Search the Community

You took the words right out of my mouth!! Find a new more supportive Bariatrics' Team.

The longer you participate on this forum, the more differences you will read with instructions given by surgeons to their patients...each doctor has their preferred protocol. My surgeon required a 2 week pre and post op diet, so I was on liquids for 4 weeks. And post op, I could not even have the fresh veggies! The low carb liquid diet is prescribed to shrink your liver, to allow the surgeon to have better access to place your band. Obese people tend to have more fat in their livers. So, I hope you are using the sugar free jello. You really should find a Protein drink that you like, because likely periodically post op you will return to drinking Protein Shakes after fills. I have to return to a liquid diet for 2 days after getting a fill, then 1 additional day on soft foods. I would continue to search and try several more brands until you find at least 1 that you do like...and be certain to read the nutritional values/ingredients label. You should look for shakes which have a minimum of 20gr protein per serving, and the best protein for bariatric patients is whey isolate protein. There has been some heated discussion on the forum about whey protein, but it is still considered to be the gold standard for bariatric nutritional needs. I use the Wheybolic Extreme (1.5 scoops) from GNC (chocolate and cookies 'n cream flavors). When mixed using 1% milk, I get 37 gr of protein per shake. You should also have been given a number of protein grams to have every day...try to meet that goal. BTW, the day before my surgery, when I could only have Clear Liquids, I had to host a luncheon (I had agreed to do that 6 months prior to having a surgery date) for my woman's club. While everyone was enjoying their chicken salad or quiche, I enjoyed sipping my iced water...you do what you have to do. My band surgery had been delayed for over a year due to unplanned medical complications, so when I finally received medical clearance, I ran with it before anything else could happen to delay it again! Best wishes as you continue on your journey...

Wow, that is so awful. I'm so sorry. Definitely file a complaint. It will help others avoid having to go through what you went through. A center of excellence is important to have, but as we can see, it doesn't seem to guarantee bedside manner and attentive care, which it should. I read through what it takes to be a center of excellence, and it involves the following (the disease-state in our cases would be bariatric surgery, essentially, I think): Board certified specialist and subspecialties in the disease-state Current diagnostic and treatment technology Standardized (where applicable) care plans If surgical services are involved standardized surgical and medical device packs Unique or innovative service not found in the service area Long-term sustainable business plan Dedicated full-time CoE director or manager Center defined capital budget for acquisition of new technology, devices etc Outcomes better than the national average Active satisfaction measurement of physicians, payers and patients Patient referrals from what would be considered outside of the normal hospital or health system service area Fully developed patient disease-state educational materials (and that doesn't mean a pamphlet from an association or pharma) Outcome case studies Transparency dashboard which reports surgical and treatment outcomes, case mix index, mortality and morbidity data, financial indicators, satisfaction rates for physician, payer and patient, quality measures, market share, etc Joint Commission CoE certification*(Leon) Other third party external accreditation's if available for the disease-state The disease-state is a core competency of the organization Centers brand name and brand architecture is consistent with and fully integrated into the hospital or other providers brand plan.

I don't think your Bariatric Program would approve of the nutrient/carb/sugar values in Shakeology. How are you doing with it during pre-surgery diet, are you losing weight with it?

I had Type II diabetes and was taking 2 prescription medicines prior to RNY gastric bypass surgery. When I left the hospital 2 days after surgery, I was off all my blood sugar medicines and haven't taken any since. I am 4 years post-op and once per month check my blood sugar levels to verify they are still normal. It was that quick. Some diabetes patients do not experience this effect, but many do. Some see a reduction in the amount of medicine they are taking for the condition. From what I can see, it somewhat depends on how long you have been suffering with this condition and if you progressed to insulin to treat the condition. Generally right after surgery, the volume of food is so minimal that you will not experience constipation at the beginning. At least that is my experience. You may not have a bowel movement in the first week but that is due to a lack of solid food. As time goes on and you transition to solids, constipation can appear. Sometimes I became so compacted that I had to use a glycerin suppository and place it up my rear end for relief. This worked effectively but I did not want to do this for ever. For me, I found a simple solution. I ate an apple a day just before bedtime and the next morning would generally result in a bowel movement. But there is a trick to this. I had to eat the skin in addition to the pulp. So apple sauce would not work. These are the recommendations from several individuals on this site for dealing with constipation after surgery. 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 (be careful with this one because it can cause the runs) Aerobic Magnesium 07 Ground Flax Seeds (but don’t try to grind it yourself). Use 2 tablespoons per glass of water every night before going to bed. Bowel Clear (herbal blend) 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 minute

