Tiffykins

Yes, log all of your diet attempts with weight lost and gained. Put down your WW stuff, any other diet attempts like Atkins, or workout regimens, then document if you have issues working out with your joints due to your weight. I documented back 5 years, some of the numbers were guestimates, but I just logged it from the last 5 years, and submitted it with my paperwork to the surgeon at my first consult.

Had a pretty amazing little appointment today with the maternal perinatal ob(high risk doc). I hit the fabulous 29lbs gained by their scale, but they admit they got a new scale and it seems to be weighing everyone heavy. At this point, I honestly don't care about the number on the scale, I'm just ready for her to get here. Tatum is perfect, she's growing, thriving, over 5lbs at this point, her lung/pulmonary function testing was normal today, her echo was spot on normal, and she has a full head of baby hairs ! ! ! Dr. B even said if I were to deliver today, she would perfect. I start the prednisone therapy tomorrow, & will have platelets rechecked in 2 weeks on the 17th. As long as my platelets hit 85K, I'll be able to have an epidural. If my platelets do not respond, then they are going to evaluate giving me a spinal block with a very light amount of anesthesia. If this is not an option, general anesthesia for the csection is the only option for delivery. Overall, we are absolutely fabulous ! ! ! Delivery is November 1st. I am on restricted activity, and by their defintion, I am supposed to just sit around for the next 25 days until she gets here. Waking induces some pretty strong Braxton Hicks type contractions, and I'm definitely not allowed to do much of anything for the next few weeks that could possibly induce full on labor.

You're sleeve is at that pivotal time where it matures and you can fit more in. The key is to feed it the right foods, Protein rich and nutrient rich foods that will keep you satisfied longer. There is minimal stretching with the sleeve, but with slider foods(carby, crunchy, popcorn, chips, pretzels etc) those will slide right on through and are just empty calories. The stomach isn't going to shrink back down, it just doesn't work that way. The key is continued to eat small portions of the right foods and if you're hungry adjust your calories/carb/protein intake to counterbalance your hunger. If you went off a PPI, it could be silent reflux causing the hunger, if you weren't on a PPI, unfortunately, hunger can and does return for some sleeve patients.

It really sounds like fear and him not really being ready to accept that you HAVE to do this for YOU. He'll still be able to his food, he'll still be able to do whatever he wants with his body. I never made any concessions in our family meals (other than making some healthy substitutions) because I chose to have VSG. I still cooked all the same meals, we still ate out, we still had social functions to attend, and I never expected anyone to cater to my post-op eating. I still bought ice cream, Snacks, and other foods that I simply avoided during the losing stage. My husband and I struggled with post-op life, and me losing weight. But, he knew I was going to do it. I'm pretty brutally honest, and told my husband, "I'll take saggy boobs and excess skin over you putting me in a pine box 10-15 years early because of obesity-related diseases and conditions." You might have saggy skin, you might be wrinkly, but what does it matter if in 20 years he's having to hire a nurse to wipe your hiney, or bathe you himself because you are not able to do so??? That was a true concern of mine, I was petrified that if I didn't do something NOW then what would our future really hold? Hang in there, and I hope he understand how insensitive he is being during this already stressful time.

I'm 28.5 months out. No issue with weight regain as long you continue making good food choices. I eat very liberally in maintenance, and do not diet, but I don't eat a bunch of crap foods either. I've gained 35lbs in my pregnancy and I'm 11 days out from delivery. It's not hard to regain weight with ANY of the surgeries. At the end of the day, it still boils down to the choice you make on what goes in your mouth. None of the surgeries will stop you from sucking down a 2000 calorie milkshake. As for long term, the sleeve has been performed for nearly 10 years as a stand alone procedure, and as the first stage to DS and RNY since the early 80's for super morbidly obese patients (500-600lbs) as a safer alternative to help them lose 100-200lbs before the complicated malabsorptive component was added in a second procedure. And, all this surgery is a partial gastrectomy which has been performed since the 1800's for stomach cancer/ulcer patients. Be it the gastrectomy is performed vertical or partially with just sections removed due to diseased tissue, gastrectomies are not new to the medical world.

