Seastars

Good luck today, Kadie! I am scheduled for June 22 - just 33 days after my first doc visit. Good news for me as that I don't need to do a liver diet, because I not-really-purposefully lost 13 pounds in the last 13 days on just regular-food high-Protein meals, so my liver has shrunk enough already. Yay! Bad news is that she said I will have to reduce my workouts a lot for several weeks after surgery because I won't be able to hydrate enough (can only take small sips) - my signature line here is SO true for me. I will miss guzzling Water. I asked my surgeon if I could be the first operation that day, but she said any gastric bypasses go first because they need more recovery time.

I'm I'm right there with you. Losing a little by lowering carbs pre-surgery (per doc's advice), hearing that the effects of the sleeve only last 5 years, and it will be major surgery that will cut into my work, workouts, summer plans (I love to hike a LOT in summer but it sounds like I'll have to scale back to walking?)... I'm starting to wonder if I should try dieting one last time. From this website I hear that this thinking is VERY common.

Low(ish) BMI peeps, How did the surgery affect your workouts? I keep searching for advice but it seems aimed at much heavier and less mobile people (i.e., recommending "walking" post-op as a workout). I (and likely most of you) are instead in the "fit but fat" category, used to good heavy cardio workouts near-daily. Did you have to cut back post-op? I know we have to avoid swimming and lifting >25 pounds for a few weeks, but what about running, hiking, biking? How soon was it before you could have a vigorous workout? Did you feel you had enough energy for a workout given your low calorie intake? Was it hard to hydrate enough?

I've found unjury chocolate splendor mixed with milk to be bearable. That's the only one though. It doesn't contain aspartame or other artificial flavors which is why I think I can tolerate it.Sent from my XT1254 using the BariatricPal App Not true. That brand has sucralose (Splenda): whey Protein Isolate, Fructose, Cocoa powder (Alkali Processed), Natural Flavors, Soy Lecithin, Xanthan Gum, Sea Salt, Acesulfame Potassium, Sucralose, Potassium Chloride. Vega brand uses "natural" stevia but that tastes just as bad as the artificial stuff, to me.

I appreciate hearring all success stories, but yours is fantastic!

I really appreciated the author's 20-year perspective. Did you find anything more recent from him?

Thank you! I like the Premier Protein Cholocalate and Vanilla both (haven't tried strawberry - I've heard that's gritty). Ordered the Necter Variety Sampler today too, and picked up some other brands' individual packets at Whole Foods to try. But I think a coupla weeks straight of chocolate and vanilla shakes will drive me bonkers!

How are you guys (who are getting very close) doing on the liver diet? Are you drinking a lot of Protein shakes, or real food? I am newly appreciating no-carb foods like mackerel, herring, tuna that are so portable for lunch at work and camping. I've been taste-testing various shakes and am gagging at all the chemicals and sucralose! Any suggestions? Maybe after surgery I'll start a line of shakes with savory flavors: nacho cheese, potato/broccoli, curry, miso, blue cheese, buttered popcorn, tomato/spinach, ranch, carrot... Not really kidding!

I still don't have a surgery date. Doing all the prepwork though: finished blood tests and EKG, psych visit #1, dietician visit #1. The dietician isn't asking for much - just two weeks' of food logs showing more Protein than carbs each day (plus at least 100g protein per day, but I already do that), to show that I can manage to do similarly post-op. Once I show that, they will schedule surgery. My surgeon's "liver diet" limits carbs to 20g/day (yikes!) but otherwise I get to eat. Two weeks of that is coming up soon! So all's well for me, except that I was disappointed by my dietician's opinion on a goal weight range for me: 164-178#! She says that will incorporate my existing 125# of lean mass, plus 30% body fat (I'm currently 41.3% fat). She doesn't like using BMI. Her suggested weight seems too high for me. We will see... I want more like 150#, 20% fat, as my goal!