I arrived in Mexicali on Sunday afternoon, 10/2. I rode in with 2 other patients and we all visited and shared our stories. After our labs at the hospital, we were taken to the hotel and checked in about 4:30 pm. Since we were all really hungry, we met up in the hotel restaurant a few minutes later and had a really wonderful dinner. For a large plate of chile rellenos , Beans, rice, tortillas, chips and a margarita......my bill was $13.00! With a full tummy and a sleeping pill from Dr. Aceves, I had a very relaxing night at the hotel. Ernesto picked us up at 7:00 am, Monday morning and drove us back to the hospital. Since my surgery was the 2nd of the day, I was given a sedative to relax. The rest of the day is a blur. I remember people coming in to get me....blur........I remember looking up at the ceiling as I was being wheeled to surgery......blur.........I remember someone telling me to turn on my side and bend my knees for the spinal block....blur.....and OUT. I don't remember recovery at all. The next thing I remember is being back in my room, thinking it must be over and then falling back asleep again. I was in and out of sleep for the rest of the night, knowing that nurses came in and out, taking my temp and blood pressure, but not really ever becoming fully alert. Sometime early Tuesday morning, I told one of the nurses I needed to use the bathroom. Although I stumbled a bit, I made the trip successfully and immediately fell back asleep. Later that morning, they brought me those infamous 4 little cups of blue "apple juice." They weren't good, but they were tolerable. I sipped and slept, sipped and slept, sipped and slept for hours. Several times that day, Dr. Aceves, Dr. Campos and the nurses came in and told me to try to get up and walk. I'd answer "Sure, ok." with every good intention of doing it, but I'd always fall back asleep. I really had a tough time coming out of all that med-induced sleepiness. By late afternoon Tuesday, I finally got up and walked the halls. I was completely pain-free (yes, really.....it must have been the spinal block), but I felt unsteady on my feet and climbed back into bed about 5 minutes later. Tuesday night was pretty much the same as Monday night, but I woke up Wednesday morning feeling alert and energetic. I took a shower and even put on a little make-up! Wednesday, I walked several times, visited my neighbors, sipped tea and finally got a bowl of that wonderful chicken broth everybody raves about. Yes, it IS that good. By the time I left on Thursday morning, I felt pretty good - minimal pain and absolutely no nausea. It may have been this sense of well-being that caused me to completely overdo it on Friday. BIG Mistake! I met up with a friend Friday afternoon to do a "little" shopping that turned into a 5-hour shopping spree. I thought I was listening to my body.......I sipped Isopure all day........I took sitting breaks pretty often, but by the time I got home, I felt awful. My abdomen was completely swollen with Fluid and gas. I looked 9 months pregnant and felt equally uncomfortable. That was the first time all week I broke down emotionally. I remembered reading somewhere that Day 4 after surgery is the worst..........and that was definitely true for me! So, I sobbed myself to sleep Friday night and woke up Saturday with renewed energy and renewed resolve. I really took it easy that day. I stayed in all morning, sipping Protein and napping. By 3:00 pm, I felt good enough to take my son to a birthday party. It was a huge event, and EVERY single person there must have told me to eat......twice! But I politely told them I had eaten before I came and continued to sip on my bottled Water. The party lasted about two hours and I was definitely ready to come home by then. I went to bed about 7:30 pm, slept pretty soundly, and here I am at 5:00 am on Sunday, finally getting on the Internet for the first time since surgery. To sum up, I've really had a fairly easy recovery. Considering the mess my Band had made of my stomach and liver (Dr. Aceves told me it was NOT and easy revision) I've had very little pain except for the incision sights. I've experienced none of the shoulder "gas" pain I had with the Band surgery. I've had no nausea or stomach pain......just a lot of gas and gurgling. No doubt about it, those first four days kicked my butt, however, I think I'm over the "hump" now. I have one more week of recovery before I have to go back to work and I'm sooooo glad I didn't try to rush it and go back any sooner.

