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I am at the very beginning of my WLS journey and meet with the bariatric surgeon for the first time next week. What are some things you wish you had known or had asked questions about at the start?

Erika- my friend is a little extreme and even at a yr out is at 600-800 calories now. My surgeon told me to focus on Protein now just going into.my 3rd week, but eventually 900-1200 calories a day would be an end goal. Nutritionists that specialize with bariatric patients help a ton. I saw one that goes with my insurance last week, and seeing one directly to do with my surgeon April 18th and she is open to questions from me anytime. Helped a ton so far. I personally don't know what I am doing yet (havent even had puree yet), but what my friend told me is to treat premiere Protein shakes as Meal Replacements, like Breakfast or lunch and then food protein rich at other times. But I have no idea. I am going to try weighing myself 2 times a week now, because I am getting discouraged due to a stall already [emoji20]. I hope by Friday I am down something. Fingers crossed. I also started taking measurements, because many say we lose inches over weight and not focus on scale as much.

Bariatric pal is working with a plastic surgeon now Dr Alejandro Galvez you can email Michelle@bariatricpal.com to get a quote and see his work

I too had a severe case of Gerd prior to surgery and I went in wanting the sleeve for all the same reasons you mentioned. When I was told that RNY was the best surgery for me I actually got a second and third opinion. Every doctor told me I would be making a huge mistake to have the sleeve given my Gerd situation. I actually have psoriatic arthritis and my spine has been deteriorating since I was in my early 30s. It had nothing to do with calcium deficiencies. I have had 5 back surgeries and am looking at another in the coming months. Here is the thing RNY has literally given me my life back. I take the calcium that is perscribed to me and have my labs checked regularly, The folks that struggle with malabsorption are the folks that do not take their Vitamins and do not follow up with their bariatric team. Seriously don't be afraid to do what is going to keep you healthier in the long run. RNY is the best thing that ever happened to me besides my kids and hubby. Do some more research, it will help you through this. I also have never had dumping syndrome and can eat what I want. I choose to eat very healthy. Good luck to you!

I also had my surgery in 2006. I'm finding it hard to keep on track. I have gained a little weight back. Still exercising 4-5 times a week. I went to the app store hoping to find something like weight watchers for bariatric pts but had no luck. I love the new me after the by pass but need some help getting back on the downward slope. Before and after surgery I did water aerobics but had to quit 2 years later cuz I couldn't afford it any more now I use my wii and the gym at work to walk. But still not going down. Has to be what I am putting in my mouth. I'm a nervous eater and have the hardest time when at work. Not sure why my job isn't that stressful anymore. Anyone have any suggestions? So glad to have found this app!

