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Mexico bariatric center
anniedebbie replied to sweetsmith78's topic in Mexico & Self-Pay Weight Loss Surgery
If u dont mind me asking, what was the complication u had and who was your doctor Sent from my SM-N970U using BariatricPal mobile app -
Bariatric Weight Loss Major Turning Point Decision
New&Improved replied to Hope to Resolve's topic in Gastric Bypass Surgery Forums
Well I've not had band but I did have RNY bypass and all my blood work have been fine. My hair issue wasn't loss of hair just that it grows slower. Dumping only happens if you eat like junk food which we shouldn't anyways.. My weight loss has been amazing and even surprised myself... No complications here but I am only 9.5 months post OP. Maintaining well -
Bariatric Weight Loss Major Turning Point Decision
catwoman7 replied to Hope to Resolve's topic in Gastric Bypass Surgery Forums
hair loss is very common with both surgeries. It has nothing to do with the type of surgery, it has to do with the trauma that surgery causes to the body. It's actually a risk with ANY major surgery - not just weight loss surgeries (although I'm guessing you see it more often with WLS, though, since we're taking in so few calories the first few months after surgery). At any rate, it's no more common with bypass than it is with the sleeve. Most WLS patients experience it. The good news is, for most of us, we're the only ones who notice, and also, it's almost always temporary. Vitamin deficiency is rare as long as you keep on top of your vitamins. You'll have to take vitamins with either surgery. dumping - only 30% of us dump (I never have). And it can be controlled by limiting or avoiding sugar. if you have reflux, bypass is the way to go. Bypass often improves if not outright cures it. Sleeve has been known to make it worse (it doesn't happen to everyone - or even most - but it's a significant enough minority that most surgeons will steer you toward bypass if you've had reflux issues) yes, there are more complications with bypass, but to be honest, they're actually not very common with either surgery. Most of us sail through with none - or only very minor issues that are usually "fixable". -
Bariatric Weight Loss Major Turning Point Decision
Hope to Resolve posted a topic in Gastric Bypass Surgery Forums
With battling weight most of my life 10 years ago I got a lap band put in. I am now 57 years old, 15 years ago I was diagnosed with type two diabetes At the time my Lap Band was put in my weight was 230 pounds. That might not sound like a lot of weight but for a male 5’8 it was a lot for me. In addition to having type two diabetes I have also had two neck surgeries and three back surgeries over the years. The Lap Band gave me significant weight loss. I got down from 230 to 160-165. I also lowered my Metformin from 1000 mg to 500 mg. I lost approximately 70 pounds of weight and maintained this weight for about nine years. To say that it was an easy road for me would be lying, I was constantly having the band loosened tightened loose and tightened like being on a roller coaster. I had problems with the Lap Band being so tight that I was having major acid reflux problems. In addition to that I had some small ulcers around my esophagus next to my Lap Band. Last year I decided I had enough of this and had a lot of fluid taken out of my band. The major acid reflex went away immediately however, I still have some ongoing minor constant heartburn and a small cough because the Lap Band is still in place but a lot of the fluid has been taken out. Because of that removal of fluid I have gained back for the first time in 10 years 35 pounds. Now I am back up to taking the same amount of diabetic medicine Metformin 1000 mg because of the 35 pound weight gain. The bariatric center in Los Angeles is recommending that I conceivably switch to a Bypass Surgery and not a Sleeve. This decision is not completely final yet, and the decision towards leaning towards a Bypass Surgery rather than a Sleeve because of the acid reflex problems I’ve had for so many years which only really developed soon after getting the Lap Band 10 years ago. My next surgery would be involved removing the Lap Band and switching to a Bypass Surgery all at the same time in one surgery. As in all surgeries there are risk concerns for changing the body anatomy, however regarding the Bypass Surgery my new understanding is the body does not absorb as many vitamins and nutrients as it would from a Sleeve Surgery and there is a potential for hair loss and dumping and other potential complications? Any advice or opinions from anyone that has been down this same kind of road would be much appreciated. Thank you for your time and concern. Hopefully one day I can help someone else. -
Bariatric Weight Loss Major Turning Point Decision
