RuralNurse

I had surgery on 1/10/16. My advice...don't buy a lot of shakes, powders or mixes until you have tasted them. I thought I would get prepared and purchased stuff and I can barely swallow it. I got the unjury bariatric chew-able Vitamins and they were horrible. I am someone that can eat almost anything. I used to chew TUMS for Calcium. But I could not stomach them. All of this stuff can get expensive and in your excitement for the surgery it can be tempting to purchase stuff you may not need. Good luck!

I am a lower BMI person. My insurance covers WLS pretty well but the lowest BMI they will cover is 35 and only if you also have diabetes with that lower BMI. So I am going to go to Mexico and be self pay, my date is 1/101/16. But even with that they said I MUST show up with a BMI of at least 30 of they will not do surgery. I have found only a few posts or YouTube videos on folks in my situation. What if I lose too much on the pre-op diet? Will the surgeon make my sleeve "bigger" because I'm not as heavy as most? How does weight loss go after the surgery? Meaning we know that heavier people in general can lose weight more rapidly on the same "diet" as those that are light, so what can we expect? Are the complications the same such as chance for dumping syndrome, chance for acid re-flux, chance for needing gall bladder removed later, etc? I am sure I am not the only one with these questions and think that we could support one another and give info on our journey that may help others in the future. If there is a section on this forum that I missed specifically for lower BMI WLS please feel free to move this post.

As a nurse practitioner I would tell you to see your gyne right away. In school we were told that any vaginal bleeding after a year of no periods is cancer until proven otherwise. Not trying to scare you but women put these things off and they can get worse. It may be hormone related but I would get it checked.

"I remember giving up carbs once and it was the worst week of my life." If you have time why not slowly reduce your carbs? You don't have to go from eating carbs unlimited one day to 10 carbs the next. That is miserable. Start by looking at where you get your carbs. Cut back on bread and Pasta but keep eating high Fiber carbs. It is tough to totally cut carbs but to slowly do it (especially where you say that you have time) would make it easier on you. I know that I always lost excess Fluid and weight on low carb and actually felt better once I got through the "funk". I feel that the American diet is way too full of simple carbs. And that is one reason (there are many) that obesity is such a problem in our country. Good luck!

I agree, I'm glad I did it. Maybe not the path of everyone but I know I suffered less by doing it ahead of time and not while trying to recover from surgery.

I had VSG on 1/10/16 and day of surgery weight was 189.6. Got up today (one day short of 6 weeks) and I'm down to 169! Feeling blessed...

I am a psychiatric nurse practitioner and prescribe medications and have used Viibryd with lots of my patients. I have never found it to be an appetite suppressant. Some people get some nausea, diarrhea and other GI distress with it, maybe that is part of it. It needs to be taken with food to help with adsorption. According to the trials about 3% had increased appetite and 2% had increased weight. About 29% had diarrhea. They did not list weight loss as a side effect at all in the research trials. Maybe the diarrhea and nausea is where the "weight loss" comes from that your therapist had noted. Viibryd is a good medication but not all anti-depressants are created equal and you should see your psychiatric provider to have him or her assess you for the right one. Starting on page 5 is the side effects. http://www.allergan.com/assets/pdf/viibryd_pi

I think one of the benefits of the pre-op diet is with it being low carb you kind of lose your appetite. At least most people that do low carb have a decreased appetite. I certainly do. So then after surgery when I was being so careful and ginger with what I was taking in, I was not starving. In fact I did not feel a "hunger pang" until about 3 weeks. Also when you go on a low carb diet prior you lose so much of that excess Fluid. You often get some fluid retention after surgery and it is much easier to manage if you have already lost a lot of excess fluid. I was considered low BMI so did not need to do anything other than the 3 days liquid prior. I did the low carb pre-op diet and I am glad I did. I will be 6 weeks out tomorrow and I am down 21 lbs. from surgery day and 28 lbs. from when I started the pre-op diet. Good luck in what ever you chose.

I started on day of surgery at 189.5 and today (one day shy of 6 weeks) was 169. I really focus on vegetables, cottage cheese, greek yogurt, (both good protein) and lean meat. I will start adding some fruit in this next week. But I avoid Pasta, rice, bread, or any simple carbs. I also drink tons of Water and herbal tea. I really feel that lower carb is the most healthy for me. I have done low carb in the past and could never really stick to it. But this surgery has changed my hunger and appetite and has enabled me to eat to live instead of live to eat.

