Sleeve Gastrectomy timeline

Well, it’s done. I do, occasionally, think that I must be crazy, but it’s a done deal now, so, ONWARD!

Ok, flew into San Diego on Sunday. Got picked up and taken to the Grand Hotel in Tijuana. Had soup for dinner, got to bed early. Being on Eastern time is very handy since they like to get started early.

Monday, head to Hospital Florence. It looks a little skeevy on the outside, but it’s fine on the inside. Meet the patient coordinator ladies, get settled in the room. They bring you compression hosiery to put on. Then here come the vampires for your blood. Y’all know how wound up I get about needles. The girl that did it was AMAZING. It didn’t even BLEED. I didn’t even bruise! That is a first!

So then they do the EKG. Interesting experience! They put these clamps on your wrists and ankles along with the electrodes. It takes 5 minutes. Fun!

Then there’s the chest x-ray done by a little old man named Miguel Angel. Very sweet.

Then they come to get your IV going. UGH. Of course they are bound and determined to use my left hand rather than my arm. Fine. It took two nurses and a vein finder (very much like a stud finder for the wall!) to finally get a vein. Not too painful, either. Too bad it didn’t work and my hand swelled up. So now this poor kid Luis comes and tries to find a vein. He as looking literally everywhere: wrist, forearm top & bottom… I finally said, honey, please go get someone to help you! So here comes two more nurses with the vein finder. They stick me in the middle of my left forearm. Nothing – except a huge bruise. I’d been telling them all along that they’ll end up using this one vein that I know is a good one and guess what? That is the one they used, which is in the bend of my left arm. What I told them TO BEGIN WITH. Why do people not listen?

Then the parade of Drs comes in: the internist, Camelo the surgeon (cute!) and Reyna the floor Dr (VERY cute!). I could look at Dr Reyna allll day. ;)

Then they haul me off to surgery. It took about 45 mins then about 45 mins recovery. I felt amazingly well right after surgery. I figured I’d pay for that, and I have. :P

Day two, Tuesday, I’m sore, of course, and don’t do much other than sleep and be prodded by nurses. I did have the leak test where you drink barium. Again, administered by the sweet old man Miguel Angel. I never had too much gas pain. I burped some, but not too much gas. Mainly it’s just SORENESS, which makes sense. Expect to feel like you’ve been beaten with a baseball bat.

Day three, Wednesday, we go back to Grand Central hotel rather than the Hilton SD because I don’t feel well enough to be that far from the hospital. I threw up a lot on Wednesday. Throwing up is actually much less of a production w/out much of a stomach. It’s like BLECH, VOILA! No pain, at least. Hilton refused to cancel my reservation and charged me for the room. Letters will be written to those fuckheads. That would have never happened with Hampton Inn, but sadly, I’m foregoing all Hilton properties because of this treatment, so I guess I’m a Marriott girl now. [update: Hilton did rescind the charges AND gave me a shit ton of points that will cover a one night stay.]

Thursday we come back to SD for the flight home. I am very sore and moving slowly, so Nick gets me a wheelchair. This apparently pisses off the TSA to no end. I didn’t do the nudie scan because a) it violates my rights and b) I couldn’t raise my hands anyway. Therefore I had to get a pat down, which is fine, as long as the agent is not a midget with an attitude. I told her exactly where all the incisions were, even SHOWED her and she manhandled me like I was meat. She SLAPPED my incisions in the pat down! When she hurt me, I grabbed her hand by reflex and she freaked out because I touched her. Fucking cunt. There were FIVE TSA agents called over, so I yanked up my shirt and said WHAT PART OF FIVE INCISIONS DO YOU NOT UNDERSTAND? I was also dizzy from dramamine and percocet, but they make me stand anyway. So they bring another bitch over who also manhandles me then they all walk away. ?? Letters will be written, but since they conveniently separated me from my husband and my phone, I have no pix. FUCK THE TSA. [update: I wrote an email of complaint and got a response. Then: nothing. It’s been almost two months, so I doubt anything else will happen. Time to write the politicians!]

So, that’s it. It goes by extremely quick! The coordinators Veronica and Azalia are amazing! The hospital liaison Rosa is very sweet, too. Really, everyone there is awesome and the care is top notch. Just a coupla caveats: the hospital had no hot water in the rooms one day and the wifi is fairly useless. The Hotel is NOT quiet, so don’t expect it. It’s loud with slamming doors and our last night there was a party at the pool right below us. At least the music was good! Photos of the hotel and hospital:
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They send you home with a bag of meds: prilosec, pain meds, antibiotics, mylanta type stuff, dramamine, dressings and antibiotics for your incisions and whatever else you need. At this point you have to open up the capsules and take the powder or bbs, which sucks ass. Cephalexin smells like feet. Prilosec is little bbs that have a weird taste. Learn how to hold liquid in your mouth and toss in the meds. You don’t want to taste that. Ick.