For those considering surgery who, like me, were investigating insurance coverage, the following info might be useful. Basically: <b>in about half of US states it is nearly impossible to get insurance coverage for bariatric surgery, regardless of your BMI or co-morbidities,</b> regardless of the specific surgical procedure and regardless of where you get the surgery. Prior to the Affordable Care Act (Obamacare), private insurers largely had free rein to exclude treatments (such as for obesity and other pre-existing conditions) and increase premiums for the obese. Only 4 states required insurers to cover bariatric surgery. So insurance coverage for weight-loss surgeries was inconsistent across the country (but tended towards exclusion). 2012's ACA changed that, with a federal mandate for insurers to cover bariatric surgery and nutritional counseling/weight loss plans. But there's a huge exception: states can individually opt out of some of this federal mandate. (That's crazy and defeats the universal-coverage intent of the statute in my opinion.) So, 23 states now require Medicaid (low-income state insurance), exchange (non-employer-provided) and private (group plan through your employer) insurers to cover bariatric or gastric bypass surgery (although the specific insurer can limit it, say to a BMI of 40 or above, or 35 with 1 or 2 co-morbidities). Yay! <b>These states where insurers are required to cover bariatric surgery are: Arizona, California, Delaware, Hawaii, Illinois, Iowa, Maine, Maryland, Massachusetts, Michigan, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Oklahoma, Rhode Island, South Dakota, Vermont, West Virginia, Wyoming.</b> In addition,three states provide that "coverage must be offered..." in at least some policies, but it is not required in all policies. These are: <b>Georgia, Indiana, Virginia.</b> But 24 states -including mine - still allow insurers to entirely exclude coverage for bariatric surgery. And in those states where it's allowed to be excluded, almost all insurers DO exclude it, because bariatric surgery is expensive and usually increases insurance premium cost. So the exchange insurers, to be competitive in the insurance market, exclude it. Most employer-provided plans, ditto. A few private, employer-offered, generous group insurance plans may cover it but this is rare, because of the higher premium cost. <b>These states in which insurers are allowed to, and usually do, exclude bariatric surgery are: Alabama, Alaska, Arkansas, Colorado, Connecticut, Florida, Idaho, Kansas, Kentucky, Louisiana, Minnesota, Mississippi, Missouri, Montana, Nebraska, Ohio, Oregon, Pennsylvania, South Carolina, Tennessee, Texas, Utah, Washington, Wisconsin.</b> SO, if you are in one of the 27 states where insurers aren't required to cover bariatric surgery, very likely any insurance you can get (from your employer or the exchange/open market) will not cover it, regardless of BMI or co-morbidities. If you live in one if those states, as I do, you will almost certainly have to self-pay for the surgery. Here is a good, recent (March 2016) article detailing what I've just summarized: http://www.ncsl.org/research/health/aca-and-health-mandates-for-obesity.aspx I know this is long but it may help someone reading to understand why his or her insurance policy excludes bariatric surgery entirely, when so many posters on this website seem to have insurance coverage. Don't be dismayed. Confirm your coverage (call the customer service number on the back of your insurance card) and then assess whether the cost of funding the surgery yourself is worth the health benefits. (For me, it is.) Good luck! Thanks to Silverthreads for help with this post.

Hi, group! I'm excited to read about your similarly-timelined journeys, especially once we are all post-op. I'm in Seattle (same as Farcaster, but I don't know him) and will be getting sleeve surgery locally in approximately late June (no exact date yet). I began looking at surgery just 10 days ago! Researched the surgeries and surgeons, found out my insurance doesn't cover it, decided it was worth the self-pay, chose a surgeon, did my initial workup 5/18/16, EKG & bloodwork 5/20/16 and have dietician/psych on 5/24/16. Have more classes and the pre-op liquid diet after that. I get to skip endoscopy as well as the sleep study (because I already have a sleep apnea diagnosis). Ditto pre-op proof of dieting failure (because I have years of food logs showing that, sigh). Things do seem to go faster when insurance isn't involved. Yesterday I did some taste-testing of low-carb Protein drinks, anticipating needs for post-surgery. Costco's Premier Protein (vanilla flavor; I haven't tried the chocolate yet) is actually quite good, whew! Two of the others I tried were simply disgusting, so glad to know I have something that will work. I also tried, yesterday, to eat low-carb (under 80g) just to see what post-op will be like. Answer: very very difficult without a sleeve to hide hunger. Getting 100g protein daily is usual for me, but I am used to 50% of my calories being carbs (mostly fruit). I anticipate that reducing carbs will be the hardest part of post-op for me. What part of "getting sleeved" are you most worried about? I am very excited and happy about this new chapter! Glad to "meet" you all!

Check my thread - linked on the previous page - about the Medicaid/Exchange/private relationship.

I posted a new thread today with more explanation of the disparities between the states here: http://www.bariatricpal.com/topic/367858-which-us-states-dodont-cover-bariatric-surgery-answers-here/ ...before I saw that surfergirl had started this thread. So if you want more details, click.

