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I have to drink bariatric advantage, and I don't have any food to track, just the protein right now.

Can anyone comment on the waiting period between your consultation and your surgery if you had no bariatric benefits and paid cash in the US? Did it change your pre-op testing? I was given a quote as a cash pay pt and it stated that your pre-op diet plan was not included, about $60-120. However, it made no mention of EGDs, sleep studies, etc. If I need those, my expenses will sky-rocket. I'm wondering if those are insurance requirements or physician requirements. Asking here instead of pre-op because I thought I may find more people who have been through it. Thanks!

Here's a post I made a few months back: Sleeve Gastrectomy – Does Size Matter? by Kimberly Taylor on August 21, 2013 · Comments | Weight Loss Surgery The gastric sleeve procedure has quickly become one of the most common types of weight loss surgery, jumping from obscurity to importance in only a few years. Despite it’s newfound popularity among patients and surgeons, there are many technical aspects of the procedure including bougie size that remain controversial. What is a Bougie? The bougie (prounounced BOO-zhee) is a measuring tool in the form of a long, thin, flexible tube. The surgeon uses it as a guide when dividing the stomach. During surgery, the bougie is put into the mouth and pushed down through the esophagus and stomach to the pylorus. The tube creates a bulge inside the stomach that the surgeon uses to guide the stapler when dividing the stomach. After the sleeve is formed, the bougie is removed from the body. Bougies comes in a range of sizes that are identified by a unit of measurement called a French. 1 French is equal to 0.333mm (1/3 mm) and is abbreviated as F, Fr or FR. For reference, a 40F bougie measures about 1/2 inch (40F x 0.333mm = 13.32mm, converted to inches is 1/2″). Standard bougie sizes in the United States range from 32-50F. The bougie size is not the same as stomach size, although it does influence the size of the sleeve. Generally, the smaller the bougie, the smaller the new stomach size, but the same size bougie does not always create the same size stomach. The finished sleeve size is determined by how close the stapler gets to the guide and whether the surgeon oversews the staple line and if so, by how much. While the gastric sleeve is now widely accepted as a primary bariatric procedure, there is not yet unanimous agreement on an ideal bougie size. The decision is trying to find the size that will provide the safest results with the most amount of weight loss. With a smaller bougie size, the smaller the sleeve and greater the restriction, but greater the risk of leak and stricture rate. A stricture is an excessively narrow section that develops when scar tissue grows and interferes with the normal movement of food and liquids into the stomach. It can cause upper abdominal pain after eating and chronic vomiting or regurgitation of undigested food. Symptoms usually start in the first 6 weeks after surgery. Strictures are very uncommon, but surgery is required to remedy the situation. If a larger bougie size is used, the sleeve will be larger and the operation safer, but the concern is that it may not produce enough weight loss. 2008 Study A study in 2008 found that a bougie size of 40F compared with 60F did not result in significantly greater weight loss in the short term. Comparing 40F versus 60F: At 6 months, the excess weight loss was 38.8% versus 40.6%. At 12 months, the excess weight loss was 51.9% versus 45.4%. (Study: Laparoscopic sleeve gastrectomy: does bougie size affect mean %EWL? Short-term outcomes. Surg Obes Relat Dis. 2008 Jul-Aug;4(4):528-33. doi: 10.1016/j.soard.2008.03.245.) 2013 Study In a 2013 study, researchers wanted to find out if there is an ideal bougie size. To do this, they did a search of medical literature published in the last 5 years and analyzed 32 publications involving 4,999 patients. What they found: The use of bougies 40F and larger had a leak rate of 0.92% and excess weight loss of 69.2%. The use of bougies smaller than 40F had a leak rate of 2.67% and excess weight loss of 60.7%. The results show that larger sizing bougies had a lower incidence of leaks with no change in weight loss. The researchers call for further studies before a decision is made on optimal bougies size, but recommend caution in using the smallest bougie possible because the risks may outweigh the benefits. (Study: The Effects of Bougie Caliber on Leaks and Excess Weight Loss Following Laparoscopic Sleeve Gastrectomy. Is There an Ideal Bougie Size? Obes Surg. 2013 Aug 3. [Epub ahead of print]) 2012 Surgeon Survey According to a 2012 survey of surgeons experienced in sleeve gastrectomy, the bougie size used ranged from 32F to 50F, with the most common size being 36F (used by 32% of surgeons surveyed). Studies show that the procedure is relatively safe, but there are still many variations in bougie size. (Study: Survey on laparoscopic sleeve gastrectomy (LSG) at the Fourth International Consensus Summit on Sleeve Gastrectomy. Obes Surg. 2013 Aug 4. [Epub ahead of print]) Bougie Size Bougie size is based on patient input, height, weight, and surgeon technique. The bougie size is typically smaller when the procedure is performed as a stand-alone procedure (32-50F) rather than part of the duodenal switch (50-60F). Depending on the bougie size used by the surgeon, the new stomach size will be about 60-80% smaller after surgery. The average stomach holds 30-40 ounces, or roughly 4-6 cups per meal. After surgery, a small meal of 1/2 cup to 1-1/2 cups will fill the new stomach pouch. The sleeve will stretch somewhat from the surgery size, but will get no where near the size of the original stomach. If you are planning to undergo the sleeve gastrectomy procedure, make sure you discuss the bougie size with your surgeon during the pre-op process. It is important that you understand the rationale for your surgeon’s recommendation and to feel comfortable with the size of your post-op stomach. While bougie size is a consideration, healthy weight loss will ultimately depend on following a reduced-calorie, nutrient-rich diet. The sleeve will help reduce hunger and limit food intake, but it is up to you to choose the foods and liquids that you put into your body. I made a quick EXCEL spreadsheet converting the size to mm and inches based upon the formula. Note: Per this article, the surgeon's techniques contribute to the overall size ("...how close the stapler is to the guide...", "...whether they oversew"..., etc.) Bougie Size mm Inches 32 10.66 0.42 33 10.99 0.43 34 11.32 0.45 35 11.66 0.46 36 11.99 0.47 37 12.32 0.49 38 12.65 0.50 39 12.99 0.51 40 13.32 0.52 41 13.65 0.54 42 13.99 0.55 43 14.32 0.56 44 14.65 0.58 45 14.99 0.59 46 15.32 0.60 47 15.65 0.62 48 15.98 0.63 49 16.32 0.64 50 16.65 0.66

