3 wks post op - Eating too much/fast, hungry, stall, stretching?

Hello all, I had my vsg on 5/2/17 and healing went extremely well. I went back to work within a week. I wasn't hungry until about day 5 and I feel like I've been hungry the more foods I introduce.

Week 1: I was ended on full liquids and lost only 3lbs heading into week 2. I started getting really hungry and wasn't sure when to stop eating toward the end of the week. I stuck to mainly 2oz of liquids at a time but I was quite hungry and worried about not feeling full.

Week 2: Abdominal pain from surgery was gone by day 10. I weighed in at 286lbs and started eating pureed foods (not supposed to start until week 3). The pureed foods have been going down fine - no issues, however, I did eat some not-so-pureed food that I chewed through and ate. They went down fine as well, but, I found that I might have been eating them too fast and I got sharp pains in my lower chest area that lasted a few minutes and I had to walk around to feel better. I'd stop eating after that but the hunger didn't go away throughout the day. I get hungry every 2 hours or so. I find myself munching on almonds or grabbing a cheese stick or two to curve hunger. I'm getting in about 40 oz of liquid by now but can't make it to 64. I feel like I can eat a lot more than what my plan says I'm supposed to... I feel like I can eat about 8oz of liquid (1 cup) or 4oz of solids per meal. I've been eating too fast and have thrown up twice because it takes my stomach time to catch up to how much food I'm eating. I don't realize I've eaten too much because the full feeling doesn't come until its too late. I was not going #1 or #2 regularly, but by the end of the week was going #1 maybe twice a day and #2 once a day if I was lucky. It's strange for me to not go #1 because before surgery, 2 cups of water would send me to the bathroom. I'm taking in 4-6 a day.

Week 3: I did not lose any weight and am still at 286. I introduced some soft foods and they've gone down fine as well (supposed to start week 4/5). I'm still at about 40oz of liquid but am hoping to reach 64 by the end of the week. I'm SO hungry. I eat a 2 miniature egg muffins for breakfast (8am), eat 1/2 cup (5oz) of greek yogurt when I get to work (9-10am), eat 3/4 cup of ricotta bake for lunch (12-1pm), eat 1oz cheese-1oz almonds-2oz grapes for snack (3:30-4pm), 1-2 cheese sticks as a snack (5pm-6pm), and 1/2 cup of chicken or other protein for dinner(7pm).... all of that and I'm still hungry at the end of the night!!! I'm still having trouble with being regular for #1 and #2. I've gone more frequently but I still feel very backed up and I've got pressure in my lower abdomen because of it. I've also started waking up with deep tissue pain on my left side where my stomach is.. during week 1 & 2 I was able to sleep on my side without feeling stomach pain, but, this week, it's been hurting. I'm worried that I've stretched my stomach and that's what the pain is. I'm also worried maybe a staple got loose or something... i feel like my stomach area is looking swollen and I may be leaking... is this possible?

I know I should be sticking to the diet plan but my surgery team has hundreds of clients and they just handed me a packet and expected me to just follow it. I feel like my stomach can keep down puree or soft foods earlier than what the packet says so I started eating them. I feel guilty about it but they made it seem like the reason for the stages is because of what your stomach can handle. I feel like my stomach is doing fine except for week 3 which is why I've stuck to doing yogurt and the ricotta bake since they're kind of still in the puree stage. Does anyone have any advice or has anyone gone through something similar? I'm worried my stall is because my stomach has stretched and is now used to this new amount of food. I'm trying to go back to the gym this week and do some light cardio/weight lifting to hopefully counter the scale but I don't know what to do about the food. Am I eating too much? Disregarding that I skipped stages, is the amount itself too much? Should I go back to liquids and start over? I feel misled from my surgery team. They made it seem like i was going to have this tiny stomach and that I would be full with three sips of water. I'm unbearably hungry and am eating too fast because of it which causes discomfort sometimes. I'm worried that I might head into week 4 with a gain...

My advice is to follow your plan. Now. Why did you do this if you weren't going to follow the rules? You could cause yourself serious damage. Your stomach is not fully healed and that's why the diet progression your surgeon gave you needs to be followed.