Happy Halloween from BariatricPal!#subject#> body,div,dl,dt,dd,ul,ol,li,h1,h2,h3,h4,h5,h6,pre,form,fieldset,input,textarea,p,blockquote,th,td { margin:0; padding:0; } table { border-collapse:collapse; border-spacing:0; } fieldset,img { border:0; } address,caption,cite,code,dfn,th,var { font-style:normal; font-weight:normal; } caption,th { text-align:left; } h1,h2,h3,h4,h5,h6 { font-size:100%; font-weight:normal; } q:before,q:after { content:''; } abbr,acronym { border:0; } address{ display: inline; } html, body { background-color: #d8dde8; color: #5a5a5a; } body { font: normal 13px helvetica, arial, sans-serif; position: relative; } h3, strong { font-weight: bold; } em { font-style: italic; } img, .input_check, .input_radio { vertical-align: middle; } legend { display: none; } table { width: 100%; } td { padding: 3px; } a { color: #225985; text-decoration: none; } a:hover { color: #328586; } div.outer { margin: 0 auto; padding: 14px; } table.wrap { max-width: 800px; margin: 0 auto; } td.logo { background-color: #0f3854; padding: 8px; } td.content { background-color: #fff; font-size: 14px !important; color: black !important; line-height: 150% !important; padding: 8px; } ul { margin-left: 25px; } Hey BariatricPal Members! Happy Halloween! It’s a fun time and the beginning of the holiday season. We’re celebrating a lot here at BariatricPal, and we’re super excited to share it with you! Here’s what’s in this newsletter. The BariatricPal Store: Grand Opening! Your Ready for the Holidays? Thanks for your support and for making it possible for BariatricPal continue to grow. There’s no way we could do it without you. Sincerely, Alex Brecher Founder, BariatricPal Grand Opening of The BariatricPal Store! We are so excited to announce the grand opening of The BariatricPal Store! We know, The BariatricPal Store doesn’t fit into a Halloween newsletter because it’s anything but spooky, but we just can’t stop talking about it! That’s why we’re offering 10% off all orders with coupon code SPOOKY10 just for you! Your Source for Bariatric Protein, Meals, Snacks, and supplements Weight loss surgery changes everything, especially your diet. You need to get enough protein without too many calories; eat a nutritious diet while keeping portions in check; and get your Vitamins and minerals without fail. It can be overwhelming and time-consuming…unless you have help. The BariatricPal Store can give you the help you need. We have the protein supplements, meals, snacks, and vitamins to help you lose weight and get healthy. Protein bars, shakes, and powders. Low-calorie, high-protein snacks, Entrees and breakfasts. Bariatric vitamins and Fiber supplements. Make Weight Loss Shopping Easy We know you need the top products, and they need to be healthy, nutritionist-approved, and convenient. We have all that! We also have: Tons of BariatricPal brand products. Product packages so you can pick up a bundle at once for a discounted price. meal plans for the pre-op and post-op diets, plus maintenance and back-on-track diets, so you can easily pick up the foods you need to stay on track. Sampler packs of different items so you can try different varieties to see which you like best. Other Reasons to Shop The BariatricPal Store We truly believe we’re number one. Here are just a few more reasons why. Subscribe and Save options on every product so you can get automatic re-delivery, 5% discounts, and free shipping on each order. Lowest prices – guaranteed. Free shipping on orders over $69. Save money with sales and discounts plus our Refer-A-Friend program. For help, you can look at the FAQs, give us a call at 855 WLS-BPAL (855 957-725), or use our live chat with a customer service specialist during business hours. Visit store.bariatricpal.com often to see current specials, and check out our blog for updates on promotions and new products. We can’t wait to take this next step in helping you reach your weight loss and health goals! Your Healthy Halloween Plan Halloween is about costumes, haunted houses, and scares. Unfortunately, some of the “scares” are the ones that show up on the scale if you eat too many Halloween treats, or the “scares” that come from feeling sick from too much sugar. You don’t have to experience the bad scares this Halloween, though. The trick? Plan ahead! Here are a few things to think about as Halloween approaches. Trick-Or-Treating Almost everyone is affected by trick-or-treating. If you have kids, you’ll probably find one or several big bags of Halloween candy showing up at your home when they come back from trick-or-treating. Your best defense here is to have a healthy dinner before taking them out. Then, focus on anything other than candy – you might fix your children’s costumes, be the flashlight holder, or designate yourself as the neighborhood crossing guard to keep kids safe. If you don’t have children, you may be the one handing out candy to the neighborhood children, which probably means buying a bunch of candy to give out. If that’s the case, you’re best off choosing candy that you don’t like that much, so you’re less tempted to eat it. Again, have a healthy dinner, and focus on other things besides candy for the evening. You might work on answering the door in a scary way, or taking photos of the cute costumes you see to share with the kids’ parents tomorrow. The Aftermath No matter what happens on your weight loss surgery journey, there’s always tomorrow. After Halloween, “tomorrow” is November 1. Take inventory. See what’s in your home that shouldn’t be there. Get rid of the extra candy. If you must keep some candy in your house because of your kids, make sure it’s not tempting you. You can always ask them to hide it away in their rooms. You can also make a game out of it: have them label each piece so they and you will both know if you “steal” some. Go for a walk. There’s nothing like a walk to clear your head and get you ready to go back to healthy eating patterns. Halloween’s scary, but it shouldn’t be scary because of the weight gain. It should be scary because of the fun things you get to do. With a little planning, that’s exactly how your Halloween can be. Healthy Halloween Tips Did you know there are tons of fun things you can do to get into the Halloween spirit without touching a piece of candy? Here are a few ideas! Go for a Walk It’s true…walking is really quite a good answer to most questions. How to burn off a few extra calories before Halloween? Go for a walk. How to enjoy the Halloween decorations in your neighborhood? Go for a walk. How to let your kids show off their Halloween costumes to all the neighbors? Go for a walk. Get the point? Get moving! Volunteer That’s right. You may think that volunteering is just asking for trouble, since you may be faced with a lot of candy. In truth, it’s a chance to be surrounded by the Halloween spirit while being so busy you don’t have time to grab a treat. Volunteering at a local school, homeless shelter, or retirement home can be the perfect way to immerse yourself in Halloween. Help decorate for a party, serve treats, clean up afterwards, or help make costumes. You’ll be appreciated, and you’ll get to be a part of the holiday in a way that’s healthy for your body and soul. Make Healthy Treats It’s true…treats make Halloween so much better. But you can do better than chocolate, candy corn, and decorated Cookies and cupcakes. Here are a few ideas. Greek yogurt popsicles: Use a little sweetener and keep them white for ghosts, or add some pumpkin and cinnamon and shape them into pumpkin shapes. Then you can decorate them like jack-o-lanterns! Jack-o-lantern orange protein cups: hollow out oranges to leave the peel mostly intact. You can “carve” a face in the peel shell to make it look like a jack-o-lantern, and fill it with cottage cheese or fruit. Greek yogurt “eyes:” freeze circular spoonfuls of Greek yogurt with blueberries for eyes. A happy, safe, and healthy Halloween however you choose to Celebrate it. Don’t forget to come talk about yours on the boards at BariatricPal! See you there!

