- HEALTH TRACKER
According to Dr. Roslin in the referenced article -
2) Sleeve and bypass patients with bmi’s of 35 to 40 will lose virtually all of their excess weight. Those 40 to 50 approximately 70 to 75% of excess weight. For those above 55, they will lose 50% of excess weight. This means if your BMI is greater than 55 you will lose approximately 15 bmi units and still have bmi of 40.
Obviously, these are averages, so there will be some who do better and some who do not so well than these numbers indicate; there's no harm at all in being above average!
Average loss the first week or so is even more variable than overall results as it is heavily influenced by pre-op weight loss (we tend to lose quickly initially whether from surgery or simple dieting and then slow down, so those who have been in diet mode prior to surgery may not see as big of a loss immediately after surgery than those who lost no weight pre-op.) Add to that variables in hospital treatment (lots of fluids pumped into us often causes major water weight gain in the hospital, that then drops off rapidly), starting weights (heavier people tend to lose more gross weight in any given time, but a lower percentage of excess weight), and simple individual variances.
Likewise, my program called for mushies/purees/soft proteins from the hospital on out (subject to individual tolerances.). With some twenty years of sleeve experience behind the program, I can't argue too much with their success. It may seem early relative to many of the programs that are based upon bypass protocols, but is fairly consistent with most programs based upon DS (sleeve plus intestinal rerouting) experience.
Avo is a good food to have in our diets, unfortunately their calories by virtue of their high fat content (but good monounsaturated fat!) limits the amount that we can sanely include in our diets during the loss phase. I had small amounts (like, 10-15 g) of avo in my salads from the first month on out. Now, in maintenance, the 80-100 cal of half of a smallish avo (50-60 g) is not a big problem, and it makes a decent contribution to our daily potassium intake, which is almost always a challenge.
If you are having regain issues with the VSG, a revision to an RNY will likely be of little help as it's regain character is similar to, if not somewhat worse than, the VSG. The linked article that was just published in the OH newsletter outlines the differences between the different WLS procedures, and why the RNY may not be your best solution:
In the article, Dr. Roslin's conclusion (and that of most surgeons who aren't tied to selling the RNY since that's the best that they can do,) is that the DS is the more obvious choice, both from the perspective of it starting out with a VSG and adding the malabsorptive component, and also that it just plain works better than the RNY, particularlys since the RNY's caloric malabsorption is only temporary.
Fortunately, you do have access to two of the best in the business in your area - Dr. Rabkin, who works out of San Francisco, but has an office and support group in Ventura (unfortunately, it was last night - first Wed of the month,) and there's Dr. Keshisian who works out of Glendale. On the cost front, Dr. Rabkin is out of network for most insurance plans (though his hospitals are in-network) but I don't know of what insurance affiliations Dr. Keshisian has (call and ask.) I have Aetna and they covered Dr. Rabkin's fee 100% as we had already hit the max out of pocket limit on the policy for that year, so that's another consideration.
Good luck, and research and consider options carefully. As is often the case, the short term cheapest route may not be the best or cheapest in the long term - I know of at least two local patients who are double-revisors - band to RNY to DS - which is something that you really want to avoid if at all possible.
Congrats! This is a great way of setting short term goals - something that we can control that leads us in the right direction towards our ultimate goal; as opposed to getting disappointed because one fell short of losing X pounds this month, which is something that we can only sorta-control.
I had little problem with liquids from the outset (unlike my wife who did have more liquid restriction when she went through this a few years ago. I could put away a bowl a broth (maybe 6 oz?) and a half cup of juice in a sitting in the hospital. The doc had no concern about it, as it was just normal variations between individuals. Once into more solid food over the next few days, the restriction was certainly there and the sleeve worked as advertised, and still does a couple years later.
In the hospital - yogurt, scrambled eggs, etc.
I started having small salads (including some leftover meat for protein,) by the end of the first month. I typically use chopped spinach instead of lettuce for the benefit of its' somewhat better nutritional profile. As usual, try new foods one at a time to test for tolerance.
