2goldengirl

This is where program recommendations can differ widely. Some focus on Protein alone, others (mine, for example) really encourages the inclusion of veg, fruit, and a few whole grains early on. I keep my protein count up by having a Premier Protein each morning, first thing. I was able to begin some veg about week six. Note that I weigh my portions - there are some Proteins that even now (four months), I coiuldn't manage a full 1./4 cup of them. I can handle about 2-2.5 oz of protein at a time. I get my veg in for Fiber, texture, and Vitamins. Less fruit than veg. My macros re where my surgeon wants them, I'm losing, so I'm happy. Some programs (and the people in them) are vehemently against adding veg/fruit/complex carbs until maintenance. C'est la vie.

In the short time I've been on these boards, the most common insurance question is "will XYZ Health Plan approve me?" Here is how to find out BEFORE you move forward. Find your insurance card. Call the toll-free number on it (member or subscriber services) and ask specifically whether your plan has any exclusion for bariatric surgery. It's rare, but it does happen. If you have your "Evidence of Coverage" or "plan documents" booklet shoved in a drawer somewhere, any exclusions will also be in that booklet. Sometimes the person on the phone needs to look up the surgery by Procedure code, or CPT code. The code for a gastric sleeve is 43775. If you don't already know that your deductible or copay is for a hospital stay, the time to ask is now. While you're on the phone ask them to send you a copy of their criteria for bariatric surgery. Most plans will do this; in California, the law says they have to do this. If you have trouble getting them to send it to you, or you simply don't want to wait for the mail, go to your good pal Google. Google "nameofinsurancecompany plantype medical policy bariatric surgery" for example, "BCBSNJ PPO medical policy bariatric surgery" . I did that, and got this link: https://www.horizonblue.com/providers/policies-procedures/utilization-management/prior-authorization-lists/ppo The criteria themselves aren't on this page; but it does tell me that prior auth is required for bariatric surgery. OK, where to go from here? Over on the left, I see a link for "policies". I click that, and there it is: "Medical Policy Manual". There is a disclaimer page there, and then three other tabs. I click the "alphabetical" tab, and looky there, a link to the bariatric surgery policy. Here is that link: https://services3.horizon-bcbsnj.com/hcm/MedPol2.nsf this particular example is one that takes more steps, a lot of plans have a direct link and whammo, you can just pull up the policy. Have a look at the top of the policy and you will see the "last reviewed" date. This can be important if your plan has a recently reviewed policy and your PCP and/or surgeon's office isn't aware of any changes. it can make you crazy if someone you're dealing with insists that the policy is different than what you see in front of you. I am having this problem right now, myhealth plan has recently dramatically changed their policy and made the whole process much more simple - but even after sending a copy to my surgeon's office, they are having trouble wrapping their heads around the change. I get it, it's a big change, and it's a patient who is better informed than they are. Be aware that your surgeon or bariatric clinic may have requirements for all their patients in addition to those set by the insurer. These are done in order to assure you have the most successful surgery possible. Your surgeon has the right (and responsibility) to require that you adhere to a pre/postop diet, get certain preop testing done, etc. I hope this is helpful, I happen to have been in the business of getting services of all types approved for twenty years. It's SO much easier to get your hands on this information than it once was!

That isn't true for everyone. I was not commanded to be walking 30" a day from Day 1. My calorie target during my weight oss phase is based on my measured RMR. I'm not to go below 1290/day. My surgeon's general recommendation is for 700-900 calories at weeks 6-8, and 900-1200 by week 12. I actually had my RMR tested and it had slowed, so the exercise physiologist and my surgeon don't want me going below my RMR so I don't slow it down even further. I'm losing 6-8 lbs/month, inches as well as lbs., maintaining my lean mass, and feeling great. I'll take it!

Soft-boiled eggs and refried Beans were mainstays for me. I was soooooo sick of sweet things. I also appreciated the Fiber in the beans.

Closed/private group?

This is SO sad. You are ruining HIS life? He thought you wouldn't go through with it? I'm sorry, this makes him sound pretty selfish. On the day you were married, didn't he make you some promises? For instance, to not act like a total jerk?

At only three weeks out, you haven't healed enough to deal with alcohol. Unless you're at something like a wedding and need to take a mere sip at the toast (and there are always plenty of nondrinkers at weddings), it simply isn't worth it. Your sleeve needs a solid 6-8 weeks healing time before you try anything off-plan.

I'd really encourage you to talk with your surgeon about this and have your surgeon check in with your transplant team, as well.

And telling him was your first mistake. It's none of his business what surgery you need. Even HR doesn't need to know.

I keep a spreadsheet. Once a month, a friend takes my measurements, and I have formulas plugged in that tell me how many inches I've lost since the last measurement, as well as from the start. I don't think these details would be of the slightest interest to anyone but me so I've no need to blog or youtube about it all.

Unfortunately, increased appetite is a known effect of Prednisone. I'm sorry!

No, your reason for healing perfectly has nothing to do with your preop shower. There is nothing magic in any soap. If there were, there would be no postop infections, and everyone would need to use whatever the magic soap was. It's a longstanding truth in the business that postop wound infections start in the OR.