My sister started getting the shakes from Insure in January when she had her surgery. Unfortunely, when I tried last week they said Alabama had not renewed there contract at the present time. I was so disappointed because the insurance company paid for it and it came directly to your front door. Hopefully, the contract is renewed before my surgery date. Good luck!

My surgery is scheduled July 14th and I'm getting nervous. My bariatric surgeon instructed me to avoid patches and gummies. I'm going to try the patches anyway better that then nothing at all. I'm going with the patches because most supplements have soy, eggs, yeast, wheat, gluten and plant based properties in them. I'm intolerant (significant bloat throughout body, skin irritations, canker sores, irritability, dumping--mainly due to having my gallbladder removed) of all the above. I'd be curious to hear from others who find the patches effective and the results of bloodwork to back up your claim. Thanks!

I am using Bariatric Advantage. The vanilla flavor has 27 grams Protein, 7 grams carbs, 1.5 grams fat and 150 calories per 8 oz serving. I actually do not find the taste offensive as I do other high protein Meal Replacements. I buy on Amazon for $63 for 35 servings. I have the chocolate flavor as well and that is also good. I was told that after surgery I could add powdered milk to up the protein. Not sure how that would taste!

Last week many bariatric specialists convened in Miami. Here's the link to the agenda: https://spring.asmbs.org/schedule/. If I get time this week, I'll try to post links to the actual lectures. One focus: Periodic testing blood for "deeper" indicators of inflammation and potentially altered body chemistries, post-WLS. Ex: To help the "different" gut flora (bacteria), do pts need Probiotics on an ongoing basis? Also, should GBS/RNY, VSG and LB be done as an outpatient if the patient is uncomplicated, except for their BMI/weight? Hospitals will say no, as will hospital-based doctors. But does the patient need to bear that expense if they are otherwise low risk? (My VSG was done outpatient; anyone else? Did you do well?)

My surgery date is July 14 and I'm super excited for this change in my life. I'm a self-pay so I didn't have to jump through insurance hoops. I have pre-op on July 10, and my 2-week diet consists of 2 Protein shakes/day and then 1 sensible (protein like chicken or fish, veggies) meal per day. The day before surgery is Clear Liquids only. I really only have one worry. I'm not worried about the 2-week pre-op diet. It won't be easy, but it's easier than many who have to do solely liquids. I'm not worried about the pain…it's temporary and I can get through it. My biggest concern is possible complications, since I am self-pay. I know that complications are relatively rare with the sleeve, and my doctor has an amazing track record, but if I were to be in the unlucky few with complications, I don't know how I'll afford it. I really don't know what will happen. It's nice to talk to other July sleevers. I need to do a better job of checking this forum. I'm in a few Facebook groups for bariatric surgery and tend to spend my time there. I need to remember to keep coming here! July is coming up SOON!

I am going to large hospital in Philadelphia, it's not an 800 clinic. This dr. come highly reccomended. I found out today that my insurance excludes bariatric surgery. There is nothing for the doctors to fight since its excluded. So now I get to be fat the rest of my life as i can not afford self pay. I can loose weight but can never keep it off. Just so frustated because it took a long time for me to come to terms with having to have surgery to help myself and feel like I have been punched in the gut.

You find me a surgeon in the US that will take you as a patient after you have gone out of the country to have your surgery because of the cost.....that will show me that they did not miss the money in their pocketbook. Does anyone out there that has had surgery in a foreign country that now has a bariatric surgeon that is willing to see them as a regular patient......just curious

I don't think it's about the money. Even though I have heard wonderful thing about the bariatric surgeons in Mexico, there is still a stigma attached. It's even in the pop culture. I remember watching a Grey's Anatomy episode concerning a botched bypass done in Mexico. I think it's very small of them to not let you in on the support groups, but I think there is an unwritten rule like the cop's blue code that shuns the people who have had surgery in Mexico and doctors like to keep their patients separated. I was curious myself how the insurance deals with it. My surgery cost $15.000. I paid and extra 10% for lifetime follow-up and the support group. Also, what if a complication arises? Will insurance cover a Mexico sleeved patient? There also may be malpractice insurance regulations that these surgeons have to follow. They may not be allowed by their own insurance to see Mexico sleeved patients. That said, why can't these surgeons be a little kinder and explain things? As a side note, 99% of my surgeons patients are either lapband of bypass. There are no sleevers in my surgeon's support group. That's why I come here. This is a great place!

