Was a humpty dumpty

Hi neighbor!
I am so glad you posted this, it answered many of my questions. I live in the AV and also have Kaiser. My referal was sent in by GP last Friday. Please keep us posted with your journey.

Kimmy you can do it!

This sounds like good news for some people.
http://asmbs.org/2012/06/access-to-care-alert-the-cms-final-decision/
Dear Colleagues,
On June 27, 2012, The Centers for Medicare and Medicaid Services (CMS) released their decision on coverage for the laparoscopic sleeve gastrectomy (LSG). The final decision will allow laparoscopic sleeve gastrectomy to be covered by intermediary Medicare administrators as a stand-alone procedure at their discretion. The text of the decision is below.
On behalf of our patients, ASMBS is very pleased and gratified that CMS has recognized the true value and compelling need for coverage of this procedure. ASMBS will immediately initiate the formal pathway for coverage with each regional CMS intermediary by reiterating the arguments for coverage as expressed in our excellent April 2012 appeal letter written by John Morton, MD (Access to Care Committee Chair and Secretary/Treasurer) and Matt Brengman, MD (Insurance Committee Chair) ASMBS Response to CMS Sleeve Coverage Decision.
In addition, in the Top 5 on the 5th July 2012 newsletter from ASMBS, the Access Committee will provide additional instructions as to how you and your patients can help in the effort to achieve coverage in each particular region of the country. This again demonstrates our future need to work together in regional collaboration.
While more work needs to be done, this experience demonstrates that the ASMBS Rapid Response Initiative for Access to Care works. The overwhelming response from patients, surgeons and integrated health members, along with the strong evidence base for LSG, provided CMS with a persuasive argument for LSG coverage. In addition, the multi-disciplinary support of the American College of Surgeons, SAGES, The Obesity Society and the American Society of Bariatric Physicians displayed an Obesity Care Coalition in action working for our patients’ best welfare. We are thankful to the Obesity Action Coalition and our industry partners, Covidien and Ethicon, who all played vital roles. We will now go forth to each individual intermediary, and this decision will open the door to widespread coverage based on the strong, available evidence. We are confident coverage will be achieved.

I was told less that 1% also.

Interesting just found this on the web.
Is It Really a Stall?
A stall or plateau refers to an extended period of time during reducing efforts where there is no weight loss according to the scale AND no loss of inches according to the tape measure. So if you've been following your chosen low carb program to the letter, and it seems that the bathroom scales have become permanently stuck, take your measurements. Also notice if your clothes are getting looser, or if you can now fit into formerly tight garments. Chances are, you are continuing to lose FAT, but your body is adding lean muscle tissue, especially if you have been doing weight-training exercise as well. And muscle is less bulky than fat for the same amount of weight, so your body will be smaller and leaner. If this is the case, you haven't stalled at all; your body is just recomposing itself.
This is why it's so important to record your body measurements at the very beginning, so you'll have a reference as you progress. Don't just measure chest, waist and hip. Other key areas to measure are neck, upper arm, thigh and calf. And yes, having some "skinny" clothes hanging around helps too. It's a great feeling to have a pair of jeans that previously wouldn't come past your knees to make their way up past your hips, then be able to do them up (with pliers, while lying flat), then be able to do them up while standing and be able to breathe at the same time .... and so on!
It's normal for the body to go through adjustment periods while you're losing weight. A plateau lasting 3 or 4 weeks is no cause for alarm, nor is it a reason to QUIT. Check your measurements as noted above, and stick with your program. Low Carbing is about making permanent, lifelong changes; a few weeks is just a brief period in the rest of your life!
One other thing to consider - are you within 5 to 10 lbs of your original goal weight? Following a low carb, hi-Protein WOE and exercising may have given you an increased muscle-to-fat ratio than you had previously. As noted above, muscle tissue weighs more than fat, but takes up less bulk. Maybe it's time to rethink your goal weight. You may already be there! Congratulations! Now you can focus your energies on maintaining your proper weight, instead of struggling to drop a few more pounds.
Possible Causes