"Just have faith that your surgeon has a reason to ask you to do something: to give you the best chance of a healthy, complication free recovery." You mistake my meaning. I've been a licensed health care professional for more than thirty years. I DID trust my surgeon, and was given NO requirement to do any of this - no infections or anything dire occurred. There is a lot to be said about overuse of antibacterials, similar to overuse of antibiotics.

It just doesn't make any sense. OK, you bathe with Hibiclens. Then you get dressed to go to the hospital. Then you get dressed in a hospital gown once you get there. All the bacteria you may have washed off is now redeposited on your body. You gargle with Listerine. And report to the hospital two hours or more before your procedure. During that time you breathe, talk, produce saliva - and replenish the bacteria that normally live in your mouth.

Stop doing this to yourself, In the initial four to six weeks, your body has one overriding objective: to heal from major abdominal surgery. You and your head may think weight loss is the be-all-end-all, but your body needs to heal FIRST. Get in your fluids. Get in your Protein, however you can do it. do the best you can. And stay off the scale. It isn't going to be your friend right now. The weight loss will come, but it isn't a race. Treat your body with respect and kindness, it's been through a lot lately.

Not a preop recommendation out here in CA that I'm aware of.

You can trim the loose edges off with small scissors, just leave what's still adhered to your skin there.

You aren't "stalled", you are a fresh postop. Your body has one overriding priority right now: healing from a major abdominal surgery. Follow your postop instructions. Get in your Fluid. Get in your Protein. Nap when you're tired. You are very, very hard at work on the inside. Weight loss will come if you follow your program. Hide the scale, give it to a neighbor, but stay off it. Honest. This is all quite normal!

It may seem like the insurance hoops are burdensome and pointless, but there really is some method to the madness. The intent is that you will go into this surgery as well prepared and healthy as possible. They really do want you to succeed. Every pre-op test, clearance, class, and appointments is for your benefit. Best of luck in your journey. I second this. I've shepherded more than 65 people through the process, and I can tell you, that no matter where you get your surgery, or by whom, it's impossible to be over-educated or over-prepared. No matter what you decide, it's completely worth the time you take to do the mental and emotional work to know what you're getting in to, and what changes you will need to make in your relationship with food - and with yourself. If you have emotional issues that contribute to your obesity, know that those issues aren't removed along with (most of) your stomach.

It's extremely difficult for your body to build lean mass during weight loss. Why? You need a calorie surplus to do so. What IS very common is for your body (for a number of reasons) to replace fat loss with Water gain, hence the Fluid shifts you''re seeing. Especially in the early weeks of a workout program, there is muscle inflammation (which means water!) as the result of the increased work. At six weeks out, you are only just at the end of the most major part of your healing. You may be contributing to your still by not eating enough if you are only getting in 750 calories/day. At six weeks out (plus your preop diet), your body has been in a big time calorie deficit that your body has likely slowed your metabolism down to compensate. I learned this by going and having my RMR tested. I was about nine weeks out at the time. My metabolism was at 60% of what would be expected for my age and gender. The PhD in exercise physiology I worked with exhorted me never to eat less than my RMR each day. Mine is more than 1200 calories - I suspect yours is even higher than that.

Wait a minute. You say here you are certain that your surgeon "screwed up" and further, you are sure you know why. Because you've "tested" your sleeve, even before you knew you should have. How specific were your surgeon's postop guidelines concerning volume and over that timeframe? Were you directed to eat not more than specific amounts? Did you follow those recommendations? Did you tell your surgeon that you'd "tested" your capacity against that of relatives who were further out? And why, in the name of all we hold dear, did you put an entire 20-oz steak on your plate in the first place? Were you not taught the things we all have - small plates, small volumes, chewing throughly, eating slowly? You put a 20-oz steak on your plate, eat it, and have the nerve to say your surgeon "screwed up"? Time for some ownership of your choices. You definitely should talk with your surgeon, and soon - but try listening, rather than jumping to conclusions. I was never banded, so I can't say anything from personal experience about the band-to-sleeve surgery. but undoubtedly your surgeon has information that you need. Ask. Don't tell, ask.

I'm confused. You're saying here lettuce will fill you up to soon, and you also call it a slider? One reason I'm enjoying my salad is because it doesn't fill me up too soon. i can get in my protein and still get some crunch. Win-win for me.

Having worked in managed care for the past twenty years, I can assure this is NOT a case of "they don't want to approve it". It's more a case of there being a difference between a doctor visit with a contracted doctor and a request for surgery at the wrong facility. Doctor visits generally don't require authorization, just a referral, and that referral is good for up to a year. Surgery is different, it does require prior authorization. It just really irritates me to hear stuff like this. Believe me when I tell you, we are all working way too hard to get people care they need to be playing any silly games with people. Believe it or not, a lot of us are licensed professionals, and grown-ups. You have NO idea how many rules and regulations govern what we do, and don't, do. Denying anything happens infrequently - about 1-3% of the time, actually. Today I am working with a new bariatric client, and two different people near death from liver failure. No, neither of them were drinkers. I came here for a quick time-out between phone calls.

Preferred will know who you're capitated to. Ask Preferred IPA the question - who is in-network for bariatric surgery at my capitated hospital? Preferred will be doing your authorizations. For now, forget about asking for a variance, you are not the only bariatric member they have, and they undoubtedly have a system for routing bariatric patients. Your PCP's office ought to have done this much for you. They also probably have one person there who deals with bariatrics - that's the person to talk to.