I’m now on day 4, Friday, and I’m up early. Didn’t sleep much. I am having Nick pick up a bed wedge for me today, I think that will help. Since there is a drain hole on the left, I have to sleep only on my right, so my neck is jacked up from that. ALSO: make sure to practice your deep breathing! Anaesthesia is very hard on the lungs. The bed wedge will make it easier to sleep on your back and help clear out your lungs.

Today I woke up extremely dehydrated, so my main task today is to follow the 4 oz every half hour rule. So far, so good. I’ve had gatorade, Silk Vanilla and some weak tea + Silk.

Just checked my weight. Pre-surgery it was 239.8; today it’s 242.2. ? Anyhoo, it won’t be that for long. :)

My Bariatric Vlog is UP!

I got my Canon camera rigged up and I’m now officially a vlogger! I put up two intro videos with my stats before surgery.

My YouTube Channel is http://www.youtube.com/c/AngelaPrattvlog.

Aside from a little weirdness with the sound, the camera takes great video. The next few will be iPhone ones while I’m in Mexico and San Diego – assuming I’ll feel like doing anything.

I’ll be doing weekly updates with weight and inches lost as well as what I’m eating and how I feel.

Follow my channel if you’re so inclined. :)

Bariatric Vitamin Regimen

Along with protein, the next most important thing for a gastric sleeve patient is vitamins. This also applies to RNY patients – even more than sleeve because bypass pretty much eliminates absorption of all nutrients for the rest of the patient’s life. My posts are guides for sleeve in particular, but I’m sure RNY patients will find them helpful as well.

Bariatric Vitamins
Bariatric Vitamins

The only vitamin that requires lifetime supplementation for a gastric sleeve patient is vitamin B12. Why? Because this vitamin requires a protein made in the stomach called Intrinsic Factor. The vitamin binds to this protein in order to be absorbed in the small intestine. Less stomach = less intrinsic factor to bind with B12.

I take a handful of supplements every day – as listed in this post. I’m a firm believer in taking vitamins and herbal supplements because I can tell a difference when I don’t. I’ve found suitable replacements for all the capsules except turmeric and selenium. I take turmeric for inflammation and selenium for hot flashes. I don’t expect to take any of these for the first couple of weeks, but I’m going to try to take one as soon as I feel that I can. There is much discussion about when you can take pills or capsules after surgery, so I’m going to play it by ear. You have to take omeprazole immediately, so that would indicate that you can take pills/caps. I’ll just have to see.

But for ease, I have gotten everything else in a chewable form. Here is the list:

Multivitamin Gummy Kirkland (Costco had a better price than vitacost) 2 gummies has 833% of daily B12
Vitacost Quickdots B12 sublingual melts 1000mcg per one tab (Vit B12 is water soluble, you cannot OD, so take a LOT)
Kirkland Signature Calcium Chews, SF Chocolate; 500mg Calcium/200IU Vit D, I take TWO to give me 100% calcium and 400IU of Vit D. I was taking Nature’s Plus Chewable Cal/Mag/D3 (600/300/500iu per 2 tabs; about 85% of daily) but I like the chews better.
VegLife Vegan chewable Iron 18gm iron per tab. This is a child’s supplement and is extra gentle. I do not take iron because I’m never anemic and it hurts my stomach, however, I thought it would be prudent to add this to my regimen while I can’t eat much meat. I’ve tried it out and it seems to be OK on my whole stomach. We’ll see how it is in a partial stomach.

As for my insomnia supplements, I think I’ll get some Deep Sleep tincture and valerian tincture. Since I’ve no idea when I’ll be able to take multiple pills or caps, I want to have *something* available if I need it.

Bariatric High Protein Smoothies

Since so much of the bariatric diet depends on blended things for the first couple of months, I’m exploring various kinds of smoothies. I’m in my last two weeks pre surgery, so I’m trying to do a smoothie for breakfast every day. Not a fan of smoothies, but it’s doable. Here’s what I’ve discovered.

I’ve said this before, I’ll say it again: GET A NUTRIBULLET. Unless you have a Vitamix or Ninja already, which I did not. These things make the best purees you’ll ever see and they are MUCH more affordable than a Vitamix.

