Surgery questions

[Munchkin]

Is your experience typical? I ask because you touched on my next question. I’ll try asking here before making a new post.

Why does it seem like the DS post op diet restrictions/tolerances etc are so different than what sleevers say? Not pertaining to the weight loss/malabsorption but the quantity and types. Is it strictly because of the malabsorption? Sleeve size?

While I’m not a binge eater I do love me some carbs, who doesn't? I know DS absorbs carbs 100% (right?) so does it not phase you to have to avoid carbs? Like a surgically induced Atkins diet?

I like that. Surgically induced Atkins.

We absorb 100% of the simple carbs. Sugar. It's 60%(hope I remember this right) of the complex carbs. If I am wrong someone else will come along and tell me I am a bonehead and that's OK.

It was about 7 months postop that I became able to eat a normal meal. I was on a trip to Las Vegas, alone, and I was eating prime rib at the bar and chatting with the bartender. I wasn't paying attention because I was talking and I realized I had eaten ALL the prime rib and a couple bites of broccoli. All sleeves will expand over time and eventually you will be able to eat more. Today I can eat like a horse some days and only a pony other days.

You go into the DS knowing your diet will be protein based for the rest of your life. You will be counting protein forever. Some write it down or use an app. I have been doing this so long that I just keep a tally in my head. I can probably tell you at any time how much protein I have had so far. Combine the need for protein plus restriction and you won't have room for much else during your quick weight loss phase. Most people would probably agree in the beginning, it's protein plus a couple bites of something else. Even snacks should follow along this line. It's always protein first. Hopefully, you learn how to eat during this phase and it will serve you well.

So yes, you are sort of losing weight because you are on Atkins with the added magic of malabsorbtion. Lots of people have said the restriction makes you lose the weight and the malabsorbtion helps you keep it off. That is a simplification but it doesn't hurt to look at it that way. The stand alone sleeve is just a diet with a smaller stomach. Always remember that. For them it's low cal, low carb, low fat. They absorb everything they eat. Many sleevers live on 800 to 1K calories per day. We don't have to do that because we have malabsorbtion. Many DSers think of fat and protein as free foods. The more the better. We don't absorb 80% of the fat so to a large extent this is true.

Some develop intolerances that last forever. Almost everyone has foods that cause problems in the beginning. Try them once in a while and eventually most of these issues go away. You can choose to avoid these foods or not. Up to you. If your consequence is ferocious gas, you may choose to eat whatever at a time when you know you will be alone and close to a bathroom. The only food problem I have left is beets. If I eat beets I better be close to a bathroom. So most of the time, I avoid beets. It's not a big deal. I have lived with the surgery long enough to know how most foods affect me most of the time.

It takes time to figure yourself out after surgery. If you have nausea or diarrhea, treat it. Don't stay miserable. Get yourself healed. Stay hydrated and walk. After you heal, just concentrate on losing as much as you can as fast as you can. During easy weightloss the only GOOD carb is one you don't eat. Just lose the weight. Aim for 10% under goal. You will have the rest of your life to figure out what you can eat. Maybe life will give you a carbfest at the end of your weightloss period. I feel sorry for these folks because even though it's great fun, it usually doesn't last and they will have to go back to being careful and eating right. The other end of the curve is maybe you will run out of easy weightloss before all the fat is gone and you will always have to be really careful. No one knows where they will end up so make the best use of your time! Just lose the weight!

Don't think for a minute that I have never had french toast, lasagna, bagels, or dessert postop. I have had all these things more than once or twice. And fresh baked bread??? I will always eat that. Then I know I need to really careful and stick to my plan for a few days so I don't gain. What the DS did for me was make me NORMAL(at least foodwise). I know if I overindulge and eat things I shouldn't I can cut back and mitigate the damage. I can manage my weight like a normal person.

 

[FloridaJen]

I like that. Surgically induced Atkins.

We absorb 100% of the simple carbs. Sugar. It's 60%(hope I remember this right) of the complex carbs. If I am wrong someone else will come along and tell me I am a bonehead and that's OK.