I can really relate to your post. My husband became the food police, and started offering me little bites of his ice cream or other junk food while I was in the losing stage. I always declined, and then the comments would start. We had to really sit down and talk about my issues. He does NOT understand the need for surgery, even though he was supportive and knew that I was going to lose weight he was NOT prepared for me to get so small. He wanted me to quit losing at around 175lbs, and felt that was small enough. The comments about leaving him after you lose weight are directly tied to his own insecurities and there's nothing you can do but reassure him that you'd leave due to his behavior whether you were fat or skinny. My husband got really possessive, and would make me uncomfortable in public with his constant need to touch me and "claim" me as his property. He pulled some major b.s. on me once when a man came up and was just being polite by saying "hi, how are you?" He rushed over, slid his arm around my waist, and kissed my forehead. I looked right at him and said "Stop hiking your leg on my thigh!". He was so mad that another man would even speak to me, and it did cause a lot of conflict. What he failed to ever recognize is that I got hit on before even at 270lbs yet he was never intimidated or threatened by other men when I was fat. It was a long road for us, but we communicated and worked through it. Once I reached goal weight, I continued to lose another 25lbs. It got even worse, and we really had to sit down and talk it out. I had to remind him that I was healthy, that I was not starving myself, that I was eating double the calories and carbs that I ate during my losing stage, and that I was under direct care of multiple doctors. He still to this day tries to get me to eat more because my surgeon believes I need to maintain around 140lbs instead of 125lbs, and that I would not look so thin. So, I made the mistake of taking him with me to an appointment where my surgeon addressed my maintenance weight. I've never been able to live it down, and now with the 30-33lbs weight gain in the pregnancy, and the urging of my ob's to keep my weight around 140lbs once I deliver, it is even worse. He's hidden the scale, he's back to being the food and medication police, every day I hear how much did you eat today, did you take your meds, and Vitamins, did you drink all your Water? Every day it is a battle. At this point, and being over 2 years out, it's a lost battle, he's lost a lot of his possessive tendencies, but the fact that my face and neck has plumped out in the pregnancy, he likes it better. He has a preference for me to be a bit bigger, and a little more fluff, it's just so difficult. I have no magic answers or solutions. I just want you to know you are not alone, and I wish I had some fabulous solution, but alas, it's a struggle for us even being this far out. It spurs a fight/argument a couple times a week because he knows that I plan on getting back down to my original maintenance weight. He's so mad that I have moved my pregnancy clothes out of the closet and have pulled out all my "tiny" clothes in preparation to wear those again.

You should probably cut carbs, increase Protein and stick to clear fluids. Eat protein rich and dense foods, set a meal plan and schedule and stick to it. Liquid diets won't guarantee weight loss and can actually cause Water retention.

And you can appeal, there is no reason to just let insurance deny you. I can help with that as well. Don't just have a surgery because insurance will cover 1000s of people win appeals for VSG for numerous reasons, so please just don't give up and get a surgery that you will regret in a few years.

And, partial to full gastrectomies have been performed for stomach cancer and ulcer patients, those patients have other issues with having a diseased organ, however, most are able to live very normal, fully functioning lives without most or all of their stomach. Personally, I don't miss my stomach. I have good portion control, I eat normal foods, lost all my weight, and knew for many reasons that VSG was my answer. I recommend perusing over to Obesityhelp and checking out the Revision board and look at how many complications and revisions are being done for RNY patients. I don't think you are crazy, you're in the research stage, and you're doing great. Think twice, cut once. You deserve the best life possible especially when choosing surgery. I never had buyer's remorse or thinking "oh sh*t what have I done?" I knew what I had done, and I knew the rewards would pay off.