Okay, 4 weeks have gone by, and there's been no weight or inches lost. This is definitely a stall. Here are a few things to consider, perhaps one or more of these factors may be the cause.
1. Carbohydrate level is too high - the number of carbs you can consume per day to continue to lose fat and weight varies from person to person. Some lucky individuals may be successful at 50 or more grams per day. Others are metabolically resistant, and must keep the carbs near Induction level for most of the Ongoing Weight Loss (OWL) period. For Protein Power followers, this would mean staying at Phase 1 Intervention level until goal weight is achieved.
2. Hidden carbs - Carbohydrates can sneak into your food without you really noticing! A gram here and there; pretty soon they add up to an extra 10 or more grams a day that you may not realise you're eating. Herbs, spices, garlic, lemon juice, bottled Salad Dressing - these foods are not carb-free. Processed lunch and deli meats, bacon, ham and sausages often have added starch, crumbs, sugar, dextrose etc. Make sure you are accurately measuring the "known" carbs. A whole stalk of broccoli is more than 1/2 cup. And keep an eye on the coffee. It is not carb-free - a 6 oz cup of java has 0.8 carb grams. That's a small cup too. Add some cream, and a packet of sweetener, hmmm.... 3 or 4 mugs a day can add up to significant carbs. Also, beware of foods made in the US - their labelling laws allow manufacturers to list the carb count as zero if it's less than 1 gram, even if it's 0.99 gram! Get a good carb counter, and look up the foods you're eating. Keep an accurate food diary, and maybe you will spot a trend. Corrine Netzer's "Snacks. Protein is required by the body to provide the building blocks of all our muscles, organs, hormones, enzymes, etc..... if we do not consume the protein in our diet, the body will use the only available source - your muscle tissue - to get what it needs. Less muscle tissue further contributes to a slowed metabolism, and reduced fat-burning. So, eat up!!

4. Overeating - In general, it's not necessary to restrict or even count calories while following a low carb program. You should eat when you are hungry, and eat until you feel satiated. But don't go overboard; it's not a license to stuff yourself to the point of being OVERfull. Studies have shown that eating smaller but more frequent meals lead to more weight loss success than eating the same amount in 2 or 3 larger meals per day. Eat slowly, and chew your food thoroughly. Listen to your body, and learn to recognise when it says "enough". Overeating can sometimes be a consequence of meal-skipping as well. You are just so hungry when you do get around to eating, or you may feel you need to "make up" for the fact that you haven't eaten all day. It can really work against your weight loss efforts if you fast all day, thus forcing your body into slowed-metabolism "starvation" mode, then eat and eat all evening. This night-time eating will trigger the release of insulin, which will cause your body to make and STORE fat while you sleep.

5. Lack of Exercise - If you have not been exercising regularly, this may be a reason for your stall. Exeercise will boost your metabolism and burn fat. Exercise, especially weight-training, will build muscles, and muscles are more metabolically "active", thus will increase fat burning as well. If you have been exercising, and have hit a plateau, perhaps your body is signalling for you to change your routine. Increase the duration and/or the intensity. If you've been jogging or cycling only, try adding some weight-lifts to your workout - and vice-versa, if you've only been weight-training, you should add some aerobic activity as well.

6. Not Drinking Enough Water - Adipose tissue, ie. fat, is mobilized through a process called hydrolysis. As the word suggests, hydrolysis requires plenty of Water. Insufficient amounts of water in your body will hinder effective breakdown of fat. If you're exercising, or if your environment is warm and/or dry, you need to drink more water. If you are in active ketosis, you need to drink more water to flush the ketones out of your system. How much is enough? A bare minimum recommendation is 64 Fluid oz (that's 8 - 8 oz glasses) of water a day. Some experts suggest you should divide your current weight in pounds by 2; this number is how many ounces you should drink each day, but no less than 64 oz.

