A Sad Story.......

 

I recently had lunch with the person who actually took the time to talk to me about WLS and his recent VSG at the time. This was the first time I had heard of the VSG and it lead me down the road of the path I ended up choosing.

 

Fast forward 4+ years later...... the tables are turned...... he wanted to “pick my brain” 

 

The short story..... he went from about 400lbs. to 300lbs. now he is 400lbs.+

 

He admittedly doesn't eat right and not trying to fool anyone.

 

***Note: I chose a different bariatric program.

 

He claims it is hard because both his wife and daughter are obese and they were all on board at first, even talking about having surgery themselves, but than old habits overcame the household.

 

So, onto lunch...... I asked him.... how much can you eat? He said, about a normal small meal. 

 

So..... I said, I’m gonna order for you..... you like chicken? he said yes, so I ordered a roasted half chicken for him with the sides. I ordered a fried calamari appetizer for myself.

 

During our wait I explained “The Frisco” protein first/pyloric valve 101 thing to him..... he had heard of protein first but never learned about the pyloric valve function.

 

So, the food comes..... at this point he realizes this is an “experiment” and he is the case study. He is an open book and all for it and does not feel the least bit threatened cause were here for him.

 

So, I say...... eat nothing but chicken, no sides no drinking and start with the chicken breast and just eat like you normally do.......

 

I figured I’m gonna close and shut his pyloric valve and see what we got here..... he proceeds to eat the entire chicken breast...... at a nice slower than normie pace. He than starts on the leg.......

 

He see’s the way I’m eating and he said he used to eat like that “at first” but than gradually started eating more and more.

 

He finishes the leg and I ask him if he is “full”...... he say’s pretty much, but I could eat a little more. So I say go for it.... let’s see it cause were trying get a good sample of your capacity. He proceeds to eat the Mac&Cheese (don’t judge..... science goin on here) and some salad. I’m very curious at this point as he eats about 3-4oz. (volume) of the Mac&Cheese and a little salad and he says.... that’s about it.

 

Than he asks me how much I could eat..... I say about a third of the breast a few bites of salad and a bite or two of the Mac&Cheese........

 

Now the sad part....... he starts to change his tone.... and says, we definitely did not have the same surgery.

 

At this point I am truly at a loss...... I explain to him how 100 cals a day over his caloric balance point can be a 10lbs. a year weight gain and even with my much smaller capacity that I have to watch it and have had to reel in a few pounds several times over the past couple of years.

 

I’m not really sure what my next move with him is...... the truth is I’m a bit overwhelmed. He is basically like a normal obese person that faces extreme dieting. His only surgical option would be the added DS with a better eating plan in place.

 

I left very sad and it has been on my mind ever since. This is the guy that showed me the way to my VSG and the life I live today.

 

This guy went to a known practice here in the SF bay area, went to the support groups but it just didn’t work out......

 

If you don’t think sleeve size matters and your not thinking about long term eventual capacity......think what you may..... just think that you may be wrong also.....

 

Sure.... it’s what we do with it, and this guy didn’t do it correctly, but it seems that he could have used a stronger tool from the get go to at least have something to reel in....

 

frisco

That is very sad to hear!

That is very sad and very scary to me. The thoughts of regaining is terrifying to me. I'm only 4 weeks out, but I know I don't stick to my plan, it could be me! Thanks for sharing! And I will be praying for you and your friend.

I am sorry you are dealing with this, I know it is not easy to see people who came before us falter.  I have dealt with this quite a few times too and it's not much fun when you run out of answers.  Do you remember what Dr. C said to that man who came to our group from another surgeon with the same issues?  I can't remember if he advised him to have more surgery or to eat differently.  I would love to remember what he told him. 

I remember. First plan of attack was the food plan. After that, Dr. C said there MIGHT be some surgical options, but he would have to take that on an individual basis.

 

Thank you.  That would make sense. 

Very sad. I am sorry you are having to face this. Has to be gut wrenching.

I would also like to add or counter, however you want to view it, I do believe that surgical technique and overall sleeve construction have a great deal to do with long term capacity, too. As you know, my sleeve is a larger sleeve made with a 40f, but made tightly, over-sewn, and a true sleeve shape top to bottom. I have had my share of worries about my sleeve size. At almost 2 years out my capacity is stable. I do weigh and measure my food still, except when I'm out. I do very well on about the same portion you describe in your post: 2.5 - 3 ounces dense protein, a 1/4 or so of veggies and a few bites of a starch (if I even have one).

So, yes, size matters, but I think surgical technique and construction are equally, if not more important.

Yah..... I get that and should have mentioned the other component.....
larger sleeves have the "potential" of stretching out more than smaller ones. DrC has mentioned this as his findings and it has been very true on what We've seen from the bigger eaters here.
The point is that the person has to repeatedly over eat and stretch it out to that kind of capacity. The sleeve won't stretch by itself. Clearly and admitabaly this person stretched his out and he said it wasn't hard to do. He said his capacity basically doubled from the first year to the second and than doubled again from year 2 to year 3..... Do the math, that's 4x from year one.....

He also mentioned what many bigger Sleevers mention here.... About never having foamies or throwing up....

Clearly your not an over eater and have been educated for long term success.... My friend here.... Well not so much....

The other thing that also scares me is that I have met people here that came from the same program.

frisco

I think you are both right.  Let me explain.... I don't think that Devon has a larger sleeve than we do, I think his doctor does use a larger boughie than ours did but his doctor is all about making a tight sleeve around that boughie.  I think the difference in technique is a huge part of the eventual capacity.  I have eaten with Devon on many occasions and I can tell that he eats about the same amount of food as I do.  I don't think Devon's stomach will stretch much more.  His doctor made sure to cut close to the top and the bottom and he kept things pretty even all the way through and my guess is that he pulled pretty tight around the boughie.  I think all these things go into making a smaller capacity stomach.  The boughie is just one element....that is why so many of the studies on long term results and boughie sizes are all over the place.  They can't isolate the dependent variable enough to draw any real meaningful conclusions. 

I have the uncanny ability to turn every post into something about myself. Having said that I have a question for you. I don't know what size my sleeve is (and I will ask) but are you saying that people who don't get foamies or throw up typically have a larger sleeve? I have had neither (but I usually weigh and measure and stop eating when I hiccup). There have been a few times that I've REALLY felt my restriction but not gotten to the foamie / throw up phase. Do you think my sleeve may be a bigun?