Alex Brecher

There are some really good surgeons and hospitals in Tijuana, Mexico. It's a real shame that a few bad apples are ruining it for all. According to the CDC, the surgeons, companies, and hospitals that are all linked to this superbug are: Grandview Hospital (owned by Dr. Mario Almanza) Dr. Mario Almanza Weight Loss Agents Obesity Goodbye Center

I just posted this a little while ago...

The following article was just posted in the San Diego Tribune. "With several patients in local hospitals struggling to recover, public health officials are warning San Diego doctors to be on the lookout for signs of a deadly infection linked to weight-loss surgeries performed in Tijuana The county Health and Human Services Agency this week alerted the medical community that four patients have popped up in local hospitals with drug-resistant superbug infections of the same type that prompted the U.S. Centers for Disease Control and Prevention to issue a travel advisory in early January. The CDC has continued to caution those who travel to Tijuana for surgery, as the number of cases have more than doubled. Most are connected to patients operated on at Grand View Hospital near the U.S.-Mexico border. To date, CDC officials said, a total of 25 cases of drug-resistant pseudomonas aeruginosa have been detected among U.S. citizens who crossed the border, usually for “gastric sleeve” surgery that significantly reduces the size of the stomach, accelerating the pace of weight loss. Pseudomonas is listed among the CDC’s top threats among microbes that can resist antibiotics. According to a 2013 report, the bug kills about 440 people per year in the United States and infects about 6,700. In January, CDC officials said that the subspecies detected among Tijuana weight-loss patients is particularly nasty due to its ability to destroy carbapenems, one of the most effective and broadly-acting classes of antibiotics available to modern medicine. Maroya Walters, a CDC epidemiologist with a doctorate in biochemistry and molecular biology, said Tuesday that while the world’s foremost public health agency saw its last Grand View case in late January, additional infections have continued to surface among patients who were operated on at other as-yet-unnamed Tijuana hospitals. The most recent case was detected on Feb. 12. The current rate of new cases, she said, has not reduced enough for the CDC to remove or change the travel advisory it issued in January. “Right now, we don’t have any assurance that the infection control issues have been addressed,” Walters said. In San Diego, Dr. Eric McDonald, medical director of the county public health department’s epidemiology and immunization services branch, said that his office became aware of two local cases, one in October and one in January, after his office issued a preliminary notice to doctors on Jan. 16. Neither of those cases, he said, is a San Diego County resident, with one residing elsewhere in California and another living out of state. He said two more patients, both who live in San Diego County but had surgeries in Tijuana not related to weight-loss at hospitals other than Grand View, were admitted to area hospitals with pseudomonas infections in late February. Three of the four cases, he added, remain hospitalized today and are being treated under special protocols designed to keep infectious diseases from spreading. “At this time, we have no evidence of secondary infections associated with these hospitalized cases,” McDonald said Monday. He said that having four cases pop up in San Diego hospitals made it important for his office to let all local doctors know that they need to be proactive, asking about surgery in Mexico and responding with extra precaution, including patient isolation, where appropriate. “We just wanted to reiterate that you shouldn’t wait until after you know that a person has this organism to begin taking contact precautions,” McDonald said. “If you know someone is coming in with an infection, and you know they’ve had surgery in Mexico, then you should take these precautions right away.” Eighteen of the 25 cases — 20 have been confirmed and five are suspected — occurred in patients who were operated on at Grand View Hospital, according to CDC epidemic intelligence officer Ian Kracalik. He said Mexican health officials told the agency they detected lapses in the procedures used to sterilize medical devices used in weight-loss surgeries. Kracalik said additional information on exactly which devices were improperly handled was not made available by the Mexican health agency that conducted the Grand View investigation. Initially, he added, Mexico’s La Comisión Federal para la Protección contra Riesgos Sanitarios or federal commission for the protection against sanitary risks, told the CDC that it had shut down the surgical areas of Grand View on Dec. 19. But there were strong indications that the surgical center near the U.S. border remained open, with several new infections appearing after patients underwent surgeries at Grand View after Dec. 19. “It is clear there was an ongoing risk during that period when the hospital’s surgical area was not supposed to be operational,” Kracalik said. Health authorities in Mexico said they were not available to discuss the developments Tuesday. Kracalik added that the CDC received word that Grand View shut down “sometime after Jan. 31,” which was the last date on which the CDC received a report of an infection case linked to the hospital. Most of the cases, the CDC representatives added, are associated with Dr. Mario Almanza, a surgeon whose website declares that he is the “leading bariatric weight-loss surgeon in the world.” Almanza received significant media attention in 2018 when he was named in a class-action lawsuit by former patients, including a lead plaintiff who said her procedure left her with complications including internal bleeding, according to coverage by Channel 10 News and others. Almanza, contacted through weightlossagents.com, the stateside travel agency whose phone number the doctor lists on his website, did not return a request for comment Tuesday. With Grand View apparently shut down, CDC officials said they noticed that Weight Loss Agents had begun referring weight-loss surgeries to another Tijuana hospital called the “Obesity Goodbye Center.” Reached through their promotional Facebook page Tuesday, the company said that while Almanza “performed procedures for a couple of days at our facility always following our sanitation protocols,” he is not affiliated with the hospital in any way. The center said its own sanitation practices “exceed international standards.” An attorney for Weight Loss Agents, Glenn Krinsky, said the company has done everything it can to cooperate with the CDC, including providing information on 700 patients it had referred to Grand View since August. The CDC’s Walters said the agency is following up with those patients to better gauge the spread of pseudomonas or other surgical infections."

