carb low calorie diet. And I don’t know if it was me telling myself it was temporary or the realization that the surgery was coming helped, but I just kept extending and extending the date on my low carb diet. I ended up losing 48 lbs before the liquid diet which was greatly needed because I started at 339, and my surgery weight was 282. I’m 5’10 and my goal weight is 165. The liquid diet was no big deal, maybe because my diet was already very low calorie. I think I ended up losing about 8 pounds or so on it. It was a full liquid diet, and I did not vary from the diet at all. I want this to be the part of my life where I’m not constantly having a “little extra” or “just this bite” and I figured it would be a good test of willpower. surgery was a bit rough. I was in a fair amount of pain when I woke up, and I felt very nauseous. I could definitely feel my stomach, and it did not feel good. I wasn’t able to keep any water down, and the pain meds made me very sick. I ended up throwing up the small amount of water I’d drank snd the pain meds up all over myself the first night. But the next day was a tiny bit better, and it got better every day until day 4 I felt great. I ended up being able to drink water totally fine, no problem with protein or anything. I think my surgeon is a bit old school because I have a 4 week post op liquid diet too. No mush or purée stage here. I’m currently finishing up week 2 of the post op liquid diet, and like the preop diet I’m not going to cheat or go off plan. It was a long road to get here and I am going to do everything in my power to make this work. So far I am down about 10 lbs post surgery, so I don’t think I’m going to get the dramatic 30 lbs weight loss in the first month or anything but that’s fine. I’m down close to 70 lbs from my high weight, and it feels great. I’ll try to follow up every month or so with progress. HW:339 SW: 282 CW:271 GW: 165

Acetaminophen capsules or caplets for pain control. calcium citrate I like Bariatric Advantage in the cherry flavor. But there are other companies who make them too.. namely Celebrate and Building Blocks. Look up their websites and find their emails and ask for samples. My doctor has samples out too.. I know some folks who take the Viactive soft chews for calcium. I prefer not to use those cause they've got hydrogenated vegetable oil in them, but you might have a different opinion.

How much do you have to lose???? I had over 100 pounds to lose and around 5 months out I had dropped around 90-95lbs. There is no average since the percentage of weight loss is the primary indicator for weight loss surgery patients and not actual pounds lost. A patient that has 100+ pounds to lose might lose more number of pounds as someone with only 70 pounds to lose, but it's the percentage of weight loss is what is used to figured "average weight loss" for bariatric patients.

Jazsleeve Insurance goes by the BMI at the time of your consultation. If your BMI is over 50, you wont lose so much weight you won't qualify. Your Bariatric Surgeon knows more about the process than your pcp. Stick to the advice they give you. Talk to their insurance specialist. On the other hand, the nutritionist and psycholigist will quickly approve you when they see you have adapted sound eating habits. Focus on your goal. Thank God I had my husband telling me that the entire time. Six months seemed like forever! I just finished my 6 months and am about to be submitted for insurance approval. With God's will, I will start my preop diet in 2 weeks and be sleeved in 4 weeks. I always tell my kids.........lots of people start the race running fast but the one who can endure to the end always wins!

I used Bariatric Advantage and would use a pill crusher and turn them to dust.You could try taking a little at a time.Im not sure if it’s acceptable but maybe crush them and put them in some water.I hope you get relief soon.

So, surgery is Thursday...I woke up this morning, and my little boy crawled into my bed- and suddenly I had this overwhelming terror of something going wrong in surgery. I thought- my God, I don't want to die having an elective surgery. I know the risks are low- but it's still surgery. I'm sort of having a hard time shaking it. (Sorry for the heavy subject matter-lol). For the life of me, I can not figure out why Insurance companies consder Bariatric surgery elective. Breast implants and face lifts are elective surgery (in my book.) Speaking stricky for myself, the pre-op anxiety was worse for my wife. Don't put too much pressure on yourself. You are doing the rght thing for the right reasons. What could possibly happen if you don't take care is potentially much worse.

Started my "all shakes" diet today. Piece of cake. Sure the temptation is there to eat a spoon full of ground turkey my kids cooked up but im quickly learning to direct my attention to something else....like a shake. Was surprised to hear from the bariatric nurse today that ill be in the hospital for only one night....which made my day. For some reason i had it in my mind id be in for 3 nights.

Hello fellow sleevers. I had my surgery last week on Thursday 11-9-17. I'm in Colorado. I just got this Bariatric Pal app 2 days ago. How do you choose a photo and out your info at the bottom? Sent from my SM-G925T using BariatricPal mobile app

Congratulations!! I had my surgery August 11. I’m on puréed foods. Invest in a Bariatric Cookbook (recommended by my Nutritionist). It has been so helpful. Has recipes for all stages . The hardest part is the fluids. But it’s a process so take it day by day.

Hello, The go to surgeon in the Tucson AZ area is Dr. Jeffory Monash. He is Board Certified in general surgery and specializes in Laproscopic bariatric lab band, VSG, and RNY. All the best.