I began this journey on July 8, 2007 weighing 243. On this date I attended a seminar, hosted by my surgeon, that was an overview of Bariatric surgery. My sister and I both attended and that night decided we had to do this. I have been overweight since adolescence, but more severely after my 4th boy was born. I am tired of feeling insecure about the way I look, but moreover am afraid I am risking my health if I don't lose the weight. I have an obligation as a Christian to take care of my body and be a good wife and mother, and I can do none of theses things well at my current weight. Between July and September my surgeon required several pre-op classes: 2 visits to him, a behavioral health seminar, a visit to a dietitian, an exercise therapist, and a psychologist. At the time I felt like this was overkill, but am now learning that these visits were very useful and I learned about some of my responses to the life changes I am implementing before I even had them. I am also a self-pay. My insurance would not even consider it. No, I am not independently wealthy! I am a stay at home mom (with 4 children!) and yet I felt that I HAD to do this for everyone's benefit. I know it will be a struggle to pay for it, but there are better things in life than money! I am being banded tomorrow morning, Friday, September 14. I'll let you know more then...

...something comes up to likely stop it altogther. Finally, after waiting 3 weeks for the initial wls seminars in my area for the 2 drs I'm considering (& getting my DH on board for me to get lap band (self pay) ) we just found out that DH may be out of his job! More than me getting wls, I'm so sad for him. The worst part is that he's not getting laid off. His industry isn't bad. Its literally like they just are letting him go for no reason. Well, they haven't officially yet but its looking that way. He spent yesterday refreshing his resume & contacting other firms. We'll see what happens. I haven't worked in almost 4 years. Its a little embarassing to make a student loan payment on a degree you don't use but I hope to work one day again. I always used to feel like I was overlooked, underused, and unappreciated because I was fat & frumpy. (Technically, I still am! ) Anyhow, I don't currently bring in an income to help. Fortunately, dh is an excellent saver & we can live for almost a year if he was out of work. Unfortunately for me, it was to be some of that savings for lapband. Now what do I do? Dh and I are supposed to go to wls seminar #1 tonight (for the Davis Clinic here in Houston.) I already know my insurance doesn't cover any bariatric surgery (but even if it did- my husband's insurance is now precarious as it is.) I was so excited at the prospect of lap band before the holidays. Now I feel guilty. Dh said we could still go to seminars and if his employment situation changes, it may still happen that I get 'banded' (someday.) I hope tonight brings some good alternatives & ideas for payment. On the one hand I really feel this surgery will save my life. On the other- how do I reconcile taking food off our table if given the option? I'll update post seminar.

I would start calling bariatric doctors in your new location and ask the questions. Different doctors have different requirements. For me, my doctor saw me at 3 wk, 6wk, and will again at 6 months and at a year, as well as and every year after. I am also required 6 month labs, year labs, and labs every year after.

Mine was 2 weeks. I lost 18 lbs! If I remember correctly it was 4 shakes and 2 protein bars a day. My drs office uses the Bariatric Advantage brand shakes and bars, the shakes aren't too bad if you blend them with ice. And we were supposed to have a small banana every day, so I would add a frozen banana to my "breakfast shake" and it would turn out very tasty. I would probably keep up with the powdered shakes if I hadn't gotten lazy and realized the ease of the ready to drink ones:)

Someone is bound to know the answer to this one. all the Protein powders my nut recommends are whey protein isolate. We were looking at the different brands and types today,, and the carbs, sugars and protein contents were close. what are the differences between whey protein isolate,whey protein concentrate and soy protein...other than the obvious soy-milk base. how will they affect the bariatric patient. i am 6 weeks out and have no problem with milk or soy. thanks

I am 6 days post-op today. My pre-op diet was 10 days of liquid, including 4 Bariatric Advantage protein shakes a day (I was never able to get more than 3 in), sugar free Popsicles, sugar free jello, fat free chicken, beef or vegetable broth and water/crystal light, etc. I was also able to have up to 2 cups of vegetables off of a specific list, either all at once or split through the day. The day before surgery was clear liquids only. The point of the pre-op diet is to shrink the liver. That makes it easier to get to the stomach with the laparoscopic devices.