BariatricPal Box of the Month Club Do you love getting surprises in the mail? Are you ready to get help losing weight, boosting your protein, and keeping your diet fun and exciting? Are you a fan of great flavors, easy meals, and snacks, and exclusive discounts? Join the Club! That is, the BariatricPal Box of the Month Club. Each month, members receive a unique bundle of store products and samples. No two months’ bundles are the same. Each month, the items in your bundle are carefully hand-picked by our store experts for you to enjoy. What’s in the box? It changes each month, so you will find out when you open it! You might get… Top-selling store products. Samples of our newest products so you can be first to try them! Great-tasting protein bars and shakes in both classic and daring flavors. Ready-to-eat snacks and/or instant meals – all high-protein, low-carb. Samples of vitamins, minerals, and health-boosting supplements. Other weight loss helpers, such as measuring aids. You can count on at least 8 to 10 items in each Box. You’ll get at least $50 worth of top-quality products and exclusive coupons every month. Getting the Box is the only way you could try all of these products without buying bigger quantities of them. Who is it for? YOU, if you want: Great-tasting, fun products. Exclusive discounts every month on the products you try. Variety, taste, and protein on your pre-op diet or solid foods post-op diet. Help losing weight with or without surgery. More protein, less sugar, and more flavor. Samples of new and delicious products without committing to an entire box. High-protein, nutritionist-developed menus to help you lose weight. When you fall in love with the contents of your monthly Box, you can buy them at The BariatricPal Store. We sell every product that we put in your Box, along with over 1,500 other bariatric and weight loss products. Plus, we guarantee the lowest prices anywhere and offer free shipping. Count on the joy of opening your box and discovering new products each month. Shipping is free! You do not need to worry about what the neighbors think because the Box is discreet – it has no bariatric-related words or logos. Join the Club and make weight loss fun!

Check out BariatricPal Multivitamin ONE "1 per Day!" Bariatric Multivitamin Capsules! With just ONE convenient & affordable BariatricPal Multivitamin ONE each day, you can get the bariatric vitamins and minerals you need to stay healthy! BariatricPal Multivitamin ONE was designed and developed by a team of the world's leading Bariatric medical professionals.

