Recent Posts

Dr. Guillermo Alvarez
on 6/17/21 7:32 am
Topic: 6 Tips to avoid Sabotaging your sleeve | Gastric Sleeve Surgery | Questions and Answers

Good Morning!
I made this video to help you avoid sabotaging your Gastric Sleeve.

Check it out here:

Dr. Alvarez

on 6/17/21 6:34 am
Topic: RE: food scale?

Hi, I'm very glad that you decided to take such an important step as losing weight.

on 6/16/21 4:45 pm - CA
Topic: RE: Might do a revision from VSG- DS or RNY

The RNY revision doesn't seem to be worthwhile from what I have seen over the years on these forums - twenty pounds, give or take, about what one would expect from going through all of the intense dieting during the pre- and post- op periods. Occasionally we see someone do really well, but they seem to be outliers who took the opportunity to really get serious about their diet and habits (if I'm going to go through all that again, I'm not letting that happen to me again...) Fundamentally, the VSG and RNY are too similar metabolically to really expect a great difference between them, and indeed, overall that is what we see with virgin procedures - very similar results.

I have seen several people come through our support group who have gone to the DS and overall did well with it, as one would expect as it is a metabolically stronger procedure than either the VSG or RNY. If your sleeve is basically behaving itself - not giving any significant side effects like intransigent GERD, then the most straightforward approach is to go with the DS, as you are already half way there with your VSG. Also, if your A1c is being stubborn about normalizing, then the DS would also be preferred, as it is stronger against diabetes than either the VSG or RNY.

You are going about this at the right time; when I talked to my surgeon about this, the prospect of a DS completion/revision if the VSG alone wasn't enough, he told me that this works best if you catch it before any substantial regain occurs. So, by his estimation, you are hitting it at the sweet spot. The down side of this timing is that insurance may not cover it if your weight has gone below the normal qualifying levels of 35/40 BMI with/without qualifying comorbidities and there are no complications that are being addressed (and it doesn't sound like there are.)

1st support group/seminar - 8/03 (has it been that long?)  

Wife's DS - 5/05 w Dr. Robert Rabkin   VSG on 5/9/11 by Dr. John Rabkin


on 6/15/21 3:07 pm
VSG on 06/11/18
Topic: RE: Need help getting back on track

My suggestion: Instead of trying to overhaul your diet immediately, fix one thing at a time. Even when you're not coping with depression, I think this is a good approach to dieting. With depression in the picture, a step-by-step approach to any kind of change can help you from getting overwhelmed.

1. Track everything you eat.

As you track your eating, think about why you're eating. Were you hungry? bored? stressed? Just wanted the sensation of chewing or crunching something? Was it a social occasion and you wanted to join in? I've learned that it's perfectly normal and healthy to eat sometimes when you're not hungry. Everyone (whatever their size) does it. Instead of trying to white-knuckle through these urges, I find it best to plan for it by having foods on hand that are fun to eat and low calorie (or low carb, if that's your goal). Some examples: pomegranate seeds, carrot sticks, frozen grapes/cherries (suck on them to defrost a bit, then chew), sugar-free jello, sugar-free popsicles.

Also, for the less-healthy foods, why did you choose them? Were you stressed and trying to self-soothe? Before my surgery, I made a mental list of things that I could do when stressed out, like curl up under the duvet, drink some fragrant herbal tea, take a hot shower, snuggle with my cats, listen to music. Notice how these activities involve a lot of different senses, as do the fun-to-eat snacks I mentioned earlier. I find it helpful to remind myself regularly to engage other senses besides taste.

Too tired to cook? Personally, I hate cooking. I knew I should meal-prep, but that was never going to happen. So instead I looked high and low for healthy prepared meals. I was surprised at all the options available. I have to drive a little farther to do the grocery shopping, but it's worth it.

I found that my desire to eat varies from day to day, even when taking activity level into account. My high-hunger days are usually balanced out by my low-hunger days. Realising this was a game changer for me. Now when I have a day where I eat more than usual, I don't feel I've "blown" my diet. I accept that it was probably just a hungry day, and I only need to worry about it if there are a few days like that in a row. I've noticed that my cats do the same thing. Some days they'll naturally eat more than usual, some days they'll eat less than usual.

2. Identify one thing that you can improve about your diet without feeling deprived.

Look at the things you eat most often. Perhaps one of them would be just as satisfying if you chose a sugar-free version, or made some other small change. Perhaps if you had better options on hand, you would chose them. Perhaps meal-prepping would help.

