44 Year Old Mother of 2, PCOS, Sleep Apnea, Back and Knee Pain. Houston, TX
I was skeptical and afraid to have WLS. I had...
Today's visit was much less chaotic. The office manager (whom is very sweet) came in herself to make sure all of my questions were addressed. Dr.S is my favorite doctor. I just think he is a big sweetheart. I think the last visit was crazy due to some clinic changes. It had nothing to do with me. It was just timing.
Anyway, this visit was so much better, and they went out of their way to make me feel special. ( Dr. S can undoubtedly be very charming....but really, that is his job.)
I am very happy that I went to see him again this week, he was just a doll.
I am considering some other procedures, but it will be a little bit before I can have another procedure. I have do more thinking what I want to do.
(I have to overanalyze my analysis and then re-analyze my overanalysis.) lol
I hope my bb is healed by next month when I return.
Also, he said I can start abdominal exercises now, so I am very excited about that too!!
Weight Loss and Exercise: The struggle is real
I haven't posted very much to my WLS review because I was busy healing from plastic surgery. It has been nearly 9 months since I last posted anything. I want to say what an amazing and exciting transformation this has been for me!!
I am so happy that I decided to have WLS ! I cannot imagine still having to "drag" all of that extra weight around. (Even though I was curvy, and nobody thought of me as "obese" - At least that's what they said- I was definitely obese.)
I can look back and think about days when I stepped on the scale, and no matter what I seemed to do or how hard I tried, the numbers just didn't go down. It was terribly depressing. I did not understand then that the extra fat produces hormones that disrupt your metabolism, and keep you fat. It is just nearly impossible for some of us to lose the weight and keep it off without having WLS surgery.
Part of the puzzle for me is that I do believe (No, I KNOW) that I have a slow metabolism, and I have had more than one doctor tell me that my thyroid is not functioning well; however, Dr. Marvin did not want to put me back on Synthroid, even though I took it before. My core temperature runs at about 96 F. (No kidding) One endocrinologist had me taking it every morning before I got out of bed, and I recorded in the 96 to 96.5 range every day. He said my thermometer was broken, or that I didn't know how to take it. (Oh, come on. I am a nurse. I know how to take my damn temperature.) So, I used my old mercury thermometer. Same temps. Perhaps some of you also have this problem ??
Anyway, it is very frustrating to be eating only 1400 to 1500 max calories per day, doing all of the running, lifting and cycling that I am doing, and have my weight hardly budge. (I am still the exact same size I was 4 years ago; although, I do believe more of it is muscle.) My hip measurement is pretty much the same, but I have bigger thigh and arm circumferences. This can make shopping somewhat more difficult for me. Especially pants. I have to buy them with the stretch in them. Or wear leggings. (Yes, I am part of the leggings are pants movement.)
On a positive note, despite the slower metabolism, at least I haven't gained any of the weight back...I am so into my exercise now that I've had my tummy tuck!! It gave me that extra push. My figure just looks a lot better, and I am happier when I buy clothes, and they actually look pretty good. I just took my "after" photos for my tummy tuck last week. Despite the fact that I hated taking nearly naked pictures (lol), and my body is certainly not "perfect", my ps says that I look good. Well, I know it's his job to make patients feel good about themselves, but I do hope that he meant it !! You know how many women he probably sees everyday, (Some of whom I'm sure look a lot better than I do.) But, when your ps tells YOU that you look good, you want to believe it......
So, back to the weight loss. I am certainly disappointed that I have not been able to lose more weight. (When I had my combo surgery in January, and was not exercising, I lost about 15 lbs. just like that. Just sitting in my recliner and walking around the block.) I do not understand this at all. Crazy.
Now that I am back at exercising, I have gained back about 8 pounds. I am really dumbfounded. I can see that some of it is that I've gained muscle, but my pants do fit a bit tighter also, even though they are the same size as before. This is just upsetting; I just want to throw that scale away, and never weigh again. But, I know that this is something I cannot do. I have to try to figure out what is going on with me, and try to find the right formula between exercise and diet that produces weight loss. My trainer says eat fish, veggies, and some fruit. Drink lots of water. No or not much carbs.
However, if you are going to cycle, then you have to eat carbs. You will simply run out of stored glycogen halfway through the ride. You have to eat foods with a higher glycemic index at certain intervals before you go, and during the ride. Even the night before. So, not eating carbs is not going to work for me all of the time. And I am not giving up cycling because I love it!!!