Why not switch to a ONE per day capsule like BariatricPal Multivitamin ONE for your Multivitamin? You can follow your meal plan and get your exercise in, but you are selling yourself short if you are trying to lose weight without taking your vitamins! BariatricPal Multivitamin ONE capsules can help prevent the nutrient deficiencies that are all too common after bariatric surgery. With just one convenient & affordable BariatricPal Multivitamin ONE capsule each day, you can get the vitamins and minerals you need to stay healthy!* The vitamins and minerals in BariatricPal Multivitamin ONE may help: Maintain normal metabolism and energy. Promote healthy bones, joints, blood, and heart. Support normal mood. Support healthy wound healing and immunity. Maintain cellular integrity and antioxidant functions. Promote healthy hair, skin, and nails. BariatricPal Multivitamin ONE was designed and developed by a team of the world's leading Bariatric medical professionals. The fast-dissolving small veggie capsules are very easy to swallow and use. You only need one a day to meet recommendations for bariatric patients. BariatricPal Multivitamin ONE is based on the latest post-op guidelines from the American Society for Metabolic and Bariatric Surgery (ASMBS) to provide over 20 vitamins and minerals. BariatricPal Multivitamin ONE is especially high in nutrients such as iron, vitamins B12 and D, folic acid, and biotin, that are known to be at risk for bariatric surgery patients. Specifically formulated according to ASMBS recommendations not to contain calcium to avoid interference with iron absorption. BariatricPal Multivitamin ONE Highlights: 100% of the daily value for 20 essential vitamins and minerals. Formulated based on the latest ASMBS guidelines. One small convenient capsule daily. Gluten-Free, Dairy-Free, Soy-Free. Fast-dissolving veggie capsules. Made in the USA. Easy to swallow. Affordable. BariatricPal Multivitamin ONE "1 per Day!" Bariatric Multivitamin Capsule is also available in an Iron Free version here. Designed for patients that have undergone weight loss surgery such as RNY Gastric Bypass, Gastric Sleeve, Duodenal Switch, and other malabsorptive weight loss surgery procedures. Available in 30-count or 90-count bottles, with or without Iron! *Please take a calcium supplement separately to prevent interference with absorption of iron.

Detour makes protein bars so insanely delicious, you can’t wait to devour them. And they take their nutrition just as seriously, starting with high quality, complete whey protein. Find the Detour protein bar that fits you at the BariatricPal Store!

If you had surgery with Dr. Mario Almanza, Weight Loss Agents or any other surgeon at Grandview Hospital in Tijuana, México after August 2018, it’s recommended by the Pan American Health Organization / World Health Organization (PAHO/WHO) that you should be tested for hepatitis B, hepatitis C and HIV. Please read https://www.who.int/csr/don/5-march-2019-carbapenem-resistant-p-aeruginosa-mex/en/ for more detailed information. “A local investigation at Grand View Hospital identified reusable equipment that was not being appropriately processed, which poses a small but potential risk of transmission for bloodborne infections among patients.” There are some amazing surgeons and hospitals in Mexico. PLEASE do your research before selecting any surgeon in any country!!!

Local patient run WLS support groups are fantastic but most don't have a long lifespan. BariatricPal started almost 100 local meetups a few years back and almost none are still around today.

“Complete” But Lacking Essential Nutrients What does a “complete” multivitamin contain? It could provide anything from all the essential nutrients to just a few. There is no legal definition for “complete.” In the case of Flintstones “Complete” multivitamin chewables, “complete” apparently means that it has all 13 vitamins, but only 6 of the more than 15 essential minerals that you need. Quantity Is Critical For bariatric surgery patients, it is not only important to get each of the necessary vitamins and minerals, but also to have the right amounts. You need high amounts of some of the vitamins and minerals, and Flintstones chewables simply do not deliver. For example, the American Society for Metabolic and Bariatric Surgery (ASMBS) suggests at least 12 mg thiamin (vitamin B1) per day, while a chewable has 1.5 mg. You will also be short on: Vitamin A Vitamin D Vitamin E Vitamin B12 Iron Calcium And more. “Doubling Up” Does Not Work If one tablet is not enough, can’t you just take two? Well, not really. First, getting twice as much as certain nutrients may still leave you short. For example, 2 Flintstones chewables provide 1,200 IU of vitamin D, while recommendations for post-op gastric bypass patients are to get 3,000 IU per day. And no matter how many chewables you take, you will never get enough of essential minerals such as selenium and chromium, since the chewables have none. Multivitamin: What Is in a Name? We usually refer to them as “multivitamins,” but most often, we really mean, “multivitamin and mineral supplements.” Sometimes, a “multivitamin” that you buy off the shelf really is literally a bunch of vitamins with few or no minerals. Do not get confused by the name when purchasing your supplement. Read the supplement facts label to see which nutrients are in the supplement, and how much there is. Safe Choices, Your Way To be sure that you are getting the right supplement for bariatric surgery post-op needs, you are best off choosing a bariatric supplement. It may be a tad more expensive, but it could prevent deficiency diseases such as anemia or peripheral neuropathy. The BariatricPal Store has Multivitamin One and a wide range of other multivitamin and minerals formulated according to ASMBS guidelines. Choosing a bariatric surgery-targeted multivitamin instead of a kids’ supplement does not mean you have to choke down capsules if you cannot stand them. You can always opt for another form, such as Powder or a Soft Chew. BariatricPal Protein One has 28 essential vitamins and minerals, along with protein and fiber, in Unflavored powder or great-tasting shakes such as Chocolate, Vanilla, Cookies and Cream, Peanut Butter, Chicken Soup, and more. For help figuring out which vitamin and mineral supplement may be right for you, you can look at the attached ASMBS guidelines or check out our Bariatric Vitamin Guide, which breaks down recommendations for each surgery type. Also, be sure to talk to your doctor about your individual needs before trying a supplement. ASMBS-Nutritional-Guidelines-2016-Update.pdf