LapSF Two Year Study LapSF Five Year Study - abstract only LapSF Five Year Study - presentation (requires Windows to play) Literature review on the sleeve - requires $$ to get the full text unfortunately Sleeve best for over 50 crowd Video of a sleeve with lots of education discussion Video of a sleeve that is more about the operation Ghrelin levels after RnY and sleeve Ghrelin levels after band and sleeve Diabetes resolution in RnY vs. Sleeve Comparison of band to sleeve - literature review http://www.iabsobesi...veDietGuide.pdf http://www.cornellwe...gastrectomy.pdf Some of this is outdated, but some of it is great information: http://www.sleeveguide.com/ http://www.ssat.com/...ts/08ddw/O4.cgi http://www.hopkinsba...tion_sleeve.pdf Eglin surgeons use small bougies so this is just for informational purposes: http://www.ncbi.nlm....aultReportPanel http://www.medpageto...age/ASMBS/20937 http://www.associate..._pg2.html?cat=5 5 year post-op stats http://www.ncbi.nlm....um&ordinalpos=1 http://www.ncbi.nlm....pubmed/20338286 Sorry for the craptastic formatting, but I'm too lazy to take out all the little funky "Font" thingies. Pre Op /The Op If self pay - What does your fee involve? Is there some follow up care thrown in there, like labs at 3,6,9 and 12 months? Pre op diet � what to eat/drink and how long for? Do I get a nutritionist/psychologist? What size bougie is used? (This is the medical instrument which determines the size of your remaining stomach) Do you oversew the staple line? How many incisions do you make? Do you go in thru previous scars? How many nights in the hospital � is there facility for someone else to stay in my room as well? Do they need to be with me 24/ during my hospital stay? How many leak tests do you do? How many sleeves have you performed? Complication/leak stats? How many if any deaths? Who do I contact if I think I have a problem (most places give out an emergency number)? Is the hospital equipped an ICU and blood bank in case of complications? If complications do happen to occur, are these complications/additional surgery/days in hospital covered by the original quoted price of the surgery? Would you remove my gall bladder at the same time if needed? Can you give me some patient testimonials or do you have any before/after pictures of your patients that I could read/look at? Is it standard operation procedure, ie: no nail polish, no body jewellery? Do I need to stop taking any particular medication pre op? (Take a list of what you take and dosage) Post Op How often are the post op check ups? Where are they? � is price included? What supplements/anti acid drug would I need to take and for how long? Do I need labs done post op? � Are these checked with you or my local doctor? DO I get a dvd of the operation? Post op diet? How much weight would I be expected loose? What if I loose too much, how to maintain? Do you use heparin? � Will I have to inject it myself? How soon after the op can I��drive, swim, work out, lift weights, lift my kids?

Ohhhhhhhhhhhhhh and here is my update from today on obesityhelp regarding my platelet counts and prednisone therapy: PLATELET COUNT - 121,000 WOOT WOOT. . . The Prednisone worked beautifully, and all the crankiness, little weight gain, increased hunger ARE ALL WORTH THE END RESULT ! ! ! "Thank you" just isn't enough for me to say at this point for all y'alls support and prayers/good thoughts/swinging chickens ! ! ! We were hoping for a jump to at least 85,000 and here we are at almost normal level. Just for reference, I started off around 70,000. Again, without VSG this would not have been possible, and I'm elated and beyond blessed once again that I chose the "right" surgery for me, for all the "right" reasons ! ! ! I'm cleared for the epidural, and will be awake for Tatum's arrival ! ! !