DOES ANYONE IN THE DFW AREA OF DENTON, TEXAS KNOW OF A BARIATRIC DR. WHO WILL DO FILLS ON PATIENTS THAT HE DID NOT DO SURGERY FOR. I HAD MY SURGERY IN MEXICO AND I HAVE A LIST OF DR.S THAT WILL DO FILLS THAT AREN'T ALL THAT CLOSE TO ME. THREE OF THE MOST PROMINENT SURGEONS IN MY AREA WILL NOT DO MY FILLS BECAUSE I HAD MY BAND PLACED IN MEXICO. I HAVE MY BAND BOX (ALLEGAN) WITH THE SERIAL NUMBER, I HAVE THE IMAGES OF MY FLUROSCOPY AND MY DR. NOTES. IF ANYONE COULD ASSIST ME, I WOULD BE GRATEFUL. HAD SURGERY NEW YEAR'S EVE, SO I AM GOING TO BE DUE FOR MY FIRST FILL SOON. THANKS SO MUCH!

I just bought wonton wrappers at the store like two hours ago because I keep seeing so many bariatric-friendly recipes using them. Tonight, though, I'm making crustless ham/pineapple pizzas with roasted broccoli/cauliflower/carrots. Both are in the oven right now. https://www.ellaclaireinspired.com/no-crust-pizza-bites/

Hi everyone, I am new here and am a Vancouver resident. I have been thinking about getting the sleeve done and have a consultation with Puget Sound Bariatrics on June 13th. I wanted to reach out to anyone that has had it done there and particularly any Vancouver (BC) residents that may have had the procedure done there. I would like some feedback and some info on how everything went for you and how difficult it was travelling back after the surgery. Obviously I have a million questions and would really like to buddy up with someone thats in the same area so I can chat with them about their surgery, progress ect... If you can help out with this please reply to this post or private message me. I really appreciate all the help. thanks so much!

I did a consult at Puget Sound Bariatrics but went with a different Dr. A couple of reasons why I selected a different Dr: 1. I'm a bit of a wimp and just felt that I would be more comfortable in the hospital for a couple of days rather than being released the same day. 2. My insurance gives me the best benefits but going to a designated Center of Excellence which in my area is Evergreen Hospital. 3. Felt more comfortable with the Dr I choose than the Dr I met with at Puget Sound Baritrics. That being said, I do know other people that have gone there and have been very successful.

I was in extreme pain yesterday and didn't know what was wrong. I thought it was something surgery related. I went to the hospital, and it turns out it was a kidney stone. Any one have a similar experience? I am only 4 weeks out, but hear that my chances of kidney stones is higher due to having Bariatric surgery Sent from my iPhone using the BariatricPal App

Thanks, i dont personal know anyone who has had bariatric surgery so its kind of hard to know who people suggest

