AboutTime077’s Posts
I think the phrasing is correct. If, hypothetically, you had someone who had NEVER dieted in their life? Yes, you would tell them to watch what they eat before you rearranged their insides.
If a woman who had always had a healthy BMI gained weight after pregnancy, would you immediately refer her for bariatric surgery?
For people who are not chronically obese, are otherwise healthy, and have experienced weight gain for the first time in their life, yes, I believe "watch what you eat" is appropriate advice. I agree that it is not appropriate guidance for those of us who have been obese for most of our lives, but it may be appropriate for some.
That's why I stated, chronically.
I'm always amazed that they refer to WLS as "not a first line treatment." If you've been chronically obese for years it's a foregone conclusion that you dieted/exercised and failed (as we all do). So yes, indeed, in my view it absolutely IS and should be viewed as a "first line treatment" because, well, it's the only treatment or intervention that has a snowball's chance in hell of working. And any obese person who is being told anything different is really being done a terrible disservice. I get so angry and annoyed at people who attribute chronic obesity to 'poor life choices' or a failure to exert adequate will power, etc. While it's somewhat forgivable to hear this from medical "civilians," it's really depressing and irritating to hear the same tired advice being proffered by medical doctors.
I'm a clinical psychologist and I see many patients who struggle with obesity issues. I won't even begin to get into the psychological correlates of chronic obesity (depression, lack of self worth, job discrimination, etc.) as I think most of us are all too familiar with these, but I have been very clear with my patients that they can diet to their heart's content, but every single piece of valid and reliable data would suggest that there's less than a 2% chance of maintaining that weight loss over 1-3 years post-diet. I tell them flat out that their choices are really not that complicated -- either try and accept yourself at your current size and make the best of it, or go speak to a bariatric surgeon about WLS as it's the only tool that exists (right now, at least...who know what might be around in 10-20 years) which will give them a [very good] chance of achieving for themselves what they're hoping for.
The sanctimonious, self-righteous and frequently, condescending "advice" to "watch what you eat and exercise more" crap really needs to stop -- from medical professionals more than anyone. WLS is NOT "the last resort"....it's the ONLY resort that conforms to the data and the only choice that makes any sense. So, in my view, it's the FIRST AND ONLY resort!!!
Rant over. Sorry to bore you, but I really had to get this off my chest
It's not weird, actually.
Every surgeon and clinic has their own regulations.
Two weeks post op, I had a protein shake for breakfast and 1 cup steamed veggies and 4 ounces of baked chicken or turkey for lunch and dinner.
One week, I went to four shakes a day. 48 hours prior, clear liquids only.
I started soft foods (scrambled eggs, oatmeal, cheeses) 7 days post-op.
Thank you.
Who knew there was so much variation between what surgeons want. You would think there'd be some standardization. After all, human bodies are human bodies. They don't vary from surgeon to surgeon.
Either your pictures were more graphic than usual or they are over-censoring here lately as they aren't in the post anymore. I don't recall underwear pictures being removed in the past (and many pre-ops and early post-ops find them helpful).
Are you uploading them to OH first or linking to TinyPic (which seems to be the hosting site doing the censoring)?
LOL
What a very strange world we live in. In a day and age of unrestricted internet porn we are now censoring bariatric underwear pics? Go figure.
I did lots of protein shakes. My pre-op diet was 2 meals were shakes and one small meal for dinner. Though, right before surgery I got really sick lol, basically could barely get broth in. I don't think that sounds bad, as long as you're getting your food in before surgery. Calories, I'm not sure about. My surgeon did not give me a calorie target for my pre-op diet, just one for post op which I have yet to follow. At over a year out, I don't think I could get 1200 calories in me without just feeling stuffed all day long.
That's weird. My doc doesn't want any solid foods pre-op for two weeks or post-op for a month.