It was about 7 months postop that I became able to eat a normal meal. I was on a trip to Las Vegas, alone, and I was eating prime rib at the bar and chatting with the bartender. I wasn't paying attention because I was talking and I realized I had eaten ALL the prime rib and a couple bites of broccoli. All sleeves will expand over time and eventually you will be able to eat more. Today I can eat like a horse some days and only a pony other days.

You go into the DS knowing your diet will be protein based for the rest of your life. You will be counting protein forever. Some write it down or use an app. I have been doing this so long that I just keep a tally in my head. I can probably tell you at any time how much protein I have had so far. Combine the need for protein plus restriction and you won't have room for much else during your quick weight loss phase. Most people would probably agree in the beginning, it's protein plus a couple bites of something else. Even snacks should follow along this line. It's always protein first. Hopefully, you learn how to eat during this phase and it will serve you well.

So yes, you are sort of losing weight because you are on Atkins with the added magic of malabsorbtion. Lots of people have said the restriction makes you lose the weight and the malabsorbtion helps you keep it off. That is a simplification but it doesn't hurt to look at it that way. The stand alone sleeve is just a diet with a smaller stomach. Always remember that. For them it's low cal, low carb, low fat. They absorb everything they eat. Many sleevers live on 800 to 1K calories per day. We don't have to do that because we have malabsorbtion. Many DSers think of fat and protein as free foods. The more the better. We don't absorb 80% of the fat so to a large extent this is true.

Some develop intolerances that last forever. Almost everyone has foods that cause problems in the beginning. Try them once in a while and eventually most of these issues go away. You can choose to avoid these foods or not. Up to you. If your consequence is ferocious gas, you may choose to eat whatever at a time when you know you will be alone and close to a bathroom. The only food problem I have left is beets. If I eat beets I better be close to a bathroom. So most of the time, I avoid beets. It's not a big deal. I have lived with the surgery long enough to know how most foods affect me most of the time.

It takes time to figure yourself out after surgery. If you have nausea or diarrhea, treat it. Don't stay miserable. Get yourself healed. Stay hydrated and walk. After you heal, just concentrate on losing as much as you can as fast as you can. During easy weightloss the only GOOD carb is one you don't eat. Just lose the weight. Aim for 10% under goal. You will have the rest of your life to figure out what you can eat. Maybe life will give you a carbfest at the end of your weightloss period. I feel sorry for these folks because even though it's great fun, it usually doesn't last and they will have to go back to being careful and eating right. The other end of the curve is maybe you will run out of easy weightloss before all the fat is gone and you will always have to be really careful. No one knows where they will end up so make the best use of your time! Just lose the weight!

Don't think for a minute that I have never had french toast, lasagna, bagels, or dessert postop. I have had all these things more than once or twice. And fresh baked bread??? I will always eat that. Then I know I need to really careful and stick to my plan for a few days so I don't gain. What the DS did for me was make me NORMAL(at least foodwise). I know if I overindulge and eat things I shouldn't I can cut back and mitigate the damage. I can manage my weight like a normal person.

Thank you so much for this detailed response. I will definitely make the most of the weightloss period!!
I am no stranger to tracking food and if Protein is all I have to track, I'm golden. Having weighed and logged all macros for nearly 2 years I am pretty good at eyeballing already. I can put some meat on a plate and tell my husband exactly how many grams it is and be correct, give or take 2-3 grams. I think the most difficult thing for me is finding a variety of protein sources to keep myself from getting sick of something. Hopefully, my aversions don't end up being chicken, because I can live on chicken salad.

 

[Munchkin]

Thank you so much for this detailed response. I will definitely make the most of the weightloss period!!
I am no stranger to tracking food and if Protein is all I have to track, I'm golden. Having weighed and logged all macros for nearly 2 years I am pretty good at eyeballing already. I can put some meat on a plate and tell my husband exactly how many grams it is and be correct, give or take 2-3 grams. I think the most difficult thing for me is finding a variety of protein sources to keep myself from getting sick of something. Hopefully, my aversions don't end up being chicken, because I can live on chicken salad.