Hope to Resolve posted a topic in LAP-BAND Surgery Forums
With battling weight most of my life 10 years ago I got a lap band put in. I am now 57 years old, 15 years ago I was diagnosed with type 2 diabetes At the time my Lap Band was put in my weight was 230 pounds. That might not sound like a lot of weight but for a male 5’8 it was a lot for me. In addition to having type 2 diabetes I have also had two neck surgeries and three back surgeries over the years. The Lap Band gave me significant weight loss. I got down from 230 to 160-165. I also lowered my Metformin from 1000 mg to 500 mg. I lost approximately 70 pounds of weight and maintained this weight for about nine years. To say that it was an easy road for me would be lying, I was constantly having the band loosened tightened loose and tightened like being on a roller coaster. I had problems with the Lap Band being so tight that I was having major acid reflux problems. In addition to that I had some small ulcers around my esophagus next to my Lap Band. Last year I decided I had enough of this and had a lot of fluid taken out of my band. The major acid reflex went away immediately however, I still have some ongoing minor constant heartburn and a small cough because the Lap Band is still in place but a lot of the fluid has been taken out. Because of that removal of fluid I have gained back for the first time in 10 years 35 pounds. Now I am back up to taking the same amount of diabetic medicine Metformin 1000 mg because of the 35 pound weight gain. The bariatric center in Los Angeles is recommending that I conceivably switch to a Bypass Surgery and not a Sleeve. This decision is not completely final yet, and the decision towards leaning towards a Bypass Surgery rather than a Sleeve because of the acid reflex problems I’ve had for so many years which only really developed soon after getting the Lap Band 10 years ago. My next surgery would be involved removing the Lap Band and switching to a Bypass Surgery all at the same time in one surgery. As in all surgeries there are risk concerns for changing the body anatomy, however regarding the Bypass Surgery my new understanding is the body does not absorb as many vitamins and nutrients as it would from a Sleeve Surgery and there is a potential for hair loss and dumping and other potential complications? Any advice or opinions from anyone that has been down this same kind of road would be much appreciated. Thank you for your time and concern. Hopefully one day I can help someone else. -
I had the regular BYPASS was sore a few days but now over 9 months out with no complications..
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What is the best feedback your therapist ever gave you?
orange_lily replied to orange_lily's topic in The Lounge
I like this! Kinda like gratitude journaling - challenging yourself to find something that is good even when it feels like everything sucks! Congrats on your progress, complications and all! ❤️ -
What is the best feedback your therapist ever gave you?
Sammi_Katt replied to orange_lily's topic in The Lounge
I got *really* lucky. Both of my therapist's parents had gastric bypass, so she really understands everything I go through and am going through. The best thing she ever told me is that with all the things I've been through to get here (I had a lot of complications after my sleeve), I'm alive and healthy and doing well for myself. I can still have a bad day, but it'll never be as bad as it had been now that I'm getting healthy for myself. She also mentioned that on bad body image days, I should try my best to focus on the fact that this is a *healthy* change for me, even if I feel like I'm still big. NSVs are a huge thing for us, and she tries to make me find one a week to tell her, especially if I was having a bad week. I can always find something, though, so I know something's working, and it's been really helping with my body image because, hey, I *am* making changes, even if my brain doesn't want to accept it sometimes. -
How long out of you or for Sleevers?
Ajjacobs replied to Sandy Milner's topic in POST-Operation Weight Loss Surgery Q&A
I took of 3 weeks. I'm working from home doing Telehealth. I am 5 days out and exhausted. No major complications (no major pain, no nausea, no vomitting, no reflux, incisions healing) but I am fatigued, my tongue is coated white patches and some brown colors that mostly scrape off) from my chocolate protein shakes, chewing multivitamins, etc.. I assume. If it doesn't clear I probably call doc in a few days. I shouldn't be dehydrated because I'm drinking fluids all day (64oz). Maybe I should do 64 water plus the liquid meals. I walk around the house and get dizzy. Make sure to take enough time off because I am thinking I should have taken 6 weeks. -
How long out of you or for Sleevers?