And I guess this would also apply to the 1 month post-op diet as well.I know the deal is "full liquids" but you still have to keep your calories to no more than 1000-1200. I'm thinking five protein shakes (800), one tomato soup (120) and maybe a Greek yogurt (100). And, of course, lots and lots of Snapple Diet Peach iced tea (0).
Does this sound reasonable to you? Any other suggestions or advice. Pre-op diet starts 4-18, surgery on 5-2.
Scared a bit but looking forward to this.
Awesome post. So insightful and helpful. You really are a poster child for what this journey is all about, not only physically, but emotionally and psychologically.
All I can say is "Bravo!" 
Two weeks is standard advice, but it really varies by the person and how extensive the surgery is. I think you've said you had a lap band? Is it being removed at the same time?
I was really pretty much fine after a week, but still got tired easily for another 2-3 weeks.
Yes I had the lap band but it was removed about four years ago. Should have gotten a revision to VSG then but I really was in no mood to pursue anything else at that point . As they say, 'hindsight is 20/20.' I think I'll play it safe and take two weeks off. Better safe than sorry.
Thanks for your feedback.
I'm a clinical psychologist so it's a pretty sedentary job. I was thinking a week or ten days.
What was your experience and what had your surgeon advised?
TIA for any feedback.
VSG is a metabolic and bariatric surgery. It changes the way your metabolism functions and it reduces the size of your stomach. The size reduction provides a sense of "restriction" when the stomach is full. Prior to surgery, our stomachs are HUGE, so reaching that sense of restriction took a lot more food. Now we feel full, or satisfied, with much smaller amounts of food.
Thank you. That's exactly what I was asking.
Forget about ghrelin. It's an incredibly overblown aspect of surgery that just doesn't make much difference. Hunger is far more complicated than one hormone -- one which is made in other parts of our bodies, not just the stomach.
None of us became obese because we weren't eating enough. Hunger is much more in our heads than our bodies.For the morbidly obese, satiety has nothing to do with it.
Many also struggle with acid after surgery, and acid will feel like hunger.
Also, no one logs on and writes. "I'm not hungry. What do I do?" People log on because they are having trouble with too much hunger.
Ok, let me put it another way. Exactly how does this surgery differ from or improve on the dismal results we've all experienced from the myriad diets we've tried in the past?
What, exactly does VSG offer that enables us to succeed after so many years of failure? Your post suggests that satiety is not substantially altered and that the ghrelin - hunger issue is largely wishful thinking.
So exactly what is it that VSG does then?
I thought that the entire raison d'etre of the sleeve was to limit intake and thus, provide a dramatically greater feeling of satiety much sooner than before. Beyond this, it is my understanding that the removal of the part of the stomach which is excised contains tissue which produces ghrelin which causes feelings of hunger. The net result would then be that there is far less hunger throughout the day.
Am I mistaken in these assumptions? Reading through many of the posts here I'm not hearing too much about what this surgery does to aid us in our journey. Often, it just seems like people are adhering to a very difficulty diet characterized by endless deprivation.
Am I missing something?
Please understand, I'm not looking to argue or troll, I'm genuinely interested in hearing about the specific benefits of this surgery. I'm wondering if people who post on forums such as this may represent a skewed sample of individuals who are experiencing problems and are looking for help or guidance.
Wow, only one week of the dreaded liquid diet??? You're lucky. I'm going in either April 25th or May 2nd and my surgeon wants a two week full liquid diet.
Can anyone tell me what the typical protocol is? I know right after surgery you have to either grind up your pills or find a liquid form. After a period of time can you resume taking your normal medications and vitamins?
I know the final word on this comes from your surgeon but I was wondering what your experience has been.
TIA for any feedback.
I never had reflux/GERD prior to my VSG. In my case I can say it had ZERO to do with overeating or eating too much at one time. It had everything to do with the fact that the VSG is a closed, high pressure system and the acid has nowhere to go but back up the esophagus. Also, the tone of my LES is very low, with allows the acid to splash up on my esoplagus. At its worst, my acid was 409% higher than normal. I won't speak for everyone, but in my case, your explanation missed the mark.
