Move more Eat Less... surgeon update...

For those of you that have been following my Friday-Weigh In ...Gains!!!  I met with my surgeon to discuss my frustrations. I was told the secret to any bariatric or other weight loss is simply to eat less and move more. I do not feel any restriction with my RNY and can eat a regular sized meal. My surgeon's reply was "Why would you do that?".  I explained that I am never full... and wonder is this head-hungar or is there something mechanically wrong with the surgery. The surgeon said it is "poor choices on your part". Hummm... was this surgery the wrong thing to even try...sigh???  I am eating between 1200-1300 calories a day. The surgeon did my BMI and told me that based on my weight I am eating at least 600 excess calories per day. How with journaling can I be that far off??? I told him something is WRONG!!! After my reading on Obesity Help ... I've asked for thyroid and cortisol testing. I also asked for an endoscope study to be done. My surgeon's comment was "I'll do the testing...but it all boils down to eat less and move more". I'm so FRUSTRATED!!! It seems the more I try the worse the results become. I told the surgeon I saw his nutritionist and by following her suggestions ...since my 5/15th appointment I've put on 10.5 lbs!!!  I asked about going back to protien shakes and bars and again my surgeon stated "those are no longer necessary once you are over 1 year post op... you can get all the protien you needed from a regular diet".  Oh the list goes on about the appointment... but the bottom line is... do I let him do an endoscope on me when he's already dead set against any possiblities of anything being wrong with his surgical procedure on me? I just dont' know where to turn... so I ask each of you that reads this... what's your honest opinion if this were you... what would you do? Am I just over reacting??? Comments are appreciated :-). Thanks,
Kathy

I do not think it sounds like he is not  being very supportive and I would prefer to find a Dr. who is willing to work with your requests and not belittle you. That being said, it is true that the bottom line is eat less and exercise more. Just like before surgery, We don't have to fill our stomach to full even if we can. But if it would give you more peace of mind, have the testing done. In the past I have felt like I have had things done, or gone on certain meds when really changing my eating habits was all I needed. Sometimes though, I couldn't seem to make the necessary change until I had jumped through the other hoops. I am so sorry you are having this struggle and will look forward to hearing what you decide.

Here's an example from my current life. I am fretting about my extreme blood sugar fluctuations ( which I think also correlate with my menstrual cycle and of course certain food intake) So I start thinking because my general MD says I just need to watch the white stuff... sugar, flour etc I am gonna "fire" her and see an internist or endocrinologist. At this point I have talked myself into waiting until I have lost to goal and been more food compliant. Then see if I am still having  the problems. Just because she told me something I don't want to hear, basically I like her as a Dr. and am gonna try to turn this around before I go the other route.

Listening to our doctors and trying to turn our situations around is the ultimate goal. I can't imagine having the extreme blood sugar fluctuations... that has to be tough. I like the goal you've set of losing the weight and achieving a compliancy that you can live with. My false reality with bariatric surgery was that I set myself up for failure. I thought I'd feel restriction with smaller meals and it just hasn't happened from day one after my surgery. I've been able to eat and drink all that was put in front of me. A friend at my support group couldn't not believe I ate the whole popsicle and drank the drinks they gave me after surgery. Who knows maybe they just installed a funnel from my mouth right to my intestine. I'm honestly never full , have never dumped and just dont' feel like a normal bariatric patient. My dietary guidelines are like those that never had bariatic surgery... so again why did I even bother with the surgery?  I dont' mean to be so negative but it's tough trying to act like a bariatric patient when the quanities I can eat are like someone that never even had the surgery. I know it's time to roll up my sleeves, dust off my broken pride and get busy... but I'm more confused now than ever as to what diet to follow or what to eat...as the rules of bariatrics just are not working. See you on friday for the weigh in. Thanks so much!!!! for your continued support.
Hugs..
Kathy

I think the answer is eat less and exercise more.  Calories count just like they did before.  Cut back some on your calories and exercise A LOT more and see what happens.  It's a matter of finding the balance for you.  LiveStrong.com/thedailyplate will compute the calories you need to consume to lose the weight you want to lose (i.e. 1 pound a week) based on your current weight and your exercise level.  The less exercise, the fewer calories  The less you weight the fewer calories you can eat and lose.  I've found this to be a wonderful site for planning my food and being certain I get the nutrients I need.      I cannot stay on track without planning at least two days ahead - I may rework my plan, but I need a starting point.  "Remembering" or "Estimating" just isn't accurate.  I don't alter my plan in any way that violates my calorie allotment for the day or my nutritional needs for the day.  I monitor my calories, protein and surgars (per my surgeon's nurse's advice)  Of course, the way we eat is high protein and low carb. 