Jessicaandmike3 replied to Sandy Milner's topic in POST-Operation Weight Loss Surgery Q&A
I would definitely wait. I’m 3 weeks out on Wednesday from sleeve surgery and I’m still exhausted and drained. I don’t even have energy to brush my hair. But I’ve also had complications with mine. -
Average weight loss following VSG
ms.sss replied to over65's topic in POST-Operation Weight Loss Surgery Q&A
I know I say this all the time (as do several other members on this forum), but here I go again: Everyone has to remember we are all so very different and have different circumstances that will affect our individual weight loss. Comparing total pounds lost is deceiving as a myriad if different factors affect this. People who are heavier in the onset will generally lose more total pounds. If you MUST compare (and we all know that we shouldn’t!) compare percentages and/or BMI changes. A 300lb person losing 25lbs in the first month is mathematically the same as a 200lbs person losing 16lbs. Same goes with a 6 foot tall person vs. someone who is 5’3”. Add in gender, medical history and amount of weight loss before surgery, etc., and the formula gets even more complicated. In the long run, (i.e., average the percentage changes over a course or say, a year), one will often find (if one more or less sticks to plan) that most people will end up with the same numbers, in terms of percentage weight lost. Of course, there will be outliers. It’s hard, but try to remember that this is about you, and you alone. The determination of your success is not dependent on the numbers of others. I know, easier said, right? Just do the best to u can. ❤️ -
5 years post op and have huge REGRET!
anniedebbie replied to escape_pinacolada's topic in Gastric Sleeve Surgery Forums
I totally agree, I researched tremendously and saw vsg to be better suit for me due to certain complications rny has Sent from my SM-N970U using BariatricPal mobile app -
just a little encouragement
Bariatric Blondeshell posted a topic in PRE-Operation Weight Loss Surgery Q&A
Hey guys, just a little something to keep you encouraged. For me, the pre-op phase was the hardest part of my journey. I am currently 9 mos. P.o. from gastric bypass. I love my tool and wish I had went forward 3 years Ago when I first started this journey. I had lots of questions, but I wanted to know what life was like after the procedure. I wanted to hear from people who were experiencing it. So, this is my info..sw 264 lbs. , cw 186 lbs. Medical issues before surgery...hypertension, diabetes, pcos, infertility, lupus, heart murmur. I currently only take a low dose hypertension pill ,but they will evaluate that at my next post-op appointment. Life is good and I have had zero complications, zero visits to the hospital after surgery. Im grateful for that! I started a YT channel ( under my name Bariatric Blondeshell) that addresses the pre op phase and what life is like for us after surgery. I hope if you check it out you will be encouraged afterwards! Keep pressing on everyone, you deserve this! -
5 years post op and have huge REGRET!
Hop_Scotch replied to escape_pinacolada's topic in Gastric Sleeve Surgery Forums
Unfortunately not every surgery ends all rosy, there are some surgery complications and some people do have issues in the medium to long term. If you don't want to see anything that you perceive to be discouraging, negative and anxiety inducing you will need to give a lot of threads a miss or not be on social media at all. The OP came for support and encouragement too and should be able to tell there story. -
Gastric Sleeve Nerves and Anxiety! Questions!
smg replied to nat2013's topic in Gastric Sleeve Surgery Forums
For me it was life changing in every sense. The surgery was quite simple, minor pain at the incision areas, but aside from that really no serious pain. Thankfully, I didn't have some of the 'gas pains' that others have. No nausea, vomiting or extreme discomfort. Not really very hungry for the first few weeks either. I'm not sure if it's common practice, but right before my surgery and at my 6-month check up I had a "Myers Cocktail" which is basically a bunch of vitamins given through IV. Really helped with recovery and energy levels during a time where you really can't get much energy from food. YMMV, but for me recovery was super fast. I was eating pureed food by day 2 and solid foods by I think the end of week 2. Don't worry too much about calories in the beginning. Regardless of what you eat, you won't be able to eat much. Refried beans were a lifesaver for me the first few days on pureed foods, and the Ricotta bake that you see mentioned so much here was also a staple. Couple pieces of advice (again, everyone's different but some of what I see on here leads me to believe that the issue is more frequent than some others): Pay attention to your water. Sounds silly, but right after surgery I had no interest in drinking anything. I had to remind myself to drink water. So I started carrying around my water everywhere. That helped. Kept me sipping throughout the day. One of my biggest issues pre-op was that I ate fast, and when I say fast I mean really really fast. I honestly believe that was a huge part of my weight gain as it led to difficulty digesting, overeating, etc. Use the time in the beginning to re-train yourself on eating slowly and chew chew chew chew chew! Even your liquids. Even your pureed food. Even your smoothies. Chew it all. Sounds weird, but