I can give you my reasons for VSG over RNY. . . Personally, it's something that you have to decide for yourself and what you are willing to live with for the rest of your life. This is an extremely long post, but please read until the end as the reasons really come to light with my recent pregnancy. If you would like any medical reports, articles, studies to back up these reasons, feel free to let me know, I just don't want to bombard you with too much. But, I have it all for reference. This is my standard reply when this question pops up every couple of days. I won't try to sway anyone one way or another, but I'll give you my reasons for choosing VSG over RNY for my revision from the band. You can also check out the revision, failure, and food issue forums on here to get an idea of some long term RNY patients. For me, it was never an option. The cons outweighed the pros. The VSG was my 2nd, and final WLS. I could have easily had RNY, but I fought to have VSG as my revision from the band. Some factors I considered in deciding on VSG. The pouch that RNY offers is similar to the pouch with the band. Least to say, a pouch sucks, I love having a normal tummy, just less capacity and still fully functioning. 1) No blind stomach left behind that can be difficult to scope yet can still get ulcers and cancer. 2) 2 years max on calorie/carb/sugar malabsorption, but a lifetime of vitamin/nutrient malabsorption. This process is called adaptation, and it happens with intestinal bypass surgeries. 3) I had a pouch with the band, and it sucked. I'm pretty fond of my pyloric valve and the sleeve let me keep it. I love having a normal functioning stomach, just smaller in capacity. 4) Regain stats and #of RNY patients seeking revision truly scared the poop out of me 5) I have too many friends in real life that struggle with Vitamin deficiencies post-RNY, and most of them either never got to goal, or have gained back a significant amount of their weight. 6) The long term complications with RNY were too numerous for my comfort level. Pouch or stoma dilation, strictures, vitamin/nutrient deficiencies, ulcers, 7) I researched gastrectomies that had been performed for stomach cancer and ulcer patients, and found comfort in the long term results and minimal complications of patients that had lost most or all of their stomachs had dealt with over several years. 8) I was a volume eater, and knew a restrictive only procedure would work for me. That was my thought process when I got the band, and I thought I could beat the odds on complications. Sadly, the band only lasted 8 months before I had to revise. 9) I did not want to have food or medication restrictions. I chose WLS to have a "normal" life, and I think it's normal to eat a couple of Cookies. With RNY, I wasn't willing to go through the possibility of dumping if I wanted to have a couple of cookies, or a slice of cake on occasion. The big scare for me is medication restrictions for life. NSAIDS and steroids are a NO GO for life with a RNY pouch. I realize that I may never be diagnosed with a condition or disease that requires steroid use, but it is possible. I want the best long term results with the least amount of complications. Malabsorption is not anything to play with in my mind, and I was not willing to take that risk. I lost all my weight in my ticker with the exception of 7lbs with the sleeve, and I did it in 10.5 months. The 115lbs fell off the first 6.5 months, and then the rest I lost as I was getting into maintenance over another 4 months.. It's been a fabulous journey, and I'm easily maintaining with zero issues for nearly a year at this point. I want to add that every WLS regardless of your choice will require discipline. Only a percentage of RNY patients dump on sugar/fat, pouches and stomas stretch, then you have the medication restrictions. I'm not trying to convince you, but these were my concerns when I knew I had to revise from the band. I started at 263 the day of my revision and today I weigh 127lbs. I bounce on the scale 125-130lbs any given week, and I couldn't be more ecstatic! Best wishes in your research! P.S. I wrote this before pregnancy. And, just as an update, I'm 8.5 months pregnant and thriving (Actually I'm 14 days from delivery, this was written several weeks ago, it's just me being lazy with the copy/paste). I have zero issues consuming enough calories/protein/carbs to support my body and another developing human. My labs have remained stellar throughout the pregnancy, and life is pretty good. I am over 2 years out at this point, and couldn't be happier with my decision to have VSG over RNY for my revision. It's been an amazing journey. P.S.S. Since the pregnancy, I have been diagnosed with a genetic clotting disorder and the ONLY treatment (zero cure) is a daily aspirin therapy. With VSG, this treatment is possible, if I would have gone with RNY my doctors (surgeon, 2 ob's, PCM) are unsure how this condition would have been treated especially during the pregnancy. Grant it, I only take a baby aspirin every day of my life, but it is an NSAID. Least to say, when my high risk ob found out I had a partial gastrectomy and NOT RNY, he was elated because there really is zero other option for treatment at this point, and the aspirin therapy is working well with my platelets and if all goes as planned, I will be able to have an epidural for my c-section instead of having general anesthesia. Maybe a small issue to some, but being awake for the birth of my daughter is top priority for me. As a very recent addition; as of 10 days ago, I was advised I would have to be given a steroid(dexamethasone or prednisone) to help get my platelet count up as they have dropped. If I would have had the RNY, this would NOT be possible, and pretty much general anesthesia would be required for the csection. We're looking at other options for delivery such as a spinal block instead of a full epidural, but the doctors are positive the steroids will get my numbers up. At any rate, if I would have chosen RNY, I would surely not be able to have steroids. Looking back, I can't tell you how grateful I am that I was able to choose VSG.

That's only 1/2 ounce, and that is definitely not what your stomach will end up at after healing and swelling. There is no bougie size that is even recommended that small. I have a 32fr bougie stomach, and I'm short so my stomach isn't too long, and I can eat 4-6oz of dense Protein depending on the meat type, slider foods/soft foods/puree consistency I can fit in about a cup. I can eat about 3-4 medium to largish sized sushi rolls. So, I can't even give an educated, or guestimated answer to this one even with all the research out there.

I agree that it's no easy task, and coping skills are definitely learned behaviors. I was a self-medicator, and food was not my drug of choice. BUT, I can totally relate to the thought process of "do real people have true coping skills?" I thought it was impossible to find normalcy without drugs, sex, alcohol, partying, socializing etc etc. But, after I lost my weight, I really had to fight the urges of old habits creeping in. For me, I'm an obsessive, Type A personality. I mean seriously, my pantry is labeled and alphabetized with pretty little scrapbook cards, my closet is organized by sleeve length, size and type of clothing. There are other areas of my life that are total clusters and I keep them that way to feel "normal". Anyways, the one thing I did was really throw myself into research, feeding my body properly, and getting on the right path with my head and body. I knew that I had to change some behaviors with food like late night eating, and looking for that stuffed, Thanksgiving day full feeling. I had to occupy my mind with other things. I wrote a journal, not a blog online, a paper journal to express my feelings, and thoughts and mainly frustrations. It was venting of sorts, but it was just for me. I did become obsessed with the scale, I shopped until my little heart was content, I shopped so much that I hated trying on clothes, and even now, shopping for clothes has lost most of it's appeal because I got to a size 0 at the Gap, what else is there achieve??? Some find great comfort in support groups, and counseling sessions to where they can work out their issues with others in the same situation. Some throw themselves in exercising and working out, I wanted this to be me, I wanted to fall in love with working out, but alas, exercising is just like scrubbing toilets. For me, I had identify and really isolate those issues that caused me to turn to other venues to make me happy, or feel content and not stressed. I had to really find that other things in my life gave me joy. It's a tough road to travel, but it is possible. One of my most helpful outlets is volunteering. I became a stay at home mom/wife after my revision/complications/extensive recovery, and all of a sudden I was at home alone, bored, sad, and didn't have any friends. Seriously, no one local to hang out with, or even call a friend. I joined the base spouses' club, started bowling on a league, started volunteering on base, and with various organizations just a couple hours a week. I found great joy in giving to others, and finding a world existed outside of myself.

