Making my way to the starting grid

[737captain 54]

Well, the time is now! After years of denial, "I'll start tomorrow", "it's the way I'm built, I have big bones" and all the other excuses it's time. I like beer and French fries and as a result of my job I'm constantly bombarded with fast food opportunities.

I'm a 62 year old, airline pilot and finally ready to take the plunge. My wife and I attended a seminar earlier this week and we are currently seeking insurance approval.

I have lots of questions but the first is this. I have the surgery, time goes on and I get a steady weight loss and eventually reach my target weight. How do I maintain that weight and not continue to shed pounds until I'm a skeleton chewing on a small cube of steak? With the band I see that the fill can be adjusted but what happens with the sleeve?

[Inner Surfer Girl 12,015]

Welcome aboard, captain! Buckle your seatbelt, you are in for quite an adventure!

I was sleeved April 20 of this year and couldn't be happier with my recovery and progress. I've lost over 150 pounds from my highest weight and just had my six-month follow-up.

I have a lot to lose still so can't answer your question from first-hand experience, but from everything I have learned, it seems our bodies are pretty good at finding a weight that it wants. There are folks who are on this forum who have been maintaining their weight for a long time who can give you more insight.

As someone who is new to the process, I recommend you learn as much as you can, read a lot, ask lots of questions, and take notes. My program gave me a binder full of information that was invaluable for collecting all kinds of information. It became my bible. Especially, immediately before and after surgery.

What I have learned so far that works well for me is to:

Focus on Protein and fluids. My target is at least 100 grams of Protein and 64 oz fluid/water a day.

Take all of my Vitamins and supplements as instructed.

Avoid (for the most part) starches (like rice, Pasta, potatoes, etc.).

And

Exercise.

Participating on this forum is a great way to learn.

Best of luck with your journey. I wish you all the best. Keep us posted on how you are doing.

[The Candidate 3,215]

Congrats on your weight loss surgery decision and best of luck!

[RickM 1,747]

Welcome aboard, Captain, and enjoy the flight. Generally, we have little problem overshooting the mark on our weight goals with the sleeve; indeed the more common problem is to fall short of the goal, though as a guy with a low/moderate BMI, rapid loss is more common. The typical loss pattern is for declining loss as we progress, since we have less excess mass to move around and that burns fewer calories (think of having to retrim to maintain altitude as your fuel burns off.) Occasionally someone will get over-hyped on exercise, working toward marathon goals or the like and will experience stable or increasing loss as they progress, but they are the exception.

Assuming a nominal sleeve (one without defects like a stricture or twist that blocks things up,) after things are fully healed and flowing smoothly (a few months' time) it is fairly easy to adjust our diet to meet our needs. The restriction that we get varies with the composition of the food that we eat. Your basic meats will still be fairly restricted, 3 ounces, give or take an ounce or so, as the pyloric valve in the bottom of the stomach closes up to let the stomach process it. However, there are lots of "slider" foods out there that require minimal stomach processing and slide on through with little restriction; unfortunately, most junk food fits into that category, but so do a lot of good things like fruits and many vegetables.

Drinking calories, using "meat lube" (gravies and sauces) along with slider foods can be used, in the negative sense, to "eat around your sleeve" or in the positive sense to help you get in the calories and nutrition that you need to be stable. These are variables that we learn to play with attain stability. Given that our sleeves mature to be of similar size, (there's variations depending upon surgical technique, starting point of the patient, etc., but we are all much smaller there than we started out at,) some people will wind up maintaining at 1000-1200 calories, while others will be at 2000 or more, and anywhere in between. Yet these variations can be accommodated by how we adapt our eating technique. As a reference, I can eat about 4 oz of meat if that's all I have, but cut that back to 2 oz and thrown into a salad, that salad can be around 10 oz and often pushing 500 calories (quite a bit of avo and some cheese in there boosting that count, and I could easily make it more caloric if I were so inclined.)

Isolating other variables, as a tall guy, your stomach is typically longer than average to start with, which leads to a longer and overall larger stomach capacity once the surgery is complete and things have healed, so you will likely be able to eat somewhat more than average. Compensating some is that your metabolism is likely higher than average, and will remain above average.

In short, overshooting the mark for any length of time is rare with the sleeve (more common with the DS if they get a substantial mismatch between the malabsorption part and the patient's metabolism.) Typically the only time we see such problems are when the patient develops an eating disorder where they are so afraid of regain that they can't stop dieting - but that's a psych issue rather than a physiological one.

Enjoy the ride an please remain seated until the captain brings the plane to a screeching stop at the terminal.

[Bdunee 6]

Inner Surfer Girl ????Thank you, you really broke it down to simple advice. Merci!