Strange that you should bring up chicken salad. A local grocery store has chicken on sale for .67 per pound. Went and got 5 chickens and cooked them last night. Today my plan is to make chicken salad. A LOT of chicken salad. It will take me a while just to strip the bones!

 

[Settledownnow]

I know weight gain is possible. I am not a binge eater, but do eat sometimes from stress/hopelessness and when I’m happy or celebrating. I anticipate a lot of anxiety through the first few months due to the loss of food. Maybe forever, I don’t know. Looking to line up therapy with someone who specializes in Bariatric Surgery and addiction and also starting OA. Loading up on all the tools!!

You didn't ask but.... if you have not already done so you might think about working with a dietitian on your IBS trigger foods and see if you can get that managed. That will help you know more about if you can handle this surgery. Many people here complain about "nuts" (nutritionists) but the dietitian I saw was extremely helpful for me. She was not connected to any hospital program but in private practice with a broad range of experience. That might be why my experience was different than most. We focused on mindfulness, identifying and planning around my schedule, hunger, and stress triggers, and experimenting with the DS diet. Many RD's have long thrown out the "diet" mentality and instead focus on mindfulness, whole foods, and any type of physical movement. Also, I identified what I wanted to work on -- she did not. We talked on the phone first so I had a sense of who was a good fit and who was not. I paid out of pocket a very reasonable fee (maybe $30-40 every 2-3 weeks). It all counted toward my 6-month required diet. She wrote a letter for the surgeon for the insurance company. You can find a list of private practice dietitians here https://www.eatright.org/find-an-expert

 

[JackieOnLine]

She said over the 12 years she's been doing this she hasn't seen anything good come from DS.

feel free to give her and anyone who says things like that a link to this forum - just in case they want to be set straight.

I waited longer than the others who had surgery when I did because I wanted the DS. I can't tell you how many times they told me I was being ridiculous. I could have the RNY next week. Why was I wasting all this time waiting when I could already be thin? Well, I lost the weight and I am still close to normal almost 17 years later. And they are all except one, back to fat.

as someone who has always had Binge Eating Disorder, let me just say by all means try OA and if it helps than good on ya. however, I found I hated their entire frame of reference.

the first step is admit I am helpless? for me, at least, I need to do exactly the opposite. I DECIDE what I eat and I sure the hell am not helpless. what has helped me is working on mindfulness/zen attitudes and working on the rest of my life. when my life is working, I don't feel the urge to binge.

your mileage may vary!!

have you ever read any Geneen Roth books? I found the earliest ones were the best as she is basically just saying the same things over again in later books. from her bio on goodreads:

Geneen Roth's pioneering books were among the first to link compulsive eating and perpetual dieting with deeply personal and spiritual issues that go far beyond food, weight and body image. She believes that we eat the way we live, and that our relationship to food, money, love is an exact reflection of our deepest held beliefs about ourselves and the amount of joy, abundance, pain, scarcity, we believe we have (or are allowed) to have in our lives.

Rather than pushing away the "crazy" things we do, Geneen's work proceeds with the conviction that our actions and beliefs make exquisite sense, and that the way to transform our relationship with food is to be open, curious and kind with ourselves-instead of punishing, impatient and harsh.

 

[FloridaJen]

You didn't ask but.... if you have not already done so you might think about working with a dietitian on your IBS trigger foods and see if you can get that managed. That will help you know more about if you can handle this surgery. Many people here complain about "nuts" (nutritionists) but the dietitian I saw was extremely helpful for me. She was not connected to any hospital program but in private practice with a broad range of experience. That might be why my experience was different than most. We focused on mindfulness, identifying and planning around my schedule, hunger, and stress triggers, and experimenting with the DS diet. Many RD's have long thrown out the "diet" mentality and instead focus on mindfulness, whole foods, and any type of physical movement. Also, I identified what I wanted to work on -- she did not. We talked on the phone first so I had a sense of who was a good fit and who was not. I paid out of pocket a very reasonable fee (maybe $30-40 every 2-3 weeks). It all counted toward my 6-month required diet. She wrote a letter for the surgeon for the insurance company. You can find a list of private practice dietitians here https://www.eatright.org/find-an-expert

I pretty much know what affects my stomach, everything that is not protein. lol
I will check out the link, thank you!