Help Center -Department of Managed Care This I my appeal letter to ask that you reconsider and approve the Sleeve Gastrectomy Weight Loss Surgery that was denied by Anthem Blue Cross because they consider the procedure investigational. I believe this surgery is exactly the tool I need to improve my health and the quality of the rest of my life. I have been told by several of Anthem Blue Cross customer service representatives that 43775 is a covered procedure and that as long as my HMO approved they would pay for the surgery. This is not what I am being told now. I have been getting the runaround on this for two months. I received a letter from my HMO dated 2/6/10(copy enclosed) stating this is not a denial of service but Anthem considers this procedure experimental and has to go to the Utilization Dept for a decision. The number to call this department was on the letter. I called this Dept. a minimum of 5 times and was told they don’t know what I am talking about, this dept. doesn’t handle HMO. So I call my HMO and they say “oh you have to appeal” so I send my appeal letter to Anthem on 2/16 and wait the 30 days for a decision. On the 28th day they inform me that I cannot appeal because I haven’t been denied, oh and the people in the Utilization Dept. don’t know that their department handles this?? So they send it back to the Utilization Dept and now I have officially been denied. This part of this process has taken two months, very frustrating. I. PATIENT BACKGROUND My name is Jeani Xxxxxxx and I am insured under group plan xxxxxxxxxx. My member ID # xxxxxxxxxxxxx. I am now 59 years old. I am 5/5 tall and at this time I weigh 233 lbs. I am seeking approval for weight loss surgery. I have been overweight to one degree or another since I was a young child and was advised by my pediatrician to diet at age 10. I have made numerous efforts at weight loss throughout my teenage years and adult life. I dieted frequently as a teenager and young adult. Numerous times I have lost 40-80 pounds or more but eventually the weight returns. Weight loss programs I tried include juice fasts, traditional calorie counting on quite a few occasions, Weight Watchers, Slim Fast, Nurti-system, the Atkins diet, Cabbage soup, Mayo Clinic diet, the Zone, gym membership, lap swimming, weight training, water aerobics, walking programs, various buddy-system diets and individual, self hypnosis, ”Think yourself Thin” “ Think yourself Thin Automatically, tape you listen to in the car” Dexatrim, Metabalite, Hoodia, Green Tea Extract, and numerous other fad diets. In all cases I lost weight but each time the weight crept back, usually with a little more. Eventually I realized that traditional dieting seemed to actually cause weight gain due to increased hunger that seems to occur after significant weight loss. I believe science is only now beginning to understand the reasons for this phenomenon which is consistently reported by clinically obese people. Studies also show that genetics plays a larger role than once thought and there are morbidly obese people in my family as well as slim people. My co-morbidities include high blood pressure, high triglycerides, low good cholesterol, have had abnormal EKGs, borderline diabetes, and osteoarthritis in my hip, which my doctor said weight loss would help significantly. I have also had sever back pain most of my life. I take hydrochlorothiazide and verapamil for high blood pressure which is effective. I take medicine, Niacin for high triglycerides. I have a family history of cancer as well as strokes, heart disease and severe arthritis. I take nabumetone almost daily and ibuprofen to help with severe leg pain related to arthritis in my hip. I have taken ibuprofin for back pain that i have had most of my life even when I was not overweight. I believe I will need NSAIDS even after WLS which is why I need the sleeve as this is the only WLS that you can still take anti-inflammatory medications. I buy over the counter ibuprofen as I can get 500-200mg pills for $10.00 which last over 6 months, whereas when getting prescription I only get 30 -800 milligrams for a co-payment of $10 which only last a month. My excess weight and other health issues makes everyday activities difficult including housework, shopping, standing, walking significant distances, working and recreation. It effectively makes my world smaller limiting the number of things I can do each day. I have lived with obesity for years and strongly wish to change this aspect of my life. I fear the consequences of my high triglycerides especially considering the family history i have of heart disease. Many members of my family died of heart attack and stroke. I was stunned to learn that my weight is in the obese category but heartened to learn of this newer treatment with fewer side effects and shorter recovery. I am highly motivated to succeed with VSG and understand that food intake will be significantly limited for the rest of my life and that I must continue to exercise to be successful. Before I found out about the arthritis, which is the result of a subtle fracture at some point in my life that affected the curvature and angle of my right hip bone (this was found by an MRI that was done after pain medication didn’t help and physical therapy made the pain worst), I used to walk a minimum of 30-60 minutes a day at least 5 days a week. Since this pain in my leg as a result of the hip arthritis I no longer can do that and I am afraid that the weight will just continue to creep up on me. My particular problem is in volume eating. I eat good food, lots of chicken and turkey, lots of fruits and vegetables, the thing is I am always hungry and I eat until I am full. Having a smaller stomach and feeling full sooner seems like exactly the kind of help I need. I had given up on traditional dieting as it always resulted in failure and am pleased to have found the VSG surgical option which appears to be the only tool offering a realistic possibility of lifelong weight control for me. I believe VSG is the best surgery for me because it offers restriction like the lap-band and the RNY but without the malabsorption of the RNY. The RNY is not an option because I very much need regular doses of nabumetone and ibuprofen for the leg pain related to my hip pain and even once I lose the weight believe I will still need ibuprofen for my back pain which I have suffered with most of my adult life. Tylenol is not effective for me. I am allergic to codeine, vicodin, any pain medication of that type I cannot take. Narcotic pain relievers make my head seem fuzzy but do not help with pain. I have the same concern about the lap band. I also understand that as many as 27 percent of lap band patients require band removal and weight loss is often unsatisfactory (I think the number is even higher now). Most importantly, the VSG removal of a large portion of the stomach removes many of the cells that produce the hormone ghrelin which is known to cause hunger and appetite. The RNY and lap band don’t have this advantage. At age 59 I am concerned about the side effects of the RNY and do not want to spend 6 or more months with dumping syndrome and feeling rotten. I also worry about the ability to take and absorb other medications I might need in the future as I age. The VSG appears to offer the fastest recovery, weight loss similar to the RNY and the least amount of side effects. One recent publication, “The Best Bariatric Operation for Older Patients “ by Drs Lee, Cirangle, Taller, Feng and Jossart, 2005, concludes that “These data suggest that the best bariatric operation for older patients may be the laparoscopic VG because it achieves the greatest weight loss with the shortest operative time and the fewest complications”. I have investigated this procedure very thoroughly including attending support groups and talking with others who have had it. I have completed most of the preoperative testing and strongly believe this is the best procedure for my circumstances II. THE VSG SHOULD NO LONGER BE CONSIDERED INVESTIGATIONAL The only stated reason for denying approval for the VSG is that it is investigational and …” current available medical studies do not show that this service improves health outcomes, is as good as or better than standard alternatives, or shows improvement outside the research setting”. It is respectfully submitted that this conclusion is incorrect. The conclusion ignores the 36 studies now available on the effectiveness of VSG which indicate that excess weight loss is similar to the RNY and that complications from surgery are actually lower than RNY. It also ignores the fact that the VSG is now widely performed and is routine for many bariatric surgeons and has long been performed outside the research setting. Anthem’s policy on Surgery for Clinically Severe Obesity is set forth in a document with an effective date of April 22, 2009. This document reviews the various forms of bariatric surgery and explains when weight loss surgery is considered medically necessary. VSG is excluded from ever being medically necessary because it is designated as investigational and that “…there is insufficient convincing evidence in the peer reviewed medical literature, in terms of safety, to support the use of …sleeve gastrectomy…other than biliopancreatic bypass with duodenal switch, in individuals with clinically severe obesity.”