I know that pre-op people need to be on clears for 24 hrs or so. What about post - op? I am making home made chicken stock and canning it in 1/2 pt jars. I figure that is the right amount at one time to try to sip on. But wondering how many to make. I also have some clear broth for a lovely pork roast I made that I will can as well. I have about 24 - 1/2 pint jars and 6 full pint jars completed now. I was going to make a pot roast tonight and if I need more than that I will make some beef broth/stock and can it too (I may do it anyway for some variety). I am going to Mexico and although it is cheaper, there is not as much info upfront on expectations. I know I can't take the broth on the plane and will bring the cubes or packets. But when I get home I know I will appreciate home made chicken stock over the stuff that has to be reconstituted. Thanks for any info you can give.

I have surgery scheduled for Jan 10th. I have a lower BMI so I was directed to only go on the liquid diet one week prior to the appointment. However I have always done really well on low carbohydrate diets in the past. Typically after being on the diet for about three days I almost completely lose my appetite. I think that having a low appetite would be really great for after surgery when I can't eat very much. So I am, on my own, going on a Atkins-type, low carbohydrate diet for one week and then I will start my liquid diet as directed by my doctor. Good luck to you.

I take citalopram, I am about 9 days out after surgery I took my last tablet(30mg) the day before surgery. I have a follow up in 2 days and will ask if I can take them, for the purposes of weaning off,cause doctor advised going cold turkey will eventually have withdrawal symptoms. You have already "gone cold turkey" If you were going to have what we call "discontinuation syndrome" (which is similar to but much unlike "withdrawal" experienced with other meds/substances) it would have happened by now. Now what you may experience is return of symptoms. Citalopram is an SSRI and as such it helps you to build your own levels of serotonin, and it does this over time. Stopping it will cause a reduction in your own levels of serotonin eventually. Will it reduce enough to cause your symptoms of anxiety or depression to come back? Who knows, it may or may not. If you want to see how you do off the meds it would be reasonable to stay off it as you have already been off for close to 2 weeks by the time you see your doc. Unfortunately most primary care docs don't really understand how all of these psych meds work (unless they are a psychiatrist). They have basic knowledge and are told that many of them cause "withdrawal" symptoms. Many do, but the pure SSRIs are much less likely to do this compared to the SNRIs like Effexor or Cymbalta. If you feel good and are not having anxiety or depression now and want to try staying off, ask your doc about that. Going back on just to wean off when you have had no symptoms of coming off is not really needed. What I would add however, is monitor your mood/anxiety closely. Depression and panic can creep up and before you know it you are miserable. Keep an open dialog with your doc in case you need to go back on. Good luck!

I think this can be quite variable...I know we all would like a more specific answer. But the reality is people can have depression or anxiety (both heavily regulated by serotonin) for lots of different reasons and respond in different ways. I am a psychiatric nurse practitioner and have been caring for people with mental illness for over 15 years. I have had pts that were almost identical in age, sex, ht, wt, symptoms, etc and respond completely different to the same prescription. We are not cookie cutter people, we have wondrous variety and I am reminded of this daily. So take this as general info only. We produce serotonin in our brain but about 90% is found in the gut or GI tract. For simplicity - when you were a bunch of cells, before you were even fetus, the cells that made your brain and the cells that made your gut and intestines were identical. That is why if you have ever had a bad headache or migraine, you may get nauseated and through up; or why if you have a bad stomach flu you have a headache, why if you feel really anxious (in your brain) you feel like your stomach is tied in knots, or you get a dry mouth, etc. Or if you take meds that effect your brain like pain meds (they may make your broke ankle feel better but really they are effecting your brain) you get GI disturbance in the form of constipation. This is why so many "psych" meds can upset your stomach, cause diarrhea or appetite change. So will your medication needs change after surgery? It is hard to say. But as serotonin builds over time and is depleted over time you may not notice it for a few months after surgery. One thing that I think is important to know however; your anxiety or depression maybe worsened by how you feel, but simply "feeling bad" about yourself is unlikely to cause major depression or an anxiety disorder. So what I mean by this is, if you truly have a chemical imbalance that is causing depression or anxiety, losing weight is not going to suddenly make your world perfect and you will have no more anxiety. You may have more confidence and may be better able to express yourself; you may have more self esteem and less likely to allow others to take advantage of you; you may take better care of yourself and feel better physically, you may lose weight and get rid of sleep apnea so sleep better; you may be able to get more physical activity and release your own endorphins... But don't assume that if you really have a deficit of neurotransmitters that losing weight will make your world perfect. You may or may not be able to get off meds. I will try to put a link to a nice site that helps to explain the brain - gut connection. http://nutritionwonderland.com/2009/06/understanding-bodies-serotonin-connection-between-food-and-mood/

