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Serum thiamin - B1 (thiamin)
Normal range: 10-64 ng/mL
Postop deficiency: Rare, but occurs with RYGB, AGB, and BPD/DS

PLP - B6 (pyridoxine)
Normal range: 5-24 ng/mL
Postop deficiency: Rare

Serum B12 - B12 (cobalamin)
Normal range: 200-1000pg/mL  (Andrea's ideal is around 1200-1800)
Postop deficiency: Common with RYGB in absence of supplementation, 12-33%

RBC folate - Folate
Normal range: 280-791 ng/mL
Postop deficiency: uncommon

Ferritin - Iron
Normal range: Males 15-200 ng/mL, Females 12-150 ng/mL  (Andrea's ideal is 200)
Postop deficiency: common with RYGB for menstruating women (51%) and patients with super obesity (49-52%)

Plasma retinol - Vitamin A
Normal range:  20-80 mcg/dL
Postop deficiency: common (50%) with BPD/DS after 1 yr, <= 70% at 4 yrl may occur with RYGB/AGB

25(OH)D - Vitamin D
Normal range: 25-40 ng/mL (Andrea's optimal is 80-100)
Postop deficiency: Common with BPD/DS after 1 yr; may occur with RYGB; prevalence unknown

Plasma alpha tocopherol - Vtiamin E
Normal range: 5-20 mcg/mL
Postop deficiency: Uncommon

PT - Vitmain K
Normal range: 10-13 s
Postop deficiency: Common with BPD/DS after 1 yr

Plasma zinc - Zinc
Normal range: 60-130 mcg/dL
Postop deficiency: Common with BPD/DS after 1 yr; may occur with RYGB

Serum albumin - Protein
Serum total protein
Normal range: albumin 4-6 g/dL; total protein 6-8 g/dL
Postop deficiency: Rare, but can occur with RYGB, AGB, and BPD/DS if protein intake is low in total intake or indispensible amino acids

7/2008
There has been so much discussion lately on BMR that I thought I'd do some calculations:
BMR at current weight is about 1700 calories
BMR at 179 (goal) is about 1500.  Both are without added exercise.


6/2008
Summer Boot Camp

walking:  6:45 daily 
M/R:  I want those abs/Iwant those arms/10 minutes leg pilates
T/F/S: Ballet Strength/Pilates/Standing abs
W/S:  Stong and Graceful/Balanced Body Sculpt

Goal:  Driver's License Renewal:  7/2010
# on it: 179.  Grand total of 300 lbs. lost.

The Philosophy of Losing Weight

We stop losing weight when we stop working at losing weight.  Just as before WLS you can lose weight any time you choose to with your method of choice...high protein/low carb. WW, Nutrisystem, whatever.  Just because you have had WLS does not mean you cannot "go on a diet" if you choose to, just like any other person, but you are lucky in that you now have an additional tool to do it with and you have lost that large amount that in the past kept you from being one of those folks who wanted to lose 20 or 30 pounds.   

It will always be an issue of calories in versus calories out.  If you "stop" losing at 10 months and still have weight you want to lose, you adjust your eating accordingly to meet your body's demand...18 months....24 months....three years.....

Often, your body will "take breaks" in its weight loss to adjust (re-set?  reboot?).  They might last for weeks or even months, but then if calories taken in are less than calories expended, you will begin to lose again, perhaps not as rapidly as at the beginning of post-op, but "normally" 1-2 pounds a week.

It works oppositely also.  If you have lost too much, you increase your calories in a NUTRITIOUS way to get back to where you want to be.  However, if you fall into old eating habits and get there by eating too many simple carbs (candy, chips, sugary drinks) you'll probably overshoot your mark.


8/7/07
Dearest Weight Loss Surgery Friends,

As my NUT says, please be kind to yourselves.  Quit beating yourself up for ONLY losing 40 or 50 or 100 pounds in three or six or twelve months!!!  That is a great accomplishment that took a lot of hard work and you deserve credit for it.  Hell, you deserve a party and presents!!!

I sadly read some posts here by folks who are beating themselves up because their "GOLDEN WINDOW OF OPPORTUNITY" is nearly over and they aren't at goal.  This timeline myth deserves to be locked away with the "One pound of muscle weights more than one pound of fat" one.

The surgery, not matter if it's band, DS or bypass, is not a container of cottage cheese:  it does not have an expiration date.  Just because you are nearing the 12 or 18 or 24 or whatever month post-op "deadline" some surgeons throw around, does not mean the self-destruct will engage on your WLS and you WILL stop losing weight and never shed a pound again.  This is simply a guideline for when you can expect the quickest weight loss.  