Hi Stacy. I certainly didn't mean to imply that anyone was "at fault" for GERD, I was just speculating about what might be a cause. I apologize if my speculation was upsetting. As I said, that certainly wasn't my intention.
Beyond that, I'd like to know how you have been managing your GERD and if it's still bothering you.
Thanks
I suspect that the bariatric surgeon you consult with should be more than familiar with the requirements of most major insurance carriers in their local area. Most have surgical/insurance coordinators who can let you know what is required for approval.
Hope this helps and good luck to you.
Here's some scientific data.
https://renewbariatrics.com/heartburn-gastric-sleeve-surgery/
Why GERD may improve in some patients after gastric sleeve surgery
After gastric sleeve surgery, the weight loss leads to a reduction in intra-abdominal pressure. The resection of the fundus of the stomach significantly reduced acid production, and the rate of gastric emptying is accelerated. All these factors prevent reflux of stomach content into the esophagus resulting in a clinical improvement in the symptoms of GERD.
Why GERD may develop after gastric sleeve surgery
Following gastric resection, the large compliant stomach is converted into a less compliant banana-shaped tube. This leads to increased pressure within the stomach. Iatrogenic removal of some fibers in the lower esophageal sphincter and disruption of the anatomical anti-reflux mechanisms result in weakness of the sphincter. All these contribute to reflux of acidic contents back into the esophagus.
Stenard and Iannelli reviewed about 13 studies on gastric sleeve surgery and its effect on GERD. The mean BMI was 42kg/m2 while the average follow-up period was 29 months. One of the studies showed a persistent of GERD in up to 84% of the patients. Another study also revealed that symptoms of GERD were more in patients that had gastric sleeve surgery as compared to those that had a Laparoscopic Roux-en-Y gastric bypass.
GERD developed in about 2.1-21% of those without pre-operative evidence of GERD. A reduction in the incidence of postoperative GERD symptoms was noticed when hiatal hernia repair was added to the gastric sleeve procedure.
In another review of 12 studies involving 1863 patients by Stenard and Iannelli, the mean BMI was 51kg/m2 while the average follow-up period was 20 months. All these patients had pre-operative GERD symptoms. One of these studies showed 94% resolution of symptoms. Another study reported 41% improvement in GERD symptoms. Some of these studies showed no significant difference in symptoms between those that had sleeve gastrectomy with hiatal hernia repair and those that did not.3
The above showed that the effect of the gastric sleeve on pre-existing GERD or its role in the development of GERD varies from one individual to another and from one surgeon to the other. Surgical technique may affect the competency of the lower esophageal sphincter after gastric sleeve surgery. Doctor?s skills and experience are therefore critical in determining the outcome.
These researchers also further buttress the claim by some surgeons that gastric sleeve is not for every obese individual especially those with GERD. These set of people can have a Laparoscopic Roux-en-Y gastric bypass rather than a gastric sleeve.
Treatment of heartburn following gastric sleeve surgery involves the use of medications that reduce gastric acid secretion such as proton pump inhibitor and the use of antacids. Other maneuvers such as elevation of the head of the bed while sleeping may ameliorate symptoms. Severe cases may need a gastric sleeve revision surgery.
In conclusion, obesity is a risk factor for GERD. Many patients will have their symptoms persist after the surgery while some may experience improvement. Others without pre-operative symptoms of GERD may develop it after gastric sleeve surgery. Proper screening and patient selection should be carried out to ensure selection of patients with least risk of GERD. Those with high risk should undergo other forms of bariatric surgery. While preparing for gastric sleeve surgery, choose the best surgeon with least record of GERD complication as surgeon?s skills to play a significant role in the effect of gastric sleeve surgery on GERD symptoms.
