8th Month Follow-up and Maint Plan

Today I had my 8^th month follow up with Dr. Nishimura. I told him that I want to stop losing. I feel great and am pleased with the way I look.  I believe that I will look horrible at a normal BMI which would put me around 180 pounds.  He was very pleased with my progress and said that if I’m happy with my weight loss then I should stop. I don’t have to reach a normal BMI if I’m not comfortable losing more weight. He said although my rapid weight loss maybe over I may still experience weight loss over time and I should be prepared for that. Dr. Nish said that my body will stop before it gets to an unsafe point. He advised me to talk to the dietician. He asked me if I was exercising. I told him I was doing Spin classes at the Gym a couple of times a week.  He advised that I should cut down on the aerobics and increase the weight training and build muscle.  He reviewed my blood work and everything was in the normal range. Last test I had a problem with Iron and B-1. I also had an abdominal sonogram done to check for gallbladder issues. Received a clean bill of health on that as well. The only other advice he gave me was to cut down on the Diet Snapple (I drink this like water). He said that it has tannic acid which has been linked to cause ulcers.

I then spent a lot of time with Jill the Dietician. She took all my stats (via a Tanita Body Composition Analyzer) and compared them to my initial consult:

	12/7/2009	11/18/2010
Weight	357	214
BMI	49.7	29.8
BMR	12215 kj	8468 kj
	2919 kcal	2024 kcal
Fat %	39.8	16.4

 

I provided Jill with my food tracking via myfitnesspal.com. I’m currently consuming about 1200 calories a day she said at this rate I will continue to lose weight. She said if I want to maintain I need to add at least another 500 to 800 calories a day. She suggested having a couple additional protein shakes.  She said that 50% of my caloric intake should be protein, 25-30% fat and 25-30% carbs. She concurred with Dr. Nish on the exercise. If I continue to do more aerobics I’ll need to increase my caloric intake to compensate for the additional calories I burn to maintain my weight. Weight training will add muscle which is heavier than fat. It may also help with some of my loose skin.

Don’t know how I’m going to be able to add that many more calories. She said that I should be able to eat more soon as my pouch stretches. I told her I don’t have a pouch but she insists that I will be able to eat more in the future. She also said that it’s typical that before two years I’ll gain another 15 to 20 pounds.

Dr. Nish said he considers my operation a complete success. I should come back for a follow-up in four months. This will put me at the year mark. Jill said I should come back much sooner to way in and discuss any nutrition issues.

sounds like you had a great meeting with both your surgeon and nut..  Keep us posted on what you add and how it works for you.
why do they expect us to regain is that because we are adding in more carbs?

She said it's because will be able to eat more and it's a natural progression.

great report, mikey mike, sounds like you have a good team. you are definitely a complete success. will be interested to see how you add those calories in. But gee, a couple of additional protein shakes??!!   what a drag. I am ok with one per day these days but wouldn't like that as my calorie increase option. were any other options suggested? 

Interesting info on the diet snapple. none of us needs an ulcer.

thanks for sharing this information. good luck with the plan. D

For me, to add chunks of calories, I just add healthy fats, avocados, macadamia nut oil, coconut oil. 

I have a snack that is 32 g of Naturally More peanut butter (more fiber, omega fats and protein than typical peanut butter) and 1 T of Hershey Naturally Dark cocoa, mix it up together, turns into a fudgey sort of consistency, then wrap it in havarti (first choice) or mozz or provolone if my usual packs of  havarti are gone.

its 265 calories 11 total carbs, 5 grams fiber, 2 grams sugar, 15 grams of protein, (stats using havarti rollup slice).  I have one earlier in my day typically and then if I have spent more calories than I have eaten, I can make up calories later in the day with it without it being a volume of food.

And sure you will be ABLE to eat more in the future, and you may, or may not want to.

I tweak my calories up and down using the healthy fats and what type of meats I am eating.  Its possible to eat 2000+ calories in a day without needing to resort to empty calories or volume. 

I liken it to my budget and needing a shirt.  Sometimes I have enough money only for Wal-Mart (chicken/turkey/fish) and sometimes I have enough for Needless Markup (beef, pork, corned beef..mmmmm, patrami, salami - except you gotta watch the sodium if its an issue for you!).

Hooray for your complete success! 

Thanks for the info. I really needed that. I have to find a substitute for the snack I'm using now.

I didn't mention that I also saw my PCP for my annual physical. Even after losing all this weight, My blood pressure is still high (142/91). Still on meds for it.

I was talking to his receptionist after the exam. We started getting into diets and she asked me about my sodium intake. She's thin as a rail but also suffers from high blood pressure. She said that she has to watch her sodium level as it's a trigger for her. She had to cut down on the pretzels which she loves. It then hit me that I snack on those CVS pretzel nuggets and there loaded with sodium. Have to take those out of my diet.

Thanks again.

You are welcome, friend!!  We can figure stuff out with so many heads!

My husband is trim, has been all of his life and tends to run high blood pressure also.  Its just genetic, so sometimes that's just the crappy ol toss o the die. 

Durn ol CVS nuggets!  Maybe they can be just a monthly fun snack and not forever gone, since the carbs do not seem to be triggery for you! 

Way to go Mikey !

- I drink diet Snapple also...... gonna cut back on that.

- I'm officially starting my quest to prove your nutritionist wrong on the natural weight gain of 15-20 pounds in 2 years. I'm not happy about that! I don't want that! I don't need that!

Makes me wonder what she says about 4 years out? More weight gain?

Got me a little worried now Mikey !!!!

Thanks for such a thorough posting of your appointment!

frisco

That was the second time she brought that up. I think her experience is based more on RNY results. The first time she mentioned it to me was a couple of weeks ago at our support group meeting. She backed it up by asking (in front of me) three patients that were 2, 4 & 5 years out. They agreed with her but they were all RNY patients. She kept saying pouch and that it stretches.
It's my goal to proove her wrong as well.

Hey, I too am worried about this so called 10 or 15 lb regain effect. I have heard Dr. Cirangle say this is pretty common. But I would like to hear from all the longer term sleevers in this group if that is true. I think Mikey is right that this data comes from RNY people and I am not sure there is any data on sleevers for this. Lapsf will have their 5 year sleever study out pretty soon. Hope it addresses this. I lost a little below goal for this reason and not because surgeon told me to. Gonna try to remember to ask this at support group in a couple of weeks. anyone going to a support group sooner might ask as well.

I for one do not want to regain 10 or 15 lbs and be back to the old diet struggle. I want to maintain pretty close to this weight. For one thing, if I gain 10 lbs those sparkly a$$ jeans won't fit! Can't have that!. Again, great report Mikey. Lets all share results of our follow ups. My one year is going to be probably in january even though I am a year now, but want to push the blood panel expense into next year for insurance reasons and doctor ok'd this. D