I didn't control fat or carbs during the loss phase (just calories and protein,) but fats typically fell between 25 and 40 g per day. Now that I can afford more in maintenance, I aim for 60 g minimum to promote proper absorption of the fat soluble vitamins, under the advice of my RD.
The other factor is what the doctor uses as the basis for "normal" weight (above which anything is "excess weight") - it's usually somewhere around a BMI of 25 (the upper end of the "normal" range) but that can vary from doc to doc - my doc uses 24 in their reporting of EWL numbers. The basic math would be (starting weight - current weight)/(starting weight - normal or goal weight).
Another consideration on goal setting is more individual, as BMI numbers are good for population studies, but are less useful to individuals. If one is particularly muscular or light framed, their ideal weight may be higher or lower than what BMI may indicate - some people who are 5'2 should be 110 lb, while others of that height should be 150 lb based upon their body composition.(fat mass, lean mass, etc.)
I don't know anyone in the South Bay area, but in the region my choice would be Dr. Keshishian in Glendale. He is one of the few long time DS/sleeve docs in the region and one of the few in the country with the competence to take down a troublesome RNY and revise it to a DS, so is well experienced in various WLS complications. Had I not gone up to SF for my sleeve, he is the one in socal who I would have gone to. Also well regarded for troubleshooting WLS problems is Dr. Crookes at USC which is a bit closer to you, though he tends to be more of an RNY guy. Overall, I get a better feeling from Dr. K and know more people who are very pleased with him.
This is a very individual thing, both from the perspective of surgeons' plans and different patient needs. Some docs adopted the current low carb fashion while others have not, and we as individuals respond differently as well. Others here have noted the popular 40g limit while others don't strictly control carbs and do just as well. I had no max or min but was typically in the 70-100g range which worked well for me; later during the loss phase I strategically added more complex carbs to improve endurance. For most it is probably more important what the carbs are rather than how many there are - simple carbs (sugars, white flour products, etc.) are less useful and more likely to trigger cravings than complex carbs like fibrous vegetables and whole grains.
Generally, once the incisions have closed and healed - my doc's general instruction is three weeks for immersion, though I had one tempermental incision that continued weeping some a bit after that so it was four weeks for me. Then there is the issue of the intensity of exercise how far out, which also varies some from doc to doc; most docs say somewhere between four and twelve weeks for workouts of increasing intensity (and walking from the get-go.) Mostly, you want to avoid too much stress on the abdomen to avoid developing hernias at the incision points.
During the loss phase it was anywhere between 70 and 120, typically on the higher side later on as I needed more enduance energy; in maintenance it's normally anywhere between 120 and 200 though at the moment it's probably on the low side (haven't really checked it) as I'm really pushing the protein for surgical recovery from reconstruction.
I was having steak at 6 weeks - anything was permissible, as tolerated, after the first month. When my wife went through this a few years ago and was having problems with ground beef, her surgeon suggested that filet is often better tolerated. Another of those quality over quantity benefits of the sleeve!
I used oat bran and wheat bran and often added some to my yogurt along with a few raspberries. The oat bran is more carbs for the fiber, but a fair bit of protein as well, while the wheat bran is a bit more than 4g fiber for 6 carbs in 10g of bran, an amount that easily mixes into a half cup of yogurt. The corn bran is worth trying (I would have had I known about it back then) and if I can find a convenient supplier I may throw some into my waffle mix instead of the wheat or oat.
Liquids, purees, mushes and soft proteins progressing as tolerated for the first month (scrambled eggs and yogurt in the hospital,) followed by everything else as tolerated after the second month on. With twenty years of sleeve experience, it's hard to argue that he doesn't know a bit about the care and feeding of a sleeve.
I have one, which isn't particularly noticeable except to the docs; the inquinal hernia that I have (that's the 'turn your head and cough' one for you guys,) is symptomatic and both are getting repaired next week along with a TT. If you aren't feeling anything from it, and things aren't bulging out from it, then you should be fine until reconstruction time (as always, check with your doc on these things!) My wife had one after her WLS and it did periodically bulge out (best guess is that it got opened from some extreme coughing after it was weakened by the incision they put there in the surgery.)