helped me monumentally. Don't try to jump into exercise too early, but don't put it off too long either. We all do this to bring about changes beyond food. We all want to be more active, make healthier choices. It's easy to want to jump right in, but I would wait until you get clearance from your doc (ask) to start, because any injury can cause complications with the surgery or set you back in your recovery or both. Also, you don't want to wait too long because it's WAY TOO EASY to fall back into old habits. Ask your doc at every checkup if you're cleared to exercise and when you are, get moving. Have a plan ready to go. Start with walks and move into beginner plans if you have to and then progressively take on more as you can, but start. Don't get discouraged with stalls. They happen. For some they happen sooner than others, but I think most of us experience them. Just stick to your plan. There are some good articles on here about how to work through stalls. Stalls will hit your ego a lot harder than your overall progress, I promise. Keep with your plan, and you'll push through. Use this time to change what you eat. Just because you can't eat as much of something does not mean that it's a good thing to eat. In the very beginning (first 1-2 weeks), you just need to get something in. Once you start back on solid foods, make sure you're choosing healthy foods. That doesn't mean you have to count calories, macros or any of that. Of course you can if that's what helps you, but I would use this time to find what works best for you. Since you can't eat a lot of different foods, chances are when you start back on solids you'll likely be eating only 1-2 different foods at a time. There won't be 3-4 sides, etc. It's a good time to see how different foods make you feel. Some people do great on a high-protein, low-carb diet. That didn't do it for me. I stuck with the physician's plan for the first 30 days (high protein), but I wanted something more balanced and more sustainable (for me) long-term. I made the change to go to a whole-foods based diet, and it's what I still do today, almost 5 years post-op. I stay away from anything processed as much as I possibly can. This doesn't limit me as much as other diets and it worked really for me. Try foods and see how they make you feel. Weed out the ones that leave you feeling bad, bloated, tired, etc. Enjoy what you couldn't enjoy pre-op. When you get out there and start enjoying the things that you may not have been able to do before your surgery, it's automatic motivation to stay on plan. If you have activities or certain things you have had to sit out because of your weight, having the opportunity to do them is like being a kid again and doing these activities for the first time. Remember those experiences. They will get you through any challenges you might face. Remember that times do get challenging, but that's why you're here. There's a lot of support here. I'm sure you have family and friends to help in that arena as well, but there's something about talking with people who've experienced everything you're going through. Don't forget that we're here. Sorry for the long-winded post, but I hope this gives you some encouragement as you start your journey. Best of luck to you and please keep us in the loop with how everything is going! -
5 years post op and have huge REGRET!
mil_unloaded replied to escape_pinacolada's topic in Gastric Sleeve Surgery Forums
I feel as though your post is important as it shows more about the risks that we are taking going down this route. While most complications are rare, it’s important to know about some beforehand, so you know what may (or may not!) happen to you. I feel I’d rather be braced for the rare possibility that I have a complication (or several in your case), than go into it completely blind. At least you could know more about how severe of a complication it could be, or not be. I hope that you, escape_pinacolada, find your relief soon, and that this will be just a blip on the radar of a future life of healing and recovery. Best wishes. -
5 years post op and have huge REGRET!
GingerStylz replied to escape_pinacolada's topic in Gastric Sleeve Surgery Forums
I’m not talking about complications with surgery. I’m talking about vitamin malabsorption and other issues. With RnY you are completely moving everything around and rerouting. Everybody I spoke to about before I made my decision has had issues plus it does have a higher rate of failing as well. I had been looking at this as an option for about 15 yrs. I spoke to people who had different surgeries. Not every case is the same. To me the the sleeve had the least amount of risk and changes to your system as you are only removing part of the stomach. People also need to understand that what may be good for one is not good for all. -
5 years post op and have huge REGRET!
catwoman7 replied to escape_pinacolada's topic in Gastric Sleeve Surgery Forums
horror stories about RNY are about the same as with VSG - i.e., they're very rare with both surgeries. It sounds like they're more common than they actually are because people are more apt to post about them - to get support or advice - than they are if their surgery went off without a hitch. People don't usually broadcast that they had a surgery that went great with no issues - but they do if they've had serious complications. Major complications with either surgery are very rare. -
5 years post op and have huge REGRET!
