CamarilloCA

Hi Nursebarbie, I did check with the bariatric case manager. She was the one who gave me the information on how to get started with Kaiser, but both she and others at Kaiser told me that the excess skin would have to hang below the pubus in order to be covered by my insurance. Even if it were covered, the upgrade price to a tummy tuck or 360, which includes the covered panni, is still higher than other surgeons in the area. This surprised me because I was under the impression that cosmetic surgery was offered to Kaiser members at cost, but it is actually offered to patients at currently accepted prices if not slightly higher.

Nursebarbie, I am sure that you are right about the different plans; however, no one has ever checked what plan I am on when giving me quotes about the prices for the cosmetic surgery. I have a feeling that, if these surgeries are not covered by insurance, which they won't be most of the time since they are cosmetic in nature, then the plastic surgeon sets the price by inserting his fee into the equation. But whether or not a procedure would be covered by insurance definitely depends upon the plan that an individual is on as you say. The other thing I wanted to make sure to emphasize is that, when dealing with private non-insurance surgeons, the fees are all negotiable. Getting estimates from three or four or even five different qualified board-certified surgeons is not unreasonable. There are a lot of qualified surgeons out there, and so you can shop around and get the best price that you can and a surgeon that you feel comfortable with.

I am going to put down what I learned in the past few weeks with the hope of helping someone that is looking for reconstructive surgery here in Southern California. I came here a few weeks ago looking for this information but couldn't find it, and so hopefully, someone else will benefit from what I have learned. First, let me say that I love Kaiser Permanente insurance, Kaiser Permanente doctors, and Kaiser Permanente coverage. I have had them for over ten years, and they have rarely let me down. I used to be under an employer's health insurance, but now that my husband is retired, we pay out of pocket for our coverage. I did get a referral for my excess skin from my Primary Care Doctor to Plastic Surgery in West L.A. when I asked for one. In that case, you have to attend a class, and then you can see a surgeon immediately following the class to see if you qualify for the pannectomy. I did not go this route because I was certain that I would not qualify. It is my understanding from several people that the excess skin has to hang below the pubis in order to have the insurance cover the pannectomy. If you have a history of documented rashes between the folds of excess skin, especially if they have turned to infections at times, this can also help you qualify for an insurance-paid pannectomy. Instead, I contacted Jene Miles, (310)857-2116, and she gave me the information that follows. You have to call the appointment scheduler at (310)857-2763 and schedule a cosmetic (paid) consultation. I had an appointment in West L.A. on Cadillac Ave to see a Dr. Lee, who came highly recommended. It is difficult to get an appointment with him right away because he only sees one patient in the morning and one patient in the afternoon on the days that he does cosmetic procedure examinations. You have to specify when you call that you are a cash pay consultation, and the fee is $100. The soonest that I could get an appointment in early July was for September 5th, but you can call and keep calling every day or every week to see if he has had any cancellations, and sometimes people do cancel their appointments with him. The pannectomy is the removal of skin only. Kaiser's rates are as follows (as of this writing): If you qualify for a pannectomy, you can "upgrade" to a tummy tuck or to a 360 lower body lift. The tummy tuck is $9750 if you don't qualify for the pannectomy and $4500 if you do qualify and are upgrading. A 360 circumferential body lift (or belt lipectomy) is $17,000 if you don't qualify for the pannectomy and $14,000 if you do qualify and are upgrading. The 360 numbers include a one-night stay in the hospital, which is mandatory. All other procedures are outpatient. All cosmetic procedures are done in the Kaiser hospital on Saturdays only. Some other numbers: if you add a breast lift, the cost is $6500, but you will get 20% off a second procedure on the lowest price, and so if you added a breast lift to one of the other procedures, the cost for the breast lift would be $5200. You can get a breast lift with implants, but they don't recommend it, and that price is $15,000 through Kaiser. An arm lift is $5900 less 20% if it is the second surgery, which would make it $4720. While I was waiting and getting increasingly anxious about my excess skin -- I have lost 100 pounds now since VSG surgery in April, 2012 -- I did some research on some other private practice doctors and was amazed and pleased to see that many of their rates were actually less than Kaiser's best rates. I was sure that I would not qualify for a pannectomy through Kaiser and would therefore not get their best rates, but even if I did qualify, their best rates were actually more than some other plastic surgeon's rates. I started by having consultations with some plastic surgeons in my area that were experienced with these procedures on bariatric patients. I also asked my VSG surgeon for a referral, and he gave me one. I only wanted to see plastic surgeons that didn't charge a consultation fee. I wasn't going to spend $350 here and $100 there while I am trying to save for these procedures. I had a couple of virtual consultations, which was a pleasant way to go. I took pictures of myself and emailed them with some completed questionnaires and medical history information. The surgeons that came recommended to me who do a lot of these procedures are Dr. J. Timothy Katzen in Beverly Hills, 310-859-7770, http://www.360bodylift.com/; Dr. Agha in Orange County, http://plasticsurger...contouring.com/, 949-644-2442; Dr. Michael Pickart in Ventura, http://www.pickartplasticsurgery.com/, 805-654-8800; and, Dr. Douglas J. Mackenzie in Santa Barbara, http://www.pacificplasticsurgery.com/ 805-898-0700. I thought Dr. Agha was a bit too far of a drive for me, and his prices were higher than the others, and his staff really gave me a hard sell on the phone, which I didn't care for. Dr. Katzen seems like a very nice guy and has a great video on his web site following two bariatric patients that had the 360 done by him. His prices were competitive, and he offered discounts for booking by a certain date. He did a tummy tuck and breast lift with implants on AmySDMom on You Tube if any of you have followed her video blogs. He does do multiple procedures at once, which is appealing to a lot of people to get it all over with at once, but doing some procedures separately can be better for healing and not as expensive if done on an outpatient basis without an overnight hospital stay, which can run $1000 a night. I ended up choosing Dr. Michael Pickart, who seems extremely competent and approachable. His prices are competitve and affordable for me, and he is the closest to me. He is very experienced in dealing with bariatric patients with excess skin and answered all my questions, and I feel very comfortable with my decision. Needless to say, I canceled my appointment with the Kaiser doctor in September. I am scheduled to have my 360 body lift on September 17th and, following that procedure, will have a breast lift, an arm lift, and an inner thigh lift in subsequent procedures with Dr. Pickart. I hope this has helped someone. I would love to keep this thread going and hear what your experiences are.