So, there is this whole thing about my weight and the different types of exercise that I enjoy, and learning how to manage my diet to arrive at my goal weight. I am really struggling. I would like to be about 20 pounds lighter. (My BMI really is borderline, and I would have to lose at least 10 pounds to get off of the borderline side of the BMI chart.) My trainer says this is ridiculous, but I would really like to achieve my original goal. However, exercising and eating right are not just about my goal. It is now my lifestyle, and a change that I will remain committed to.
So, this is where I am today. I am very happy about the progress I've made, but I never did hit my "goal" weight which was 150. I would probably look pretty thin at that weight, but then the less you weigh, the easier it is exercise!! Plus, it would just feel good to finally make my goal, even though I cannot say that I am not thrilled with my progress so far.
If you are overweight/obese, and have co-morbid conditions like high blood pressure, sleep apnea, and /or diabetes, then please consider having WLS for your health and honestly, for your sanity. Yo-yo dieting is bad for you, damages your metabolism, and will eventually drive you batty. Not to mention the damage that being heavy does to your self esteem.
Please see a board certified bariatric surgeon with a lot of experience in the procedure that you need or want to have. If you live in or around the Houston area, then please go see Dr. Robert Marvin. He is simply wonderful, and you will be in great hands!!
I am not going to post pics of myself due to anonymity, sorry. Besides, all of my "fat" pictures have since been destroyed and/or thrown out along with all of my "fat" clothes.........
Still Struggling 4+ Years Post
I posted last month, & I said I was stduggling; Unfortunately, I still am. I have cut out all sweets, bread, sugar, and almost all alcohol. (wine is all I like).
I still have a bad day every once in a while where maybe I slip on one thing or another, but for the most part, I am sticking to my new eating plan. I have been out of town several weeks in a row recently, but I usually bring my own food along so I won't be tempted. I still don't see a huge difference in my weight, but it has not been long enough for me to see a difference.
I am pretty hard on myself, but I am really hoping to see a change in the right direction. I did lose about 15 pounds with my tummy tuck 6 months ago, and gained 8 pounds back. So, if I can lose 10 lbs. , then I will be thrilled.
I just want you to know that even at 4 years out, I am still working hard toward my goal. It is a personal goal, & not one other people even know about. I don't discuss my weight with any of my close friends simply because most of them are way heavier than I am, and that would be insensitive of me. That doesn't keep
me from feeling like I could do better....
I am just going to try to accept where I am and continue with my plan. I am working out with my trainer in the morning, & I am looking forward to it!!
If / when I reach my goal weight, I will post. Until then, wish me luck, as I seem to be STUCK!!!! I know posting about losing the last bit of weight might seem silly, but it isn't to me. I started this journey with a goal in mind, & I am still plugging along. I really want to get there.........If you are a WLS patient, then maybe you will understand.....
My Hair Is Falling Out
It's been a month since I wrote in. I am still at the same weight, despite giving up the foods that I thought would help me lose weight. And I believe I am still the same size. I quit running altogether, substituting cycling 25 miles x2 each week, and then elliptical and weightlifting, and some core stuff, and whatever other crazy exercises my trainer makes me do. lol. I noticed about 3 weeks ago that some of my hair was falling out in the sink, and it got some thinner. Yikes. I wondered if it was the surgery I had 6 months ago, or if it is related to hormones (I have an estrogen patch, and rarely have any menopausal symptoms.) I feel pretty good in that respect. So, now I am focused on maybe adding more protein to my diet. I am at 50 to 60 g per day, which Dr. Marvin said was enough. I take the 2 multivitamins every day, plus 10,000 mcg of Biotin, Zinc, and I was taking Tumeric; however, I stopped, since it made me feel tired, and I read it can interfere with the absorption of iron. Something I probably do not need. (I wondered if that was making me tired.)?
I need to have my bloodwork done and my visit with Dr. Marvin. (keep saying this) I have been really busy, and I just need to make time to go. I have no idea why I haven't lost any weight. It seems like cycling 50 miles a week would burn more calories than running 15. At least by the calculations I did based on my height and weight. But, Dr. Marvin told me that it can look that way on paper but not be that way in real life. Whatever. Talk about discouraging. However, I am still going to do the exercise, because I like it, it's fun, and I have to do it for well being, and at least weight maintenance. My knees are doing better since I quit running, but cycling does make them ache some. This is the problem with getting older.........lol
Feeling a little down
Since almost none of my friends know that I had WLS, I can't really talk to any of them about this.....so that leaves you..