 

[FloridaJen]

feel free to give her and anyone who says things like that a link to this forum - just in case they want to be set straight.





as someone who has always had Binge Eating Disorder, let me just say by all means try OA and if it helps than good on ya. however, I found I hated their entire frame of reference.

the first step is admit I am helpless? for me, at least, I need to do exactly the opposite. I DECIDE what I eat and I sure the hell am not helpless. what has helped me is working on mindfulness/zen attitudes and working on the rest of my life. when my life is working, I don't feel the urge to binge.

your mileage may vary!!

have you ever read any Geneen Roth books? I found the earliest ones were the best as she is basically just saying the same things over again in later books. from her bio on goodreads:

Geneen Roth's pioneering books were among the first to link compulsive eating and perpetual dieting with deeply personal and spiritual issues that go far beyond food, weight and body image. She believes that we eat the way we live, and that our relationship to food, money, love is an exact reflection of our deepest held beliefs about ourselves and the amount of joy, abundance, pain, scarcity, we believe we have (or are allowed) to have in our lives.

Rather than pushing away the "crazy" things we do, Geneen's work proceeds with the conviction that our actions and beliefs make exquisite sense, and that the way to transform our relationship with food is to be open, curious and kind with ourselves-instead of punishing, impatient and harsh.

I never ever wanted to try OA because I heard things, like what you said, over the years and knew it wasn’t for me. I probably wouldn't be trying it now except a friend mentioned it and wants to try it. So I am going to try it and if it’s not for me then I won’t go back.

 

[Settledownnow]

I never ever wanted to try OA because I heard things, like what you said, over the years and knew it wasn’t for me. I probably wouldn't be trying it now except a friend mentioned it and wants to try it. So I am going to try it and if it’s not for me then I won’t go back.

No, you do not have an "addiction." You have obesity and it is a disease. The focus of OA is eating sugar free and flour free, following a meal plan your sponsor provides (a diet), and following the 12 steps.

 

[FloridaJen]

No, you do not have an "addiction." You have obesity and it is a disease. The focus of OA is eating sugar free and flour free, following a meal plan your sponsor provides (a diet), and following the 12 steps.

Yuck I’ll go once to support my friend.

 

[JackieOnLine]

it helps some people so it's not a bad thing to try - just keep in mind there are other options.

and I know it's not for me!

 

[DonRobbie]

Resident newbie with a million questions. I’m starting to think ahead to actually having surgery and will ask surgeon these things, but thought I’d pick your brains also.

Is it more or less typical to have gallbladder removed during DS?

With my previous band removal I would guess I have scar tissue and I also think I have a hiatal hernia. Is it possible to do all these things at one time?

Do most surgeons check your nutrient levels prior to surgery? What might I request checking beforehand?

I have fatty liver and last few tests showed elevated ALT and AST, is it heard off for people to get the liver biopsied while they are in there?

Besides trying to lose some weight and exercise, what can I do or take now to prepare my body for what’s to come?

How many people have you known or have seen die from this surgery or in the year following?

Thanks again for your continued guidance.

Jen

I'm a noob (only 7 months out), and I did not "shop around" by talking to a bunch of docs so you should weight the answers of the vets higher than mine.
.
At the practice I had my DS at (Mexicali Bariatric Center) they only remove the gall bladder if you pay extra to have it done (I believe they will remove it during the op if they find it is already in trouble but they won't remove a healthy one as a matter of course). Many docs do remove the gall bladder during weight loss surgery hoping to head off another surgery 6-18 months later. It's worth talking to your doc about, with this being your second abdominal surgery it might be worthwhile to preempt the possible need to go in again (my understanding is every time they do surgery you have some scarring and adhesions which can cumulatively make it very difficult and dangerous for later operations. I'm on Actigall (Ursidol) during my rapid weight loss phase in hopes of lessening the chance of gallstones and/or needing my gall bladder removed. I asked Dr Campos at Mexicali Bariatric about taking Actigall and he thought it wasn't a bad idea but that I would likely still get gallstones. Knock on wood, I still have my gall bladder. It "talks" to me sometimes but it's on a twinge level not a pain level.