When I went to my Bariatric classes, I was told that this is not a problem with gastric surgeries ( Roux n y, gastric sleeve and lap band) because in part of all the fluid we have to drink ( 64 oz) and the body's need for extra protein to heal and maintain now that be eat less. I don't think the grams of protein will be a problem, but, you should ask you doctor. You will be monitored though with blood lab work and one of the labs measures the amount of protein. Kidney function is also monitored. If either is too high, your doctor would and should know and adjust your diet accordingly.

Before I could swallow whole pills I was using Bariatric Advantage Calcium Citrate Lozenges. Now I just bought a two pack bottle from Costco for dirt cheap! Comparable to Citracal. One pill 2x per day should work, maybe 3 sometimes if I'm getting those darn leg cramps.

In my case, day 1and 2 were easy but by day three I was feeling weak, hungry, grumpy, tired and I had a terrible headache every single day thereafter. I completed day 1-6 without cheating but on day 7 which was easter Sunday, I threw out my diet and ate some food. My headache completely went away. On Monday I called my nutritionist and told her about my headaches and how I cheated. She recommended I do the modified diet instead, which is having 3 protein shakes a day, a small meal and a snack. I started this diet on Monday and I haven't had a headache since, and haven't felt the urge to cheat. I found out that wendy's chili salad is a great source of protein and it pretty munch contains everything you need in a small meal. I've been having that for lunch ever since and it's so delicious! (I also try to eat about 2 ounces of grilled chicken with my meal to add more protein) and as my snack I usually have an apple. I ordered my meal replacement protein shakes from bariatric advantange. I find that the chocolate is the best flavor and each shake has 27 g of protein. Their protein bars are great (by the way if you do the modified diet you have to toss out the protein bar from your original liquid diet). I have two days left and then I will be on the other side! I wish everyone else luck!

Stick with the sleeve... sadly, 2 of my friends that have had gastric bypass haven't done well. I've worked in bariatrics are a loonngg time... if there is a will, there is a way! Hang in there!

