Search the Community

Hey there @NurseMichael! Just watched the video, liked and subscribed - really enjoyed it. Love your energy and passion, and while I don't know how much I can get out of it at this point in time (only one month post-op), I know it won't be long at all until whatever I learn will be so valuable. Thank you for doing this, what a great service to the bariatric community! P.S. Is it bad that I burst out laughing when your mic fell over? 😂 I'm so glad you didn't edit that out, it made the video even better!

I'm also three days post op and like you also miserable. I haven't come close to my daily Protein or liquid totals but what I have been doing is sipping, sipping, sipping at Water and my Isopure whenever I think about it even during the night. You don't want dehydration at this early stage. Just keep it simple for now. And my doctor cautioned against using straws as this adds air to your stomach with each sip. Good luck! My diet program can be found under http://www.kp.org/misg Go to bariatric surgery > patient resources

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

Start your summer with savings! The BariatricPal Store is having a HUGE sale on over 2,200 Bariatric products!! Take 25% off BariatricPal brand products using code BARIATRICPAL18 and 15% off everything else using code MEMORIALDAY18!

Hello everyone! I am new to this forum as well. I started my journey back in July 2015. I had my sleep study completed and then I had to register for a weight management class which is required by my insurance which is Kaiser. I had to wait until November to take the class because they fill up fast. The class lasted eight weeks and after the class I attended the orientation on January 27. My next step was to have an hour-long appointment with the nutritionist and social worker. I completed that on April 20 and also had my blood drawn the same day. Now I'm just waiting for the bariatric team to review my chart on May 4 and then call me to schedule a consultation with the surgeon. The process is so long but it is definitely well worth it. I'm so excited to get the call for my next step. I am so glad that I found this forum and glad that I have all of you for support. I would love to hear how your journeys are going and any advice that you have. Sent from my iPhone using the BariatricPal App

I have read so many articles and talked to several Bariatric doctors who continue to tell me that my pouch will not stretch however your brain somehow adapts allowing you to consume more. At about the one year mark I noticed depending on what I choose to eat, I can eat 1 cup of food max. I am now 19 months post op and I still have that same restriction. I can eat 2 to 3 ounces of dense Protein and a bite or two of veggies/fruits and I am almost overly full. However if I eat a bowl of cream of wheat, I can eat almost a full serving. I believe what I have researched, that we adapt, our brains do that. Our stomachs don't stretch. Incidentally I have also learned that I can over indulge in things like Cheezeits! I do eat them but if not careful I can mindlessly nibble way over a portion! I know this because I gained 2 lbs eating the wrong stuff for about 2 weeks. Boy was I pissed at myself. I got back on track and within 1 week I lost those 2lbs eating the right foods and never feeling hungry. Also, I noticed when I was eating too many carbs those 2 weeks I had several episodes of hypoglycemia! It came on so very quickly that it was scary. It became a vicious cycle. Eat too many bad carbs your body will crave it. So now that I know what not to do, I think I will stick to the plan and if I want Cheezeits, I will measure out one serving and watch my carbs the rest of the day!

I don't know that there's a lot to say. Like, the only response to talk about disordered eating is "go to therapy". Which is great for the people for whom therapy is accessible and effective, but for most people it isn't one or the other. I've been in therapy for literally decades. I've been hospitalized in an ED ward. Still have an eating disorder. Also, you really don't want to talk about disordered eating on a bariatric forum. What is disordered eating, after all? Weighing and tracking everything you eat? Getting upset if you break a diet rule? Avoiding social situations where food is going to be present? Exercising no matter what? Refusing to eat food for any reason but the bare minimum necessary to fuel your body? That's compliance. That's a good bariatric patient. That's a success story.

I was sleeves Monday, June 15 and I used Dr. Jesus Lopez Dominguez and went through Bariatric Pal. I can't say enough good things about Dr. lopez and his staff. The name of the hospital was Centro Médico Quirúrgico Santa Fe. I would recommend them to anyone

You need a new bariatric surgeon who is experienced at revisions. Best of luck to you

