3 weeks post op questions

Hi I'm fairly new here. I've replied to some posts but not posted my own yet. I had my surgery 3 weeks ago as of yesterday and the forst two weeks were really rocky with a readmission due to post op complications. I'm finally starting to get back to my normal life but have a few questions. I'd appreciate any input. 

1. Exercise - I've been walking around my neighborhood daily and it's not very large neighborhood but by the end I feel exhausted. I'm not short of breath or really that satisfied tired feeling after you work out it's more a total body weakness. Is this normal for this time frame? Should I walk less?

2. Nutrition - My surgeons instructions were to only eat when I "feel hungry." Well I only feel hungry about two times a day and am on the soft diet till next week. I'm writing down everything I'm eating and It's not even breaking 400 calories. My surgeon doesn't like protein shakes but I started adding them this week just because I was worried about still feeling so tiered so much. Is this amount of calories okay? 

3. Weakness/tiredness - I feel tired and week still. It gets a little better every day but I'm concerned that this isn't going to improve. I'm taking my vitamins and now with the premier proteins I'm getting about 50 grams of proteins a day. I'm trying to make it to 60 grams but I just can't eat that much in a day. 

4. First night out - tomorrow I'm going over to a friends for party. I'm supposed to bring a dish. First of all I have no idea what to make that I could actually eat. Second so far I've only eaten around my family and my two best friends who know about the surgery. They know why I take two bites of something and put it away. Also I've lost 29lb since I've seen these people last one month ago. I'm nervous that they will ask me what I've been doing or even guess that I had surgery. (Most of my friends are either MD's or other 4th year medical students) This is my first time post op to be back with my less close friends and classmates. It's making me very anxious and I'm not usually an anxious person. 

5. Feeling underwhelmed - I don't know why I'm feeling like this but I'm also worried that I'm not doing well enough on the surgery. I lost 10lb pre op and another 19lb in the last 3 weeks but even though my two best friends see a difference I'm not really seeing it in the mirror. I told this to my husband and he said that I'm being a "gunner" even about weight loss. That's a term medical students use to call one another an over achiever. I'm just scared that I won't succeed and that I'm not losing enough during this initial period. I feel stupid feeling that way because 19lb is a lot. I want this to be successful and as I get closer to week 4 and starting a more normal diet that I'm going to mess it all up. I guess this last one isn't really a question but more of me just expressing my feelings. 

Sorry for writing so much. I don't know anyone in person who's gone through this. Given my schedule as a medical student I haven't been able to go to any of the support group meetings in my town. 

Wow.

1) Yes, it's normal

2) Get a nutritionist and plan your eating. Don't eat when you're hungry or not when you're not. If I'd have followed that, I wouldn't have eaten at all for the first 3-4 weeks. If your pouch is so small/sensitive that you can only take 2-3 bites at "a time"... be more exact... what timeframe is that in? A meal can last you as long as 20 minutes. And if it's taking you 20 minutes to get down 2 bites of soft proteins at 3-4 weeks out, you have problems that are not normal, even for RNY patients.

3) Eat your protein as much as you can. Add high protein snacks like cottage cheese and greek yogurt to your day.

4) Either don't go, don't eat when you're there or bring a big bowl of mashed potatoes with cheese in it. I didn't hide my surgery from anyone, so this was never an issue for me.

5) You're eating 400 cal or less a day... you're not losing weight quickly because you're starving, more so than you should be. Seriously, find a nutritionist that specializes in bariatric, post op diets. If you are seeing one, find a different one because you are not getting good advice. Once you get a good one that gives you good advice, things will turn around for you.

Best of luck!

Thanks for the advise. I'll look into a new nutritionist. 

19 lbs the first month is really good.  You'll read about people losing 30 lbs the first month, but that's definitely at the high end of range.  Some people only lose 10 or 12 the first month.  There are so many factors that can affect this - gender, age, metabolism, whether or not you lost weight pre-op, etc, that's it's sort of pointless to compare yourself to others.  I "only" lost 16 lbs the first month, and I've lost almost 200 lbs altogether.  Just follow your plan and you *will* lose weight.

we weren't supposed to count calories early out, only protein grams, but 400 kcal sounds about right.

re: not seeing the difference - you won't notice it in the mirror day to day or week to week (and early out, maybe not even month to month).   But have someone take pictures of you once a month on your surgery date from different angles.   Once you compare pictures that are four months apart - or six months apart - or a year apart, you'll see a huge difference.  I seriously don't even look like the same person anymore.

re:  dinner party.  Not many people knew I had surgery.  The first month or two I used lots of excuses for my weird eating habits.  "I'm not really feeling well".  "My stomach has been acting up lately".  You could always take pureed soup or something.  Or just pretend you're not feeling well and skip it.  It gets way easier a little further out when you can eat more and don't have nearly as many restrictions - but you may still be able to swing this one....

tiredness and weakness is normal the first few weeks.  Your body is recovering from trauma and you're not taking in very many calories at that point.

re:  hunger - a lot of people lose their hunger sensation, at least temporarily (a lucky few lose it forever).  Mine came back after about six months.  So I couldn't really eat when I was hungry for quite awhile - as in months.  I just made sure I was getting nutrition every few hours.  

that's kind of weird your surgeon doesn't want you to use protein shakes.  Early out, that's often the only way people can get 60 grams of protein in.  Even doctors who don't really approve of them for long-term use are fine with them that early out - so that's kind of odd.

Thank you for the advice. I started tracking calories mainly because I was trying to track protein and on my fitness pal it automatically does the calories. I agree about it being odd she doesn't like protein shakes I can barely make it to 60g of protein with the shakes. I started the shakes about 2 days ago because I couldn't get past 30g without them. 

I haven't told anyone because first it's personal to me but also because in the medical field the medical students and residents who are essentially my coworkers right now have such a disdainful view of patients that are obese. They make horrible jokes in the workroom. I just don't want to be the but of a joke. Thanks for the advise. I hadn't thought about soup. 

I can't get to 60 grams of protein most days still and I'm almost 3 months post op. Not without a shake anyway. I would be eating all day and not drinking. I'm sure over time that will get easier. 

I'm in the medical field too, have been a RN for 16 years so I know the prejudices people have towards the obese. It's a shame and you will be better than that! 

Honestly you sound to me like you are doing fine overall. You had major surgery and then had complications, it is going to take a little while to bounce back. While I felt good a week after surgery, I still took naps every afternoon for at least a month. Anyone who knows me knows I go not take naps. 

In the first weeks I ate between 350-550 calories. I don't agree with waiting until you are hungry. You should be focusing on working yourself up to fluid and protein goals at this point. Minimum 64oz fluid and minimum 60-80g protein. Because you can only eat do little at a time, my doc said could eat up to 5 or 6 times a day. 

19 lbs in three weeks is amazing ... I am not sure what made you think that is not good. 

Be kind to yourself and don't bring a big tub of mashed potatoes. My first 6 weeks after surgery I had three weddings, my brothers 60th birthday, and s BBQ for 100 people in my back yard. First wedding I ate nothing, took my dinner home, and stepped away and drank a premier protein drink. Second wedding doc said I could have soft fish, My doc starts you on full  food by 4 weeks, so I just took small bites of protein. Look on World According to Eggface blog. She might have recipe that would work.