I bet that there are some of you out there like me that were taught or otherwise learned not to waste food, up to and including eating everything on your plate. I am the youngest of six children, and not wasting food was drilled into me. When I couldn't eat everything on my plate, my father made me sit at the table with my plate of food after the table had been cleared and everyone had left. It usually didn't work as I was full, and I just sat there until my father said I was excused from the table. I was thin as a child, but I ate plenty. I used to pick the peaches and plums and figs from our trees as afternoon Snacks, and maybe that is why I didn't always eat all my dinner sometimes. Or maybe it was because my father insisted that we occasionally try unusual foods like tripe, cow brains, tongue, soy Beans, octopus, and a few other weird food that I remember being forced to eat as a child. Anyway, I digress, and, yes, I should probably see a therapist about my abusive father issues. So, now, I have lost 56 pounds so far with my sleeve, and I'm wondering if there are others out there who eat food that could be questionable just because they don't want to waste it. For example, I bought a lobster, and I ate 1/4th of it for four nights in a row. By the fourth night, I was wondering if maybe I shouldn't eat it, but it smelled okay, and so I did. I can eat very little now, and so I end up eating a Chipotle burrito for four days in a row until it is gone when I get one. One trick I have learned is to freeze food that I won't be able to eat much of and then defrost it for dinner when I am ready. I did this with a few things, and it helps relieve the pressure of having to eat it before it goes bad. A few things I did throw out like a can of fat-free refried beans I had made with onions and cheese that I had in the refrigerator but couldn't get to for about a week. I really do hate wasting food, but I figure it is better than getting a bad stomach ache from food that has gone bad.

I got a referral to Plastics at Kaiser for a breast reduction, but the surgeons have requirements about the minimum amount of breast tissue that needs to be removed. If you don't have at least one pound of excess skin/fat/tissue, they will not do the reduction -- even if you have another medical condition like a reoccurring rash. They said that I need a breast lift, which is a cosmetic procedure which isn't covered by insurance. Kaiser will, however, do cosmetic procedures including breast lift, tummy tuck, beltectomy, etc. for their patients at a reduced cost through the Kaiser Hollywood facility. I have an appointment with a Dr. Lee in September that I am waiting for as my first consultation. The consultation fee is $100. If you do more than one procedure, I believe that you get 20% off the second procedure. I haven't actually compared their prices to other surgeons' prices, but I probably will get a second estimate/opinion, but I have a feeling that Kaiser will probably offer the best price.