Tomorrow is pre-op testing for me, I am so excited. I meet with the surgeron first, 10:30am then off to do the medical testing at 12:30pm that is to last until 4pm. I'll be able to get my FMLA papers completed while there. Once testing is done, Monday starts the two weeks of a liquid diet. I hope I do well there. Trying to decide if I need to pack protein drinks, for tomorrow. It will a long day so I want to be equipped with what I need so I don't eat anything that I should not have. I'll eat a high protein breakfast, and go from there. Having lost 15 lbs in June, today was a good day in that I got to wear a pair of shorts that I have not worn in at least two years. This has been an exciting journey. I am looking forward to seeing the further results. Thank you everyone that provide insight and comments on their experiences. The information has been informative and insightful. I can't wait to join the ranks of those sleeved. Karen ****************************************************************************************************************************************************************************************************************** 7/3/13 Today was an exciting day as well as long. I left my home at 9:30am and headed to the hospital. My appointment with the surgeon was for 10:30am, I arrived to bariatric program office at 10:00am. I was a bit excited. I wanted to see what the scale said. What was special about my visit today was that when I walked in the staff greeted me with a loud "Hi Karen!" I wasn't just a patient. I met with the nurse, that reviewed the breathing tool, then the soap needed to wash my body the night before and the day of surgery. I then met with the nutritionist who discussed what I will need to do for the next two weeks. I am to drink Slimfast, where I have a 1000 calorie a day diet for 13 days, that last day will be all clear liquid. Upon leaving the surgeon's office I head to pre-admission. I get my paperwork completed, insurance paperwork reviewed, then I wait to be called in for testing. Testing consisted of blood being drawn, and EKG being performed and meeting with the anesthesiologist, they also went over how to wash the body with the special soap and there are wipes that are used an hour after them shower. Once again, I signed my name on the dotted line a lot today! I was glad I ate this morning a high protein meal and carrled with me a protein shake and a crystal light drink. I would have been starving when I left. I completed by day at 2:30pm. I did receive a discount on parking today. Nice perk. LOL My next stop of the day was the supermarket. I purchased salad and skim milk, I figure I would enjoy a good salad tomorrow. Come Monday, no more solids. I did really, I thought I would buy a bunch of junk food thinking I would have the mindset of this will be my last hoorah. But I didn't, I purchased health foods. A third stop of my afternoon was the dollar store. I ended up getting, breath strips, along with the brush and go toothbrushes. From the various readings on the site it was mentioned how folks said they would get bad breath. I wanted to be well stocked and armed once I get back to work. I am so excited and very nervous, but I know this is the right decision for me health wise. Now the race is on!

