LKH

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Well, a year has come and gone. As of 5/12/09, I have lost 80 lbs from day of surgery, and 101 lbs from the first weigh-in after I was brought aboard Kaiser's weight management program.

I still can't eat much at a time.  Breakfast most days is a Slim-fast Low-Carb shake and my vitamins.  Lunch is about 1/2 cup Whole Foods Lemon Dill tuna Salad with five saltine crackers.  Dinner is 3-4 oz of chicken or salmon or beef, and usually a small portion of some treat like macaroni salad or potatoes.  I splurge occasionally with dark chocolate or a glass of wine, and generally I'm content with fewer than 1,000 calories a day. However, I can very easily go up as high as 1800 calories, particularly if I let myself indulge in too many carbs or get bored enough to nibble through the day at work.  I log my calories at www.thedailyplate.com every day, though sometimes if I snack late at night I fail to report that extra bit of food because I don't want to log back in.

I don't exercise much at all, which may explain why my weight loss is a bit slow.  But that's all good. I honestly hate to sweat, so while I know I'd be healthier, fitter, and all that jazz if I joined Curves or something, I also have to say that I'd be spending a good part of my life dreading that trip to the gym, and/or a good part of my resources paying for a membership that I was always finding excuses not to lose.  I'm content to lose more slowly and not be miserable about such things.

A few months ago, I was putting on my bra, and I felt a lump on my chest. As a former cancer survivor, of course I immediately got anxious, but after poking the thing, I realized it was a RIB.  LOL.  More recently, I put my hands on my hips and had a similar experience when I felt a hipbone for the first time in many years.  I can cross my legs comfortably, and I can wear jeans, and the next time I have to buy clothes because I've shrunk out of my wardrobe, I'm going to be forced to go to "normal people" stores because my last wardrobe was size 0X, so I'm too thin for Catherine's and Lane Bryant now. 
I can't wear most of my old rings, and I'm almost able to put on my high school class ring.  My shoe size hasn't changed, but my feet never really got fat.

My face is back - at my peak weight, my face was round and kind of flabby, but now it's back to the heart-shaped face I had when I was young.  I recently attended a memorial service, and one old acquaintance who I worked with when I was 14 is reported to have said that he thought I was "drop dead gorgeous" when in high school, and he still thinks I'm pretty hot.  Despite the sadness of the occasion, I have to say I purred a bit.  I do have some loose skin, but elbow-length sleeves and snug jeans disguise the problem satisfactorily. (I won't say I'd be comfortable getting naked with anyone, though, and while I'm currently single, I do still hold hopes of finding a special someone, so I am contemplating some cosmetic work once the weight loss is over.) 

I haven't had huge problems with acid, but I became aware that I was craving starchy foods like crackers, and spoke to the Kaiser nut about it, suggesting that the problem might stem from a little acid that feels like hunger.  She recommended prescription-strength prilosec, and I take one each morning, and I've noticed that, while I had been stalling when I noticed the problem, my weight is now steadily going down again.  So if you find you're stalling, you might want to try something like that, because your food cravings may be an excess of acid.  I also suck on a pepcid every night when I go to bed.  

On the whole, I'm thrilled with my VSG, and highly recommend the procedure to anyone considering it.  It's the best money I ever spent on myself, and I'd definitely do it again.

I haven't been active on the forums for awhile. Last time I was active, there was just too much negativity.  So I'll post here and steer clear of the zoo.  If anyone wants to chat, I still get emails when I get PM'd, so zap me a note and say hey! 

I have been doing great.  I'm down nearly 80 lbs since February, 59 lbs since day of surgery.  I bought clothes a few weeks ago two sizes down, and I'm already having to safety-pin the pants.  I have a lap, and I can sit in hard-backed chairs with arms and not feel squished. 

In my pre-op class, I was told I could expect to lose about 30% of total body weight, which would mean I have 8 more pounds to go.  I don't see why I shouldn't expect to lose quite a bit more - at least the 32 lbs I still need to lose to have a BMI in the merely "overweight" range, and maybe even another 62 lbs, to put me in the "normal weight" range. 

