I am furious with my surgeon at the moment... This is NOT my fault!

[Daydra 345]

This is likely to be long... and more accurately a vent or a rant than anything else, probably.

I had my (about 3 month) followup with my surgeon today and I am spitting mad! About 5 weeks in I had some nausea, which resulted in me averaging less than 700 cal/day (don't have my charts on hand to give an exact #) for about 3 weeks. For me, that was too low and resulted in an extreme lack of energy, nearly passing out, I thought I was extremely dehydrated, and long story long... I ended up in the ER trying to figure out if something was really wrong. Turned out to be no big deal, and all I needed was stronger anti-nausea meds, fortunately. Unfortunately, as soon as I was able to eat at my prescribed calorie level, I gained 10 pounds within just a few days, and now, 4 1/2 weeks later, my net loss is only about 1/2 a pound.

I've done some reading on what happens when a person is subject to starvation or semi-starvation and then is able to re-feed. In the simplest terms, the body pretty much thinks it better hang onto every bit of energy it can in case there is another "famine" around the corner. One thing I read stated that in a fairly short period of some level of starvation, one can expect the body to take up to 3 weeks to stabilize. Now that I'm at about 4.5 weeks from beginning to eat more appropriately and feel like my body is still not normalizing, I'm looking for more information on exactly what's happening, so I can figure out what to expect and how best to support myself and my system while it adjusts. This is the same kind of thing I always do when I encounter a problem... A big part of my identity (and career, in fact) is in problem solving. Nearly everyone within my sphere of influence comes to me for answers and advice. I encounter a problem, work to understand it, decide what I think is the best course of action, and then implement it and see if or what adjustments need to be made. Not really any different from anyone else, but I work really hard to figure things out and come up with good solutions and I'm pretty well recognized and trusted among my friends (all well-educated professionals) as having a talent for it. So that's the background...

When my surgeon walked in and asked how I was doing, I admitted to being frustrated since getting the nausea worked out a month ago. I explained what had happened with my weight. I told her that I documented over the last 2 weeks (just the duration of the report I ran) that I had been running about a 1200 cal/day deficit and didn't really understand why my body wasn't responding. She stopped me and asked me what that meant (I think now because she didn't think I knew what that meant). I told her that I use a bodybugg (sophisticated body monitor that measures caloric output)... before I even had a chance to finish my first sentence, she cut me off and told me that I couldn't go by the information that a bodybugg gives me, and I can't use it to decide how many calories I should be eating. I tried to explain to her that was not how I use it. That I've been eating an average of 1100 cal/day over the last week (again, just the length of report I ran), which is still 200 cal below what the nutritionist in her office directed me to eat. I told her that I simply compare what I eat to what I burn to get an idea of what I should expect from my body. I explained that I have used this method to great success (115 pounds) within even the last 4 years and my experience with it has been that it was exceptionally accurate and reliable for me in the past (measurements proved to be accurate right up until surgery). So, sometime between right before surgery and now, I went from being able to eat about 2400 calories/day (without any significant exercise) without gaining weight to not being able to lose at less than 1/2 that. That tells me that there has been some significant change very recently and warrants some consideration and perhaps investigation, but did not trigger any reconsideration of her stance, no thought or discussion toward figuring out why my body isn't responding as expected. She got defensive and said "Well it's not working for you now, is it?" That was pretty much where I determined that I would be unlikely to take any further advice from her on this particular topic...(talented surgeon, but this is complete b.s.) She asked me if I was measuring my food. I replied I was. She then tested me, and asked me if I owned a food scale (So, what? I'm lying to her now? I told her I was measuring my food, of course I own a scale! 2, in fact! And GASP! I use them.). She then said that maybe 1100 calories was too much for me. (I'll note here that I'm about 5'9" and have a very large build for a female. I have had a weight loss doctor tell me that I had the largest bone structure any woman he had ever treated. I'm also naturally muscular and athletic. I have never had any trouble burning calories. I have always been successful in losing weight when I was able to maintain an intake lower than my expenditure. My issue seemed to be in the amount of effort it took to do that when I felt like I constantly needed to eat. At some point, I would get tired of it and give up.) She stated that I could drop down to 800 cal/day and still preserve my muscle mass, but I would have to exercise rigorously at the same time, and make sure that I "resisted the temptation to increase my calories with the increase in activity". (I'll note here that an average of under 700 calories with no exercise put me into a state of such low energy that I needed to go to the emergency room. I don't think a hundred or even 200 or 300 more than what put me in the ER would be healthy for me considering it would be combined with an extra burn of approximately 400-600 cal.) Thank you, I will pass. She then went on to say that I can't expect my body to fall in line with "normal people" because I'm a morbidly obese patient and "they" have different metabolisms than "normal people". I bet you're pissed now, too... That's all fine and good. She's right in that there is a lot of research and studies on the metabolic hormone differences in morbidly obese people in comparison to normal weight people. However, she's doing the exact same thing as lots of doctors do that is completely unfair... she's responding to me based on her stereotype of an "obese patient". There are many hormones that have been discovered that play critical roles in metabolic function. They interact with each other and their respective receptors to give the brain the "right" signals. There are about a million places where this system can have a glitch, a breakdown, or simply function sub-optimally so to imply that all obese patients are the same is just as much garbage as saying that all people are the same. That was the "easy" answer, and completely unhelpful.