Dr. Ren or Dr. Fielding at NYU. See LapBand.com for a surgeon locator.

We've received verified reports that Dr. Jaime Ponce de Leon is operating at Grand View Hospital after the recent CDC warning and WHO warning on Drug-Resistant Infections! More recently, the Public Health Agency of Canada has also issued warnings about using this hospital and associated surgeons. We're very disappointed at Dr. Poince's decision to put patients at risk for this life-threatening infection. There are some amazing surgeons and hospitals in Mexico. PLEASE do your research before selecting any surgeon in any country!!!

I've been using the same Yunmai "mini" Wireless Bluetooth Smart Scale with 10 Body Measurements for at least 2 years. The app is awesome and it's only $34.99 at the BariatricPal Store.

How far are you out of surgery? Generally, you're allowed caffeine 30 days post op. Definitely, follow your surgeon's instructions. According to the ASMBS: Q Do I need to avoid caffeine after bariatric surgery? A: Caffeine fluids have been shown to be as good as any others for keeping you hydrated. Still, it is a good idea to avoid caffeine for at least the first thirty days after surgery while your stomach is extra sensitive. After that point, you can ask your surgeon or dietitian about resuming caffeine. Remember that caffeine often comes paired with sugary, high-calorie drinks, so be sure you’re making wise beverage choices. Are you taking your vitamins?

Why don't you take an all in one multivitamin that has all the B12 you require and doesn't have any taste?

For sure! I have Bypass and use BariatricPal Multivitamin ONE "1 per Day!" Bariatric Multivitamin Capsule with 45mg Iron. Ask your surgeon but you should be fine with a capsule. I was taking them the week after surgery without any issues. All surgeons allow Bypass patients to take capsules 30 days post op.

We have a ton of options at the BariatricPal Store. Read customer reviews at https://store.bariatricpal.com/collections/protein-powders . Most of the products are whey protein isolate

You can follow your meal plan and get your exercise in, but you are selling yourself short if you are trying to lose weight without taking your vitamins! BariatricPal Multivitamin ONE Iron Free capsules can help prevent the nutrient deficiencies that are all too common after bariatric surgery. With just one convenient & affordable BariatricPal Multivitamin ONE capsule each day, you can get the vitamins and minerals you need to stay healthy! The vitamins and minerals in BariatricPal Multivitamin ONE may help: Maintain normal metabolism and energy. Promote healthy bones, joints, blood, and heart. Support normal mood. Support healthy wound healing and immunity. Maintain cellular integrity and antioxidant functions. Promote healthy hair, skin, and nails. BariatricPal Multivitamin ONE was designed and developed by a team of the world's leading Bariatric medical professionals. The fas129.99t-dissolving small veggie capsules are very easy to swallow and use. You only need one a day to meet recommendations for bariatric patients. BariatricPal Multivitamin ONE is based on the latest post-op guidelines from the American Society for Metabolic and Bariatric Surgery (ASMBS) to provide over 20 vitamins and minerals. BariatricPal Multivitamin ONE is especially high in nutrients such as vitamins B12 and D, folic acid, and biotin, that are known to be at risk for bariatric surgery patients. BariatricPal Multivitamin ONE Highlights: 100% of the daily value for 20 essential vitamins and minerals. Formulated based on the latest ASMBS guidelines. One small convenient capsule daily. Gluten-Free, Dairy-Free, Soy-Free. Fast-dissolving veggie capsules. Made in the USA. Easy to swallow. Affordable. BariatricPal Multivitamin ONE "1 per Day!" Bariatric Multivitamin Capsule is also available with 45mg of Iron here. Designed for patients that have undergone weight loss surgery such as RNY Gastric Bypass, Gastric Sleeve, Duodenal Switch, and other malabsorptive weight loss surgery procedures. Available in 30-count or 90-count bottles here.