. Nevertheless, the lap band and Realize band procedures are approved as medically necessary in this same document based upon what appears to be two three year studies involving 219 and 352 patients respectively. There is now a considerable body of data and studies supporting the safety and effectiveness of the VSG as a primary procedure for weight loss. The June 2009 Supplement to Bariatric Times reporting on the Second International Consensus Summit on Sleeve Gastrectomy (available at www.bariatrictimes.com) includes 10 papers pertaining to the safety and effectiveness of the VSG presented by leading bariatric surgeons. In Reducing Risk in Bariatric Surgery: Rational for Sleeve Gastrectomy, Dr. Eric J. DeMaria concludes that “A growing body of evidence suggests sleeve gastrectomy may be an appropriate primary bariatric surgical procedure primarily due to low risk and ease of surgical revision when required.” In the paper presented by Drs Jossart and Cirangle, four years of data showed a 68% excess weight loss by VSG patients, a figure not largely different than RNY patients of the same time range. Most significantly, in Debates and Consensus: a Summary by Dr. Michael Gagner, important questions concerning the VSG were debated and conclusions reached by the 400 conference participants. Question 6 was as follows: “Question 6: In your opinion, is there currently enough published data to support the sleeve gastrectomy as a primary procedure to treat morbid obesity on par with adjustable gastric banding and Roux-en-Y gastric bypass? Several groups presented cohorts of patients with follow-up periods of 4 to 8 years the day before. Jossart and colleagues in San Francisco presented eight years’ experience including 1,200 cases, whereas at more than four years, weight loss resulted in a similar curve to gastric bypass. At higher BMI (greater than 55kg/m2) a plateau of nearly 40kg/m2 demanded a second stage, but below a BMI of 55, the operation was terrific. Schauer and colleagues assessed the literature from 35 reports, studied more than 3,000 published sleeve gastrectomy cases, and found an extremely low mortality rate (near 0.12%). Results have shown excellent weight loss and co morbidity reduction that is comparable to or exceeds other bariatric operations and that the sleeve gastrectomy is safe and efficacious. Himpens of Belgium analyzed his patients from 2001 through 2002(sic) to attain six-year follow-up. Sixty-five percent of 46 patients were considered a “success” (%EWL greater than 50 ) at two years. At six years the success rate was maintained at 59 percent. Weiner from Frankfurt and MacMahon of Leeds, who started in 2000, also had similar results. *** Certainly, the audience thought there was enough evidence published to support the sleeve gastrectomy as a primary procedure to treat morbid obesity on par with adjustable gastric banding and Roux-en-Y gastric bypass with a yes vote of 77 percent. This is perhaps the strongest contribution to this second consensus conference.” A review article entitled “Systematic Review of Sleeve Gastrectomy as Staging and Primary Bariatric Procedure” was recently posted on the web site of the American Society of Bariatric and Metabolic Surgeons dated May 26, 2009. The authors are Drs Brethaur and Schaur and Jeffrey Hammel M.S. of the Bariatric and Metabolic Institute of the Cleveland Clinic, Cleveland, Ohio. Thirty-six studies involving 2570 patients who had the VSG procedure were analyzed. Their conclusion was: “From the current evidence, including 36 studies and 2570 patients, LSG is an effective weight loss procedure that can be performed safely as a first stage or primary procedure. From this large volume of case series data, a matched cohort analysis and 2 randomized trials, LSG results in excellent weight loss and co-morbidity reductions that exceeds , or is comparable to, that of other accepted bariatric procedures. The postoperative major complication rates and mortality rates have been acceptably low. Long-term data are limited but the 3- and 5- year follow up data have demonstrated the durability of the SG procedure. “ To date ten thousand patients have had the VSG surgery with good success. Many are going to Mexico or other foreign countries because their insurers refuse to pay for the VSG even though it is less expensive than the RNY procedure, the so called “gold standard” of weight loss surgery which takes several hours and requires a hospital stay of 3 or 4 days. The VSG can be completed in one hour by a skilled surgeon and most patients stay only one night in the hospital. While there is certainly follow up care, the repeated fill and unfill procedures required by gastric banding are unneeded for the VSG. Nutritional supplements are much less of a problem than with the RNY. Many insurance companies are recognizing the value and cost effectiveness of the VSG and have approved the VSG for at least some patients, including BSBC Federal, Tri-west Tri-care Prime, United Healthcare, the Veterans Administration, Aetna, Blue Care Network HMO, Healthnet, Anthem BC of Connecticut, Definity Health/United Healthcare, PPO, Empire Blue Cross Anthem, and UHC. The VSG sleeve gastrectomy is now routinely offered by Kaiser Permanente to all patients that qualify for Weight Loss Surgery and would not do so if this surgery was not proven to work. I don’t think it is fair that if you have five people, one with Kaiser, one with United, one with Aetna, one with Cigna and me with Anthem Blue Cross of California, the other four will be offered the sleeve and I will not. The California Department of Insurance has recognized that VSG is widely accepted by the American Society for Metabolic and Bariatric Surgery as a standard procedure at medical centers for excellence. In Decision #EI09-9645 the physician reviewers reversed the health plan’s denial of the patient’s VSG request and concluded that VSG was the most appropriate option for the patient. The same conclusion was also reached in EI06-5882 though the patient had significantly more co-morbidities. That decision noted the important fact that the VSG is nothing more than the first part of the duodenal switch operation which includes the second step of intestinal modification and as such, the VSG portion has been performed for many years as part of the DS procedure. Some patients have the VSG first as part of a two stage procedure and find that they do not need the second stage. Thus, the VSG is not as new and investigational as Anthem’s conclusions seem to imply. Anthem does cover the DS procedure which includes the VSG as one part. According to an article published in the Detroit Free Press on August 17, 2009, Blue Cross Blue Shield of Michigan, in conjunction with the University of Michigan, has been compiling a large detailed data base on bariatric surgery in order to improve surgical outcomes and provide cost savings. In three years of data collection, it appears that the VSG now accounts for as much as 12% of all bariatric procedures. This percentage indicates that the procedure is far beyond investigational status. This data base indicates that 10,000 VSG procedures are known to have been performed. My Anthem group policy excludes investigational procedures and defines that term as procedures: “ 1) that have progressed to limited use on humans, but which are not generally accepted as proven and effective procedures within the organized medical community; or 2) that do not have final approval from the appropriate governmental regulatory body; or 3) that are not supported by scientific evidence which permits conclusions concerning the effect of the service, drug or device on health outcomes; or 4) that do not improve the health outcome of the patient treated; or 5) that are not as beneficial as any established alternative; or 6) whose results outside the investigational setting cannot be demonstrated or duplicated; or 7) that are not generally approved or used by Physicians in the medical community. It appears that the VSG, based upon the articles cited above, has been performed on thousands of patients, has been accepted by a consensus of participating members of an international conference devoted to this subject, is widely accepted by the ASMBS, does not require FDA or similar government approval, is in fact supported by at least 36 studies analyzed by highly respected physicians, is as effective as the RNY and more effective than gastric banding in terms of percentage of excess weight loss, has fewer complications than the RNY, has as good or better reduction of co morbidities as other procedures, and has results that are similar in studies by both United States and foreign physicians. The VSG therefore no longer falls within the definition of investigational procedures excluded from coverage. The conclusions stated in the previously cited Anthem Policy on Surgery for Clinically Severe Obesity are simply no longer correct and that policy should be updated to include VSG coverage or disregarded. With the VSG patients lose about 68% of excess weight and lower BMI patients like me often do much better. Weight loss will most certainly help my back and hip pain and improve ability to exercise. High triglycerides, high blood pressure, and borderline diabetes are corrected in about 76 percent of WLS cases and I am hoping for this result. It is therefore highly likely that my health will be improved by this procedure and I respectfully ask for your reversal of this denial. I am a mother and soon to be a Grandmother and I want to improve the quality of my life so that I will be healthier and able to help raise my grandchildren and be able to take an active role in their life.Thank you for your review of this matter. I greatly appreciate the fact that the state of California has a procedure to help insured patients who find themselves in disagreement with their insurance companies. I strongly believe this decision will greatly affect the quality of the rest of my life. Thank you for your time. I eagerly await your decision regarding this. I can be reached as indicated below if further information is needed. Enclosed is a copy of my denial letter from Anthem Blue Cross My HMO is Healthcare Partners Primary Care Provider is xxxxxxxxxxxxx Gastric Surgeon xxxxxxxxxxxxx Sports Medicine xxxxxxxxxxxx who ordered MRI and diagnosed arthritis Cardiologist xxxxxxxxxxxxx did my last EKG and stress test All these doctors agree Weight Loss Surgery is a good option for me. Respectfully yours, Jeani Anderson xxxxxxxxxxxxxxx xxxxxxxxxxxxxxx (xxx) xxx-xxxx Work info: xxxxxxxxxxxxxxxx xxxxxxxxxxxxxxxx xxxxxxxxxxx CA 91101 (xxx)xxx-xxxx ext. 244