I went from a solid, perky, happy 40/42 D/DD (depending on the bra cut) to a TINY 32B. The trend I've noticed since being around and watching other women's progress is those who were well-endowed before weight gain set in, they were able to keep a lot of their volume. For those of us who only had big boobs because we were fat, lose them to a much more drastic degree. I remember being a b/c cup in middle and high school before I got fat so I'm pretty sure I just wasn't meant to have big boobs at a normal weight.

meat, cheese, eggs, and greek yogurt were my staples through my losing stage. I ate 4 meals per day with each meal consisting of a minimum of 15gr of Protein. With that plan, I rarely went over 30gr of carbs. I never went over 40gr per day through my losing stage. Those days the carbs were from adding extra sauces, or flavor packets from dressing, or Soup packets to greek yogurt. I didn't snack or eat anything extra. The days I got really close to going over 40 were days when I'd eat pinto, refried or black Beans for the fiber content. But, those days were few and far between. I should add that I didn't fret too much about carbs until I got into eating a really solid plan, and since I had complications that was 6-8 weeks out. I drank a lot more calories than most through the clear and full liquid stage. But, once I got to mushies, purees, and soft solids, I was a low carbing freak. Meat especially ground meats (venison and beef mainly) chicken thighs, deli meat, and scallops were my go to meats. I ate huge amounts of venison, tried some buffalo and bison (but that stuff is uber expensive), and ate greek yogurt like it was going out of style. I'd buy those large blocks of cheese and eat chunks of cheese as a snack. 1oz of cheddar cheese (full fat) is 0 carbs, 7g of protein, throw an xL or jumbo egg on there and that's 15gr of protein in one meal with zero carbs. I didn't eat fruit, the only veggies I ate were green beans and on occasion a couple of broccoli florets. Any veggie on the glycemic index over 60 points was not touched. At about 4.5 months out, my surgeon wanted me to add in more carbs to slow down my losing. I bumped up to about 50 per day, and I was already close to goal so my losing was slowing down anyways, but I did eat a few more bites of beans. It was boring, not gonna lie, but I kind of just sucked it up. Nothing tasted as good as having a 4-7lb loss per week average so I dealt with a boring menu until I got to goal.

I'm a low carber, and I never counted "net carbs". With net carbs, you subtract the fiber and apparently the sugar alcohol from foods to get "net carbs". I didn't have the time or energy to bother with net carbs. A carb is a carb to me. My body will burn those carbs over my fat stores, and protein bars with sugar alcohol give me horrendous gas. I'm talking peel the paint, eye-watering, gut busting, cramping gas so I avoid them even this far out.