escape_pinacolada posted a topic in Gastric Sleeve Surgery Forums
Hello, I am new to this forum but I really need to warn others. I am 5 years post op from the sleeve surgery and am MISERABLE! I have also had 4 more surgeries to fix a hiatal hernia at the esophagus and stomach as well as pouches that were formed by the surgery. I have not been able to eat normally since the surgery and by normally I mean the way you are suppose to after VSG. I haven't been able to drink water without pain. My SW was 245 and now I am at 184 and losing since my most recent surgery. The recent surgery was to fix the hiatal hernia again. I was told it was a "new" way of fixing the hernia, nothing more was told to me. My pancreas was also removed at the same time. My surgery was called a Nissen Fundoplication, its pretty complicated. They use of the stomach to be wrapped around the esophagus so it won't go up into that area again. From the beginning I have had GERD very bad, it was so bad I was on 2 different medications as well as over the counter antacids so that is why the Nissen Fundoplication. It has been horrible this 5 year journey. I am getting all of my records together for a second opinion and to possibly have a revision to the RNY. This surgery was the biggest regret of my life. My life has suffered more and my relationship has also been hurt by this. I am always so tired and sick, and my husband is worried about losing me. I have also been just left to flounder. I have had numerous swallow tests and load of medications but NOTHING allows me to drink a nice glass of water, albeit a sip at a time, without pain. So in one word "YES" i regret everything about this surgery. Heather -
Obsessing about Plastic Surgery!!
Darktowerdream replied to ChubRub's topic in Plastic & Reconstructive Surgery
Hope all is well with everyone. I’m deal with some things. Not necessarily related to my surgery. I can’t remember if I said that I’m not sure but one thing I think that helped with post op swelling (besides compression stockings) was Garden of life Turmeric gummy supplements. I also took my usual Garden of life whole food based gummy multivitamin, natures way hair skin and nails formula gummy, plant based omegas I added extra Biocell collagen and antioxidants. of course it can take 4-6 months to a year to see the true results (Something like that) it is still a bit unreal to me. I haven’t looked at the big picture yet. I don’t see myself as small. I struggle with body dysmorphia and sometimes it’s a battle between chronic health issues and wow my stomach really is flat I’ve never had an actual flat stomach ... I will be honest also and say I sleep in my Faja though I haven’t quite figured out the Faja and underwear thing I mean you can’t wear them under the Faja but it’s too weird to not have anything with the open crotch. Especially wearing dresses. 🤣 The open incision on my left T incision (thigh lift) is finally getting closer to being closed. I had a protruding swollen “fat cell” which is what usually fills an open incision in secondary wound healing. it was keeping the incision from closing. And a blood blister next to it. It was swelling and also two small areas in the incision had some small blood pockets. Not to be TMI but I snipped and drained the swelling of built up blood in the “fat cell” and pressed it hard to push it into the incision and the “blood blister” next to it was the likely culprit I found a suture in it and drained it and cleaned it the best I could. Afterward It looked better and I could see the incision has nearly closed. I just have to monitor for any internal swelling. I haven’t mentioned it to my surgeon since it’s the weekend and I don’t want to be an annoyance. I’ve learned to take care of things myself most of the time. Even had my surgery been in the same state I’d have been doing the same thing ... The open incision on my backside (coccyx or whatever you call it) the stress point, it’s no longer a hole not healed yet but getting there. A couple of incision points need to heal more. Considering my immunodeficiency part of me expected some complications but in a way these were small compared to ones I’ve seen online. Especially for thigh lifts if the surgeon is removing more than just skin. I’m surprised at how smooth some parts of the incisions are. I’m not worried about scars. Though I think I’ll notice a few little things down the line ... like behind my knees, my calves, the incision on my inner thigh in pictures I take for wound care checking has an odd angle to my inner thigh. But One difficult thing for me is I’ve never seen myself as pretty and I’m not happy with my face maybe it’s loose skin. And maybe I just won’t ever see myself that way. I actually bought a article of clothing I never thought I would. A romper. For when the incisions are healed enough for the last bandage to come off. And I get up the nerve to wear it. I’ve Been wearing dresses since they are easiest but very casual ones. Since I’m mostly home except when I venture out for errands. I actually bought a girls size large dress at Target (Under $4) and was surprised it fit. My mom wanted a picture to show a friend. Sigh 😔 I hate my face. It’s still a bit unreal that I had three surgeries June 15th ... sorry for babbling. -
Sorry you're feeling so awful. I felt terrible when I first woke up from surgery and had a lot of feelings of regret. I was lucky enough to be feeling much better by the next day, so I can only imagine how it would be to feel like that for 5 days. I'm not a doctor and I can't make any promises, but it is very, very unlikely you've messed up your body forever. You may take longer to heal than you hoped. You may have some complications that require additional treatment. But it is really rare to have serious complications, and even if you do, almost all complications can be fixed. I'm sure you picked a good surgeon who knows what he or she is doing. Have you contacted your surgeon's office? They want you to call if you're having problems. Maybe it will help to remember that you put a lot of thought into the decision to have this surgery. I'm sure you had good reasons for it. They say you shouldn't make decisions when you're in a heightened emotional state -- like being in a lot of pain, as you are now. Trust the decision you made when you were clear-headed and not clouded by pain. You'll get back to that point again and this awful time will just be a blip in your memory. I hope you feel better soon!