It's unclear how prevalent it is DUE to VSG, because correlation does not equal causation. For example, I've got fructose malabsorption. If I eat something that's high in fructose, it leads to stomach acid. Is that due to VSG? Nope, since I had it prior to VSG. However, my stomach is now smaller so it's more noticeable post-VSG than it was prior. (And I do wonder how much of the time acid issues are related to unrealized food intolerances.)
What causes acid to be an issue? Boyle's Law. In a nutshell this means "decreased volume leads to increased pressure." When the stomach volume decreases, the increase in pressure can cause acid that was happily hanging out in your stomach to get pushed up into the esophagus. This isn't a problem with RNY because the valve/sphincter at the "bottom" of the stomach, the pyloric valve, is removed, so the RNY stomach is not the same high pressure environment as the VSG stomach is with it's intact pyloric valve.
It has nothing to do with volume of food.
Some people have pre-existing acid issues that are caused by hernia and this can be fixed during surgery. Some people have pre-existing acid issues for other reasons - dietary or whatever. Sometimes this continues to be a problem post-VSG. Sometimes it doesn't. Sadly, it's sort of a crapshoot.
I never had problems with acid prior to surgery, at least not that I was aware of. I rarely ingest(ed) high fructose things because of my fructose malabsorption. When I accidentally did it post-op and had the acid issue, it freaked me out until I figured out the cause! Due to my paranoia, I am considering asking my bariatric surgeon for an upper endoscopy at my 4 year follow-up next month. Just to make sure everything is okay in there.
All that said, if I had a history of acid issues prior to WLS and there wasn't an obvious cause such as hernia, I would get the RNY every day of the week and twice on Sunday. There's no way I'd even consider VSG.
Thank you for your thorough and excellent explanation. It is much appreciated. I have never had any problems with GERD so I'm certainly hoping I don't develop any following the procedure. Do you know or are there any statistics on what percentage of people develop GERD following VSG surgery?
If it's fairly low, like perhaps 10%-15% I think the risk is definitely worth it; if it's 50%-60% that could be a real cause for concern.
Finally, is GERD usually controllable with PPI's or the like?
How common a problem is this for those who have had VSG surgery?
It seems to me that this would likely be due to eating too much at any one time resulting in your smaller stomach not being able to handle the volume of food going into it and then backing up into the bottom of your esophagus. If this is what's happening then it seems like it's something that could be pretty easily avoided by reducing your intake at any given time.
Or am I missing something?
Wow! That is super impressive. You must be so proud of yourself. Terrific achievement and a great deal of hard work.
Congratulations. I can only hope I have anywhere near as much success as you.
Thank you for your reply and good wishes, Shannon. Due to the issues I had with the band I don't think I ever had reasonable restriction. I'm hoping that the sleeve provides significantly more help in this regard. I'm also wondering if your ability to avoid overeating has been helped by the limitation of ghrelin going into your system as this is supposed to regulate feelings of hunger and satiety. Is it true that with the removal of that part of your stomach which produces this hormone, you feel significantly less hungry?
Hello. I'm a 69 year old man who had the lap band 11 years ago. It was a real disappointment as I could never get the fill amount just right and, ultimately, after leaving it completely unfilled for a number of years, had it removed because I was starting to experience some minor stomach distress. At the time, my surgeon asked me if I wanted to have this revised into the sleeve and I (foolishly) declined as my overall experience with bariatric surgery had been such a disappointment. Now I realize that this is my only option to a better life.
I'm hoping that Medicare covers this (anyone who has information about this and could post it would be greatly appreciated) and that the approval process is not too unwieldy. I see that many are talking about a daily caloric intake of 700-800 calories. This seems amazingly low. Is the combination of the smaller stomach size and the (vast) reduction of gherin that helpful that people can actually do this over an extended period of time without losing their minds or climbing the walls?
Any tips for a sleeve newbie?
Any advice or information, including your own personal experiences would be greatly appreciated.
TIA