Protein powder is your best friend. I got vanilla and unflavoured. I buy from vitacost.com and I recommend them for good prices and good quality products. They also have a 100% satisfaction guarantee, which I used with the first thing I ever bought from them, an old lady supplement that had bad side effects for me. They gave me credit and I didn’t even have to return the unused product.

Anyway, protein powder is a necessity when you only eat 1/4 cup at a time. The vanilla powder has 11gm protein per scoop and the plain has 18gm. I’ve found that the plain is fine in anything: soup, smoothies, purees, whatever. It has no effect on the end product other than just a little thickening, which is why I recommend not adding it until you are serving. I’ve been using the vanilla in breakfast smoothies and 2 scoops work fine when making about 3/4 to 1 cup. I’m trying to get the recipes down to about 1/2 cup – it’s harder than you think!

What I’ve been using in various combinations are these ingredients:
Silk Vanilla (it is fortified with more protein and calcium than dairy milk; 6gm protein/cup)
Greek yogurt (LOTS of protein: 23gm per cup! I like Fage.)
Natural peanut butter, smooth (8gm protein per 2 Tbl)
Vanilla protein powder (Vitacost brand, 11gm per scoop)
Unflavoured protein powder (Vitacost brand, 18gm per scoop)
frozen fruit; strawberry, blueberry and mango blend
Agave syrup if I want something sweet (rarely)

Fruit Smoothie (About a cup)
1/3 cup Silk Vanilla
1/4 cup greek yogurt
1/3 cup frozen fruit
2 scoops vanilla protein powder

This will blend up and gain volume to about a cup. About 35gm of protein. I’m working on smaller portions.

Peanut butter banana smoothie (about a cup)
1/3 cup Silk
1 med banana
2 Tbl smooth natural peanut butter (or ANY nut butter)
1/4 cup greek yogurt
2 scoops vanilla protein powder
2 cubes of ice if you want this cold

About 37gm protein.

Peanut butter smoothie
Same as above but no banana. Add ice if you want this cold.

I’ve seen various recommendations for protein intake, from 50gm to 100gm per day. Judging by these smoothie recipes, I’d say that getting in 70gm is totally doable even if you just drink these two smoothies all day. I’m going to try to see if I can make one that’s half a cup finished AND has 2 scoops of protein powder. I’ll update this post when I do that.

The reason people lose hair is the decreased protein intake and not taking enough B12. You MUST load up on gummy vitamins! I’ll make a separate post about that. Protein and supplements are not negotiable. Same for omeprazole (Prilosec), which is necessary in the first few months while the stomach adjusts to its new size.

I also have lots of veg purees that I intend to use for high protein soups. I’ve tried this with the unflavoured protein and it is EASY to put in 2 scoops (36gm) per 1/2 cup serving. So one smoothie and one serving of soup will give you plenty of protein if you keep the flavour profile up. I don’t like fruit much, so I’ll probably eat a lot of soups. I need flavour, which is why all my purees have onions, garlic and S/P in them. I refuse to give up FLAVOUR just because I have to eat purees! Neither should YOU.

Gastric Sleeve Diet Discussion

I just read Ultimate Gastric Sleeve Success: A Practical Patient Guide to Help Maximize Your Weight Loss Results by Dr Duc Vuong. I’d recommend this book for all bariatric patients, because he embraces a whole foods approach to recovery and establishing new eating habits. It is totally worth the $8 Kindle version.

While I love his EAT REAL FOOD mantra, the book is biased towards an Asian diet. He never addresses anything dairy other than to say “only baby cows should drink milk”, which is in line with his Asian background. He also does not address taking medications – as in, when can you take pills again, etc.

The first chapters of the book are very informative about how the surgery is done, with diagrams, which I love. I think for any bariatric patient, this book is A MUST READ. It definitely goes against the crappy diets handed out by the “nutritionists” who work with bariatric surgeons. Every diet I’ve seen has been absolute CRAP. Geeze, no wonder everyone loses their hair if they only eat fruit smoothies and yogurt for eight weeks! The diet given to me was boring, fruit based and asked for WAY too much protein: 80 grams a day!! WHAT?! I don’t eat that now! That is a LOT of protein, and unless you can eat whey powder straight, it’s doubtful you’ll get that much down. I’m aiming for 40-50gm.

Another very important point that Dr Vuong addresses is “mushy food syndrome”. This is when a bariatric patient continues to eat mushy foods long past the time needed for the stomach to heal. By continuing to eat mushy foods, you not only are not helping your new stomach to work properly, but you are not getting satiety because these foods slide right through your pouch. You eat more and this can undo your weight loss. It’s important to start eating real protein as soon as possible after your sleeve surgery. Dr Vuong goes into rating foods on texture, which I think is an INVALUABLE thing for bariatric patients to learn.