Well, so I'm back to this arena. I had a Realize Lap-Band put in back in October 2009. Since then, I have lost a grand total of ... wait for it ... 0.0 lbs. Dialed up the band saline level to the max allowed, went through four bariatric doctors, one of whom tried to sell me on an MLM, and two left the industry or otherwise ghosted me. It's been ... a helluva ride and a helluva disappointment. I clearly did not do the research needed and chose the wrong procedure. I felt zero decrease in hunger with the band, and while it of course made me eat much slower, it did absolutely nothing to quell hunger. I have felt hungry pretty much 24/7 for the entirety of this damn thing. And no, I didn't lose weight and then slowly gain it back, except for a bit on the first month post-op. My nine year weight history has been a flat line. I understand I'm at least a little bit unusual, but a) I'm probably not that unusual and b) it's the truth. So I'm back, on track for a VSG on 1/25, and doing self-pay as work insurance has a very strict, absolutely no exceptions allowed one time max on bariatric procedures. They are "graciously" paying for the band removal, subject to my $6k HDHP annual deductible. (Hence delaying until January - I'll hit my deductible for the year for anything that comes up post-op). Researched Mexico but decided to pay more to stay local - I'm a Virginian and Mexico is far. I might have felt differently if I lived in the Southwest or West Coast. Anyway. Has anyone else had a failed band - no complications, no leakage, just no weight loss - and then succeeded with VSG? I want to hear your stories! Brian

A good friend of mine recommended this site to me for some good support and conversation with fellow Lap Bandees. I'm 24 years old and have always been a "big guy." However, in the last few years, I've become more and more sedentary and thus gained a lot of weight. So around a year ago I started looking into bariatric surgery to get me on track and help me improve my health. Well, on April 3rd, 2008 I was banded by Dr. Darrin Hansen of the South Valley Surgical Center in Sandy, Utah. So far I'm feeling really good and haven't had too much pain. I'm excited to get to a place where I can get exercising and resume a (quasi) normal life. I'm a student and I work full-time for a law firm so this downtime is hard for me to accept. I'm glad to have learned about this site and I feel I will frequent it with questions and for general support. I have a blogsite I've set up for any and everyone to check out and follow my progress. You all are welcome to comment on it. Becoming Half the "Mozart" I Am (My nickname has been Mozart since I was 8 years old...)

...probably the same reasons people don't talk about therapy outside of the bariatric universe. i dont think the taboo that is (unfairly) assigned to mental health management is specific to us as a group. 🤷🏻‍♀️

Welcome and congratulations on making such a smart decision about taking control of your health and well-being by having bariatric surgery! What's helpful and what's not in terms of prep (and on an ongoing basis) will depend on your personality type and how you prefer to learn, but what I've found to be most useful and beneficial is staying away from social media for the most part, and instead engaging in a great deal of on- and offline research. I read A LOT of scientific papers and studies prior to surgery (and still do), and was careful to seek out evidence-based information and data on types of surgery, outcomes, complications, expectations, etc. from scientists, obesity specialists, bariatric surgeons, bariatric dieticians, and other medical professionals working in the field. What a lot of quality, realistic thoughts and suggestions you're receiving in reply to your question here! I would add that for me, taking maximum advantage of the first 6 months -- and particularly the first 3 -- after surgery has been *crucial* to my overall loss and success. If you're not hungry after surgery, take full advantage by keeping your calories very low, because the honeymoon phase is finite. Begin entrenching good food habits right now (if you haven't already) and work to sustain the changes over the long term by cutting out processed foods, highly palatable foods, and sugar and instead focusing on eating healthy, whole, nutrient-dense foods once you've passed the fluid stage(s). Start an regular exercise program if you haven't already. Look for ways to keep increasing your NEAT (non-exercise activity thermogenesis) and act on them daily as your ability increases over time. Contact your bariatric team immediately with any concerns that may arise around potentially significant physical or psychological issues because social media absolutely cannot help with those. Wishing you all the very best with a successful surgery and recovery, and much ease as you pass through all of the bariatric stages and into your new life 😊 Highly-Palatable-Foods-slides.pdf

thanks to everyone for their replies and input. my dr has not done any ds (which the first part is the sleeve). so his 6 sleeves done is all hes done. i definitely have had many conversations with him about the procedure and my concerns, and i am confident in his ability as a surgeon or i wouldnt of chosen him. of course i would of wished he had done more sleeves, but out of the insurance list i had to chose from (about 25 drs), only a handful had done sleeves at all. and as i stated, my dr had the most of anyone on that list with 6. i actually didnt chose him because of his 6 sleeves done, but i chose him because he seemed the most qualifed surgeon on the list out of the ones who had done sleeves with 100's of rny's and lapbands. and also he is working out of a well known ny hospital recognized for their excellence in bariatrics. the hospital, st lukes hospital in ny is also a major research center on bariatrics surgery too. i feel like im in good hands, and honestly, i couldnt afford to self pay right now, at least not in the states. so im kind of locked in to trying to find the best option that my insurance will cover. if i had to self pay, i would probably go to mexico to dr aceves as he seems to be very qualified as a surgeon and the price for going out of the u.s. makes a big difference. ill keep hoping for the best and hopefully it will all turn out ok. my first big step is meeting with my dr on june 30 (only 12 days away) and thats my final visit before he submits everything to the insurance. take care everyone and thanks again.