I posted this in another thread that discussed HIPPA as many people don't really understand how it works. I agree that it is no body's business but it is important to understand what HIPPA can and cannot do. Just so you are aware, HIPPA does not cover information from one person to another in the context of "visiting", "talking" , "divulging", etc. It is only in the context of a client or patient and his or her health care worker/provider. If this person you are talking about has provided health care to you, such as has functioned as a nurse taking your vitals, a physical therapist working with you, your doctor/PA/NP, dentist, the receptionist that makes your appointments, the billing/coding person involved at the clinic/hospital, etc., then yes it is covered by HIPPA. If you just work with her (regardless of if it is in a hospital, clinic, Wal-Mart or a bank) and you divulge info to her she is not bound by the HIPPA law. There may be other legal things like libel or slander but I am not a legal person so don't know anything about that stuff. I work in the medical industry in psychiatry so am pretty familiar with HIPPA, as in mental health we are even more protective of info and know that a lot of people do not really understand HIPPA. I just don't want you to have a false sense of security. Unless a person is directly involved in your health care, they are NOT bound by HIPPA no matter where you work.

I don't understand why people feel they HAVE to tell anyone at work. If you were having a rectal transplant you would probably just tell your boss you are having health issues and need to take time off. I am only taking 3 days and have told people at work that someone in my family is having surgery and I need to be there for them (my mom happens to be having a surgery at the same time so I'm not lying). I do see if you are taking more than a week that you may need to tell your boss that you are having medical issues yourself and can't "blame" it on "family". I also fully support people that want to tell supportive people in their life, but just know you don't have to tell anyone. It is no one's right to know anything that you do to your body.

Just so you are aware, HIPPA does not cover information from one person to another in the context of "visiting", "talking" , "divulging", etc. It is only in the context of a client or patient and his or her health care worker/provider. If this person you are talking about has provided health care to you, such as has functioned as a nurse taking your vitals, a physical therapist working with you, your doctor/PA/NP, dentist, the receptionist that makes your appointments, the billing/coding person involved at the clinic/hospital, etc., then yes it is covered by HIPPA. If you just work with her (regardless of if it is in a hospital, clinic, Wal-Mart or a bank) and you divulge info to her she is not bound by the HIPPA law. There may be other legal things like libel or slander but I am not a legal person so don't know anything about that stuff. I work in the medical industry in psychiatry so am pretty familiar with HIPPA, as in mental health we are even more protective of info and know that a lot of people do not really understand HIPPA. I just don't want you to have a false sense of security. Unless a person is directly involved in your health care, they are NOT bound by HIPPA no matter where you work.

I've heard that it's nice there Yep, quiet for the most part, have to drive a long way to get to a Wal-Mart, only 13 kids in my 9 year old's 3rd grade class. Last census 600 or so people in the town, we have a huge county but there is not one single stop light in the whole thing.

A true psych eval asks all those things because they can be very relevant. Yours may have just been a "hoop" for insurance, meaning surgeons will contract with psychologists, nutritionists, exercise physiologists, ect to do the evals and treatments and make recommendations that the ins demands. They will have people that they refer to knowing they will usually do what is necessary to get the surgery done. Remember it behooves your surgeon to get the ins to pay for it. And typically a psych eval is reimbursed for a certain amount. Lots of therapists and psychologists do side work in the form of evals for certain things (my friend does chemical dependency evals and gets $1000 for a 3 hours consult requested by an attorney). So some do a "real" eval and do a thorough job and some do what it takes to get paid.