You do have to be careful about some of those recipes as in their efforts to be low carb they can wind up being higher calorie than a regular recipe. When I was looking into making a cheesecake for our anniversary last year, and making it affordable, I looked at various sites like eggface, etc. and found that indeed most of them were more expensive than their normal counterparts. I wound up adapting a classic Joy of Cooking recipe and it came out at about 265 cal and 10g protein for a similar 1/12th serving (but higher carbs,) and it would have been close to 200 calories had I used the fake sweeteners instead of sugar.
There are a lot of good ways to make these treats occasionally affordable for us, though we do have to be careful and analyze the recipes that we find and decide if the compromises that they make for one reason or another are worthwhile - is it being low carb, low fat, low whatever, worth it being higher in calories if it works out that way.
Now if I could figure a way to make that white chocolate cheesecake from Death by Chocolate affordable!
It is certainly something to ask or discuss with him. Surgeons have different opinions and policies on it. With the VSG, my doc checks it when he is in there and removes it if he feels stones in it but otherwise usually leave it in, but with his DS patients he routinely removes it because if it does need to come out later he doesn't want some other surgeon getting confused with the altered DS anatomy in that region, which isn't an issue with the VSG. Some docs will do pre-op ultrasounds or other tests so that they can plan ahead of time. Some may use other criteria such as BMI or amount of weight to be lost to bias their decision. It's a risk/benefit tradeoff and each doc has his own approach to it.
Mine was fine at time of surgery and hasn't given any problems since.
Overall, the sleeve and bypass have very similar performance in weight loss and regain (with some indications that the sleeve may be somewhat better in the regain department, see below,) while the bypass is a lot more "expensive" in terms of lifestyle and medical treatment limitations. If I had needed something stronger than the sleeve for my problems, I would have gone with the DS which offers better overall weight loss and regain performance than either, at a side effect cost that is similar to, and in many respects less than, the RNY.
The other aspect of the RNY that is troubling to me is that surgically speaking, it is something of a dead end - if it isn't the right thing for you, it is very difficult to revise it into something better like the DS. There are minor tweaks that they can do to the RNY configuration to try to improve things - banding the pouch or tightening the stoma - but nothing that changes its' fundamental characteristic if that turns out to be incompatible with you. Revising to a DS is something for which only a handful of surgeons are genuinely qualified to do.
A useful presentation on the different characters of these procedures is here -
and it is well worth a look-over.
If you are not feeling any distress, then you should be fine. There is a wide variation in how we all respond to this procedure, how much inflammation we have after surgery, and how our pyloric valve passes liquids. I had no problem drinking (sip, sip, sipping, of course) a bowl of soup (6, maybe 8 ounces?) and a half cup of juice in one sitting in the hospital, while my wife, when she went through this a few years ago, could barely drink her nominal stomach size of shake in a sitting. Both were in the normal variations seen within the patient population according to our surgeon, so really nothing to worry about.
That's not a bad profile, depending upon the context in which it is used. It's not far off of the organic sprouted wheat bread that I used in sandwiches part way through my loss phase when I needed to add more complex carbs to the mix (somewhat lower in calories and protein, than what's posted, but I wasn't looking for its protein.) It wasn't any particular problem digesting it as part of a sandwich with other moistening components in it.
If your doc isn't concerned about it, there is little reason for you to be concerned about it, either. Some will adopt a low carb diet with various restrictions because they have specific medical needs for such treatment, or they may have some success with such diets in the past, while others simply see others doing it and want to be on the "in" diet. I couldn't afford the side effects of such diets, so I maintained as much of a balance as I could beyond my basic protein requirements, which meant that carbs were typically in the 80-100 g range early on, rising selectively into the 100-120 range later in the loss phase to keep up with my energy demands (but those were not target levels, but just how things shook out once the basic protein and calorie restrictions were met.)