I have been trying really hard to re-lose that last 10 lbs. that I lost with my tt surgery 6 Months ago; then re-gained it....
I have given up sweets, bread, most carbs, wine, & pretty much all other foods except protein & veggies....This was very hard for me.....Then I switched from running to cycling ...( I was doing both before, but I am finally up to being able to just replace running with cycling altogether.) I did this mostly due to knee pain.
Then my hair started falling out some, so I added more vitamins, protein & EFA.
I feel like that has stabilized now, but I am not losing any weight !!! Just in a holding pattern....
I am pretty aggravated.....I am cycling 50 miles per week..Sometimes more. I am up to 27 miles at 17 mph. My goal was 30miles. I am almost there....My trainer really knows nothing about cycling. He says he could only do about 4 miles & then he would probably pass out...lol
My husband tries to encourage me to go ahead & ride with a group for more support & fun, but, honestly, I'm just not feeling it. I don't know why....My husband is not interested in road cycling, & he can't go as far as I can, so he is not going with me....
He is into a different type of biking...
So, waah !!! I am a bit depressed, but I know that eventually I will snap out of this & make some progress...I was running more often than I am cycling, so this probably has affected my mood....
Anyway, I just wanted to say that I am still not really where I hoped to be by now & it stinks !!! I am just going to keep on hanging in there....Maybe something miraculous will happen !!!! :)
my hair started falling out some....&
Hair Falling Out & Fatigue. Figured It Out.
Just wanted to update you that the mystery is solved....I saw my gyn last week for fatigue & my hair falling out. He ran a bunch of blood tests. The verdict is iron deficiency anemia. I really didn't think I was still anemic since no periods since December, but apparently I either never recovered from it after surgery, or the cause was not just heavy periods....
Now I have to start taking iron again, & return in 2 months for more tests....He talked about looking for other causes, & so I agreed and we have a game plan : Oh, joy.
I knew something was up when I was exhausted every day by lunchtime, & my hair was falling out. It's not as bad since I started the hair vitamins, but, I still see some shedding. At least it's not my hormones !! lol.
Despite the issues, I did reach my cycling goal of 30 miles about 2 weeks ago, then I went from cycling 25 miles x2 per week to cycling 20 miles x 3 per week. I think I will just stick to my 60 miles per week for now until maybe my iron level gets above 30 and my Hemoglobin gets above 10. I don't even know how I have managed to cycle this far with my anemia. I just know that I was anemic 3 years ago, & I still am; Although, these levels are the lowest by far.
I am not going to spend a lot of time worrying about it, though. I know that even with supplementation, it could be a while before I get my energy back. I am still going to do my exercise. I am able to pretty much keep up with my work, it's just that I feel like I am dragging by noon, & I have to force my way through the afternoon ! I am doing ok under the circumstances.
I will let you know what happens. I did make my appointment with Dr.Marvin, but I could not get in for a while, so that's why I scheduled to see my regular doctor (who is basically my GYN, since I really only use the urgent care for other stuff.)
At least now I know.
I don't think my wls had anything to do with the anemia since there is not supposed to be any malabsorption with the sleeve; however, I was not anemic before I had this procedure.....Hmmm...
I will just have to wait & see if additional testing tells us anything more....
Post VSG Iron Deficiency Anemia
I recently posted that I have IDA and it was somewhat surprising to me that I still have this 8 months post total hysrefectory. I figure no bleeding = normal iron count. Not so. I have done more reading recently regarding this issue....Post vsg patients should stay on at least 18 mg of iron daily....This can be achieved by taking daily mvi containing iron. My mvi does not contain iron....I hate ingesting iron for many reasons....Mostly due to slowed GI motility & constipation issues.....I purposely bought mvi without iron for this reason....Big Mistake....
My wls doctor said VSG does not lead to malabsorption because there is no re-routing of the anatomy.....However, upon further reading, I just discovered that because the surface area of the stomach is decreased by at least half, if not more, of its original size, there is much less stomach acid to convert the iron from food into a state that can be absorbed...Thus, it is very important to continue iron supplementation after surgery.....Something I wish I had known before. My wls doctor told me that when my iron levels came up, that I could discontinue the iron supplement. This is obviously not working for me, as I have been up & down with low iron since my sleeve in 12/2012...
He even told me that my heavy periods were likely the cause ......