Looking back to when I had my gastric bypass surgery in 2003, I don’t believe that my bariatric surgeon really discussed the gastric bypass pouch rules or stressed their importance with me. I recall him saying, “I do the surgery. The rest is up to you.” So, I am very glad that I came across the “Pouch Rules for Dummies” published free online. The “Dummies” version of the pouch rules was adopted from an original article written by Dr. Edward E. Mason, the “father of obesity surgery.” It is well-worth your time to read and follow these rules. They should be an intricate part of your bariatric lifestyle so as to achieve permanent weight loss. In fact, it is suggested that you become an expert in their use. It also is stated that even years after gastric bypass, by returning to the use of the pouch rules and the proper use of your tool, that you can drop excess weight that has been gained from what you originally lost. Learn more here: http://www.mybariatriclife.org/gastric-bypass-pouch-rules-for-dummies/

I take Centrum Silver chewable and have no problems. The vitamin that made my mouth feel yucky was the B12 sublingual. I changed over to B12 injection once a month and have had no other problems. If you ar not in the "silver" age bracket ( I am 51) then they have the regular Centrum chewable. Bariatric Advantage vitamins are too expensive for me.

The warning bells that I hear is that you have a PB 3 times a week bc you are going too fast. If you have another fill before you address this the PB's will only get worse and you will be more prone to eating the ice-cream, which is easy and soothing after a PB. I would recommend you manage things to reduce the PB to 1/fortnight the most then determine if you need or can manage another fill. If old habits are sneaking in, yes a little amount of Fluid will help take the edge off, but as others have commented (great to see), re-address your total food intake and exercise levels. Hope this helps Helen Bauzon Specialist Bariatric Dietitian

I am using Dory Ferara at the Long Island Bariatric Center. She's a Nurse Practitioner and was a coordinator for Lap Band trials. She works with several NY area MD's as well as Dr. Gabriel & other Mexican Docs. She has offices on LI, Westchester & NYC & sees people from all over the northeast. She charges either a flat fee for a year's care (about $1,250) that includes as many fills as you need) She performs fills either under floroscopy ($100 for radiology center's fee) or without. After having my first fill in TJ under floroscopy she had to unfill me a little then add some. She did it w/o the flor. & was totally fine. She also sees patients on a per diem basis, first time she charges a little more (maybe $350) & meets you at the radiology center for floroscopy. Then you can choose with or without for the next fills (I THINK $250 - $257) per, but don't quote me, cause I'm using the flat fee method) Anyway, her # is 516-579-0094. The sec'y there can give you her NYC or Westchester #'s. Sorry this is so long, but I really like her a lot. Hope this helps someone.

Are the bariatric fusion chewables a good choice of vitamins for the sleeve patients?

Thanks. I'm only taking the Bariatric fusion Vitamins. No need for any other supplements according to my surgeon and my labs (from August thru March when last done) are all within normal range. The price is right for me

Haha - yay! I now have a bariatric sistaaa! I'm no longer nervous about anesthesia. I'm sure I'll start freakin out again in a few minutes. *zennnnn*

I had GERD before sleeve surgery. In the past, I had some pretty bad bouts of it where it caused chest pain. I also had GERD pretty bad with the band. I'd also go long periods with nothing, so it was a mystery. When I started looking into another bariatric surgery, my surgeon cautioned me, but continued to perform pre-op testing. The doctor felt that my GERD was "situational", meaning that it was related to diet and obesity. So, we decided it was worth the risk, but he warned that there were no guarantees that I wouldn't have GERD after the sleeve. I had surgery on 4/10/18 and about 3 weeks afterwards, I started getting heartburn. I started on Nexium right away and the symptoms are well controlled with it. I wouldn't say that it's severe or "intractable" as my psych evaluator so kindly put it. It's just a little bit of heartburn and if I eat too late in the evening, I will wake with a sore throat (easily remedied by sleeping on an inclined bed). My advice, discuss with your doctor. Every person is different and every person will respond differently.

I have been using this site for a lot of my research throughout my decision process, and now that I am moving towards my surgery date. This has been my journey so far: Around Thanksgiving of 2016, i had made my final decision to pursue bariatric surgery. I had the support of my family and friends, and I was ready to go. I had a recommendation for a surgeon, and so I made my consult appointment. I had my first consult on December 6, 2016, and I brought every piece of medical information with me to that appointment that could possibly prove that I had met the insurance qualifications for approval. I left that appointment fairly certain that I would have my surgery some time in January 2017. On December 14, 2016, I had an appointment with my PCP for medical clearance, and I also had my psych evaluation that same day. They were both kind enough to provide me copies of my records right after the appointment so that I could give them immediately to my surgeon's nurse. Once they received all of those documents, along with the proof of following a 6 month medically supervised weight loss program, they scheduled my surgery date for January 17, 2017. YAY!! I had my Endoscopy done on December 20, 2016, and was cleared or surgery. At this point, I am scheduled on January 4, 2017 for a pre-op class that will explain pre and post op eating plans, and any other surgery prep items. I then have my last appointment with my surgeon on January 5, 2017 before my surgery. This whole process has moved so fast, which I am so excited about. At each step of the process I have been worrying that one piece or another would disqualify me from the insurance approving the coverage. My surgeon's office has assured me that I meet all of the qualifications, and there is no reason the insurance should deny me. At this point, I am just counting down the days to January 17, 2017. I am so excited that I have already started cleaning out my closet! Thanks to everyone on this site for sharing your journeys, and allowing all of us newbies to learn from you! I look forward to becoming an active member of this group.