With a healthy eating (I had typed "diet" and changed that because I'm not talking about the latest fad to roll down the pike) and exercise plan, you can still lose weight, conquer that last 20-30-40 pounds and reach whatever goal you've set (please make it a reasonable one).

Which reminds me of a story....

Back in junior high, I had a sweatshirt that I was particularly proud of (mostly because I'd found a "normal" thing that fit).  It was a putrid yellow color, had fuzzy green footpints on it, and said "I'm the doormat for the Jolly Green Giant".  My can't-be-understood-by-an-adult junior high persona thought this was hilarious.  Now, I couldn't let myself be a doormat for anyone, not matter if they were jolly or green, and especially not for the hidden fat alter ego inside myself that nay-says every accomplishment.  (Think Moaning Myrtle from Harry Potter but way too overweight to ever fit down a toilet pipe!!!).   

Quit being a doormat for your "fat personality" and take credit for your great accomplishments!!!  Continue working it and you will get to whatever goal is suitable for your body. 


8/4/07

A poster was asking about menus for eating at about 4-6 months out.
My diet was six small meals.  Some days I counted my protein drink as a meal; some days I added it as extra.  (I cannot eat chicken or pork so none are on the menus.)

Day One 

1 cup Calorie Countdown milk with 1 scoop protein powder

1 C SF yogurt with 1t. sf jam

1/2 C beef-veg soup
1 T. pb and 1/2 small banana
1/3 Pria Bar

1/2 C cottage cheese with salsa
3/4 oz. pretzels

Stuffed tilapia (2/3 of the serving)

1 C cal countdown milk
1 SF cookie 

Day Two

1/2 c Cheerios and 1/2 c milk 
1/2 banana

Atkins Bar

3/4 oz. pretzels
2 oz. lunch meat ham
1 oz. cheese

Shrimp Bisque 1 C

Lean Cuisine Spaghetti and meat sauce (ate about 1/2)

Cal Countdown milk and sf hot cocoa mix
1 sf cookie

Day Three

1/2 C Special K/1/2 c cal countdown milk

1 orange

1 ff beef hotdog
1 oz. cheddar
1 oz wheat thins

Atkins Shake

1/2 mini bagel
1 c beef stew

2 sf popsicles

Day 4

oatmeal with raisins 1 c.  (made with milk)

AchieveOne
2 string cheese sticks

Lean Cuisine Mac and Cheese (ate about 2/3)

12 grapes
1/2 Pria Bar

1 Fish Fillet w/ ranch dressing
1/2 c green beans

hot cocoa made with cc milk

Day 5

AchieveOne

2 oz. moz cheese
 4 melba rounds

Insides of two beef tacos (Taco Bell)

South Beach Bar

Beef Fillet (2 oz.)
Salad w/ ranch
1/2 c broccoli cheese soup

SF pudding cup with 1/2 c sliced strawberries

Day 6

1/2 c. Total cereal/1 c. milk

South Beach bar/AchieveOne

(Red Lobster)
clam chowder/salad
1/2 biscuit outsides

1 oz. turkey
4 melba rounds

Lean Cuisine Enchilada (ate insides of enchilada and some of the rice)
1/2 c green beans

protein shake smoothie (milk, protein powder, frozen fruit)

Day 7

1 c milk with SF CIB

Atkins breakfast bar/hot tea

1/2 baked potato with cheese
2 oz turkey

sf jam and peanut butter
4 melba rounds 

Chili salad (Wendy's chili on salad)
Sour cream and cheese

1/2 c applesauce
1/2 c vanilla yogurt


6/26/2007

From the adventures of Karen and Damn!

My stability ball kicked my butt, literally.  It tossed me off like Lightin' the bucking bronco.  Then I had to go catch it!!!!!!!

Just when I was getting cocky about being a big old jock with my power walking, I decided to try Stability Ball 1, 2, and 3 on my new favorite cable channel Exercise on Demand.

The instructor who has one of those high class British accents told me to follow Tonya for the beginners session.  I did but Tonya didn't seemed to be struggling as much as I was.  And her ball seemed much better behaved than mine.  Maybe I should have gotten a gray one instead of a red one---they seem calmer.  

Thirty minutes later I was lying on the floor and the ball was on top of me and I think it was laughing.

You've got to try it!!!!!

Day 2

Did a fast one mile WATP with weights and then did battle with Damn (that's my stability ball).  Let's call it a tie today...it's now resting in its corner (I think it's looking at me).  I actually accomplished rolling down the ball on my back and BACK UP!!!  