Based on what I have read today, it is pretty standard to be iron deficient post VSG.... This might not seem like a big deal to you at the moment, but having IDA has definitely affected my quality of life...I am simply too tired to meet the daily demands of raising 2 kids and meeting my household demands without running out of energy midday. Not to mention keeping up with my exercise regimen.
Bottom line: My advise to all sleeve gastrectomy patients is: Take at least 18 to 30 mg of iron daily. Do not wait to become iron deficient......The pure exhaustion of it all is not worth it......
I am now taking 60 mg of iron 2x daily until my energy levels pick up......Then I will decrease it to 30 mg daily....
Hopefully, I will feel better very soon. And I plan on discussing this issue in detail with my wls doctor at my next visit....which is pretty soon.....
So, Good luck!! I hope you stay healthy & do not have to endure this issue.....
Iron Supplements Post VSG
3 year appointment for my regular 4 year checkup date in December.--OK I am a year late. I'm sure he will fuss...(More things happened this year.......2016 has definitely been a challenge.....)
The good news is that I am feeling so much better after 3 weeks on iron !! Not nearly as tired. Getting more done without getting as fatigued.....
Hired a cycling coach. He has me eating mostly protein, veggies, fruit & water...
Carbs only on cycling days.
Can't say that I never deviate from the eating plan, but I think I have lost a pound or two in the 2 weeks I have been on it. He has increased the frequency & intensity of my work outs, so I am glad for the increased energy levels... I cannot always do all of the exercise on my plan, but I do my best. He is ok with it, & I love having an experienced person to teach me...He is pretty cool & sort of a freak in a good way. Lol-' Plus he's a lot of fun to talk to while we're riding ..... That's a plus.
I can't say that I feel 100% back to normal, but I do feel a lot better!
So, since I doubled my 60mg to 120mg daily...I have probably recovered in half the time....Soon I will have to go by Dr. Marvin's office before my scheduled appointment to pick up some more iron pills....
I like the kind he sells because it is easier to digest & causes less constipation.
I am sooo happy for finding out the problem with my energy level & hair loss. I am glad it was pretty much an easy diagnosis with a pretty easy fix.
If you turn up iron deficient post VSG, just be sure to take your iron supplements & keep your appointments with your doctors who are following you.
Good luck !
Almost 4 years post VSG: Holiday Advice
My 4 year VSG surgiversary is Dec. 27th -
Second best Christmas present I ever got- The first being my daughter born at Christmastime.
Although I am right around the same weight and size as I was at my 1 year surgiversary mark, I am more muscular & have vastly improved cardio endurance. I ran & lifted for 3 1/2 years. Now I am learning to road cycle & continue weight lifting. Cycling is somewhat easier on the knees.
(but not the bottom)! It is somewhat a more difficult sport to learn, & takes a lot of patience, practice & commitment. But each time you do it, you get better!! Just be ready to be picked on and humiliated at every ride until you get it down. But don't let this discourage you; You get to go home and cry into your cereal....
It all just makes you stronger.
I had a hysterectomy & tt 10 months ago. I feel great except my core strength is coming back slower than the rest.....Having this surgery greatly improved my life, as I am no longer planning my entire life around the pain of endometriosis & cramps. Also, having a flat stomach is the stuff dreams are made of.........
And for the holiday advice :
3 words about the Halloween candy & treats: THROW IT AWAY....
I know that sweets are part of the fun of the holidays. The key is don't keep anything hanging around your house that you do not want to eat......Because you WILL eat it. Now that you've had some candy, get rid of the rest. If you can't stand to waste it, then put it in a nice tupperware, and give it to someone else. Maybe your doctor's office would like to have it.
Also, beware of the holiday "feeders". You know : all of your overweight friends who think it would be nice to give you a plate of cookies, brownies or fudge, etc. for the holidays.....So they bring it by & you smile and say thank you.
When they are gone, throw it in the garbage. Sounds ungrateful, and maybe it is, but IMO, real friends don't give sweets to previously overweight friends who are busting ass & dieting to stay in shape......Just sayin'.
I've been throwing treats (and starchy foods) in the garbage for 4 years now, & I have been able to maintain my weight. You simply cannot afford to keep that stuff around. You gotta do what you gotta do...
If you are heading to a party, eat a healthy snack before you go. And watch the alcohol. It really is nothing but empty calories & you can have fun without it....
The average weight gain during the holidays is 7 pounds. 10 pounds is usually a dress size. Don't give yourself bigger pants for Christmas....Keep on exercising, keep on watching your diet, and stay motivated.....