Well, here I am. Back from the hospital after a 2 night stay, with 85% of my stomach missing. I'll try and describe what it was like day by day... Day 1 (Surgery Day): Let me preface this by saying that I did not sleep a wink the night before surgery. Not. A. Wink. So, upon arriving to the hospital for my 7am appointment, I had already been awake for 24+ hours. So that probably added to the dream-like quality that everything had to it that day. But still, that's the only way I could possibly describe everything that happened that day. It was surreal. Since I couldn't sleep, I decided that my husband shouldn't either, so I got him up at 4:30, and we set out from our hotel for the hospital at 5:30, even though it was only a 30 minute drive, and we didn't have to be there until 7am. At this point, I was convinced that I was probably going to die on the operating table, so I was giving my husband instructions, such as "My wedding ring is in the change pocket of my purse. I'll want to be buried with it on." Stuff like that. I'm sure he was amused by it all, but looking back, I can't believe I did that to my husband! (who already has some anxiety issues BTW) So we arrived at the hospital super-early, and I tried, yet again to catch a 15 minute nap in the car. When it became apparent that even that wasn't going to happen, we went into the hospital to register at 6:30. They brought me back pretty quickly, but left my hubby in the waiting room. They weighed me (219.4) and brought me into a room with a stretcher in it, and told me to change into the gown and socks that were on the stretcher. Now, I don't know if they just see that someone is having bariatric surgery, and automatically put the XXL gown on the stretcher, or what, but that gown was huge. You could have put three of me in it. The socks were also ridiculous, they could have fit on my feet over a pair of winter boots! But I did as I was told, and proceeded to spend the next hour and a half trying not to flash everyone in the pre-op area... Then a nurse came in, took my vital signs, and did an admission questionnaire and had me sign paperwork. Then three separate anesthesiologists came in and talked to me, looked in my mouth, and asked me several of the same questions the nurse had just asked. Then another nurse put an IV in my left hand. Then, finally they allowed my husband to come back in. We sat there and talked for awhile, and then my surgeon came in... now I know many of us bariatric surgery patients have had multiple appointments with their surgeon prior to the actual surgery day, but for me that was not the case. I'd only met Dr. Shillingford once for about 5 minutes, in January. But meeting him for the second time on surgery day, I was again reassured by his confident demeanor, and his relaxed bedside manner. Plus it helped that every other medical staff person I'd met so far that day had referred to him as an excellent surgeon. Once he arrived, that really seemed to get the ball rolling. Just about 10 minutes later, they were giving my pre-op "cocktail" (I asked, it was Versed). Then we rolled into the OR. I remember them asking me to scootch from the stretcher I was on, to the operating table, which I was able to do, and then....nothing. Next thing I knew, I was lying on a different stretcher, in a different room, with a different gown on and someone was taking an oxygen mask off of me, and putting me on a nasal cannula (the little prong things that go in your nose). I was in a lot of pain, which I guess they anticipated, because someone handed me a little button, and said I could push it as much as I wanted for pain medication. Now, being a nurse, I know there is a lockout period, so you can't overdose yourself, so I must have asked that. They said it was set to dispense medication every 8 minutes. There was a blood pressure cuff on my right arm that kept squeezing every few minutes, so I decided to push the button every-other time the BP cuff went off. After three or four pushes, the pain had faded into the background, but by then I was becoming nauseated. Like clockwork, they asked me if I wanted medication for nausea. Yes, please! Once I had those nausea medications in, I was feeling pretty good. Good enough in fact, that when they got me up to my room, I was able to stand up and waddle over to my new bed almost all by myself... At this point, I was hooked up to two IV's, I had a foley catheter in, and I didn't know it yet, but there was a drain hanging off of the right side of my abdomen. But the only thing that was sore (and still is) was the incision on the left side of my abdomen. I later found out that's where my stomach was taken out. The rest of that day went by in a little bit of a blur. I wasn't allowed any water, or anything else by mouth, but they did give me some swabs, and some ice chips, which were a godsend. I remember going for a walk, up and down the hallway with my hubby later in the evening, but other than that, I pretty much slept in between being asked, like 10 times, by 10 different people if I was diabetic, and/or did I need to have a CPAP machine (no, and no). And that was pretty much Day 1. And since I'm pretty wiped out, I think I'll save Days 2 and 3 for another post...

Has anyone ever been lied to regarding the complications with the band? I was looking back at my lap-band journal to the notes I had taken when I was first looking at, and shortly after I got the band, and I feel like people were not exactly truthful, for instance, about complications. I feel like I need to vent a little and share the things that were told to me, 'cause I think it's unethical to misinform patients. 1. I was told that it's really rare for bands to have to be removed, although I see a disturbing number of surgeries here, to remedy slippage, infection, kinks, port repositioning etc. 2. When I asked about the port flipping, quite a few places said they'd never heard of it, and that the patients from whom I'd heard of this, must be mistaken. 3. When I asked about the port sticking out when people lose their weight, my surgeon said that would not happen, but I've already seen pictures of people whose ports show. 4. When I went to the fill doctor that my surgeon sent me, I asked if the doctor would be seeing me and they said yes, when I saw him in the hall and asked him a question, he said I could only be seen by his assistants, as I was a liability since my surgery was done by another doctor. 5. When I was researching clinics to do the surgery, a representative from NWWLS in Everett sent me gristly pictures of a supposed counterfeit gastric band that had been put in by a Mexican doctor and removed at the NWWLS. I google image searched the name of the image and found 3 other websites for bariatric surgeons claiming they'd removed the same counterfeit band themselves. I wish I could find the picture... it was scary and unprofessional. Anyway, those are the things I was told that were a little misleading. Have you guys ever been told stuff like that?