I use Centrum chewables twice a day. Also use the Bariatric Advantage calcium citrate chews. But I let them dissolve. After surgery, before I left hospital, my surgeon gave me prescriptions for Iron, B-12, B-1, Vitamin C and calcium citrate with D. I didn't start the calcium chews til I ran out of the prescription calcium citrate. They also gave me a sample schedule to use which was very helpful. The hospital gave me a pill crusher. My surgeon's office said not to worry about starting Vitamins for 14 days. They wanted me to just focus on drinking my fluids and Protein. I found it was easier for me to fill ice cube trays with broth and sugar free Jello. Two cubes was two ounces. I would have two ounces of broth or jello three times a day and didn't drink liquids a half hour before or after my meals. I found this stage easy because I got into the routine. Every surgeon is different but I found a lot do recommend the two ounces three times a day. Oh. And sugar free Popsicles were great to break up monotony. They count as a liquid. Also really liked lemonade flavor of vitamin Water zero for when you get tired of plain water. It's made with stevia and works better for me as I am sensitive to Aspertame. It gives me headache. I wish you the best of luck !!! It has been a whole new learning experience and I am so happy I did it. I am 6 months out and 82 lbs down.

I don't know what your sweet tooth craves, whether it just be something sweet or something like a candy bar. I went into my local Vitamin world the other day and was looking at the powders and Protein drinks they have available (because that is the ONLY place in my town other than Smith's grocery store & Wal-mart that has anything I will be needing for surgery) and I ran across these OhYeah bars. They had 4 different bars the one I tried was chocolate Caramel Candies I was surprisingly shocked at how good it tasted and reminded me of "Candy" It has a soft filling with tiny M&M looking candies on top and covered with chocolate. It says "Good Grab right size right choice" (it's a little smaller than a payday bar) It has: 180 Calories, Total fat 9g, Carbs 19g, Sugars 8g, Protein 14g I know calories and sugars are maybe a little high but if you do it once in a while it shouldn't be to bad, I figure with 14g of Protein it makes it ok ;}~ Also I just got the Bariatric Choice Catalog and it has some "candy bar" like Protein Bars. The SF chocolate Dream Protein Bar that looks just like a candy bar says it's similar to a Nestle's crunch bar it has: 160 cal, 10g Protein, 12g fat, 6g carbs, 0 sugar. So these are a couple things im planning on looking into. I hope this helps ya a little bit.