And don't forget: Garbage day is your best friend !!
Go VSGers!! Happy Holidays!
4 year post VSG Checkup
So, I finally did make my follow up appointment with Dr. Marvin, and it is next week. I am so nervous about the weigh in that I actually think I might have to cancel. lol. I have not been as successful at losing the last few pounds that I wanted to lose, and I am sorely disappointed about that; however, I do know that I have more muscle than I did before, and that my body shape has surely changed due to the exercise I am doing. My thighs seem bigger as in more muscle, and my core is stronger. I am still the same size, but my jeans fit tighter in the thighs, and I don't know if I like that or not.
I was not as strict as I wanted to be about the diet, but I did OK. The problem is that it does work for me when I stick to it, but when I have a crappy day, then I think, oh well, what the heck. Might as well eat that pizza. lol. I love pizza, and pizza loves me. Anyway, another problem is that bread makes you fat. So, unfortunately, pizza is the enemy, which is a darn shame since it tastes so good.
OTOH, I really did well at Thanksgiving. I hardly ate anything. By the time I cooked it all, I was too tired to eat it, and I didn't even eat half a plate of food.
I didn't miss any of it. I didn't buy any dessert or make any. The kids just wanted store bought cookies. (Good because the smell of anything like that cooking makes me weak in the knees.)
Another issue is that in my fairly recent conversion from running to cycling, I am now transitioning more from indoor cycling to outdoor. I am not able to ride as many miles outside as I can do on the trainer (yet) so that has cut into my calorie burning efforts. It takes time. I am not as good a cyclist as I was a runner. Go figure. I am sticking to it, though because I absolutely have to make this work. My cycling coach says I am getting better....It just doesn't happen very fast. So, I am just going to keep the faith in my coach, and follow his training program to the best of my ability.
I am also still lifting with my other trainer at the gym 2x per week. I know I am making progress there, as the weights are getting heavier....
I am less than thrilled to go in and see the doctor because I know that I am not where I wanted to be at this time, and I don't know if I can face the disappointment in myself. I know weight is just a number, and the bigger picture is overall muscle vs. fat, level of fitness and overall health etc., but I so wanted to be closer to my goal for this check up.....
I've had a pretty stressful year, and I will be glad to see 2016 go. There were some great things, but the not so great seemed to outweigh the others. I am a positive person, though, and that which does not kill us definitely makes us stronger. Dear God: I'm strong enough now; Please let me win the lottery ! lol
I will let you know if and when I do go in for my 4 year check up. Still haven't made up my mind as to if I am actually going to go through with it......
My daughter opened one, and I ate 2 pieces. Honestly, I felt ok about it because I have not had much of an appetite since I caught a cold last week...
I am still not completely well but am doing much better. I put the candy on top of the bookcase, even though I would like to throw it away.
(And I should, but I'm afraid of bad karma since it's holy candy from church......) Seriously, I'm a bit superstitious.....
So, we will keep it at least until trash day. (Friday) Then out it goes.
Anyway, I don't plan on eating anymore if it.
I am doing ok with my eating plan. I did great over Thanksgiving. Didn't eat too much. Overall, I have struggled with carbs ; I try not to eat any except fruit. And I try to eat it early in the day.
I have not been able to work out much this past 10 days due to being sick. I did cycle 20 miles on my trainer Sunday. (It takes about an hour & burns about 530 calories according to my Garmin.) I would like to get back to 60 plus miles a week but not sure if I can this week. I am going to try to cycle again tomorrow morning. I also missed all my weight training last week due to being sick. My trainer was not happy, & neither was I.
Anyway, struggling to get back into the swing of my program......I think it's easier to stick to the healthy eating when I stick to the exercise....Also I missed a couple of rides with my cycling coach due to the weather which has been all over the place from windy & cold to hot & rainy.
It's been somewhat hard to stay motivated due to being sick & also time demands due to all the extra Holiday demands: decorating, shopping, etc......but he is always checking on me and there for encouragement.......He has been awesome!!
We are staying home for Christmas which is good because I will have more control over the food in the house and the meals. I am pretty much going to keep my same eating plan except for Christmas Day. I will have what I want that one day. Other than that, plan is the same. So far, it's working. Still got on same size. Yay!
My advice to other VSGers is to try to keep your same eating plan except for Christmas Day.