Hi Su. Yeah, I'm not surprised nobody at Dr. Amson's office got back to you. Their office admin is a mess - in fact it's one of the reasons I gave up on having gastric bypass. All worked out in the end, though - I am deliriously happy with my band and soooo glad I didn't go the RNY route, even if I did have to pay for the band myself. Worth every penny! In any case, it's possible that the support group offered specifically for Dr. Amson's patients might not accept patients who have had lapband or bypass done by another doctor (Amson only does RNY). However, there have got to be other, more generic bariatric support groups in your area, and it's just a matter of finding them. Hopefully if you can reach someone at Amson's office they can give you some info on that. Are you aware that there is a bariatric conference going on in Victoria the weekend of March 27-28? First of its kind on the island, apparently. It's called Beyond Bariatrics, I think, and anyone who's had any kind of bariatric surgery can go. Registration fee is $120 and includes dinner Saturday night. I'm attending. Google "beyond bariatrics victoria" and you'll find the link.

Posted 5th June 2009 Well, giving nuff thanks and praises, I've made it to 50. It seems really weird saying that. 50 use to seem such an old age. I'm optimistic about the future, I'm grateful to have made it thus far, and would now like to improve my health and quality of life. Later this evening I'll be celebrating with family and close friends. I've choosen an Italian restaurant located at Canary Wharf (Amerigo Vespucci). Tomorrow I'm hoping I can get a pedicure a spa treatments. Update: Today I have an appointment with the bariatric team, will I get my date today? Lets hope my blood pressure has gone down a bit. I really am excited that this could be the day, what a wonderful birthday present that would be. I've waited so long. I recently had an appointment at the hypertenstion clinic and saw for the first time Prof. Jackson, the consultation was fantastic, I left there for the first time hopeful and confident that he had a grasp on what needed to be done. My medications have been changed yet again. I've also been given treatment for anemia (iron tablets) if this causes me any complications such as constipation, they will do an infusion of iron. On another note my daughter and gran daughter are off on holiday for 3 weeks on Monday. Dajah is just 14 months and spends a lot of time with me. Oh boy,I'm going to miss her sooooo much, I'm already worrying about her - but I've not communicated that to my daugher, I just pray that they enjoy themselves and get back safe. Hyacinth.

This was one of my main motivations for surgery. My orthopedic surgeon very kindly say me down and told me that if I didn't lose weight I would be disabled. And it wouldnt be a matter of decades, but a matter of a few years before I was wheelchair bound. That, and knowing there were many more unseen, life threatening side effects to being morbidly obese pushed me to get a referral to a Bariatric surgeon. Sent from my iPhone using the BariatricPal App

Create in me a clean heart and renew a right spirit within me!

Dr. Susan Brinkley in Frederick, maryland is who I use. She is pretty good. She isn't a bariatric surgeon but she has a band herself.

Hi everyone! I am fairly new to app and appreciate all of your advice. I am currently covered under Tricare Prime and have been working with a civilian provider. Everything has been going very smooth. I originally decided to get the Lap Band, but after talking to several other patients, attending support groups and information seminars, and doing a lot of soul-searching, I've decided that the sleeve will be a better option for me. As many of you know, Tricare does not cover the sleeve surgery at civlian providers, but they will cover it at an MTF. I refuse to go to the surgeon at Winn (the MTF on the post we are on) because I had an AWFUL experience with him. He is the reason why my husband and I requested a civilian provider. I am half way between Fort Jackson and Fort Benning and am willing to go to either of these facilities to get the sleeve procedure. I was curious if anyone knows any MTF bariatric providers at the on-post hospitals on either of these bases? If so, please let me know. It is a four hour drive either way for me and don't want it to be a waste of a drive! Please help me!

1) My insurance had a 'no wt gain' stipulation and it was from my starting weight and I had 6 months required supervision. 2) My insurance approval was sent in after my last NUT appt. , I already had my physical clearances but had not had my surgery labs and EDG - those are scheduled after approval. 3) N/A - had Humana 4) If your insurance requires PCP approval, then yes a PCP can be biased and could stall your chances. BUT you can change primary physicians, or fight through the PCP's supervisors - everyone answers to someone. This has happened to people on bariatricpal, and they changed to another PCP. Mine wanted to send me to a Humana bariatric physician 2 hours away and I said NO. I will petition my insurance to go out of network - at in-network cost because that is a burden to go that far and it was approved. Good luck.