I do have a little lose skin, and I wouldn't be surprised if I have a lot more before it's all over.  If I look like a soup chicken I'll think about plastic surgery. 

As for appetite, it's back, a bit.  I get hungry at mealtimes, but I still don't need much food to be stuffed.  I can pack away a lot of calories if I browse through the day, and I still have to struggle with that temptation when I'm bored at work - which is most of the time.  But the one day so far that I actually really let go and just pigged out, I only ate about 1800 calories, which would still result in weight loss for me at this weight.  Most days my intake is somewhere between 900 and 1200, more when I'm so tired of protein-only that I have to add a few carbs just to feel like I have a life.

I have also had some hair loss, but so far not enough to be noticeable on my scalp.  I can see my hair is a bit thinner, but thankfully I had a lot more than most people to begin with, so now I just look the same as everyone else.  I got a cute short cut and it looks fine, and I have to spend more time sweeping hair up from the bathroom floor and pulling it out of the dryer vent.  Otherwise no biggie. 

My surgery ended up costing me just under $6k (that was my 30% coinsurance, plus copays).  It's the best money I ever spent on myself.  I highly recommend this procedure.

Oh, and for anyone who is interested in the "God" side of this, if you go back to my first blogs, I tell the story about how I had made up my mind that the sleeve was the only surgery I wanted, and was initially told my my insurance (Kaiser) that they did not cover it.  But I learned that one of the clinics that they work with for bariatric surgery was credentialling a new surgeon who does the procedure, so I asked to at least meet with the doctor in charge of the weight management program.  He told me that Kaiser had a new policy - they just approved you for bariatric surgery - it was up to you and the surgeon which procedure you wanted to have.  So I applied for the bariatric program, got approved, jumped through all the hoops (psych eval, classes, etc.), and chose the surgeon who does the sleeve.  He agreed with me that the sleeve was the better choice for me, and voila, I was sleeved!  It seemed like a God thing to me that, just when I was looking into it, Kaiser had only recently opened up its policy to allow for other procedures, and had only just begun credentialling a surgeon who did the procedure I wanted.  OK, so you want to hear the rest?  It turns out that not long after I got my sleeve, Kaiser decided to crack down again - they decided they wanted to look at longer-term evidence for the sleeve before they approved any more.  Now, I have no doubt, with the latest 5-year data from Dr.'s Cirangle and Jossart, that they will quickly approve sleeves again.  But isn't it wonderful that I slipped in during the brief window when Kaiser was approving the procedure?  Stuff like this keeps reassuring me that God has his hand on me.  I love that. 

So that's my six-month update.  Catch you in another few!

Been seeing a lot of stuff dealing with how some folks are losing slower than others, and I decided (as usual) to do a little research on it. 

Basically, if you want to lose 1 pound, you need to burn 3500 calories more than you take in.  What does that mean? 

Let's say the average person on this site is mid-forties, female, 5'4", and weighs in at 250 lbs.   That person would naturally burn about 2371 calories a day just living a sedentary lifestyle. 

Post-op, she takes in an average 700 calories a day the first month.  That means she burns about 1,671 calories a day more than she takes in.  Over a month, she will lose 14.3 lbs, or a bit over 3 lbs a week.  That's without doing anything.

The next month, she's going to burn a bit less, 2280 calories a day if she's still sedentary.  And most likely, after a month she's going to be taking in a few more calories, say 850.  So  this month she's going to burn about 2.8 lbs a week.

Now let's talk about exercise.  If our example person, call her Jane, were to start walking, say 30 minutes every day, at a moderate pace, she would burn another 199 calories, or 2/5 of a pound a week.  If she also did some light weight lifting for another 30 minutes, that would take it to 376 calories a day, 3/4 pounds a week. 

If our 250 lb Jane Doe had weighed 350 lbs to start, she would burn nearly 500 calories more each day, doing absolutely nothing.  So she'd lose another pound a week.  And if she exercises, the workouts burn more calories than her 250 lb counterpart. 