For those that are following my progress on the breast reduction/lift, it looks like I don't qualify. Ironically, there isn't enough material for them to remove. According to the doctor, the rules set by Kaiser is that 400 grams of material has to be removed from each breast in order for a woman to qualify for reduction surgery, which includes a lift. Kaiser doesn't cover lifts alone even if you have a medical reason for a lift like a ever-present rash like I have. Since I have lost 100 pounds from my heaviest and 75 since my sleeve surgery, I have virtually no fat there. It is all skin, and that means that I don't have enough to remove. Had I gone in a few months earlier, I probably would have qualified. So I guess I just have to live with the rash that won't go away. I am going to try to file a grievance to see if that gets me anywhere. The doctor also said that plastic surgeons at Kaiser Woodland Hills will be able to perform cosmetic procedures at cost for Kaiser patients in about six months. The cost of a lift would probably be around $5000-$6000.

I went to the group class yesterday at Woodland Hills. They hand you a booklet, which you can read in about ten minutes, and then they go over each item in the booklet and present each page with slides and a slide presentation. There really wasn't much that I didn't know already, but here is the gist of it: 1. If your BMI is over 30, you have to lose weight to get below a BMI of 30 before you can have a breast reduction. 2. You have to have a medical problem in order to qualify for surgery. Medical problems include a rash, disproportionate breasts, and shoulder grooves from bra straps that have dug in over the years. 3. Kaiser does not cover breast lifts as that is a cosmetic surgery; however, they do cover breast reductions, which is a surgery that removes tissue, skin, and fat and lifts the breast. 4. A panni and breast reduction can be done at the same time but often is done separately. 5. A breast reduction is a same day surgery, and you will go home that day. 6. You will have two drains and have to wear a zip front sports bra for the week or two and no underwire bras for six months. 7. It is important to be at your goal for a panniculectomy but not for a breast reduction. 8. In order to qualify for a panniculectomy, you must have an apron that hangs down below your genitals. 9. In order to qualify for a breast reduction, you must have 1 pound of tissue to remove on each side. That last one, having a pound of tissue, fat, and skin on each side upset me. The nurse said that, if you don't have a pound on each side (equivalent to a pound of butter), that you could end up having to pay for the surgery yourself. She said that the surgeon literally weighs the amount he takes off you at the surgical table. She said that the rules are strict about this. This upset me because I have lost 100 pounds from my heaviest weight and have breasts that sag down to infinity and beyond, and I have a terrible rash, but it is mostly skin, and I'm not at all sure that I have a pound on each side to remove. After the meeting, I went up to her, and she looked at me and said, "You don't have enough material to remove. Talk to her." By "her," she meant the physician's assistant from the Plastic Surgery department that had come to the class to answer any questions. I went up to her and told her of my concern of not having a pound on each side, and she said, "We don't go by that. It's more about fixing whatever medical problem you have." What a relief. The nurse running the class said that if anyone needs a breast lift they could have it done at cost through West L.A. and that it runs about $5000-$6000. I think she meant the Hollywood Kaiser. The nurse said that Plastics will call for a consulation appointment at which time the surgeon will examine you to determine if you are a candidate. You can also request a particular surgeon, but you may have to wait months if that surgeon is in demand.

Maura, I am going to Kaiser today for a breast reduction class, and I will ask what is needed to get a panni. I do believe that you would qualify given what your described is going on with your loose skin. I think all you need is for your primary care physician to send a referral to Plastics for you. Ask him to do that for you.

Also check out You Tube which as some VSG and plastic surgery video blogs. Cabernetqueen and Kellawanda both had plastic surgeries done and documented their surgeries.

I was just sent a letter that I have a Breast Reduction Class at the Kaiser Permanente facility in Woodland Hills in December. I am so excited!

I'm in the same predictament. I have lost 70 pounds and am at 135, but I could easily lose another 20 and be at 115, but 115 is going to make me look really really thin, and so a happy medium is probably around 120-125. I just don't know. I have to see what 115 looks like when I get there. These goals are all mine. The doctor never gave me a goal weight, and quite frankly, I don't think a doctor should tell a person how much to weigh. Anyway, I digress. My boobs are like mud flaps, and so I am looking into a reduction (removal of skin) surgery now. I am sure that, by the time it happens, I will be at my goal weight anyway. There is no way, however, that I would ever get implants again. I had those for 25 years before they ruptured. They are not meant to last a lifetime. Good luck to you! I say, "Go for it."