Middle-of-no-where, Montana

My situation showed me how the people that "were so supportive" were not really being truthful. I began with my insurance company and started jumping through hoops. As I was doing that told a few people and they were all very sportive, "You have to make your personal decision of what is best for you", "Good for you!", "Let me know if there is anything I can do", "I'm so glad you are taking this step in your health". THEN - my insurance denied me...I told them all it was denied and then I heard from the same people: "You are going to be so glad you did not do that", "You will feel so much better that you did it on your own", "I'm glad you are not taking the easy way out", "Weight-loss surgery is for lazy and vain people, you are better than that". Now I am going to Mexico, surgery in 2 weeks. I have told only my sister and mother, both of whom had WLS years ago and understand and really are supportive. I hope everyone has people that will honestly be supportive. But remember you don't owe anyone an explanation of anything. I also have to have a hysterectomy with bowel and bladder repair sometime this year. I am not explaining that to anyone either. They will see I don't use the bathroom every 30 minutes, but I don't feel I have to tell anyone anything. When people see my weight loss I will say that I have decided to make some hard changes in my life and take better care of my health. I am eating better, I am not on some fad diet and I am getting more exercise. Just be careful who you tell, remember you can't "untell" anyone.

This response sounds like a "sugar rush". Often when people eat a high sugar item (especially liquid as it can absorb across the mucous membranes) and they have diabetes, pre-diabetes or insulin resistance they get a similar response. Does this drink have high carbs or aspartame (that your body can sometimes "experience" as real sugar)? Dry mouth and becoming very tired, fatigued or sleepy is often the response a diabetic (or similar) gets when ingesting glucose. Not sure if that is your situation. I would try a different brand or type and see if you get the same symptoms.

I am glad I fuond this thread. So many of you have so much in common with me. I tried to get it done through my hospital (I'm an NP) and my insurance but they said I had to have at least a BMI of 35 and diabetes. I have been up and down most of my life and now at 51 am having health problems. For people to say that a lower BMI should not do it, they need to know that people with low BMIs get type II diabetes, hypertension, sleep apnea, joint problems, high cholesterol and a whole host of other problems related to obesity. I have told my mother (she had WLS in the 1970s when it was very new) and my little sister who had RNY about 13 years ago. I have never been as heavy as they were so never even considered it. When I first checked into in with my ins I told a few people and they were all like, "Good for you, but you don't seem that heavy". "Let me know if you need anything". Then my ins denied me and they all said things like, "you will be glad you did not take the easy way out" "You will feel so much better by doing it on your own" "You would have regretted it". So sometimes when people sound supportive they really are not being honest. I am not even telling my husband or adult kids. I will be going to TJ, Mx and have surgery on 1/10 and I am so excited I ca hardly stand it! I like reading this as I see others compared to me and it gives me kind of an idea about how fast I will lose (a ball-park anyway). Good luck to all.

I am a psych NP and do psych evals for a living (not specifically for WLS though). Your psych eval is probably just to make sure you are not in the middle of a manic episode and making an impulsive decision; that you have realistic expectations (i.e. NOT - I weigh 350 lbs now and after surgery I will lose all this weight and apply to the Miss America Pageant); that you are making this decision yourself and it is what you want (i.e. you don't have a controlling boy/girl friend/spouse that is forcing this on you; that you don't have such a low IQ as to be unable to make your own decisions, that you don't have a mental illness such as body dysmorphic disorder, etc. Also it can be more info to support your surgery to your ins company. If they can document how being heavy affects your mood and emotions that may be beneficial to get the ins. co. to say "yes". I would imagine people are rarely disqualified for a psych eval and if it does happen to a person, it probably should happen to that person.

Good luck to you on this. Insurance varies so much. My insurance covers this very well but they are super strict. They would not allow sleep apnea, elevated cholesterol, GERD, or stress urinary incontinence to pass. They said the lowest BMI I could have is 35 and with that I MUST have diabetes or it was a No-Go. I hope yours is more lenient I am scheduled for January 10th in Mexico as well!

Thanks. I will have to figure out how to PM. How would you feel about questions here on the forum so others could join in? I see there is more interest!