Thank you, thank you! It makes sense that more calories = better mental function (we all remember some crazy lo-cal diets and fasts). But I will be prepared for the worst. Agin, thank you!

Thank you for the clarification on Medicare/Medicaid! You are absolutely right.

Oops, "premium visit" in my post above should be "premium cost." Doggone autocorrect! Oops, "premium visit" in my post above should be "premium cost." Doggone autocorrect!

Ele Marie, yayyyy! I'm so glad you had insurance coverage for this expensive treatment. California is indeed one of the states where insurers are required to cover Bariatric surgery. I know this is off-topic, but for those considering surgery who, like me, were investigating insurance coverage, the following info might be useful. Prior to the Affordable Care Act (Obamacare), private insurers largely had free rein to exclude treatments (such as for obesity and other pre-existing conditions) and increase premiums for the obese. 2012's ACA changed that, with a federal mandate to cover Bariatric surgery and nutritional counseling/weight loss plans. But there's a huge exception: states can individually opt out of some of this federal mandate. (That's crazy and defeats the universal-coverage intent of the statute in my opinion.) So, 23 states now require Medicare, exchange and private insurers to cover bariatric or gastric bypass surgery, but 27 states -including mine - still allow its exclusion. And because Bariatric surgery is expensive and usually increases premium visit, the exchange insurers, to be competitive, exclude it. A few private, employer-offered, generous group insurance plans may cover it but this is rare. SO, if you are in one of the 27 states where insurers aren't required to cover Bariatric surgery, very likely any insurance you can get (from your employer or the exchange/open market) will not cover it, regardless of BMI or co-morbidities. If you live in one if those states, as I do, you will almost certainly have to self-pay for the surgery. Here is a good, recent article detailing what I've just summarized: http://www.ncsl.org/research/health/aca-and-health-mandates-for-obesity.aspx I know that is detailed but it may help someone reading to understand why his or her insurance policy excludes Bariatric surgery entirely, when so many posters on this website seem to have insurance coverage.

Yeah, Medicare nationally approves Bariatric surgery, but subject to state regulation. (Medicare is a combined fed/state program.) So each state decides for itself, and about half - mostly in the north and west - won't cover it. The exchange (Obamacare) and most private insurance plans follow suit. Crazy. But that's why many of the Americans on here who talk about insurance, are from the southern states.

RNYOYo, that is fantastic to hear about your energy level soon after surgery! I hope for a similar outcome. Ele marie, my insurance won't cover any Bariatric surgery regardless of BMI, and won't cover any diet or nutritional program. Crazy. So I'm self-paying. My surgeon is willing to go a little below 35 BMI (I have a co-morbidity).

Thank you, everyone, for telling your stories and sharing tips! It is very reassuring. Keep 'em coming! I don't have a surgery date yet (probably late June). I have a BMI of 32.8. I'm most concerned about: -micronutrient deficiency. The longer-term sleeve studies show this is very, very common. Any of you long-termers who can report that your regular Multivitamins are enough to keep your blood levels normal? -being too fatigued and fuzzy-brained to work for weeks after the surgery. I don't need to account for vacation days at my job, and I can work from home if necessary, but I've got a huge project in August that will need focused thinking and writing for most of June and July. More than a week off work will compromise that. So I'd love to hear from folks who were back to a desk job and reasonably efficient, a week after surgery! (Or if not, please tell it too me straight - how long did it take for your brain to return?) -surviving the pre- and post-op liquid diet phases. I like Fiber and crunch! But I suppose one can endure anything for just a few weeks. I'm pretty active (cardio daily) and eat nutritiously (although way too much) with lots of Protein. I don't smoke, drink (alcohol, coffee, soda). So the maintenance phase doesn't seem too difficult (knock wood) - just much smaller portions, starting with protein, and much more chewing! I hope that having a lower (although still obese) BMI and being fit now, will help me bounce back to regular activity (and brain) after surgery.

How many days were you off work? How's the nausea? Is it difficult to get your liquids in? Are you glad you did it? Anything pre-op that you are glad you did, or wish you'd done differently? Thank you!

Another Seattlite here! I don't have a surgery date yet; should be in about two months, after I complete all the tests and (ugh) the two-week liquid diet. I've been reading lots of journals, food diaries and messageboards (mostly this one). Would very much like to hear about Kooky and Kadie's journeys so far!