Your stomach is still healing - you can't trust it to tell you that you're hungry, that you've eaten enough or anything else. This is why it's critical to follow your instructions.

You shouldn't be doing any sort of exercise aside from walking until you've been cleared by your surgeon - this normally doesn't happen until 6 weeks post-op.

You weren't "misled" by your surgery team. They gave you clear guidelines and you chose to ignore them. At this point hunger can often be caused by dehydration (and you admit that you're not getting enough liquid) and also stomach acid. If you're not taking a PPI already, add that to your life.

With the way you're eating now, I wouldn't be surprised if you headed into week 4 with a gain. The surgery is not magical - you still need to follow the rules and do the work.

Thanks. I guess I just don't feel like the packet is a one size fits all kind of thing and I was hoping for a more individual plan. Other plans I've seen, people started puree stage during week 2 and they're at soft foods week 3. My hospital's old plan was like this as well until they changed it a few months ago. I really should stick to it though so I think I'm going to go back to stage one and go from there.

I met with my surgeon and he's happy with my progress (as of week 1) and my water intake. I mentioned my hunger but he said it was normal and didn't mention anything about antacids. I'm slowly drinking more each day and was cleared for light exercise after 10 days post op.

Your hunger isn't normal. It's probably either acid or just simply head hunger - you think you want to eat. Physical hunger is pretty rare that soon after surgery from everything I've read and the vets have said. At 4 months out I do feel hunger now, but 99% of the time it can be distracted (head hunger) and if it can't I have very obvious hunger signs and it's been hours since my last food. I still drool over donuts and pizza, and it's battle of wills to just not eat them.

You need to plan out your food and stick to it. Pick a calorie and protein goal based on your plan and track everything on something like MyFitnessPal. Make sure you are weighing solid proteins and measuring liquid proteins. I'm currently getting 650 calories per day and 80-90g of protein.

At 3 weeks out I was on purees, which in my plan included canned chicken and fish, ricotta bake etc. I could eat about 1oz of food at a time (a couple of fluid ounces). Given the nerves in your stomach are cut you can't feel the damage you may be doing.

Did you explain to your doctor that you advanced your diet to include foods like almonds and half a cup of chicken at 3 weeks post op? For reference, I'm 3 years post op and can barely get in 1/2 cup of chicken. Almonds were not part of my diet in the pureed or soft food stage since they're not soft. But if you told your doctor that you've deviated from his plan and he's pleased with your progress and fine with your progression, I guess you're fine. My surgeon would not have been pleased or fine and would have insisted I go back to following the plan he worked hard at creating.

The plans are a one size fits all because your team has a lot of experience and knows what works for their patients. The times it doesn't fit all, it's in the conservative direction - not the "advance your diet more quickly" direction.

Your hunger is normal - but it's due to lack of hydration or uncontrolled acid. You need to be getting 64 ounces MINIMUM a day and until you're able to get in that much fluid, you shouldn't be thinking of putting anything not fluid into your body. Fluids are your job initially. Acid can also mimic hunger - you can get a PPI over the counter. Most people end up taking something like Nexium for the first few weeks post-op.

I also completely agree with the suggestion that now is the time to find a therapist if you don't have one already. It's worth figuring out why you've self-sabotaged this early after, in theory, committing to being successful with weight loss surgery. There's a lot going on here and a therapist can help you unpack all of that.

What's done is done but you can start doing it right, from here on out. Focus on hitting the water and protein goals. If you hit those you can eat other stuff but only if you hit those first. Try to drink water between every meal. It will help you feel full. I use Mio personally because I don't like plain water. Eat as slowly as possible and chew at least 30 times on each bite to give yourself time to feel full. I think you'll be ok if you get back to basics.

Thank you for your kind words.

I'm going to try focusing on my water and protein goals for sure. I always thought of chewing 30 times as a puree type thing but it does make sense that it will slow me down. Still getting used to that but it doesn't hurt to get reminded.

I think it's way more important to chew well after purees. I chew up all my solid proteins to mush before swallowing. It does help with over eating but also with that dry "too much food" feeling.