I think many docs will repair minor hiatal hernias "while they are in there" (I know for mine several patients mentioned having hiatal hernias repaired during their operation) but if it's going to be a major project they'll usually punt in the interests of keeping your time under general anesthesia down (particularly with heavy folks the longer you are under general the greater the risk of complications).

I haven't heard of a liver biopsy being done typically during a DS, but I only have direct experience with one (my own). I will point out that my liver enzymes went up quite a bit post op (normal during rapid weight loss) so it's possible the liver may get worse before it gets better.

Get your Nutrient levels up now. I've struggled with D even preop and I think it would have been helpful to have gotten it to the high end of normal preop when it wasn't so much work. Less weight and being more fit is a positive for surgical outcomes (both in terms of weight loss and not dying).
Hit Goodwill, clearance sales, and other cheap places to get some clothes for the trip down. I don't have to dress up for anything and mostly wear jeans and t-shirts and it has been pretty spendy keeping myself clothed these last six months. On the other hand your tastes may change somewhat on the way down. Know thyself and plan accordingly.

I only personally know one weight loss surgery patient who died post op. He was one of my wife's friends from high school and had a gastric bypass. Unfortunately he also had developed a drinking problem preop that continued postop. His liver failed a few years postop. It was a brief illness but a lot of suck was packed into that time.

 

[JackieOnLine]

At the practice I had my DS at (Mexicali Bariatric Center) they only remove the gall bladder if you pay extra to have it done (I believe they will remove it during the op if they find it is already in trouble but they won't remove a healthy one as a matter of course

FYI I went to the same hospital but the surgeon I had has since passed away.

I told him that I had no gall bladder issues but was worried about needing a second surgery after weight loss when I had no health insurance and how expensive it would be. This was after he told me they would not remove a healthy gall bladder. but we did discuss the price and I gave them the extra money (I forget how much it was) and when I woke up after surgery my gall bladder was gone. he had also taken a mole off the top of my ear - I'd asked and he said it was no problem. bonus!

so you never know for sure until you ask.

 

[FloridaJen]

Thanks Don! It will actually be my 3rd surgery if you count band removal. I really want it taken out and I hope the hiatal hernia will be repaired because I’ve seen a lot of issues over the years where it becomes a big issue not to.

I hope to find a way to get my levels checked now. I already take D3, iron, probiotic, multi and magnesium. But of course just a normal dose.

And thanks for the clothing tip. I should be thinking about that kind of stuff more, but I’m still so focused on the surgery details

 

[FloridaJen]

FYI I went to the same hospital but the surgeon I had has since passed away.

I told him that I had no gall bladder issues but was worried about needing a second surgery after weight loss when I had no health insurance and how expensive it would be. This was after he told me they would not remove a healthy gall bladder. but we did discuss the price and I gave them the extra money (I forget how much it was) and when I woke up after surgery my gall bladder was gone. he had also taken a mole off the top of my ear - I'd asked and he said it was no problem. bonus!

so you never know for sure until you ask.

My band surgeon in Mx repaired my hernia also and has since passed. I feel like they are more open to requests than US surgeons. We shall see. I know it’s not good to be under too long, but I want whatever can be done while I’m under to be done-it has to be better than more surgeries.

 

[DonRobbie]

And thanks for the clothing tip. I should be thinking about that kind of stuff more, but I’m still so focused on the surgery details

One other thing on clothes, my experience is that the top and bottom part of the body don't always lose in unison so tops and bottoms that can be mixed and matched across sizes seems like a benefit if you need to look nice. I think I went down 3 sizes in jeans before I swapped out my shirts (Probably could have stood to do it a couple weeks sooner).

For immediately post op if you are travelling I followed some advice I had seen and got a compression top as well as compression socks. The top helped a little with keeping everything still. But obviously it only worked as a compression top for a couple of weeks. The socks help reduce the chance for blood clots.