I love all your comments. It is nice to know that we are all dealing with the same issues. Isereno, I didn't know you could freeze cheese. That is great. I may have to do that. Newgirltx, I totally agree with your posting. My dogs are really important to me, and I can't imagine my life without them. Everyone should adopt a dog from a shelter or rescue:-) Your bulldog is adorable in your picture. Fiddleman, I like your picture too! Butterthebean, you are funny! It is nice not to have to bend over to pick up stuff! Summersmile, it will get better. You will begin to recognize how much you can eat. I still make a big salad and sit down with it. Last night my plate was full of lettuce, homegrown tomato, cottage cheese, and smoked salmon with salad dressing. I ate about six or seven bites, and I was done. I'll have it again for lunch today, and then what I don't eat will go to the chickens, but it will be all lettuce by then probably.

Fiddleman, I never thought I could give up Starbucks French Roast Beans either, but Nespresso has surprisingly good quality coffee, and the Nespresso machine is easy to use and clean, which I like. It does have a milk frother, but I don't use it because I just heat my milk up in the microwave and mix it in to make a latte. I had purchased a more expensive machine from costco initially. It was actually around $400 and not $800 like I initially said; although, I was considering the $800 model for a long time. I ended up returning it to the store when it malfunctioned. I read a lot of reviews on Amazon before trying the Nespresso, and I am very happy with it. They have a lot of different types of coffees and lungos, and three different decafs. If you get their welcome package when you first join the Nespresso club, they send you a huge variety and a nice case for about $200.00.

coffee (and caffeine) in moderation is Dr. Oz approved. The darker the Beans, the more the antioxidents. I think that sugar, not caffeine, is the enemy, and so as long as you use Splenda or Stevia or some other natural sweetner, if you need that, you will be fine. Gettingthere, I have a Nespresso machine, and my husband and I just love it. I bought it after buying (and returning) an $400 espresso machine. It is great. You will love it. Don't forget to join the Nespresso club and get your welcome package that comes with a free gift.

Mggonzal, I agree with you. Restaurants can be tricky now because they bring you so much food. I've read that some people ask for a to-go container right away and put half or more of their entree away right away. I've also seen a great video blog where a woman talked about how waitresses always question if there was something wrong with the food when they see that you haven't eaten much. A few nights ago, we went to Ihop, and I just told the waitress, "I've had weight-loss surgery and can't eat much, and so I need a to-go container." She seemed to understand, but really, I didn't have to tell her that at all if I chose not to. The other problem with restaurants is not only the quantity of food that they bring but the quality. So many Entrees are laden with fat, salt, and sugar. I've really noticed that my tastes in what I want to eat has surely changed since my sleeve surgery, and I am grateful for that because now I want to eat healthy food and can. Before my surgery, I wanted to eat healthy food but wasn't able to in many situations. I find that appetizers or side salads make for great choices at restaurants now. One of my favorite meals now is a salad with some sort of Protein on it like salmon or shrimp.

I am sorry too, Crystalite, that you experienced that. There is no rational explanation for why that occurred. My father was abusive too and had an anger management problem but not like yours. I hope that he is not in your life anymore and therefore cannot hurt you any longer.

I have had an espresso with milk every morning since about six weeks after surgery. I have a double shot of espresso with about 16 oz of 1% milk. The milk has Protein and Calcium that I need, and I am fine with the calories as they all come from the milk. I use Splenda to sweeten. I heard that too about the ulcers, but I had four years with coffee and the lap band, and I never got an ulcer. I'm not willing to give up coffee, and it hasn't seemed to affect my ability to lose weight. I have lost 65 pounds and still losing.

Has anyone had a Dr. Eby or Dr. Amzoyan as their surgeon for a panne or breast lift? I just got the referral from my doctor to Plastics because I have a terrible rash that won't go away around my breast area and no cream or powders have worked. I've had the rash for about four months now, maybe longer. I was given the referral for a breast lift, but I am hoping that he will do a panne also, but I still have another 20 pounds to lose, and it is all in my stomach area below my belly button. I looked up Dr. Eby on the Kaiser web site, and he looks like a good one. Edited to add: by the way, I am essentially at goal at 135 now, but I thought it might be fun to get down to 115, my high school weight. I am 5'4".

BlaqBeary, how are you doing? I was hoping to ask you a question about whether or not they made you lose all your weight before having surgery. I have Kaiser too, and I have had a terrible rash around my breasts for six months because of the excess skin, and my PCP just referred me to Plastics for a breast lift, but it would be nice to have a Pann at the same time, but I still have another 20 to lose, and after that 20, I'm sure that I will have a lot of sagging skin around my stomach area.