And here's where it REALLY gets unfair.  The same person, 45yo, 5'3", 250 lbs, if this person is MALE, will burn that extra 500 calories a day and lose that extra pound a week, DOING ABSOLUTELY NOTHING, and he will also burn more calories doing the same exercises.  Another factor that you have absolutely no control over, that can cause you to lose less than someone else is AGE.  If our person was 10 years younger, he or she would burn more calories, even doing nothing else different.

So if you are losing more slowly than others, it may be may be that you're eating more.  Or it may be that you're exercising less.  But before you go beating yourself up, it just may be that you started off with less to lose, or you have the misfortune to be the wrong gender or age.  Similarly, if you're losing MORE than others, you may be patting yourself on the back, when really the only thing you have going for you is stuff you can't take credit for, like age or outdoor plumbing.

Comparing ourselves to others is pointless.  All we can do is figure out what it will take for US to lose at the rate we want to lose.  If we find that it would take more exercise than we have time for, or cutting calories to below our dietary recommendations, it might be better to just content ourselves with the rate that WE are losing and stop thinking about how others are doing.  

Sites used to come up with these figures were:

http://www.nutritiondata.com/tools/calories-burned

and

http://www.healthatoz.com/healthatoz/Atoz/tl/misc/caloriesburned.jsp

I had all kinds of trouble finding anything on OH, until Harris2 posted this:

If you every want to look up info. on ObesityHelp forums to get information quickly, here's how to do it. First, click on the red *My OH* at the top of this page (between Home and Photos listed horizontally above). A new page will open. Click *Customize* just to the left of your avatar picture area. Then click on the *+ Search* option. That will put a new field in on your My OH page. When you want to search OH info, just click the *ObesityHelp.com* option, and Not the entire *Web* option. Then fill in the blank with the topic you want to look up and click Search! If you want to try to narrow it down to information on just a particular forum, you can add that forum name in the search field , along with the topic of your search, and give it a try. It may, or may not help keep the entries you can choose from narrowed to that particular forum....but it won't hurt to try. Happy Searching! Oh, and after you have the search field set up on your *My OH* page, next time you want to search a topic, just go to your *My OH* page and fill in the search field, choose to search Obesity Help.com only, and hit search.

So thanks to Harris2!!!

I can't post the actual presentation, but here's a great link:

http://www.facs.org/education/gs2004/gs33lee.pdf

Laparoscopic Sleeve Gastrectomy as an Isolated Bariatric Procedure: Intermediate-Term Results from a Large Series in Three Austrian Centers.

Felberbauer FX, Langer F, Shakeri-Manesch S, Schmaldienst E, Kees M, Kriwanek S, Prager M, Prager G.

Department of General Surgery, Vienna Medical University, Waehringer Guertel 18–20, 1090, Vienna, Austria, [email protected].

BACKGROUND: Gastric sleeve resection was initially planned as the first step of bilio-pancreatic diversion with duodenal switch but it continues to emerge as a restrictive bariatric procedure on its own. We describe intermediate results in a series of 126 laparoscopic sleeve gastrectomies (LSG) compiled from three bariatric centers in eastern Austria. METHODS: The stomach was laparoscopically reduced to a "sleeve" along the lesser curvature over a 48-Fr bougie. Special attention was placed on complete resection of the gastric fundus. RESULTS: After a mean follow-up of 19.1 months, patients had lost between 2.3 and 27 kg/m(2) or between 6.7% and 130% of their excessive weight. Sixty four percent of the patients lost >50% of their excess weight within an average of 20 months. Seven percent of the patients had an excess weight loss <25% and were therefore considered as failures. The only major surgical complication was leakage of the staple-line needing revision (three times). There were no operative mortalities. CONCLUSION: The final place of LSG in bariatric surgery is still unclear, but our results and those of others show that LSG can be a viable alternative to established procedures.

One Year After Laparoscopic "Tight" Sleeve Gastrectomy: Technique and Outcome.

Skrekas G, Lapatsanis D, Stafyla V, Papalambros A.

General Surgery, Iaso General Hospital, Mesogeion Av., Athens, 15433, Greece.

BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) is currently gaining ground as a new option for the treatment of morbid obesity. The main advantages of this procedure are less postoperative food restrictions, no vomiting, and absence of late complications due to the lack of foreign implants. The aim of this study is to present our experience with this new bariatric technique. METHODS: Ninety three obese patients (65 females and 28 males) who underwent LSG between September 2005 and September 2007 were studied in terms of postoperative complications and weight loss. RESULTS: Mean age was 38.37 +/- 10.81 years (range 19-69) and mean preoperative weight and body mass index (BMI) were 139.12 +/- 24.03 kg (range 100-210) and 46.86 +/- 6.48 kg/m(2) (range 37-66), respectively. Mean follow-up was 12.51 +/- 4.15 months (range 3-24). There were no mortalities, but there were four major and four minor postoperative complications. The mean postoperative excess weight loss (EWL) was 58.32 +/- 16.54%, while mean BMI dropped to 32.98 +/- 6.54 kg/m(2). Mean EWL 3, 6, 12, and 24 months after the operation was 31%, 53%, 67%, and 72%, respectively. Superobese patients (BMI > 50 kg/m(2)) lost less weight. CONCLUSION: In the short term, LSG is a safe and highly effective bariatric operation more suitable for intermediate morbidly obese patients with BMI between 40 and 50 kg/m(2).

I'm probably not alone in feeling a bit confused by the wide variations in the post-op diet regimens given by different surgeons.  Frankly, it seems like most of them just use whatever diet they've been giving bypass patients.  Others are more liberal, and they hand you the diet they give lap band patients.  As a result, two people who had surgery on the same day can have very different experiences post-op.  One may leave the hospital on purees, while the other is stuck on clears for two weeks. 

Well, Cornell University has a bariatric program, and they have published their diet specifically for sleeve patients.  Either this will clear things up for you or make things more muddled, but here you go:

http://www.cornellweightlosssurgery.org/pdf/dietary_guidelines_sleeve_gastrectomy.pdf

My suggestion is that you do what you can handle.  This suggests leaving the hospital on full liquids and purees, but if those make you sick, stick to clears until you can tolerate them.  Either way, before you depart your own surgeon's guidelines, show him this diet and see what he (or she) says.

Weight Loss, Appetite Suppression, and Changes in Fasting and Postprandial Ghrelin and Peptide-YY Levels After Roux-en-Y Gastric Bypass and Sleeve Gastrectomy: A Prospective, Double Blind Study.

From the Nutrition Support and Morbid Obesity Unit, Department of Surgery, and Division of Endocrinology, Department of Internal Medicine, University of Patras School of Medicine, Patras, Greece.

BACKGROUND:: Bariatric surgery is currently the most effective treatment in morbidly obese patients, leading to durable weight loss. OBJECTIVE:: In this prospective double blind study, we aim to evaluate and compare the effects of laparoscopic Roux-en-Y gastric bypass (LRYGBP) with laparoscopic sleeve gastrectomy (LSG) on body weight, appetite, fasting, and postprandial ghrelin and peptide-YY (PYY) levels. METHODS:: After randomization, 16 patients were assigned to LRYGBP and 16 patients to LSG. Patients were reevaluated on the 1st, 3rd, 6th, and 12th postoperative month. Blood samples were collected after an overnight fast and in 6 patients in each group after a standard 420 kcal mixed meal. RESULTS:: Body weight and body mass index (BMI) decreased markedly (P < 0.0001) and comparably after either procedure. Excess weight loss was greater after LSG at 6 months (55.5% +/- 7.6% vs. 50.2% +/- 6.5%, P = 0.04) and 12 months (69.7% +/- 14.6% vs. 60.5% +/- 10.7%, [P = 0.05]). After LRYGBP fasting ghrelin levels did not change significantly compared with baseline (P = 0.19) and did not decrease significantly after the test meal. On the other hand, LSG was followed by a marked reduction in fasting ghrelin levels (P < 0.0001) and a significant suppression after the meal. Fasting PYY levels increased after either surgical procedure (P

   Having started this journey in earnest on 8/15/07, I am finally scheduled for my surgery on May 12, 2008!  So Kaiser Colorado currently takes about 9 months!  I am anxious, happy, and relieved all at once, if that's possible! 

Lisa