There is no disagreement on the need to drink sufficient amounts of fluids every day, but there are some arguments that it's not necessary to drink only plain water. If you choose to not drink large volumes of water, you should ensure that you are consuming adequate fluid in the form of calorie and carb-free liquids. Note that coffee is neither calorie nor carb free. Three small 6 oz cups of coffee yield 12 calories and 2.4 carb grams. Add in the cream and packets of sweetener .........hmmm. Teas and herbal teas are generally close to zero carb, as well as diet sodas and mineral waters. Be careful that some diet sodas contain citric acid as a flavouring, as this has been known to stall some folks. It's best to strive to drink as much plain water as possible; at least half of your day's intake, more if possible.

7. Medications - There are a number of medications that can and will hinder your weight loss. Most notable are diuretics ("fluid pills"), both prescription and over-the-counter types. These will initially seem to make you lose MORE weight, as you lose excess body fluid. But when you are in active ketosis the LACK of fluid will inhibit fat-burning. Many antidepressants cause weight gain as well. Steroids and hormones, such as cortisone, birth control pills and estrogens will cause weight gain. So too will some seizure medications. Unfortunately, medications that are intended to lower your cholesterol will inhibit the liver from converting fat to glycogen, thus decreased fat-burning. And insulin and many oral diabetic medication will decrease fat burning and increase fat storage. DO NOT STOP OR DECREASE YOUR MEDICATIONS WITHOUT A DOCTOR'S SUPERVISION AND FOLLOW-UP.

8. Food Allergy & Intolerances - A significant percentage of low carbers report that over-consumption of cheese and dairy products will put them in a stall quicker than anything else, even when the carbs are not "hidden" but are accounted for in the daily total. There is some suggestion it may be an intolerance or allergy to the casein protein in cow's milk dairy products. If you have been eating a lot of dairy foods lately, try cutting way back, or even eliminating altogether for a week or two, and see if this breaks the plateau. Food allergies and intolerances are difficult to pin down, but are known to trigger weight gain, fluid retention, sinus congestion, skin rashes, and digestive upsets, diarrhea etc. The most common food allergens are - wheat and wheat gluten, cow's milk dairy products, corn, soy and chicken egg whites. Again, try eliminating any or all of these from your diet for a few weeks. Then, add each food back gradually, and see if symptoms return and your weight stalls again. You may have to avoid the offending food permanently, although many people find that after a few months they may cautiously eat a small amount of the food once in a while, without adverse effect.



Helpful Suggestions

1. Make sure you really are stalled. Take your body measurements with a tape. Check how your clothes fit. Try on a piece of clothing that was tight before you started low carbing.

2. Don't go hungry. Eat smaller more frequent meals, and make sure you have some protein with every meal and snack. Avoid going more than 5 hours without eating (except overnight, then make sure you have a protein-containing breakfast).

3. Don't restrict your calorie intake, it will just force your metabolism to slow down to "starvation mode". Increase the amount of protein and fat with your meals. Eat some cheese, fried Pork rinds or a handful of nuts as a snack. Use good olive or flax oil on your salads. Use heavy cream and egg yolks to make sauces for fish, eggs and vegetables.

4. Bump up your exercise level. Increase the duration and/or the intensity. Change your routine. Add weight lifts if you are just doing aerobics. And if you're not exercising yet, get moving!

5. Avoid eating carbs before bedtime. This will trigger insulin, which will inhibit fat-burning while you sleep and in fact, will initiate fat STORAGE.

6. Drink more water and other zero-carb fluids to enhance fat hydrolysis, and to flush ketones.

7. Keep a diet diary. Record the time and amount of what you consume. No one else will ever see it, so be brutally honest. Get a good food counts resource, or at least a pocket-size carb gram counter.