Thanks for your replies on this. I have been away, and so I'm sorry for the delayed response. I can take about five bites of something, even with a 38 bougie, and I'm done. Most everything gets saved for tomorrow's lunch or dinner, but many times, the leftovers go to the dogs, the chickens, or in the trash. What I can freeze, I will. If it goes bad, then it gets tossed. I now try to freeze almost everything including deli meat, and just take out a few slices at a time to defrost. Yes, Doxieville, the burritos from Freebirds and Chipotle freeze nicely, including the tortillas. I buy tortillas from costco and end up freezing them and just defrosting them when I need them. Lately, I've been trying to eat the burrito in the bowls (without the tortilla) instead of the burritos because the tortillas have a lot of calories, but they are tasty.

Thanks, everyone, for your comments and input. I too have been guilty of finishing the last two bites so that I don't waste food, but when I get that too full feeling, I say to myself, "I shouldn't have eaten those last two bites." So I try to put the food that I didn't finish, however small, in a baggy for the next day's lunch. Just to be clear, I would never eat food that had clearly gone bad, but I've eaten a few things, like Kendra has, that sat in the refrigerator for a few days to a week just so I wouldn't waste food and therefore waste money. I think the answer is that most things can be frozen and defrosted. Lettuce doesn't freeze well, but I think a lot of things like fish, meat, cheese, bread, and nuts can be frozen and defrosted. When I get a burrito from Chipotle or Freebirds, I don't get lettuce or avocado on it now because I know that I intend to eat just a little and freeze the rest. Giving a few bites to the dogs is a great idea, Butterthebean, and I do that too. I also have chickens, and they'll eat anything pretty much. Socal, I started eating nuts as soon as I got to the solid food phase. They are good for you. Just chew well.

I think Holly and Doxieville might be on to something. Maybe being repelled by certain food or a large quantity of food is because our brains are telling us that we don't want that or need that and can't do that anymore. When we were heavy, our brains were telling us to go eat mass amounts of food to maintain our weight and prepare for the next starvation period -- i.e., starvation diet -- as a method of survival. Now, maybe because the Ghrelin is gone or reduced, our brain is sending out signals that translate into, "I don't want that for me." Another good point is that it could be a emotional separation issue as Holly said. Just as a teenager separates from his or her parents with some hosility in order to exert some independence, maybe we are doing that with our love affair with food. The brain is a very powerful thing that drives many of our emotions and actions often without us even realizing it. I copied someone's saying on Facebook that I really liked. It goes like this: "I am ending my love affair with food. I hope we can still be friends."

I started reading this topic because I think that I am developing an aversion to food. I too feel nausiated watching someone eat. The other day, I was selling flowers at a booth, and a woman -- she was thin lest I be scolded -- was eating a Thai egg roll while asking me questions about my flowers. I had to talk to her while she was eating, and I found myself repulsed and nausiated by that Thai egg roll. The smell alone made me want to vomit, but she was eating it kind of loudly and getting grease all over her fingers, so maybe that had something to do with it. This has nothing to do with the size of the person eating or who they are or how much they weigh. I am deeply compassionate and empathetic to everyone and would never judge. After I quit smoking years ago, I was really bothered by the smell of cigarette smoke. I don't like it to this day, but it doesn't bother me like it used to. I think the aversion to some food will pass. In the meantime, I guess it does help to lose weight:-)

Hi All, I'm four months out and have never thrown up while eating regular food, but I had lobster the other day, and I don't know if I ate too fast or too much or didn't chew well enough or what, but I got a queasy sensation and decided that some of it better come up. The same thing happened the next day. I did notice that it was super fiberous so perhaps I didn't chew it well enough. Anyone had any problems with lobster that you noticed? Thanks!

Thanks so much, guys! I'm going to try chewing better and see if it is better next time. I just bought a whole bunch of lobster and shrimp too from costco because I decided to eat less red meat again. I've been eating smoked salmon for lunch, and it is so good! That is very interesting, scubadottie, that you became allergic. I'm so sorry that you went through that. I'll be on alert for that. Thanks. Also, I did actually have butter with the lobster. I just drizzle it on lightly and don't saturate it. I have such a small amount that it has no affect on my weight loss. I have it on corn on the cob too. It is actually better for you than some margerine spreads. Coconut oil is a fantastic alternative for those that don't want to use butter.