Check out PatchAid patches. They have better nut facts https://store.bariatricpal.com/collections/patchaid

My good friend Jay Casale‎ just dropped his latest podcast episode where he interviews Amanda Johnson from TLC's hit TV show, "Family By the Ton. In Jay's words... "Amanda Johnson currently stars on TLC's hit show, "Family By the Ton.", in which she bravely shares her journey as both a food addict and a cancer patient. When I met her two years ago, she was a sassy graphic designer with perfect makeup and a short temper, who had no time for nonsense or ignorance. She's still all of those things and more. She's also my friend, and I couldn't have been happier to speak with her in her first off-camera interview since Family by the Ton started airing. In true Amanda fashion, she held nothing back." Available on: iTunes: https://apple.co/2EQ20bG Android: bit.ly/2DxAvSQ Don't wanna use a phone: lightersidepodcast.com

You didn’t go into weight loss surgery blindly, but there are sure to be quite a few surprises along the way. Stalls can be among the most discouraging, but you are sure to notice plenty of other things that your surgeon may not have warned you about before you got your surgery. Here are a few of them. Stalls Happen Your surgeon will probably tell you about your likely weight loss. You might hear numbers such as 70 to 100 lb. in the first year, or up to 10 to 20 lb. in the first couple of months. Those might be realistic and turn out to be accurate for you, but what might also be true, that your doctor did not tell you, is that weight loss may not be steady. You might lose 75 lb. in a year, which is an average 1.5 lb. per week, but you are not going to lose 1.5 lb. every week for a year straight. You may lose 5 lb. in one week, 3 lb. in another, 0 lb. in another, and, some weeks, even gain weight. You are almost sure to encounter stalls, or plateaus, or periods of weeks or even a month when you do not lose weight, even if you are eating right. Your doctor may not tell you about stalls ahead of time, but you can handle them better if you are prepared right out of the gate. Your Metabolism May Plummet As you lose weight, you need fewer calories to sustain your basic body functions. Furthermore, when you exercise at a lower body weight, you burn fewer calories doing the same workout at the same intensity than you did when you were heavier. On top of that, your body may go into starvation mode and use even fewer calories as it becomes more efficient at using what you give it. While there is little that you can do to prevent a slower metabolism, you can at least be aware of it. Also, you can take heart knowing that you are likely to be able to exercise longer and at a higher intensity to offset some of the reduced body weight. It’s Freezing! Brrr…! Remember the days when you were the hottest one in the room, and all you wanted was to stop sweating? Those may be in the past. Part of the slowed metabolism can be due to your body’s new mechanism to save energy, which means turning down the thermostat. Another possibly surprising side effect of weight loss is that having less cushioning (body fat), so sitting in chairs or lying in bed can be less comfortable. People Can Still Hurt You You probably know that Weight Loss Surgery does not change who you are, but your doctor may forget to tell you that it does not change other people, either. You may no longer get flack for being overweight, but people can still be hurtful. They can tell you… You took the easy way out with Weight Loss Surgery. You have not lost much weight. Clearly, Weight Loss Surgery did not work. You lost so much weight that you look sick. All you care about now is your diet and exercise plan. Your Social Life May Change Some friends will stick by you. Others may desert you. If some of your friends have just been “eating buddies,” or people you go out with to the bar or restaurants, you may need to exercise self-control at the bar or restaurant, find new activities to do with those friends or find new friends. You stand to gain wonderful new friends who share your new interests, such as walking, going to the gym, or cooking healthy fun foods. The Skin Stays Losing body fat will not give you a movie star’s appearance. It may not even be all that you need to lose. You may have loose skin that flaps, chafes, and interferes. There is a chance that you will want to get skin removal surgery for cosmetic, comfort, or medical reasons. Beware Replacement Addictions You may have been addicted to food. It may have provided comfort, entertainment, and companionship. Give it up, and you are likely to find something to replace it. Alcohol is a common replacement addiction, but you can do better! Stay aware of your emotional and physical needs, and you can be mindful of what replaces food in your life. Exercise, within reason, is a common choice; another healthy option is to make some great friends who are supportive and make you feel good. Your doctor will tell you a lot about what to expect after weight loss surgery, but she may leave out several important items. Go in with open eyes, and you can prepare better and come out farther ahead.