3. Get comfortable with that one change. Then you can consider making the next change (if needed).

TIP:I find it works better to focus on doing the things I should do, instead of resisting the things I shouldn't. I try never to tell myself "no" when it comes to food; instead, I tell myself "later". How does that work? From the time I wake up, I focus on getting enough fluids (I have found I feel better if I have 2.5 litres) and eating a vegetable dish. Once I've accomplished those two things, if I really want something, I eat it. My exception to that is sugar; I never want to get addicted to that stuff again! I do eat sugary foods once or twice a year, but it always leaves me feeling a bit queasy.

on 6/15/21 1:16 pm
Topic: Might do a revision from VSG- DS or RNY


I am 1.5 years out from VSG. The surgery was fairly successful but it did not really achieve the amount if weight loss that I had hoped. Im down about 72 pounds. I lost 34 of that before the surgery. So. , I visited my PCP today and depending on my A1C number, I think I might work to get approval on either the DS or the RNY. I think this will help me get the rest of the weight off. WHich should be another 50-70 pounds. Has anyone had a similar situation and went through the revision with good/desired results?

Dr. Guillermo Alvarez
on 6/8/21 7:29 am
Topic: 7 Tips for Constipation | Gastric Sleeve Surgery | Questions and Answers

Good Morning!

I made this video for those of you that have problems with constipation.

Check it out here:

Dr. Alvarez


on 6/7/21 4:34 pm
VSG on 08/16/12
Topic: RE: Need help getting back on track

Thank you! And congratulations to you! I need to get motivated again! I am slowing cutting alcohol back and soon out. I need to get my arse moving but... not there yet.

Citizen Kim
on 6/7/21 4:30 pm - Castle Rock, CO
Topic: RE: Need help getting back on track

Giving up alcohol completely (I, too, drank wine) helped me lose around 60lbs of regain. It's shocking how many calories are in alcohol and the accompanying snacking.

It took me around 9 months to lose that, so it's not easy or quick. There is a daily menu thread on the RNY board, that is surgery inclusive, if you want accountability or something like Weigh****chers might help

Good luck

Proud Feminist, Atheist, LGBT friend, and Democratic Socialist

Dr. Guillermo Alvarez
on 6/3/21 7:12 am
Topic: MRI Scan | Gastric Sleeve Surgery | Questions and Answers

Good Morning!
I made this video for those of you that might have questions about MRI Scans regarding the Gastric Sleeve Surgery.

Check it out here:

Dr. Alvarez

on 6/2/21 2:36 pm, edited 6/2/21 2:46 pm - Calgary, Alberta, Canada
Topic: My 13th birthday with my sleeve!

Some may say I took the easy way out! If so, this was my easy journey! Honestly is key and obesity is real! It wasn?t a free lifetime pass to eating! :/ P.S. I had tried everything under the sun. I was on WW since 17 losing the same 20lbs. I turned 37 and was approved for surgery. I had ballooned to 330 from years of yo-yo dieting. I chose me.

13 years ago today, marks the birthday of my new tool! Many state, the easy way out to weight loss, Vertical Sleeve Gastrectomy! I know, RIGHT! It was a dream, the 160 pounds just fell off kinda. Little do people know, the Halifax surgeon Dr. Klassen closed me up with a leaking body part that led to a stomach cavity full of sepsis! And left the local valley doctors to figure it out. While I suffered 4 months waiting for an answer of death! Multiple visits to Dr. Bustin and the outpatients. Finally, Dr. Goddard Jr. ran the right test! Well, he sent me off to Dr. Klassen and Dr. Ellsworth in Halifax that made the mess. 3 month hospital stay, 5 surgeries later and a wound vac and JP drain! There were days I felt like just falling asleep for GOOD! But, there were a few amazing nurses! Kim, my living angel... A RN that took me under her wing and advocated when no one else was there at the hospital! I got to go home at Christmas.. With the care from Dr. Bustin and the AWESOME care from VON.. In March, they took the JP drain out. Well, he tried without taking the suction off. Than realized his mistake! Came out much smoother after that. Just like pulling raw chicken apart! The following week we moved to Calgary without any medical care. A few visits to the Urgent Care here and finding a family doctor. After a few months, they agreed the leak was healed. It was now time to get the GERD healed! And start feeling like human. 13 years later, it is still a fight with the GERD, but, managed with medication. Yes, I will always have to watch the calories/SP that go in! And yes it should be protein first. But, we all make the wrong decisions with feeding ourselves. Depends the season we are fighting. Cheers to the fight against obesity! Would I do it again! Sure, without complications! ??

#vsgcanada #vsgcommunity

Leaky sleeve survivor!!! 2008/2009 ~ 5'7"~ 42F Bougie