Hi Lou. I read your story and you've really been through the ringer. I know I wouldn't be able to afford this surgery out-of-pocket, but 6 sleeves does not make for a good experience level. I know that a lot of people on this site go far away (Mexico etc...) for their surgeries. I would not want to be so far away from my surgeon. I'm lucky to have an experienced local surgeon who accepts my insurance- a sort of trifecta. It appears that you may need to give up one of those 3 things- insurance coverage, proximity, or experience. That's a really tough call that I don't envy. One thought is this: ask your surgeon who trained him in VSG, and ask if that doctor would be willing to be present in the OR. Also, ask your surgeon detailed questions about his technique, such as: size of bougie, method of closure (my bariatric practice has had zero instances of leaks b/c they over-sew the staple line, and then glue on top of that), etc... Ask if you can talk with other patients (do they run an ongoing support group?). Ask if they do a pre-op liquid diet (a responsible and conservative approach that reduces liver size and density, and evaluates patient ability and commitment to following critical liquid post-op diet). It's nice to have a surgeon with a good long successful track record in a procedure, but on the other hand, he's doesn't sound new at all to bariatric surgery, and VSG is less complicated than bypass. Just don't be afraid to ask ask ask. It's your body and your right. Good luck with this tough decision and hang in there!

Today I had my NUT and Psych appointments and all went well. Just a few things I am confused about. (granted I still have more research to do and my eating classes) 1. I hear all the time Protein, protein, protein, She was all about vegetables and fruits. For example said she doesn't like the bariatric portion plates as it is 1/2 protein and 1/4 starch, 1/4 vegs. She said go 1/2 vegs, 1/4 starch, 1/4 protein 2. She says only 1 shake per day and doc likes us on real food after 1 month of soft food 3. I only have a 24 hr liquid diet pre surgery - I see others have more As far as shakes go what does everyone suggest? I will be reading up. Also what other things did you buy to make it easier that you feel were good? (i.e. portion plates, certain type of blender?) Lastly a good friend of mine is a beachbody coach and promotes shakeology. NUT said it is ok but I reached out to friend and had such negative feedback about surgery (i.e. easy way out, loose skin (mind you a friend lost 200 lbs on his own still has skin issues!) . It is an old friend who we aren't as close - guess I reached out to try and get the bond back but it is what it is.... Don't care much for the shakes but thought it was an olive branch I guess - Just venting here!

I am on a facebook group "Bariatric Nutrition with Dr. Susan Mitchell" and recently she posted an article from a peer-reviewed journal that said there wasn't much evidence for not drinking after you eat long term. However, I find it hard to drink when I'm really full. I never wait after drinking to eat - my surgery center never said that was an issue. Congratulations on maintaining so long! That's amazing! For the anemia, see what the specialist says. What did your GP say? Iron needs to be taken at least 2 hours apart from calcium. And it might upset your stomach. There are preparations that are better (slow iron). You might try to get back in touch with your surgeon, too, if possible, but you seem to be doing great on your own. It's inspirational!

My bariatric center advises never to crush medications. It's best to check with your surgeon to find out what they advise in your situation. Best of luck!

I can definitely tell a difference when I wear them and when I don't...I got bariatric-specific vitamin patches & I've been pleased so far. I googled and read about each kind to decide which ones I wanted to use first. Good luck to you in finding some you like!

No, a tree hugger is an environmentalist who understands the delicate balance of nature and the ecosystems. They understand that when you affect one small part of it, it affects the larger part, too. They understand that we get 1/2 of our medicines from the rain forests, which are being destroyed at an alarming rate. And they understand that we are the stewards of this earth and are entrusted to care for it, because everything isn't renewable. Extinct is extinct. I applaud them for their efforts. Now I know that they are the butt of jokes about some bug or species that they are trying to protect, but that comes from people being woefully uninformed about so many things, not the least of which is our environment. And it speaks volumes about the person making fun of them.