On January 9, 2019, The CDC issued a Level 2 Alert about Drug-Resistant Infections at Dr. Almanza's Grand View Hospital in Tijuana, Mexico. The Mexican government has closed Grand View Hospital until further notice: Key Points Recently, some US residents returning from Tijuana, Baja California, Mexico, were diagnosed with infections caused by an antibiotic-resistant form of Pseudomonas aeruginosa bacteria. All of the travelers with this particular infection had an invasive medical procedure performed in Tijuana. Most (but not all) of them had weight-loss surgery. About half of those infected had their surgery done at the Grand View Hospital. Based on information provided by the CDC, the Mexican government has closed the Grand View Hospital until further notice. CDC recommends that travelers to Tijuana, Mexico, not have surgery at the Grand View Hospital until the Mexican government can confirm that the drug-resistant form of Pseudomonas aeruginosa bacteria is no longer there We urge all BariatricPal members to stay far away from Dr. Almanza and Grand View Hospital.

Dr. Francisco Manuel Contreras Guarista We recently received information about Dr. Francisco Manuel Contreras Guarista that we need to share with the Bariatric community. Dr. Francisco Manuel Contreras Guarista was sentenced on 2/04/2011 for DRUG SMUGGLING! https://www.docketalarm.com/cases/California_Southern_District_Court/3--10-cr-00834/USA_v._Contreras-Guarista/ He is currently being represented by Santé Surgical Group and operating out of Oasis of Hope Hospital in Tijuana, Mexico. We also received information that he is a medical doctor and is not licensed as a bariatric surgeon in Mexico! Please make sure you share this information with friends and family that are researching having surgery in Mexico.

Try to see their side. You are asking them to see it from your perspective, so it is only fair that you try to see it from theirs. What are the reasons they may be against your Weight Loss Surgery, and how can you address them? In many cases, their concerns are legitimately about your well-being, and things you should consider if you have not already. They may worry that: You will not hit your goal weight this time since they’ve seen disappointment before. You will suffer complications from surgery. You will regret having a permanent Sometimes, their concerns are selfish but still worth discussing. They may worry that: You’ll stop feeling attracted to them. You will pressure them to give up their own favorite foods while you eat healthily. They will feel left out. You will not want to spend time with them. Reassure them. Address their concerns directly. Explain why you feel the surgery is safe, and how much research you have done to learn about it as well as find a surgeon. Tell them why you think Weight Loss Surgery will work for you even if previous diets have not. Let them know that you need to do this for yourself, not for them and that this will not change the way you feel about them – you will still love your SO, and respect your parents, for example. Tell them how you see yourself spending time with them after surgery, so they can be comfortable. Write it down and practice. Starting the conversation can be the scariest part of telling them. Before you bring up the subject, write down what you plan to say. This is a good exercise for you to do anyway since it encourages you to think through all of the doubts around Weight Loss Surgery. Writing it down and practicing can make it easier for the words to come when you decide to bring it up. Include them in your plans. Often, your spouse and parents, and others who care about you, just want to help. They may be afraid if they do not how to help. When you talk to them, let them know how important they are to you, both in life in general and in this important period of your life. If you tell them specifically what they can do to support you, they may feel more at ease with your decision and more confident in their roles. You might ask them to: Pick up your children from school when you are recovering from surgery. Go with you to the store to pick out protein powders and measuring cups and spoons. Ask you each night how you are doing. Cook healthy meals with you. Prepare for anything. The conversation may be as difficult and unfulfilling as you feared. Or, your SO, parents or other loved ones may be surprisingly supportive once they realize that you have done your research and are serious about making the lifestyle changes needed for success. They may even be interested in getting healthy with you and ask for your help and support in exchange for theirs. Stay strong and independent. As much as you long for your SO and other loved ones to support you wholeheartedly, it may not happen. Try not to let it get you down, though. If you are sure about what you want, go for it, with or without them. They will come around sooner or later, and if not, you may be better off without their negative influence. Letting them know that you have made up your mind regardless of their support may actually convince them to help you since there is no point in standing in your way. Stay independent in the sense that you realize that you do not need them. Your success does not depend on their approval, and you are not doomed to fail if they stand in your way. Get the support you need from others as you move forward.

Can you buy these in a grocery store? Not at the moment but there are many other brands that should be for sale locally.