At this point, I'm furious. I really couldn't go any further with her and just pretended I was accepting what she was telling me. I redirected her and told her that I really just wanted to understand exactly what was happening with my body right now, and asked her if she could recommend some resources and references for me to read. She suggested "Wheatbelly", and "Fat, Sugar, Salt". Seriously?!?! I ask for some educational information on the function of metabolism and my doctor suggests that I read a couple books on the evils of specific foods and additives in our diets? Sorry, doc. Not. Good. Enough. Pissed really doesn't even begin to explain how I was feeling. My concerns had been dismissed as something I must be at fault for, or lying about, because I must be a non-compliant patient, and when I asked for more information I was directed to dramatized crap, not educational sources. Angry. Hurt. Frustrated. Feeling like I'm still fighting the "Fat person" stereotype in a place where I should feel safe from that.

So... my next steps: Discuss this with my PCP on Monday during my appointment. I think I'm going to look into some metabolic testing to figure out what exactly is going on right now. I may discuss a referral to an endocrinologist to see if some information can be gained by digging a little deeper into my metabolic hormones. And, of course, keep reading articles and looking for books that can give me some understanding (I've got some stuff lined up I found with Google Scholar that I haven't worked my way through yet, and I have a couple college textbooks on metabolism and nutrition that I need to work my way through still). Ultimately, I may have to do what I've always done: figure it out for myself.

Full disclosure: I do recognize that it may be too early to worry. I very well may just still need to wait a little longer for stabilization. This doctor appointment just whipped up every instinct of determination to "solve" this that I have. Nothing like pissing me off to get me to throw everything I have at a problem... While I'm angry, I'm not panicking, nor am I feeling any despair. I know that I will get it figured out and all will be well once I do. I'm really not feeling overly emotional or depressed or anything over this, so fear not, caring VST circle of friends, I'm totally fine.

Thanks all for reading! I think if you made it all the way to the end, you deserve a medal!!! :-) Since I'm fresh out of medals, how about pictures of baby otters instead!

All together now... "AWWWWW..."

http://www.huffingtonpost.com/2012/03/08/painfully-adorable-baby-o_n_1332519.html

Hope you all are having a good night and I wish you all good luck and success!

[ElginChris 87]

I read your post and kind if wonder why you arent just working your program and getting healthy !!

Your body just went through major surgery, it takes time to heal, time to stabilize and you are basically ignoring the advice of a professional whom you chose, who hopefully has a proven track record of success, and has a lot more experience at this process than you?

You have been given a chance to restart your life again, at least in terms of nutrition and possibly body weight.

[ElginChris 87]

Sorry sent it before i was done.

Since you have this wonderful opportunity to restart, why are you basing your diet/nutrition on your old philosophies that really only assisted you enough to maintain a weight that you felt the need to have WLS?

Work the program, lose some weight, get healthier. You will have plenty of time to figure out your diet as you go,

This isnt meant to be a flame... I just think you are wasting a great opportunity to improve your health...

[Bkind2u 48]

Hi Daydra, I totally "feel" you. I agree with your assessment as you described, and have had some similar issues due to yo yo dieting/binging for years and my age slowing down weight loss. One thing I wanted to mention is that surgeons become surgeons because they like to go for the quick fix. I don't think many surgeons are interested in exploring other options as to why a body isn't functioning optimally. It sounds to me that you are your best resource. An endocrinologist is helpful to order and interpret hormonal tests, but again I don't see them giving you the answers and guidance you are looking for. I did see a kinesiologist who was also a holistic practitioner and he really knew his stuff. Over the years I have used both western and eastern type practitioners, and have found the eastern type to be much more whole body oriented. Western medicine has become more specialty oriented, to the great detriment of the patient in my opinion. Good luck to you, and keep posting how your Quest is going. I am very interested in hearing how you do and what you find out.

[SeriouslyChange 319]

I read the beginning of your post and then skimmed the rest since it's long and I'm tired.