Honestly, I didn't have room for much of anything in the way of carbs be it bread/pasta or fruits/veggies if I wanted to get my Protein from food sources since I couldn't tolerate shakes. I also didn't have the time nor the energy to worry about "net carbs" vs. "total carbs". If you don't have food triggers, then eating carby, sugar loaded fruits might not bother you, but I couldn't have raw fruits for 3 months post-op, and I'm not a fan of fruit to begin with. It's really not a matter of me arguing, I just know my body. When I started adding in "healthy carbs", my losing stopped. When I started adding in more healthy fats, and healthy calorie dense foods, my losing stopped. I can drop weight like a champ low carbing it so that's what I rely to be the best indicator as to what works for my body. Plus, I should throw out there that I was fairly sedentary during the first 4 months. I walked a bit, but nothing else, so I did NOT need more calories or carbs to support a huge calorie burn. There's a lot of factors that go into each individual's needs. I wanted to get to goal fast, and worry about maintenance when I got there. I knew what would work to take the weight off the fastest of previous diet attempts. I also knew justifying eating certain carbs was not changing my behaviors with foods. I did this whole "I'll eat XXX (on weight watchers) because I had the cheat points" well all that did was lead me down a path of justifying every poor choice, and then that "cheat meal" turned to a cheat day, and that threw me off. It's about my issues, and what I had to do to be successful. Others don't share those issues, others don't have to worry about fat habits, others can manage more carbs than others. Personally, I don't deprive myself in maintenance, I've learned what triggers me, I know regain sucks, heck I"ve gained 30lbs in the pregnancy. Yes, some of it is pregnancy weight, no doubt about it, and I'm right in the range they want me in considering I"m delivering in 3 weeks, BUT I've also had to add 300-400 more calories per day along with 100+ grams of carbs per day, and my ob wanted me to get in 100gr + of protein per day, which most days I got that 100gr in but some days, I only hit 70-80 because I was low on carbs. Women with PCOS or insulin resistance have difficulty losing weight, or stalling significantly even on restricted calories because of the carbs. So, for those who are plagued with one or both of those conditions, low carb is the best option. Even the reproductive endocrinologist wanted me to start low carb, induction of the Atkins diet 20 days before my appointment with him when we having trouble conceiving, even though I have never been diagnosed with PCOS or Insulin resistance, he said "you have a long history with obesity, you need to purge your system before you come in for the testing, let's get some baselines without all the dietary confusion" I popped positive on the pregnancy test and never had to pursue his assistance, but carbs can really effect many of us in several different ways.

I start off with seriously ditching all carbs. I refuse to do all liquids again, but I will eat nothing but meat, cheese and greek yogurt for about 4 days to get out of carb hell. After 4 days, I'll add in some greens, lettuces, avocados, and some other of my maintenance foods of choice. That's all I can do and it works for me. The first 2 days do suck tremendously, but my day 4, I'm very appreciative of green Beans and broccoli!

Some carbs are fine. I choose to NOT eat carbs, and stay below 30-40gr per day. NO biggie, I didn't need them for energy when I had over a 50% body fat measurement. Glycogen burning a lovely process for energy. Some people are carb sensitive, some people have medical issues that make them NOT lose weight with carbs. At least for me, during my losing stage, when I was focusing on hitting my Protein goal per day, and beating my own eating habits that got me fat, I simply did not have room for carbs so it's not a difficult process. I'm all for people doing what they need to do, but doing low carb isn't a horrible thing for a lot of people. I look at like this "no one can deny my success doing it how I did it". I'm not telling everyone to do it this way, but it worked for me and hundreds of others. It helped beat some food demons as well. There is a lot more that goes into the equation of losing weight, keeping off, and being able to make some lifelong changes that will give a patient long term success other than just saying "don't worry about carbs". It's easy to not worry about carbs when restriction is at a max, when foods don't taste good, when life isn't happening, throw a combination of life happening, death, divorce, job loss, then toss in the fact that restriction and slider foods are easier to consume, and heaven forbid some hunger comes back, NOT worrying about carbs can lead to regain. There's several posts around that prove that point with topics of 40-60lbs of regain. Not arguing, I eat carbs, I also know myself and my food issues, my eating Funyuns over a cheese stick, but I'm also well-aware of what happens when we just don't worry about stuff with my own regain story from last year's holiday season. No debating here. It's futile at this point.

Yep, you sure can. You just change your address with Tricare and go that route. I considered it when I was seeking a revision since my folks are in Texas and my husband was deployed.

Yep, if you follow the program and make the necessary behavioral changes that are required for long term success. I honestly had zero doubts that I'd make my goal. I'm 5'2", started at 270, my goal weight was 150lbs. I hit 125-130 as my averaged maintenance weight at around 10 months post-op. Hit goal at 6.5 months so it's extremely doable. The challenge of life post-op, really comes in at maintenance level. When we can eat more, when our sleeves have matured, when life takes over and we've made goal. Losing was easy, keeping it off is the ultimate challenge.

You look phenomenal chickee ! ! ! I had a super round face pre-op. No wrinkles, no laugh lines, smooth skin, and 2 chins. Post weight loss, I have major wrinkles, laugh lines, my skin is still "alright", not as smooth, but it's okay, 1 chin (no turkey neck THANK goodness), major crow's feet. I really hate it, but people still don't think I'm "old enough" to have a 13 year old. Plus, my face went from a definite round shape to extreme oval. I actually have a jaw line and pronounced, single chin.