Hope this helps

Hi Happy,
Thanks for your reply. I can so relate to "remembering" and or "estimating". I do not plan my meals ahead of time by much. I usually get up in the AM and then plan out the day. I try not to get to far ahead of myself in my planning. My calorie allotment and nutritional needs according to mydailyplate just are not working for me. I even dragged out the measuring cups and my dietary scale thinking maybe I was cheating myself with to big of portions. No matter how much I count and how much I move I can't get the weight to do anything but go UP!!!  If only the formula of eat your protien , drink your water, take your vitamins and exercise could work for me... the bottom line is it doesn't.  I'll try to plan out my meals for a week and see if that gives me any more stability with my diet.  The whole idea of moving more and eating less makes sense...but how many hours do I have to spend in the gym each day to make that work?? The 1/2 hour a day on the treadmill and my yardwork just isn't cutting it for me. Thanks so much for your continued support. I appreciate your comments very much.
Hugs,
Kathy

It doesn't sound to me like your doc is very supportive!  We have been told all our lives to eat less and do more.  That for me was the problem - if I could do that then I would not have needed wls.

You have my sympathy.  It is possible that there is something wrong with your wls.  It is also possible that there isn't anything wrong but you won't know until you've had it investigated.  But I would be wary of using a doc who is already convinced of the outcome.  If your insurance covers you to see someone else, and it would give you peace of mind, then go see someone else is my two pennys worth.

Big hugs as I know how frustrated you are with this.

Ruth

Hi Ruth,
Thanks for your support. I'm torn as to what to do about the endoscope. Since I first posted this thread my frustrations are just mounting. The bariatric group that I go to has two surgeons. I thought maybe the other surgeon could do the endoscope to see if he could offer any suggestions. Then some friends commented but "do you think one surgeon would be honest with you if there honestly is something wrong with your pouch?". The next comment I heard was "if you go to a different bariatric surgeon... he/she may have their own technique for the surgery and automatically tell you the whole thing is wrong".  Is there a golden standard for RNY surgery? Or are we all a design of the surgeon we choose? Therefore some more successful than others? I thought one RNY was just like any other RNY. I learned my surgeon uses a vertical pouch with a 15mm stapled ring for the stoma. The surgeon that works with him does a horizontal pouch with two pieces of feeding tube tied around it so it can't stretch beyond a certain point. I think finding out if there is something wrong with my wls is going to be tougher than I ever imagined. I've ordered my operative reports from my surgical hospital stay. I'll read them over and see if I can find out how long my RNY limb is, how big my pouch is and what size the connections are. Then knowing my body...maybe I can actually carry on a conversation with another surgeon for the second opinion I do so desire to get . Thanks so much for listening.
Hugs,
Kathy

First of all let me say that I don't think 1200-1300 calories is excessive at all.  However, if you are gaining weight and constantly hungry then you have to do something differently in order to make this work.  Please don't take this as me being bossy, or assuming you don't know what to eat, or trying to sound like an expert.  I am just giving you my opinion, like you asked for in your post.  If it were me in your situation, I would politely reaffirm to my surgeon that although I appreciate his advice I would still like the scope just to ease my mind.  I would get the scope and if my pouch was fine then I would thank him and move on to the "eat less, move more" philosophy.  I would set out on a plan of 3 meals and 1 snack a day with really dense protein sources and no starchy foods like oatmeal/bread/potatoes, etc. 

