I should point out I'm like a 24 right now  -- not an 18.  Size 18 is where I look the most out of proportion. I have some pretty funny photos at that size.

Bleeping autocorrect! Surging= withold

I did my marathon pre-op day yesterday, and It was quite interesting.  My husband works across the street from the hospital; so, he dropped me off at 8:00am.  We left at 6:30pm. 

I started out doing my fasting labs after which I went and pre-paid my bill.  I had 1 1/2 hours to wait; so, I went to the cafe for tea and a protein shake.   I relaxed, watched a movie on neflix on my phone (yeah, iPhone), and then headed off to nutrition and 'pre-op' class at 10:45. 

Class was with the NUT was interesting. There were 16 of us, 12 of whom (I think) are having surgery the same day (bands & sleeves).  The bypasses are done a different day.  Much of the 'class' was the same information as the online class we were required to complete before hand; however, it was good to be able to ask questions.  We got our binders with the detailed surgical information and diet progression. The head nurse came in after the NUT and explained how to wash, our blood clot prevention techniques, what to do and where to go on surgery day, etc.  

Some points of interest:

1) if you're struggling getting fluids in, they would prefer you skip a meal and drink a shake so that you can continue sipping instead of waiting an hour.

2) the reason for all the dairy (2 servings per day)  is that calcium inhibits fat storage in the body and actually destroys fat cells.

3) We all got protein goals.  Mine is 63-78g per day (no more, no less) based on my petite (read that as short)  stature.

4) Worry about protein, carbs will take care of themselves.

We went from class to the Surgeon's office to pay our bills (co-pay or full-pay), for our pre-op physical with the doctor, metabolic testing, body composition testing, and a group consult with the exercise physiologist explaining our results.  It was a long afternoon with a lot of move here, now there, and so on.  It was interesting, however.  

My surgeon answered my questions although I got a 'look' when I asked if lack of ghrelin impairs learning (as suggested in one study I read) and possibly cognitive function. He said that's been suggested by some but questionable.  I also  found out my soon-to-be bougie size (36fr).  The doc indicated that should leave me with a 3oz protein capacity.  I was told to keep on my diet and continue exercising.  OK then...

With the exercise physiologist,  I found out my Resting-Metabolic-Rate (1843 Kcal), and that I'm carrying 117lbs of lean mass (sounds great until you figure I'm still 50+% fat).  I'm going to lose lean mass, but the physiologist suggested as long as I stay above105lbs of lean mass, I should maintain my metabolism.

Of the 16 total, 4 were RNY, 6 bands, 6 sleeves. In the waiting room, the Medicare patients having RNY and the band all would have preferred the sleeve.  One of the band patients got really pissed-off by the 'why did you choose the sleeve' discussion we were having with a 1-month post-op sleever (who coincidently lives very close to me) who was raving about the procedure while waiting for her a follow-up appointment. 

That was my last pre-op step along the way to the loser's bench.  My hospital arrival time is 10:00am; so, I'm 4th or 5th in line.  I'm pretty happy with that, lol. 

I looked at one study not long ago that tracked  thyroid meds along with diabetes aind BP meds post-op to WLS (maybe the sleeve specifically, I can't remember), and it showed little to no reduction in thyroid meds. I'll have to find it. 

My understanding is that as you lose weight, you need less T4 which converts to T3, the active hormone, in you body.  Having said that, if you already have a deficit it doesn't go away.  The thyroid just excretes less T4 and you still have to supplement (albeit less, potentially). 

I'm on a replacment dose because I don't have a working thyroid anymore. Mine will have to be checked and possibly adjusted down every 8 weeks as a I lose weight or else I'll become hyperthyroid since all of my T4 is synthetic.  Even so, I'm at .224mg/day right now. I probably won't go much lower than .175 which is about as low as I've ever taken.

I'm sure one of the RN's can weigh in here. I don't want to sound like thyroid be-all, end-all.  I've just lived with major thyroid and thyroid related disorders for most of my adult life and had to do a lot of the research before ye ol' internet made the studies available, etc. 

Per my booklet from my surgeon, the danger of blood clots peaks at 4-6 weeks post op then drops off rapidly.   I hope that helps. 

I attended a support group last week with a lot of pre-op (various stages) sleevers or potential sleevers.  My surgeon made an interesting statement in response to a question about stretching the pouch. 

To paraphrase:

He said you can't rely on restriction.  The portion of the stomach being removed is relatively elastic.  The portion remaining is not.  If it stretches, it won't shrink.   The key is not to think of the sleeve as a restrictive procedure so much as a grehlin production removal procedure.  You can stretch or eat around restriction, It's the lifestyle change of eating small measured portions, not drinking while eating, etc.,  that causes you to lose weight and maintain.  The removal of ghrelin and the associated hunger that makes that all possible. 

I thought this was an interesting set of observations and way to look at the sleeve.

Way to go!  Looking great!

I'm taking 1 week off and plan to telecommute for a week after that.  If I have to, I will telecommute longer, but I'd rather get back to work because I tend to get up and move around more in the plant than I do when I'm working from home.   My big concern is my commute -- 60 miles each way. 

I signed up for it pre-op but only some of the site is functional until you have your surgery.  It has settings to allow your surgeon's staff to see your progress, etc.

I'm down 24lbs pre-op.  Here's how I did it:

Nov 8-Dec 26: Atkins induction (20g net carb/day or less @around 1200 cal/day): 10lbs

Dec 27 - January 13: Surgeon's pre-op Stage 1 diet - cut back on saturated fat & calories, added dairy 2x daily (greek yogurt)  kept carbs less than 30g (net) per day and cut caloriesdown to around 850 cal/day.: 14lbs  (just as a note, i ate a lot of almonds -- at least 1 1/2 ounces a day)
 
I started liquids today, and If i follow it precisely, it's almost no fat, 110g protein a day, and about 39 carbs (from dairy). I'm going to be at about 600 calories today.  I'm a bit concerned that I won't have enough fat for the fat soluble vitamins since my protien supplements (Isopure/Cytomax) have almost none. I may eat some 1% yogurt instead of fat free. They want me down another 5lbs or so  before my pre-op visit on Wed!  My surgeon insists that protein come from whey isolate, only.

I exercise daily, increasing duration by 10 minutes (daily) each week.  This week I'm at 60+ minutes a day. I'm taking 2 multivitamins a day, CoQ-10 and Benefiber 3x daily.  That's all part of my surgeon's preop program.

Hope that helps.  I wasn't hungry until today.

Wii Fit Plus provides a pretty good moderate workout.  It's limitations are you can't do any one exercise for all that long and I have yet figured out how to pause an exercise.  

Best of luck to you, as well!  I'll be thinking of you, and I'm very interested to hear how it all goes. 

Went to a support group tonight, and my surgeon explained that the reason the 'investigational' denial still comes up is that the ASMBS initial came out with a statement several years ago that said it was an investigational procedure for people with BMI's under 50 and essentially shot themselves in the foot.