Good afternoon, I went in at 6:45 yesterday for my surgery. I was back to my room at 11. Found out I was the only patient on the bariatric floor until 3 when I was moved to a private room on the surgical floor. Super nice corner room that had windows on both side to enjoy the mountain view. I was out of bed by that point and walking the halls. My blood sugars went up, but are coming down now and insulin was reduced to 3 units. No other meds. I am sore, but not overly so. My Dr said it went extremely well. They didn't do the upper GI x-ray today because of the snowstorm. He wasn't worried because I am drinking the three one ounce cups each hour. So I will have that on Tuesday for my post op. So glad its over. Now I get back on with the business of relearning and living life. See you on the other boards! Nell

Yes and I just asked my surgeon about this yesterday at my 10 day post op. He said you can order a stuff called dexcom from bariatric advantage. And yes it's ketosis from your body consuming more protein then anything else. I am in the same boat with you all on this. But I've been cleared to go to puree and it gets better.

Spartan's answer was wonderful. I'd just add that it's a good idea to take a bariatric multivitamin.

I just took a sample of this today. I was really afraid because the Bariatric Advantage makes me sick. I was fine with this one. Actually came on here to read reviews of it. There isn't much, is there? Would love to hear from others who are taking this. My NUT recommends double the normal Vitamin amounts. Would I still double this vitamin?

I would give the Dr. office a call, you have nothing to lose. I have had paperwork misplaced. I am impatient also, but I think by now you should have an answer. Can you check the insurance company activity on line? I know I can access all of my BCBS info on line. Unfortunately in SC they don't pay for any bariatric surgery. Luckily I am eligible for medicare because of my MS and there isn't any pre authorization required. I was scheduled for 7/23 but just got a great new job working for an airline so I postponed it until 9/3 after vacation season is over...... I can't wait!! Good Luck!!

From caloric/ bariatric perspective honey and agave are not good options. I have no idea about sorghum.

That does not sound normal. If you are 18 months post-op, you should be able to consume a cup of food per meal; not just 2 forkfuls of food. I threw your symptoms into the internet and what seemed to pop out was "late dumping syndrome". http://www.bariatric-surgery-source.com/dumping-syndrome.html I am not sure I believe this. It is possible that you might be experiencing problems relating to revisions. One individual in our bariatric support group meeting went from a lap band revision to RNY gastric bypass. Because of the scaring associated with the erosion caused by his band, his new pouch was constructed much smaller than typical. As a result, he was somewhat limited in the volume he could consume at each meal. I have personally found out that softer foods such as chili and Soups go down much easier than harder foods such as steaks.

Darn! I really thought Fair Oaks had a bariatric unit too? Not sure why I thought that. I had a spinal fusion (neck) there and got a private room. Hubby slept in the recliner for 3 days (and nights) til I was released...bless him! I hope and pray for a private room again!! Llamalover, do let us know how your appt goes!!

Energy levels can be low during this process. You will feel better as you progress. First stages 500-600 is normal. Once you're totally healed from surgery, you will continue in weight loss mode 900-to 1200 . Weight loss mode is not forever. Call it starvation or call it the reality of bariatric surgery. Calorie restriction is a normal part of this process. Hitting your protein goal, taking your vitamins, and hydration will keep you nourished correctly. Your surgeon's office or family Dr. Will do lab work to make sure you are not malnourished or vitamin deficient. My personal experience: I became a I'm a distance runner. I can not eat like a bariatric patient during running season. I eat like an athlete. Easy for me to get in 2200 calories to keep me healthy. I lower my calories back down to maintain my weight during off season. I also go back into weight loss bariatric basics to lose when I have a gain. Reality is anyone can "eat around" bariatric surgery. If you eat small meals all day long or eat bad food choices, You can seriously increase your calorie. You will gain weight. Hope you feel better soon, Jenn