Back in high school, I was an avid Water faster. I have gone 14+ days on Water alone. I am not justifying what your surgeon said at all, but just know that it is possible to not eat anything and not end up in the ER. Also, if you jumped right back up from under 700 calories to 1100, your body will gain. Had you taken a more gradual increase of say 100 cals per day, it would not have come back so quickly.

I'm sure that everything will level off for you and you will be okay. You seem to be on track other than this small bump, and you will fall back in place quickly.

[Butterthebean 8,146]

Jeez I read that whole thing.

Whatever else you do, get your BMR tested. That's the one thing you mentioned that makes sense. With that information you do not have to guess any longer. Your BMR test results will tell you exactly how many calories you're burning.

The problem with the fit bit/body bug devices is they estimate your calorie burn based in non sleever information. Everything changed the day you got sleeved. It has been well documented the metabolic "reset" that VSG causes....and they are still not 100% sure how and why. But such things as diabetics being able to go off meds immediately even before they lose the weight...these instances happen frequently.

Point is what worked before sleeve doesn't necessarily work the same way now. Also, curious about your hospitalization. Was it lack of calories or lack of hydration? Cause most people suffer from dehydration immediately after surgery, but lack of calories does not usually cause problems. Our bodies will happily burn fat at that point. But even drinking the 64 oz of Water maynot be enough for someone like you with a large athletic frame. It's not for me. I drink double that. It's always a shock to people how much of our daily Water needs are obtained through food prior to surgery. After surgery, that's no longer the case which is why they push us to drink so much.

[Arts137 1,811]

unrelated to your weight and weightloss. Consider working with a more supportive team. I know I do better when I see my struggle as a poartnership with the professionals, and I would not feel so with this one...

[Camella 209]

You are basing your research on the fact that you have gained weight as a consequence of increasing caloric intake. This makes perfect sense, however we all know that our VSG journey is by no means a journey without obstacles, stalls and hiccups along the way. It could be possible that your body is just holding on to some extra calories as a consequence of your calories being too low or it could be some type of stall that has coincided with change in diet. I have been struggling with stalls each time I increase exercise. Unfortunately this journey is different for everyone and even the most prudent surgeons struggle to provide individualized advice. I am 5"1 and my doc has suggested that I shouldn't eat more than 900 cals per day (from now to eternity). Had I consumed the same calories without surgery I dare say that I would have been bordering on an eating disorder. As the others have mentioned - this surgery changes everything. Just be patient, maybe you just need to tweak a few things here and there. My best advice would be to follow your program - stop when you are full and don't eat outside designated Snacks and meals. I hope that helps and I really understand your frustration.

[M2G 1,836]

Okay, thanks for the otter babies (WAY too cute and my daughter loves them so I will share with her.)

Yep, your metabolism has been altered by having surgery and while I don't pretend to understand the science behind it, I realize that I will be eating lower calories for probably the rest of my life unless I want to gain weight. I have experimented with calories from the very beginning and my surgeon is like "why are you counting calories...just count Protein grams, that is all I care about" which I understand and appreciate. BUT most of his patients are coming from a lifetime of frustration when it comes to the word CALORIE. So they are fed up with counting calories and I think he tries to provide an easy system to help them keep track but not obsess over calories.

I think part of your frustration is the way you were treated by your dr. I think that would irritate me too. Don't talk to me like I'm a 2 year old who needs a time out. BUT, on the other hand, I sense that another piece of your frustration is the fact that you aren't shedding pounds. I'm not exactly clear about why you were taken to the ER, usually as Butter said, low calorie doesn't equal a trip to the ER, your body just happily burns your excess stored fat. So you thought it was dehydration but wasn't? Usually the dehydration DOES equal a trip to the ER. Anyway, sorry if I didn't catch exactly what happened there. But after the ER you gained +10lbs and have slowly chipped away at that which brings you to the present where you are net -2lbs after the ER +10 GAIN?

Mentally we ALL KNOW that we aren't going to lose weight overnight, but in all honesty who here DOESN'T want the extra pounds gone immediately? I knew going into this that it would be a journey, I knew all my extra weight wouldn't immediately disappear but that didn't stop me from wanting it too. Please give yourself time and take a breather. Your body is still in healing mode. You are not quite 3 months out from major surgery, sounds like you had a hiccup (ER complication) and now you just need to mentally and physically hit the RESET button and work from where you ARE to where you want to BE.

Hang in there!

[LipstickLady 25,682]

It's my thought that you are working yourself up into a frustrated fury and while it's understandable emotionally, it's a tad premature.