For instance, I would have 2 eggs and a slice of ham for breakfast, which would be very filling and provide about 200 calories and roughly 25 grams of protein.  I would not snack between breakfast and lunch, but start drinking water and/or Crystal lite an hour after breakfast.  I would try to get in several large glasses or water bottles in that time.  
Then for lunch I would have a large (4 oz) boneless chicken breast on a veggies only salad (about 1 and 1/2 cups of lettuce, tomato, cucumbers, radishes, whatever you like) with some low calorie dressing. (I love Paul Newman's lite Balsamic Vinegrette and McDonald's even carries it for their salads!)  Or maybe tuna or chicken salad from home with light mayo and relish, etc.  That would roughly give you about 200-250 calories and over 20 grams of protein.
Then again, an hour or so after eating I would hit the water bottle and try to get several in throughout the afternoon.  
For a late afternoon snack, I would have a protein shake so it would not interupt my water intake.  There are so many to choose from that you can surely find one you enjoy still.  If not, maybe a cup of cottage cheese would work.  That's something you could store in the fridge at the office if you're not in the home.  If you are home, you could try some of the recipes floating around for protein ice cream or other protein treats.  Either way, with cottage cheese or some sort of shake, you should get another 20 grams of protein and around 200 calories or less. 
Finally for dinner I would have another 4 oz  dense protein like pork, steak, a ground beef patty, or salmon and a 1 - 1and 1/2 cups of veggies.  Depending on the choice, that would give you anywhere from 250-400 calories.  After dinner, if I needed something for a craving, I would not snack on anything more than sugar free popsicles, broth, Crystal lite or maybe a serving of fresh fruit if I had room for the calories.
Totals for the day would be under 1000 calories and over 80 grams of protein.  Those dense protein sources and water/sugar free drinks in between should keep you full.

Again, please don't feel like I am assuming you don't know what you're doing.  I'm just trying to help.  We all need a little hand holding sometimes to feel like we aren't alone.  I am re-losing a huge regain from not following the rules and surprisingly my pouch is working very well with my new committment.  Best of luck to you!

Dragonfly...
I appreciate your food guidelines very much. I've printed them off and will try anything at this point. I do have to admit I had the two eggs and slices of ham this morning and sit here typing still with racing hungar pains. I will have my coffee in another 1/2 hour or so and just fight through the hungar. I am never full or satisfied with what I eat. I feel like the bottomless pit that I just eat and it drops right through me... sort of like I dont' have a stomach/pouch at all. I can drink 8oz of water down in less than five minutes with no problems at all. Getting in my fluids is not a problem at all.  Your meal plans are terrific. They sound very similar to what I try to eat. Your time in repling with such a detailed response ... I'm very grateful for. At this point I will try anything!!!  I have been watching your posts on the liquid phase of the diet and have asked my surgeon if I could go on a total liquid diet as a "newbie" to RNY and he said NO...stating that we've undergone a lifestyle change and have grown beyond that stage of our new lives. Again , I'm not in agreement with my surgeon. IF the liquiid phase can get my scale moving back down... I think it's worth a try. I just dont' want to go against the plan my surgeon has for me...but at the same time if it would work ...it sounds like a plan. I'll just have to keep trying and hope for the best.
Hugs...
Kathy

Kathy,

I hate that you're having to face this issue with your doc. You're already stressed out by not losing and this is adding to that, which we all know, can lead your body to deal with the stress in other areas. If you would feel more comfortable going to a different doctor, please do so, but definitley research the one you will be seeing. Each bariatric doctor has their own views and ideas on how we should be using our "tool" and what kind of food we should eat to fuel our bodies.

For instance, my surgeon and his staff preach protein drinks every day for eternity after the surgery. They don't specify a certain number of calories a day. And they do say to limit sugar intake (we all know why ), no carbonated beverages, no caffeine and no bad carbs/slider foods.

I went back and saw my dietician after having a scope and diagnostic lap procedure done. My pouch is the size its supposed to be for being out 4 years. So, she put me on a "plateau" diet to help me start losing weight again.

Here's an example:
B: Protein meal replacement (30g protein, carbs and sugar/sugar alcohol should be less than 10 g),

S: Protein bars (at least 15 g protein, less than 10g sugar/sugar alcohol)protein shake, 2ozs lowfat cheese w/5 whole wheat crackers, 6 oz light yogurt w/ 1/2 c fruit, 1/2 c cottage cheese w/ 1/4 c fruit, or 2 TBL low fat peanut butter w/small apple or 2 celery stalks

L: 2-3 ozs lean protein, 1/2c green veg salad w/low fat dressing

S: Any of the above

D: 2-4 ozs lean protein, 1/4-1/2 c raw veggie or 1c-2c cooked veggies (which is a LOT of food)

S: optional but if needed one of the above.

Then at least 64 ozs of water and 45-60 mins moderate/high exercise.

I've started logging my stuff on thedailyplate and realized some days I would eat 800 calories while others I could easily eat 1700-1800 cals. It suggests I eat aroung 1625 which is hard for me to reach most days. When I exercise, it puts me around the 1000 cal range. So far, I'm starting to lose.

I hope that helps. I know sometimes just seeing what different people are doing can help us see what we might need to change or do. Hang in there, we're in this together.  Please post with any frustrations or new developments.