gr8ful1

My bariatric surgery program teaches that solid, chewable, or liquid vitamins are all fine, but that patients should not use vitamin gummies. I don't know the reasoning, but that was mentioned in the online recorded class I attended yesterday.

All I can say is that it gets *so* much better once you get used to it. That should happen soon for you. Just keep bearing with it. I hated mine at first, too. Right now I'm wondering how I'm going to fall asleep *without* wearing my CPAP mask to bed. I might try wearing it without a hose attached, just to comfort me.

I had my first dietitian appointment today, and I asked her about this. My program only restricts patients from using straws until 30 days post-op. After that, they are fine with it if it works for you. Ditto for carbonated beverages, which surprised me.

I love this. I am usually very private about doctor appointments and such, but I don’t want to be dishonest with people, either. I have at least six months to think about what to say to friends, coworkers, and family, and you’ve got me seriously thinking about writing a note or maybe a blog post.

Greetings, everyone. I am a serial diet failer. I've been on phen-fen in the '90s, on a weight management program while in the military, Weight Watchers, and physician/hospital-based medical weight management programs that included help from doctors, dietitians, psychologists, and exercise specialists. I learn what I need to do to succeed, start of strong, leave the formal program, and end up regaining all the weight I lost or more. I am the epitome of knowing what to do but failing to do it consistently for more than a few months at a time. I keep hearing that WLS requires hard work and discipline, as well as a commitment to eating right for the rest of your life. Problem is, I am over 300# because I have *failed* to do these things consistently over and over again. When I go to support groups for my medical weight management program, the only ones who are keeping the weight off are the ones who have had surgery. Surgery is a tool, but I've already been given a whole toolbox full of tools from all of the professionals that I've paid thousands of dollars to visit. I want to use them but I keep putting them away and going back to my old unhealthy ways. I can be disciplined long enough to lose 20-70 pounds at a time, but not long enough to keep it off. Am I exactly the type of person who should *not* be considering WLS? I don't know what else to do at this point. I do have an appointment to consult with a surgeon in a couple of weeks, but I don't think I'll qualify for surgery. My BMI has been above 40 for 15-20 years, and is currently in the mid-40s, but my medical records show that it has dropped below 40 whenever I've been in the middle of a weight management program and on a ketogenic shake diet, including as recently as a year ago, when I completed my last of many 12-week programs. I have no qualifying co-morbidities, but I'm heading in that direction. Use a CPAP but AHI is below 30, cholesterol high but controlled ok with statins. Sorry for such a lengthy fist post. I have read quite a few of the existing posts and this looks like a great, supportive online community.

According to the bariatric surgery policy of my medical insurance company (GEHA/United Healthcare): "clinically severe significant obstructive sleep apnea defined as an AHI >= 30 documented within prior 2 years"

My surgeon said both are very safe and effective, and I could have whichever one I wanted. When I asked him which one he would choose if he were in my shoes, he said RNY gastric bypass without hesitation. Better data supporting better outcomes, and the surgery-related complications are rarer these days, especially with surgeons who do hundreds of them every year.

Source for the data I posted.

No, I don't think so. I see a slight upward slope for those in the 90th and 95th percentiles, meaning that the weight loss continues for these high achievers, albeit at a slower rate. You beat the odds. You're doing great! Now please share your success factors.

Fascinating study, the results of which should answer lots of "what did you lose at x months" questions. For me, this also provides some large-sample data for which I can set some achievable and realistic goals and expectations for my own progress. Comparison is the thief of joy, but I love looking at peer-reviewed studies.

No problem. Looks like I found this right in time for you to finalize your 3 and 6-month goals! Wishing you much success!

Now that I've had my initial consultation with Dr. Fitzer, I'd like to share some feedback on him for the benefit of others. He smiled, he was personable, and he was not aloof. Apparently some other patients had a different experience in this regard. Maybe my expectations were low in this area, so it didn't take much to exceed them. In any case, I found nothing of concern in his demeanor, and I felt comfortable talking with him about my case and my concerns. He exhibited a lot of self-confidence. While I appreciate humility more than pride, I have no problem with the self-confidence as long as it's not unfounded. He solicited my questions, and answered them thoroughly. So thoroughly in fact, that I didn't get to ask all of them before I had been there for an hour, and he said that he we needed to wrap up the visit. I wished that he had more time, but I respect that there was another patient waiting, and that my $30 co-pay didn't entitle me to all of the doctor's afternoon. And he *more* than made it up to me by telling me that I could find a card with his e-mail address in the folder I was given, and that he would answer any additional questions I send him via e-mail. Not too many doctors offer that sort of communication with their patients - you usually need to schedule another appointment to get that kind of interaction! Another concern that others have mentioned is that you will "never see him again" after the surgery, even in the hospital on the day of surgery. So I asked him about follow-up, and he was frank with me about the other providers I would need to see after surgery. I'm ok with that. He's the surgeon, so I don't really need to see him except for the consult and for the surgery. He did say that I was welcome to make a follow-up appointment with him if I ever wanted to see him or just come visit. I have a $30 co-pay for specialists and no coverage for nutritionist visits, so how can I complain about that? Maybe I'll see his PA or NP for my 3-week follow-up, but I can also see him anytime I want. What more could I expect? Another concern was that he is a solo practice, so if he moves away or gets hit by the proverbial bus, his bariatric practice will not be there to support me after he's gone. He assured me that he is not going to move in the next five years, told me that he couldn't promise me that he wouldn't drop dead, but that he would definitely communicate with his patients about continuity of care if/when he were planning to move away. Again, I couldn't expect any more than that. I was asked to call GEHA (insurance) myself to verify benefits, even though the doctor's office was also in touch with them. I'm not quite sure what to ask, but I guess I'll ask about the "supervised diet," as Dr. Fitzer's staff didn't know my insurance company's requirement in that regard, even though I gave them all of my insurance info a couple of weeks ago. I did complete a year-long hospital-based medical weight loss program a year ago, so I hope that is recent enough to count toward the requirement. I want to get this done NOW! Overall, the initial consult went better than expected, even though I still have a lot of uncertainty and confusion about next steps, exactly what I need to do to prep, etc. I do have a follow-up scheduled with his nutritionist, so I expect to learn more during that visit and during subsequent visits to his office.

