Sore and achy- 9 weeks post op VSG- is this normal?

[SecretAgentDD 49]

Hi All...having some strange post surgery happenings and wondering what is normal.

Let me first say that I do walk pretty briskly for an hour 5 days per week and I also swim laps 5 times per week for an hour. So, I am getting A LOT of quality movement on top of general stretching, etc. I am about 9 weeks post op for VSG and everything is SORE. My knees are killing me, my back, my legs, my arms..you get my point. Weeks 4-6 I was insanely tired and that has gotten better but now I have this new problem. I don't know if it's just because I'm existing in this calorie deficit or what. (?) I'm at about 900 calories per day and have been told to keep it there until I hit goal. I am getting about 80 grams of Protein per day. I am very good about taking my Vitamins. On top of the Multi-Vitamin, I take Calcium, magnesium, tryptophan (for sleep), stool softener, ursodiol (gall bladder).

Where I am not doing quite as well is Water. Some days I am good with water, but I'd say about 50-60 oz of water might be my usual intake. I have a job where I drive a lot and I am not near a bathroom, so that's a problem I have to be careful about. There is still room for improvement there and I acknowledge it. I am working on it!

Is this achy/sore feeling normal? Has anyone else encountered this? I'm not against asking my surgeon's office, but they have not been overly helpful with my questions in the past. It feels like I get dismissed by them and that has been very frustrating. I keep getting told "well you're not our normal patient" and then I feel like I am left to figure this all out on my own. It's lonely and frustrating. I'd like to do something to not be so sore, but this has been going on for about two weeks. Any thoughts?

[SpartanMaker 767]

I'm going to start with my obligatory recommendation to talk to your surgical team. There is a possibility your issues are complications due to surgery, or even other potential medical conditions. It's better to be safe than sorry and talking with a medical professional can help rule out some issues.

With that out of the way, I will give you my non-medical opinion just based on what you posted.

Again, just based on what you wrote, it is possible that what you're experiencing is related to the volume of exercise and your low calorie intake. While it's not exactly the same, this is similar to something we call RED-S (Relative Energy Deficiency in Sport). Feel free to Google that to get an idea of what I'm talking about. Both in the case of RED-S, and what you're describing, it sounds to me like your body is telling you that you're overdoing things.

I love that you're being more active, but without properly fueling your body, you can actually cause some nasty problems (again, see RED-S). Keep in mind that your body actually only improves physically during recovery, which includes both proper rest and proper nutrition.

Dehydration can also exacerbate the problems your having. Plus, while dehydration can always be an issue for anyone, for someone so soon after bariatric surgery it can be really problematic. One of the most common reasons bariatric surgery patients end up back in the hospital is due to dehydration.

My advice would be to give yourself a down week from the exercise, which should do a couple of things. One, it will give your body a chance to recover some, which is a good thing. Two, it will help you know if this really is due to the volume of exercise and the incredibly low calorie intake. By the way, a down week, does not need to be a week completely off, Just stepping things down 25% to 35% is enough. For example, instead of walking 5 hours, shoot for 3 or 3.5. Do the same on your swimming.

Taking a down week like this around once a month is really common for even pro-level endurance athletes. I promise it's going to help and not hurt you in any way.

[ShoppGirl 4,776]

I would agree that it’s wise to contact your doctor but while waiting for your appointment you may as well work to rule out a few things. How many carbs are you having? Could it be Keto flu? Especially if you are burning all that you are eating you could be in ketosis on more carbs than someone who isn’t active. Less than 50g is what they say for ketosis for the average person but the more active you are the more carbs you can have and still achieve ketosis. Some very active people can be in ketosis on 200g of carbs, even. Maybe try adding some healthy carbs for a couple of exercise days and see if that helps alleviate your symptoms. Unless your team wants you in ketosis, in which case I guess you just have to kinda wait it out. My NP told me to increase my carbs because I am walking around 5-7 miles a day and I showed her my food log app and my activity app and she said you need to be eating more carbs and Protein as long as you keep up this level of activity. It kinda tough. Seems counter productive but I increased mine and I am still losing. I usually get them from vegetables and fruits so I get a variety of nutrients but I will add a small amount of brown rice (1/3 cup) to my dinner if my carbs are too low for the day. My calories went up a bit too but she said that was okay.

Edited September 29 by ShoppGirl

[Arabesque 7,221]

And I’m going to add another thing to consider: the impact of your lower weight on your skeletal frame, muscles and tendons. Your body changed how it held itself and your muscles and tendons worked to compensate for the weight you used to carry. Your centre of gravity will be changing too. You may notice your posture is different. Your physical structure is changing to support your smaller (& growing smaller) body. It’s like the aches you experience when you gain weight in reverse.

Pain in your knees, ankles, back, shoulders is pretty common as is losing your balance, slouching, or finding you swerve/lean in one direction or another as you walk as you continue to lose weight. I had upper back pain and I slouched (took ages to break that habit). I went to a good masseuse and ensured I had well fitting and supportive bras (which helped the upper back pain though had to keep buying new ones as my boobs shrank). I also tried to be more conscious of my posture whether sitting, standing or moving.

[ms.sss 15,561]

3 hours ago, Arabesque said:

And I’m going to add another thing to consider: the impact of your lower weight on your skeletal frame

this was what i first thought of as well.

my weird body pains showed up around 1 month post op: neck and shoulder pain, mid back pain, hip pain , elbow, ankle and heel pain. at the time i was told by my chiropractor (and google lol) that is was due to my changing centre of gravity and loss of padding (fat) when sitting or laying down which results in changes to your body's needs to hold itself up.

we wls patients lose weight so quickly and our skeletal and musculature makeup are playing catchup, hence the pain.

i was also told that slowing down weight loss helps (i.e., eat more).

for the record, i did not try to slow down my weight loss, ha!

my pain went away around 4-5 months post op if i recall (which was nearing the end of my rapid weight loss phase)

[SecretAgentDD 49]

Thanks everyone for the replies. I do absolutely think my skeleton is adjusting itself! I can tell when I am walking that things have definitely shifted and my balance has changed. I hadn’t considered this before, but it does feel almost like my bones are adjusting themselves.

I do have a check-in with my surgeon soon and will go over what I’m experiencing. We’ll see what she says.

I’ve also added in a small banana into my morning routine. I think both the carbs and the potassium are helping. I was sometimes getting leg cramps, which can be a sign on dehydration or lack of potassium.

I'm really good at watching my Protein, but not as good at making sure I’m getting much for carbs. I’m doing better this week with it. I do think my total carbs were wayyyy too low.