I disagree with his hatred of chicken, however. He also hates on pork and beef and recommends never ever eating anything but fish. Again, his Asian bias is displayed. I think chicken is a staple for most Americans and there is nothing wrong with chicken as your protein. Pork and beef should not be eaten more than 1-2 times a week anyway, so restricting those makes sense.

I DO agree that fish is softer than chicken, so eating fish to start out with solid protein is a great idea.

Dr Vuong completely ignores dairy products in his recommendations. Again, Asian bias. I think that yogurt absolutely has a place in recovery to replenish gut flora. I don’t drink milk, so I probably won’t be using it myself, but I don’t think that using milk in smoothies is a bad thing at all. Milk has protein, which is a prime ingredient for recovering bariatric patients. I plan to use Silk, a soy milk that is fortified with calcium and protein. I also have soft cheese (SOFT cheese, not hard cheese in slices or blocks.) in my soft foods list, because I love cheese and I can make a soup, or eat some goat cheese or pimento cheese if I want it. I also love cottage cheese, so that is also on my soft foods list. Let’s not forget that cheese is also high in protein.

What I’ve found, overall, when reading about bariatric diets, is that there is about a million different ideas on what you should do. The typical diet handed out by so called dieticians is a generic, fruit based diet that really doesn’t address anyone’s dietary needs. I’ve seen the exact same diet given to diabetics (high carb for DIABETICS!!). I think that this generic diet is given with the assumption that you’ve been sitting around eating junk food and drinking sodas all your life and that is why you’re fat. I see lots of assumptions from Drs and dieticians, who tend to think that you must eat really shitty foods to be fat. Which is absolutely NOT true. I eat a great diet and I exercise regularly thankyouverymuch. I do get a little bent out of shape when I consistently see these biases towards bariatric patients.

Furthermore, I think it is a damn shame that fat shaming extends to the very industry that is supposed to be helping people lose the weight in the first place.

I think that bariatric patients need to eat nutrient dense vegetables and protein powder until they can manage solid proteins. Fruits contain lots of sugars and have little nutritional value, IMO. I am not a person who eats much fruit to begin with nor do I eat lots of sweet stuff in general. I simply cannot tolerate a diet that is sweet and fruity. Ick. It makes more sense to me to eat as low carb as possible from the get-go, since that is how you should eat to maintain your weight loss. It’s too bad that 90% of what I’ve seen on forums, sites and books is conflicting and biased towards bland, uninspired, high carb foods and omg no fats. Low fat is good, yes, but not at the expense of eating high carb fruit all day long. I actually feel that bariatric recovery patients should not worry about fats since they are calorie dense. When you can only eat a cup of food a day (in recovery), you need every calorie you can get. And NO, I do not subscribe to the idea that if you let one gram of fat pass your lips you’ll go back to eating like before. Why? Because your stomach is now about 1/6 of it’s original size, that’s why. It’s damned hard to overeat when you are recovering from sleeve surgery!

Again, I feel that pretty much every bit of “official” advice (Dr, Nurse, nutritionist) is based on the assumption that if you’re fat, you got that way because you have no idea how to eat. Perhaps that is so for some patients, but I doubt it’s true for the majority. If you learn one thing while you’re fat, it’s how to count calories and what foods are “bad”. Honey, I can tell you the calorie and fat counts of pretty much any food you name. WE GET IT. I resent being given these diet rules that have no basis in reality. They are given to “wean” you off of eating real food with the notion that if you have anything other than crappy smoothies you’ll immediately order Papa Johns and eat the whole thing. This bias that if you eat anything other than nonfat yogurt and berries you’ll “relapse” into being fat is really annoying.

I think anyone going on this journey should prep lots of different kinds of foods that YOU LIKE before you go under the knife. I am prepping about a dozen different veggie purees that can be made into soup or used as is. I’m freezing them in 1 cup portions for easy thawing. I’m assuming that I’ll only eat about 1/4 cup of anything at a time, hence the small portions. I am using lots of flavours in my purees, from Asian to Indian to Korean and beyond. Onions and garlic are in EVERYTHING. I see no reason to compromise on flavour just because I have to eat pureed foods. Hummus is also a smooth and tasty thing that’s on my list.

The base recipe for these purees and a Carrot Ginger soup recipe are here.

I hope this info helps someone else getting gastric sleeve or any bariatric surgery.