8. There are several "Stall Buster" fasts that are popular and successful at jumpstarting the weight and fat-loss. They are meant to be temporary, not long term. Most popular is meat Fast . Again, it's just as it sounds, meat, meat and more meat, and not a heck of a lot else. A little fat or oil can be used to cook and dress the meat, but nothing else. And no coffee or tea. Water, water, water.
9. Some low carbers have used a thermogenic combination of herbs and medication known as an "ECA Stack". Thermogenic means it boosts metabolism and speeds up fat-burning. The E-C-A components are Ephedra, Caffeine and Aspirin. If you want to know more, click here . There is some controversy over the safety of ephedra, also known as ma huang. It's advisable to check with your doctor. Ephedra should not be used if you are pregnant or nursing, have high blood pressure or history of hear problems. Aspirin should be avoided if you have a known allergy, or if you are taking blood-thinners or have a history of stomach or intestinal ulcers.

Dana
Good for you making this choice. I was 49 at the time of my sleeve surgery.
I have never regetted my choice and only wish this was around 30 years ago.

Dana
Good for you making this choice. I was 49 at the time of my sleeve surgery.
I have never regetted my choice and only wish this was around 30 years ago.

After six weeks I was cleared for 1 cup a day. I now drink about 2 in the A.M.

Why in the hell would a surgeon have such a non supportive employee?
OMG report her at next face to face visit with the surgeon.

I'm always being asked how or what I did to get to where I am now. I'm always happy to answer any questions anyone brings to me, because I completely understand. I mean, I've been through it - the ups, the downs, the in-betweens... and I had even considered writing up a huge novel-like post to spell it all out.
But life got in the way, and here I am today.
Time got away from me and my project fell off the map. That's okay because I think that made the picture in my mind that I was trying to canvass a lot more clear. I'm seeing the forest for the trees now - and I have to tell you, the secret of my success is far more simple than I ever thought.
Finally early this morning as I was getting ready for work I started to simplify all the things I did that worked for me, and here is what I came up with:
The 5 P's to my success: Positivity. Patience. Persistence. Push Fluids. Protein First.

Minding my Q's: Quit the Salt. Quit the Sugar. Quit the Excuses. Quit the Denial.

Avoiding the C's: candy, Crackers, Cakes, chocolate, Cookies, chips, popcorn, iceCream.

When it comes down to it, these are the things that got me to where I am today. Seriously, nothing more and nothing less. I mean sure, I worked out and a lot - but I've got that covered with Persistence AND Quit the Excuses...
Blessings to you all. You'll get there, just keep doing all the right things!! I know, I say that all the time, and you ask - "well, what's that"?? Now, I've got "All the right things" written out on your screen.
THE KEYS OF SUCCESS.doc

I will be 49 on Thursday, at least I won't be fat and 50 next year.

Yaa Whoo! I was 163 on Monday down to ..............158 lbs this morning!

Yaa Whoo! I was 163 on Monday down to ..............158 lbs this morning!

Here is the link to sign up.
http://www.myfitnesspal.com/

Yaa Whoo! I was 163 on Monday down to ..............158 lbs this morning!

Love your post. It's so helpful to read what works for someone.

I would have posted earlier, but I am so freaking tired since I was up peeing all night!
LOL. I was down this morning Yay!
Lost the two pounds I have been going up and down on for the last three weeks.
Day two for me.

LOL so I google it and your question comes up..

I like the pink lemonade.

I owe everything to this site and Sleeve4 me!

I think we have a better chance at keeping it off now vs. the people 5 yrs ago. There was so little information and support out there 5 yrs ago.

I want the 20 gauge! I want to be full on a pea. Just kiddn'

Ok I ordered today. I will let you know how it is.

I think because are always told to lose only 1-2 pounds a weeks from Weight Watchers, Jenny Craig, books ect.
Everyone is thinks oh you should lose it slow and if you lose fast it's unhealthy. All the WL programs out there want you to lose slow, the longer you take the more money they make!

Glad I saw this post. I hope it is good news.. I hate when shows show the neg side.