Day 3

Today was supposed to be my exercise day off but I got to thinking about poor Damn! (my stability ball) sitting there all by himself.  So I did the upper and lower body workout and increased my handweights.  Actually, he was lying in wait like a big old anaconda.  There I was flailing along with Tanya (the low level instructor) and I let my guard down.  Next thing I knew my feet were above my head and I was rolling down the back side of the ball.  (Wish I had a video, knowing I was losing it but could do nothing to stop the inevitable).  There's just not near as much padding on my backside as  there used to be.  I think I'm going to have to tie on a pillow.  Maybe I need to call the Ball Whisperer.   

 

2/10/07

Sort of having a conversation with myself here but I thought some of you might want to listen in:

So, you've been whining to yourself that the scale really hasn't been moving much since the "high eating season" started at Thanksgiving.  Thinking that maybe this is it?  Agreeing that a 170 pound weight loss is great but that's certainly not at goal yet?

Yeah, yeah, yeah...you've dropped another size or two and you're bagging up those 22s and buying 18s BUT it's not the SCALE behaving the way you want it to.  So you decided to kick up the exercise a notch, track what you've been eating, and use the plateau buster plan.

It's only been a week for the plan but you noticed a few things:

Those 100 calorie snackies were really adding up...sweet and salty and crunchy.

If there are no carbs (including veggies and po-ta-toes and Dreamfields pasta) on the plate, you have to eat protein first. 

You have to use a measuring device (empty Diet Oceanspray container) to know you're getting the water in.

That three mile WATP DVD really kicks your butt but you can do it.

Green jello is preferable to SF popsicles as a snack when the windchill is -10. 

And guess what?  This morning the scale woke up and moved.

(By the way, I wasn't "perfect."  I had 7 soy crisps with my cottage cheese one day, a spoonful of broccoli with cheese sauce one night for dinner, and ONE Heshey's Special Dark with almonds mini on Friday with lunch.)

1/20/07

I was just sitting here, reading posts and getting really aggravated.  It's amazing how many folks post asking how much can you cram into your pouch or bragging "I can eat a box of chocolate without dumping."  Seems to me these folks are setting themselves up to fail before they begin, so to answer the question, "YES, WLS can fail."  

The current question seems to be "Can I eat the way I did before surgery?"  with the implication being I really don't want to change the way I eat.  Sure, you probably can park your rear on the sofa, eat soft slippery ice cream and easily crunchable cookies and chips.  It's a sure thing that at some point you will stop losing weight and start gaining it back.  

It seems a waste of time and effort to go through major surgery with the mind set that I hope I can continue to eat all the junk that I previously did and I'll be real disappointed in the surgery if I dump on sugars or fats or a big pile of chips or half a coconut cream pie!!!!!!!   For goodness sakes, folks, what ARE you thinking? 

If you look at this as just one more "diet" you'll get tired of and go off, it probably won't work long term and if you haven't had the surgery yet, you probably shouldn't.  If you really are ready to change the way you think about what food is for and how you eat, then you are ready for surgery.   And you know I'm not talking about a slip off the wagon.  I am speaking about not even being on the road when the wagon rolls by.

It seems like there are too many surgeons out there just collecting the fee and doing the ops without providing any kind of readiness screening or nutritional education.  Think about the surgery rationally, do your homework, have a heart-to-heart with yourself, and pick a surgeon carefully.  This isn't the fad of the week like buying a colored IPod cover or dressing your dog-ette in baby clothes. 

Had my say.

 1/20/07

I had been at the 235 mark and had been playing with the same weight since Thanksgiving   Too much holiday cheer.  (Although I have dropped another size during that time period also).  In the last two weeks the scale has started moving again (-3.5). 

I started charting on Fitday and found some interesting things.

I was eating many more carbs than I thought, so I have been backing off on those and replacing them with protein.  I consistently eat between 1100-1300 calories.  Talked to my nut and she said get the protein in (80-100 daily) and worry less about the calories UNLESS YOU"RE EATING JUNK CARBS.  I still keep my food broken into six small meals because I can still only eat about 1 cup of food at a time.

I increased my exercise (power walking) to daily.  

And I have been working at increasing my liquids to 64-80 oz. which is hard in the winter...hot tea is my friend.   I also decided that two cups of CarbCountdown Milk gives me nearly as much protein as my protein drink and tastes a hell of a lot better.  And it adds to my fluid intake.

I had been using the little lunch cups (chili, beans and franks, etc.) and have replaced them with deli ham and beef (can't eat chicken or turkey) and cheese.

These changes seem to have worked....

-170.5 since 12/05/05.  Goal:  -29.5 by 6/2007.