[Inner Surfer Girl 12,015]

Thanks!

I edited my response above because I left out the 64 oz Water.

[737captain 54]

Terrific response - thanks for all the information!

[BLERDgirl 6,417]

Welcome! Once you reach maintenance you should work with your nutritionist to increase your calories to a level that allows you to maintain as opposed to lose.

[737captain 54]

Rick,

You are very well informed, are you a medical professional? I notice too that you are reporting 5lb below your goal weight, when did you have your surgery and how long since you reached your goal?

By the way thanks so much for taking the time to provide such insight and explanation, it's a great help.

[RickM 1,747]

No, not a med pro, (was actually in aircraft structures for a while, before moving over to the aircraft-as-targets end of the business,) but have been at the WLS game for a while. My wife had a DS about 10.5 years ago, while I had my VSG about 4.5 years ago. Even after living an effective WLS maintenance life for several years with her (I lost about a third of my excess weight in the "let's see what we can do without surgery" phase, and keeping it off for 5-6 years (hence the decision to go with the VSG rather than the more powerful DS), I still didn't fully appreciate how sensitive we can be to different foods and food compositions - things that don't really matter when you have a normal, full sized stomach. It's somewhat like understanding what sex is like before you experience it. Your concerns about over-doing the loss is an understandable one, and particularly common amongst those of us starting in the lower-to-middling BMI ranges (I was about 42 at surgery time.)

We also tend to put a premium on quality rather than quantity (have a really good prime steak rather than a merely "good" one, as we can't have all that much of it in the first place - the cost difference isn't that great; even with a restaurant meal, we usually get 2-3 meals our of one, so enjoy the good stuff when you can) One of your challenges is going to be travel food, which tends to be on the low quality, junky side, which challenges anybody's weight control. And, if you are always on the move and not able to save those doggy bags from the good places, it tends to reinforce the desire to go cheap and not waste the good stuff. As your diet evolves as you lose and move toward maintaining things, you will devise a strategy that works for your lifestyle, with some combination of foods that are high density nutritionally that are readily available in your travels possibly along with some portable take-along items (like some high-quality Protein bars to fill in as needed between formal meals, perhaps?)

[737captain 54]

Thanks a million Rick

[737captain 54]

At the moment I tend to sweat at the drop of a hat. Admittedly I live in a warm humid part of the country which obviously doesn't help but I was wondering just how much excess weight exacerbates the problem and can I expect relief at least in part down the road.

In addition I get out of breath very easily so I of course avoid any hint of exercise like the plague. I'm in the "Fitness Protection Program" you will hear my say. I was in the store the other day and lifted a 50lb bag of dog food and realized I carry two of those around with me 24/7 no wonder I get winded. So I guess it's time to come out of the fat closet and into the gym.

[Dub 9,922]

Outstanding information @@rickm

I really appreciate your insight here.

@@737captain you really drove home a point with the dog food observation. Just before my sleeve & umbilical hernia repair surgery, I went out and stocked up the house on stuff......frozen foods and staples for my family and two huge bags of dog food for our two dogs. I distinctly remember walking out of the veterinarian's office with those big bags thinking that I had been "wearing" the equivalent to 4 of them for too dang long.

I understand your questions about "overshooting" your goal. I had the same questions. I think that RickM really laid it out nicely.

I'm looking forward to the lean days ahead.......

[RickM 1,747]

At the moment I tend to sweat at the drop of a hat. Admittedly I live in a warm humid part of the country which obviously doesn't help but I was wondering just how much excess weight exacerbates the problem and can I expect relief at least in part down the road.

In addition I get out of breath very easily so I of course avoid any hint of exercise like the plague. I'm in the "Fitness Protection Program" you will hear my say. I was in the store the other day and lifted a 50lb bag of dog food and realized I carry two of those around with me 24/7 no wonder I get winded. So I guess it's time to come out of the fat closet and into the gym.

Quite a bit of it, if not most, is the excess weight. In So Cal where I am, we are as warm as anywhere, though without a lot of the humidity (usually.) I haven't needed to use deoderants, etc., since I had plastics and he cut up into the pits and got out of the habit, and never found a need to go back. I perspire minimally when I do my strength training routine at the gym, though my heaviest work is usually swimming which takes care of itself in that regard. But for daily life, it's a non-issue.

Somewhere around the third month I noticed that the shoreline walk (as fast I could go without breaking into a jog or run - knees still aren't going there!) that used to get my pulse up into the130-140 range was barely getting me over 100. Since then, I've needed to head to the hills to get the system working to any degree.

Having cardiovascular and cooling systems with 50% excess capacity is a useful thing now!