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Have I ruined my pre-op diet irrevocably?
BigSue replied to MoominMan's topic in PRE-Operation Weight Loss Surgery Q&A
You’ll probably be ok if you stick to the liver-shrinking diet 100% from here on out. Keep in mind that the purpose of the pre-op diet is to make the surgery safer for you. I’ve heard that some surgeons will close you back up without doing the surgery if your liver is too big when they start. That is very rare, and I’m not saying this to scare you, but it is something to take seriously — as are all of the instructions from your surgeon. The post-op diet is really restrictive, too, and you won’t be able to eat fast food for a long time after surgery (and you might not be able to eat certain things ever again without getting sick). If you eat things you’re not supposed to while your stomach is still healing, it could cause serious complications. It’s hard, but so important to go into this fully committed to following your surgeon’s instructions. -
Revision surgery done 5/28/20
336erica replied to New me version 2.0's topic in Revision Weight Loss Surgery Forums (NEW!)
Did your insurance require you to go back through 6 months nutrition? I had my lapband removed 2016 due to complications andI now want to get Gastric. Hoping not to have to wait 6 months like before. -
The Forum Rules and Guidelines state: Disrespectful and Hurtful Posts are Forbidden In addition, “bashing” of individuals is prohibited. This includes, but is not limited to, statements that a person is: Lazy for choosing one type of weight loss surgery over another Unprepared for or undeserving of weight loss surgery because of Deserving of complications or disappointing weight loss because of their choice of weight loss surgery This tread is now frozen.
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How much guidance are you receiving before bypass surgery
BigSue replied to Myturn4me's topic in Gastric Bypass Surgery Forums
My program requires a weight loss surgery seminar (general information about WLS), a one-on-one nutrition consultation with their dietitian, and a group nutrition class (general nutrition information and some info about the post-surgery diet). I also had a 3-month medically-supervised weight loss requirement from my insurance company, which was with my PCP, who did not provide any guidance other than "eat less and exercise more." A couple of weeks before my surgery, I had to attend what they called a "consent class," where they went over all of the possible complications of surgery plus detailed pre-op and post-op instructions. Most of the information from the classes is included in the bariatric patient manual for my program. Does your surgeon have something like this? I think most programs do. If yours doesn't, you can search for manuals from other programs to get an idea, although every program varies a bit and you'll need to follow your own surgeon's instructions. You could call your surgeon's office and ask them if they have a document like this. There is a lot of information online about post-surgery meal planning and recipes (check out https://www.bariatriceating.com/blogs/recipes and http://theworldaccordingtoeggface.blogspot.com/). There are a lot of videos on YouTube about bariatric meal preparation, as well as people telling their personal WLS stories. Pain can vary a lot from patient to patient, but I can tell you I had very little pain. The first day, when I woke up from surgery, I was in a lot of pain that I'm pretty sure was gas pain, but that went away very quickly, within 24 hours. I haven't felt any pain from the incisions. For the first few days, I had a little internal discomfort when I consumed fluids. I was given Toradol for pain while I was in the hospital, and I was sent home with several prescriptions, including hydrocodone + acetaminophen for pain (which I didn't take at all, and I didn't even feel the need to take regular Tylenol), ondansetron (Zofran) for nausea, and hyoscyamine for cramps/spasms. I haven't needed any of it after the first few days.