My 4 year checkup was rescheduled for mid January due to being sick last week. So, nothing new to report there......
Good luck y'all.
4 Year VSG Surgiversary
Today (well tonight) is my 4 year surgiversary !!
I still technically have 20 minutes left to post for 12/27.
I have to say that a lot has happened in this last 4 years. I am proud to say that I am still the same size I was at the end of my 1 year surgiversary.
I have worked very hard at dieting and exercising to stay this way. It does not happen by chance. Every day is a challenge to choose the healthy foods over the unhealthy. Every day is a chance to exercise or not.
If you have read any of my posts here or under my tummy tuck posts, then you know that I face several challenges with exercise, as I have scoliosis, & back and knee pain. I ran until I really felt like my knees had taken all the beating they could stand. Then, this uear, I started my cycling journey, which has been fun but also probably one of the most physically challenging things I have ever done.
I have hired a cycling coach to help me after I completely humiliated myself on my first group ride....Trust me, it was so bad that it was nearly comical. You just can't make that story up. If I told it, you would howl....Anyway, I am working very hard at my cycling goals. My trainer says that I will be able to ride 100 miles by this Spring. Lol
I think that sounds scary, & a bit unrealistic at this point. I would be so happy if I could ride 40 miles consistently....
Anyway, I am a work in progress....It has been important for me to accept my limitations and to set realistic goals based on my age and musculoskeletal issues....., Otherwise, it would be very easy for me to get discouraged......I remain committed to my exercise regimen (lifting weights with a trainer and cycling). I have 2 coaches- A gym trainer and a cycling coach.......As coaches go, I would say that neither one is very expensive....But, I am lucky in that my husband wants me to succeed, and he suports my goals. Every time I have wanted to quit, he says, "Don't quit."
I am grateful to Him for that support.
A word about stress eating: I will be completely honest : 2016 sucked for my family. A lot of terribly stressful things happened that were beyond our control...
And even though I do not usually cry, I tried to cry all year. And December was the month I cried a lot. I don't think crying means you are weak. It is a good way to relieve stress....
And I will say that I have probably let myself eat a few more pieces of chocolate and more carbs than I would have liked to admit this Christmas...
Although, I don't think that I have gained any weight.
2017 doesn't look great either. Both my husband and I only have one living parent each, & both of them are extremely ill.
I would be very surprised if they make it through the year....
I am saying this because I know that stress can wreck havoc on my diet, & I will have to be super dedicated to my program in order to avoid gaining weight......At least I am preparing myself mentally for this challenge...
In October I tried giving up a lot of my "crutch" foods in the hopes to further my weight loss. I did lose 3 pounds. I will say that I reversed that decision by December, and I am just trying to maintain until January when I can revisit my diet issues.
I want you to know that VSG works ! And that you can use this surgery as a tool to help you stay healthy and more active in your life, no matter what fitness and emotional challenges you face.....
I am so very grateful to my Father in Heaven for giving me the opportunity to have this surgery, and for allowing me the time to make my health a priority. I am truly blessed! No matter what happens from here on out, I know the Lord is walking every step of the way with me. I feel like a true Angel, & I feel close to God. I know that everything in my life happens for a reason, & even the pain of the past year has helped me grow....
I hope and pray that those of you who are considering having this surgery yourself will realize that it can be life changing. You get out of it what you put into it. I hope that you realize that it is not a quick fix, but an important step in your journey towards life long wellness...
I wish you all the best im 2017. May the Lord bless you & keep you. If you have any questions about my VSG or TT then please write to me. It would be a blessing to me to be able to help you !!
Happy New Year y'all.
Dr. Marvin is an excellent surgeon. He has a low rate of complications, and takes time to answer all of your questions fully. He is a nice person, which is a plus, and he truly cares about his patients. I felt very comfortable with him, and felt that he was honest about what I could expect from the procedure and the aftercare. He does tend to be a busy person, but anytime I asked to schedule an appointment with him, I was afforded that opportunity. He does work with a PA, and sometimes you will have your appointments with her instead of the doctor. But, this person is very knowledgeable as well, and she can give you another perspective. Just know that if you would rather see the doctor, then I am sure you probably can if you request that. I would absolutely choose this doctor over any other in the Houston area, even if I had to pay out of pocket, which, luckily I didn't. I do not believe there is another weight loss surgeon out there with as much skill or expertise in this area. You would be crazy to use anyone else. Weight loss surgery is only as safe as the surgeon you choose. Good Luck.