Generally during surgery, the patient receives antibiotics to prevent infections from the surgery. This kills not only the bad bacteria but also the good ones. So therefore after surgery it is generally recommended that you restore these colonies in your gut. That is what probiotics do. Many people experience constipation after surgery. Some of this is due to the fact that some patients do not drink enough fluids each day. These are some of the methods individuals have recommended to counter this problem. * Eating apples with the skin * Smooth Move Herbal Tea * Prune juice (warmed) * Prunes (4 in the morning and 4 at night) * Magnesium citrate * Insoluble fibers (Garden of Life Raw Fiber or Renew Life Triple Fiber). * Haribo sugar free Gummy Bears * Aerobic Magnesium 07 * Low Fat Bran Muffin (recipe). 80 calories each 1 cup flour 2 teaspoons baking powder ½ teaspoon baking soda ½ teaspoon cinnamon 2 cups bran Cereal 1 ¼ cups milk 1 egg ½ tablespoon applesauce optional: banana, berries, mini chocolate chips Bake 400° F for 22 minutes But since you are still within the first 30 days after surgery, some of these options will be currently unavailable to you.

Still trying samples of the multivitamins that I received via mail for free (Celebrate and Bariatric Advantage). However, for calcium, I use Reviva liquid (Costco and Sam's). It is sour blueberry flavored. YUM. I take 1 oz in the am and 1 oz in the PM. If you don't have a Costco card, you can buy online and pay a little bit more ($1.50) and you can still get it. My Sam's only carries it every once and a while, so I had to go for Costco.

I take Adult Chewable Centrum, calcium citrate (caltrate isn't absorbed as well in reduced acid.. which with our smaller upper stomachs, we have less acid), D3 (many obese & formerly obese are Vit. D deficient), Glucosamine/Chondroitin/MSM, B12 (sublinguals), B100 (for energy). Andrea at http://www.wlsvitagarden.com has good info on Vitamins for bariatric patients.

Someone suggested that I post my list of questions that I brought to my consultation. Some are redundant, sorry about that. I hope this helps and please add your questions too. ABOUT THE DOCTOR: How many gastric banding procedures have you done? Is he a board certified surgeon? What types of complications has this doctor personally encountered during lap band surgery and recovery and life with band? Is there a difference among the two different adjustable gastric bands? Do you have other Lap-Band® patients that I can talk to? Do you have a video or presentation that I can watch that shows the surgery? Do you specialize in the Lap-Band® or do you perform other procedures as well? Do you perform other gastric band procedures? What is the Realize band, pros/cons of each? What are the short term issues? What are the long term issues? What is the doctor's policy when a complication occurs during a procedure? (ie: does he discuss options with family or immediately convert to bypass or other WLS). What qualifications does this doctor have regarding the specific brand of band that will be used? (Lap-Band System, by Allergan or Realize Band by Ethicon/Johnson&Johnson) ABOUT THE PROCEDURE: Lap Band vs Realize? What is the “scarless surgery?” Do you perform the procedure on an outpatient basis or will it require an overnight stay in the hospital? What kind of anesthesia will I be getting? Will an anesthesiologist be present during the entire procedure Is the surgery being done at a surgery center or at a hospital? How will you protect me from infection/staff infection during the procedure? What types of complications has this doctor personally encountered during lap band surgery? PREPARING FOR SURGERY: What tests do I have to have prior to surgery? Will I need to have a special diet before surgery? Will you notify my primary care doctor about the procedure? Do you need any of my medical records prior to surgery? AFTER SURGERY CARE AND FOLLOW UP When can I resume taking medications? How soon after surgery do you want to see me for a follow up visit? How do does the doctor determine whether or not my band will need to be adjusted? Is there a direct line in case of Emergencies? When should I have my first adjustment/ fill? What will I need to have prepared when I get home in way of food items? When can I resume exercise? How will I manage my pain after surgery? How will I have to change my eating habits after surgery? How much weight should I expect to lose in the first month? FRIENDS AND FAMILY What help can you give me to help educate my family and friends so that they can also support me? LIFE AFTER BAND: How do adjustments work and how often will I need adjustments during the first year? Ongoing? How often will I have to see the doctor over the next year and at what cost? How is it better than other forms of bariatric surgeries like Gastric c Bypass and Gastric Sleeve? What is the expected weight loss? How much time will be required for losing weight? Is there possibly a better weight surgery for me?

ALM.com https://www.ALM.com/how-to-avoid-weight-loss-plateau-after-bariatric-surgery/