Hi Alice! I just had my first surgery consult today. I expressed interest in both sleeve and gastric bypass, and the surgeon felt that the bypass was a more suitable procedure for those in the 'super obese' BMI range. And the higher the starting BMI, the greater the advantages of bypass vs. sleeve. If you haven't already done so, I would encourage you to ask your doctor which procedure he/she would choose if he/she were in your shoes, and to be open to whichever procedure looks best for *you*.

As someone who is still pre-surgery, this is very encouraging. Thanks for sharing! Your weight loss so far looks excellent, probably more than most patients lose in three weeks. Especially true for someone whose starting weight was well under 300 pounds! Are your doctor and nutritionist ok with you holding off on the transition to pureed foods? You used the words "can start," not "should start" or "must start," so I'm assuming you're still planning to follow your program. I would want to be as aggressive as possible with the weight loss too, but I wouldn't want to deny myself any essential nutrition that I needed to be healthy and successful.

Or you could tell them that you "had a growth removed." Then they'll see the pounds drop, the hair get thinner, and never guess the real reason you had surgery!

I love the idea of having your primary care doctor write the medical certification. Brilliant! There are a couple of other ways to keep your surgery type private, depending on employer policy and privacy law in your area. Where I work (US federal government), there is a 3rd-party that we can use optionally to "vet" our sick leave requests. The medical certification is sent to them, and they tell your manager only that you do or don't have a "qualifying condition" for FMLA or sick leave. Another option, if you really don't want to divulge anything at all, is to simply take annual leave, comp time, or vacation time. If all goes well, you might still face some questions when people eventually start to notice that you've lost 100+ pounds.

I'm also in the very early stages, but I've been thinking about how much to say at work, too. I don't like to talk about my health at work, even though most of my coworkers don't think twice about updating the work calendar with details about the reason for their doctor's appointments, sending an e-mail that they are taking a sick day for diarrhea, etc. I am more of a "I'm out of the office on leave until..." kind of employee. I trust my manager not to gossip, so I will probably tell him that I'm having weight loss surgery when I ask him to approve my sick leave request. I will also ask him to please keep that private (would that offend him?), because I know how quickly word gets around in the office. Actually, I think I'll just tell him that I don't plan on telling anyone else. That ought to get the message across without implying that I feel I need to remind him to keep sensitive information private. As for everyone else, I do not plan to lie to anyone, but I'm also not going to volunteer anything unless asked. People are generally respectful and don't pry, so I really don't expect to confront any intrusive or uncomfortable questions. I realize that many people still think that WLS is a cop-out, and I just don't want to defend my decision to anyone.

My wife and I shared the same interest, and ironically, an old church friend of mine (he was actually on the board of elders) invited us to his swing club. It's called GottaSwing. What a fun way to get some exercise! Anyway, every night the group meets, everyone switches partners with everyone else. Many nights there are over 100 people in attendance, so it can get quite exhausting, but it's really a lot of fun. To tell you the truth, it was kind of intimidating at first, but each Friday night begins with a 30-minute beginner's dance lesson. There is always a live band, too!

RNY gastric bypass and suffer in unbearable and untreated joint pain, or sleeve gastrectomy and an eroded esophagus or cancer? Are the choices really as bad as they seem? I like the weight loss results of the bypass, but I'm concerned about the lack of pain med options for bypass patients. I was told by my orthopedic surgeon that I *will* have early arthritis in my wrist and hand as a result of a car accident injury/surgery. I actually have pain every day now, more than 15 years after the accident, but I suck it up without meds. I would love to hear from RNY patients who have arthritis or arthritis-like pain, and whether or not the pain treatment options post-RNY are as grim as I might think. Thanks in advance!

Wow, you've done great! Did you discuss sleeve vs gastric bypass with Dr. F? Seems that most docs want the patient to choose, but the more I read about both, the harder it seems to be to have a preference.

Praying that it is indeed surmountable, you'll prevail over it, and get cleared for surgery.

That's really good to hear. I can't wait to be able to say "yes" to things like going on a zipline, a helicopter tour in Hawaii, or even the simple things like going up a ladder or my attic stairs knowing that I'm under the "maximum allowed weight" for all of these things. And sitting in booths in restaurants. Your weight loss looks fantastic, SampTheChamp. You are killing it! How much have you lost in the first couple months after surgery, if you don't mind my asking?

I should be glad that my insurance company requires "only" 6 months. I'm glad the time has been going by fast for you, though. I started this journey by attending a WLS seminar at Fair Oaks in 2014, but "having my insides mutilated" scared me to death back then. I just imagined waking up from surgery in a panic and shrieking, "what have I just done to myself?!" But now I'm ready.

I know this thread is a bit old, but I thought I'd chime in and say that I have my initial consultation with Dr. Fitzer scheduled for next Friday. Would anyone like to share why they went with Fitzer instead of a larger practice such as Inova? Fitzer seems like an outstanding surgeon and the comments here indicate that his staff is fantastic. But I'm a bit concerned that he is a solo practice, and that he could pack up and go back to New York or elsewhere, leaving me to find follow-up care and support elsewhere. How did you weigh those concerns in your own decision-making?