You lost a ton of weight pre-op and that's going to slow your weight loss after. You are also approaching that three month stall period. I "only" lost 20 pounds pre-op and I hit my three month stall at about 2.5 months. It lasted 28 days and in that time I fluctuated up and down by about 5 pounds. In that month, I lost 3 pounds but my body size continued to shrink. I ran a few 5ks, hiked a LOT, got in ton of kickboxing and martial arts classes and added calories, decreased calories, starved, gorged... My body did what it wanted WHEN it wanted.

Like you, I tallied everything; calories consumed, estimated calories burned, carbs, fat, miles, steps. There was no reason that I was in a stall other than that I was.

As much as I love science and math (I was a math/sci teacher!), it's not always that cut and dry. Stress will cause you to gain weight or hold on to what you have. I suggest you just keep doing what you are doing, exercise comfortably, eat what is healthy and makes you feel "right" and tough it out. The scale will move in it's own time. You've accomplished GREAT things so far, you will get to where you want to be, I have no doubt.

[Shells_Almost_There 357]

Hang in there, Daydra! Definitely get your BMR tested and maybe even a full blood work up to see what's going on. I hope your PCP is patient, kind, and interested so that you can get some peace of mind during this frustrating time. Good luck!

[goirish78 100]

Hey there,

For whatever it's worth, I have two thoughts:

1) Give yourself a bit more time to have everything stabilize - you've really been through the mill lately, and it may just take a little longer to get back on track.

2) It sounds as though your surgeon isn't going to be a good partner for figuring out the ins and outs of whatever is going on; now that the surgery is finished, could you maybe just meet with the NUT and only see the surgeon for whatever post-ops are absolutely required? Personally, if I had had that interaction, I'd be shopping for a new doc.

Hang in there - things will get better!!

[RJ'S/beginning 5,358]

Wow..I read your post and all the replies......Well some Doctors are in it for money others are in it because it is their baby and they want to really help people who struggle with the disease. I found one that is very emotional about the whole thing and watches his patients like a worried father...That said..If you are not getting the support you need, go elsewhere!

Stop weighing yourself so much....I know you are an athlete but you still need to nurture your body. I worry about metabolism slowing down with less caloric intake....Being active is amazing and your a full fledged exerciser....Keep your mind on what you feel like...How your clothes fit and the fact that you are moving forward whether fast or slow. You are moving!

All the technical jabber is fine..But you know your body and are learning more and more about it every day....

I was at a surgeons office the other day and he said sorry..I don't know what WLS is.. I have never heard of it...dah!!! That is a man that would never understand anything related to the struggles we go through.....Right now you are struggling within yourself....

Remember that this is a lifetime journey and there will be gains and loses and stalls and what ever else the body can throw at us....

I weigh myself very seldom..Have not experienced a stall or gain yet...I have missed them all because I go by how I feel and the clothes sizes dropping...Our minds are set on numbers... Numbers mean nothing! How you feel, how you look. What are you able to accomplish...How your health is...Those are the priorities....

Over thinking is just that sometimes...Over thinking! Hope some of this makes sense! Always willing to hear your thoughts

[Forensikchic 528]

Everyone here is different but the commonality is that we are sleeved. I averaged 400-500 calories a day for the first 6 months or so. Its all I could eat. I never worried about it. I had good success and it did slow down after the first three months. My surgeon didnt worry about it either and they never pushed me to eat more calories. It gradually increased as I could hold more food. I was 100% successful in my weight loss and hit my goal at 13 months post op. The moral is.. do not make it your GOAL to eat a prescribed amount of calories. Shoot for as much Protein as possible 70-100 grams and that's it. No need to push it. You will not be as successful as you could be if you do that. I am shocked you can hold 1100 calories right now unless its high calorie Protein Shakes. I have a friend who is also sleeved and her doctor harps on her about not eating enough. I think its all BS. I think you should eat protein first and not worry about calories. Lets face it, If you are eating lean meat, cheese, etc.. good protein sources, there is no room in there for carby foods and junk or anything else really. You cannot really compare how you eat now to how you used to eat presleeved. Its totally different and your body is now totally different. If you get enough protein and hydration, you will not feel weak even if it seems impossible to live on that few of calories. I didnt purposefully eat so few. I ate protein and I could not hold much. I was so full I was nearly sick each time I ate. I only snacked on protein as well. I ate no bread or Pasta or rice because it filled me up with one or two bites and made me uncomfortable. Good luck to you and I think that you should try to stick to mostly protein and always eat the protein first. Dont worry about calories, only protein. The weight will come off as long as you are following that simple rule. Good luck to you! You can do this!

[Bronco0605 135]

I feel just like you. I am always doing battle with doctors. Yes, they are the professionals but they are not in my skin, or yours.