Yesterday I was in Columbus.  After dropping the DH and our friend off for the OSU game, I went by Tuttle Crossing Mall and did a bit of shopping.  Ran into LB and bought a pair of 22 jeans (the salesperson told me 22 was the "normal" size at LB and usually is very hard to keep in stock.)  Got some hazelnut coffee in Godiva.  Sniffed a few new lotions in Bath and Body Works but resisted the temptation.  Then I got gas and went home to watch the game.

This sounds so normal because it is and that's the point.  A year ago I would have never gone to a strange mall.  The entire time yesterday, I never felt I was being stared at and even rode the glass elevators up to the second floor!  (In the past, I would have felt a glass elevator was another name for a display case allowing everyone below to point and laugh at the fat woman.)

Earlier this week I got a roll of film back that had been in the camera for a year.  I finally had visual proof and could see what others had been telling me about the dramatic change in how I look.  Amazing.

-164 lbs. since 12/05/05

8/15/2006

I have been noticing how many posts asking what people are eating at various months out, about calorie counts at so many weeks/carbs, etc. there have been recently so I was pondering about what I do....

I guess I have been away from calorie counting as a diet tool for so long (Atkins and Weight Watchers) it never ocurred to me to "count calories." My nut never stressed total # of calories at each phrase of the post-op diet, just the type and quantity of food. And I didn't stress much about the "final" diet high protein/low carb because my DH and I had been doing just that for two years so it is pretty much a lifestyle.

I also should say I cannot eat "a lot" of anything. Pouchy likes dinner served on a salad plate and most times refuses to belong to the clean plate club. A good example of the amount of food I have at dinner (usually largest meal) is about the size of a Lean Cuisine and usually I can't finish the last few bites.

I plan six "feedings" each day.
Breakfast is usually 1/2-3/4 cup cereal like Fibre One with Carb Countdown milk. Or a protein bar like SouthBeach or Atkins breakfast bars with CC milk.
Morning snack - yogurt or cottage cheese or "carry along" cheese (comes in several varieties now including moz. stix),
Lunch: LC or soup with added protein (I also occasionally indulge in a bunless Wendy's single with cheese, lettuce, and mustard (takes forever to eat) or two insides of Taco Bell soft beef tacos supreme with hot sauce),
afternoon snack: soy crisps with cottage cheese or protein shake,
Dinner: fish or beef (I still urp on chicken and pork), salad or veggie, MAYBE 1/2 c Dreamfields pasta or 1/2 baked potato, (best new dinner eat-out find is Ruby Tuesday's crab cake appetizer, comes with nice size crab cake, a little sauce and enough greens to call it a salad),
PM snack: 1/2 c. fruit or SF pudding or more protein if I think I'm a little lacking for the day.

Dumping: I haven't gotten the shakes, sweating, dizzy kind of dumping but I am careful about fat and sugar; however, if I eat too fast or don't chew throughly or take that one extra bite...back it comes. If I eat chicken or pork or bread and sometimes eggs, and CHINESE...URP!

Also, usually in the morning I drink an AchievOne and sometime during the day I allow myself an indulgence: ONE Hershey's Special Dark chocolate MINI bar. (30 calories) When I buy them, I count them out and write the ending day on the bag. Some days I have one and some days I don't.

I don't eat much sugar because I haven't for so long. Also, I don't regularly eat "junk": doughnuts, tater chips, cookies, etc. Occasionally I'll have sugar free items or those 100 calorie snack bag (love the Snack Fairy) things but sugar alcohols are much less kind to me now than before surgery. I do like tortilla chips and salsa (especially salsa) and have a few at Mexican restaurants. I also had a sliver of cake for my birthday. I cut off the icinged parts and ate the cake. It was fine but no big whoop.

I keep trying new water products. Propel seems the best. I dilute my Crystal Light because I think it is too strong. I disappointedly found Talking Rain is carbonated and now I have a whole case. I do occasionally have a carbonated beverage but they are not nearly as appealing as before surgery. I drink iced tea: full strength, two packets of Splenda, and find this might be the easiest way to get in my liquids for the day. And coffee but not nearly as much as before surgery (not as tasty).

Vitamins: four Optisource (bariatric vits from Walgreens.com), Citracal chews, B-12 sublingual, and potassium daily. Labs have been great.

I exercise by walking, water aerobics, or stretching/weight training about three times each week. I'd like to do this more but I am lazy. As the fall comes, I plan to increase my walking to daily and switch my water aerobics to jazzercise. (I don't like to be wet and cold and I am lazy.)

So, that's what I do. I think I'll take a page from Tooter's book and say that this seems to work for me but might not for you... 

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