Your doctor may recommend a nuclear stress test to diagnose coronary artery disease. Your coronary arteries are the major blood vessels that supply your heart with blood, oxygen and nutrients. Coronary artery disease develops when these arteries become damaged or diseased — usually due to a buildup of deposits called plaques. If you have symptoms that might indicate coronary artery disease, such as shortness of breath or chest pains, a nuclear stress test can help determine if you have coronary artery disease. Before gastric bypass surgery, I underwent almost a day of pre-op testing. Since I had issues, I was scheduled with 3 follow on tests done by specialist in their respective fields. We had one individual in our support group meetings who was scheduled for bariatric surgery the next week, but he got a call from the surgeon. They told him to report immediately to the hospital for open heart surgery. He had the surgery and then about a couple months later after he recovered from that he underwent bariatric surgery.

I'm so excited I just came home from my last visit with the nut & have passed the psyche with flying colors so now I'm just waiting for the authorization to be submitted and auth'd hopefully with in a week or so I'll be able to get scheduled.....I have a million feeling going through my head right now, the main one being happiness. I can't wait for the weight loss to begin, there are so many things I want to do but right now I just need to start with some kind of physical activity tomorow after work I'm going the the local gym and will renew my membership I also will start walking our new puppy more often & make him my #1 guy since the others are not really helping )) so for the first time in a long time I'm gonna make it all about me!!!! Sorry if I'm all over the place like I said before so many thoughts & feelings right now