Search the Community

I had another surgery 2 weeks ago for an unrelated matter (giant lipoma removal on the upper back), which was 3.5 months after my sleeve. This surgery was shorter (1 hour), but still under general anesthesia. These were my first ever surgery experiences. Now that I've had the second one, I can tell a lot better which post-op issues were related to the bariatric aspect of the surgery and which were just general surgery things. I was exhausted for 4-5 days after both surgeries. I'm thinking that's just my response to general anesthesia. But with the WLS, some fatigue lingered for a couple months. My throat hurt like hell after both surgeries. After the WLS, I was more focused on the fact that mouth and throat were so dry because my surgeon didn't let me have any fluids by mouth for 2 days and the gross taste in my mouth from that leak test fluid they use during the surgery. After this surgery, since it hurt just as much, I realize that was probably mostly from being intubated. For both surgeries, my incisions didn't really hurt that much. With the WLS, I was thinking that was just because I was having so much pain from the gas and anytime I drank anything that it was just distracting me from any incision pain. But this time, still not all that much pain - like a 2-3 on the pain scale, even though the incision was huge this time - over a foot long. I find that really surprising - why doesn't it hurt more where they cut into you?!? One thing that was different is that for the WLS, it didn't hurt that much when they removed the drain about 2 days after surgery - just felt really funny. This time, it hurt like hell when they removed the drain at 9 days. In fact, it was the worst pain I had during the whole experience. It was a 6-7 on the pain scale and lingered for a few days. Maybe it was worse because the drain was in for longer? I'm curious how other people found their weight loss surgery vs. other types of surgery? Definitely curious to hear from people who got plastics, since these come with big incisions too. How was your pain and recovery time compared to your WLS?

This clinic reports their results for different BMI ranges on their website; results are shown all the way up to 5 years out. https://mercybariatrics.com.au/obesity-surgery-2/bariatrics-at-the-edge/low-bmi-patient/

I had gastric bypass in 2014. Has anyone experienced or know someone who has experienced a condition called "Iron deficiency WITHOUT anemia"? It is also sometimes called HWA (Hypoferritinemia without anemia). This is a condition where ferritin is low but hemoglobin, RBC and other related blood markers are normal . I am experiencing chronic worsening symptoms that are identical to iron deficiency anemia (weakness, fatigue, light-headedness, brain fog) but my Hematologist doesn't seem to believe this is a real condition. In other words, since my red blood cell count and hemoglobin are fine, he believes these symptoms are not due to low ferritin. Can anyone recommend a hematologist that has experience with bariatric patients in Maryland?

I know this question wasn't directed at me, but pain is all across the board. From what I can surmise after hanging out on bariatric boards for the last six or so years, most of us have little to no pain with this surgery, though. I had none. I was sent home with a bottle of pain pills which I never opened - I wasn't in pain and didn't need 'em. But if you're one of the unfortunate folks who has pain with this, you'll have something for it - so just take the meds as directed to keep on top of it. also, vitamin deficiencies are rare as long as you keep on top of your vitamins. There are some people (a minority) who have a hard time absorbing iron in pill form who have to get occasional iron infusions, but again, that's not common. As for other deficiencies, most people who have those are those who slack off on taking their vitamins. It's important to keep on top of those - and if you do, you're very unlikely to have any deficienies.

Hi everyone! I am 10.5 years post gastric bypass and I am finally pregnant! It's been a long journey. 2 years after WLS I found out I had thyroid cancer. Then we tried for a year and ovulation wasn't detected. We stopped trying and now 6 years later we are finally pregnant! Woo! I currently weigh 123, down from my high of 260! I also eat a fully plant-based diet and generally feel very healthy. I'm excited, BUT I am incredibly nervous. My PCP checked all my vitamin levels before we started trying and all looked great, except my B12 was high... I had some very short lasting and not heavy bleeding right around implantation, so I went last week for hcg level checks and it all looked great. I had a great meeting with a bariatric dietician, so I feel good about the nutrition part. I get my ultrasound tomorrow, and then in two weeks I'll start going to an MFM. In the meantime, I'm wondering if there is anything I should be asking or on the lookout for? Thank you so much! P.s. I also have pretty bad anxiety if you couldn't tell

He's posted some new content on there over the past year or so, but I think the bariatric basics were mostly covered in his initial set of videos. Wish he'd do more updates, though his books seem to have taken up where the Youtube videos left off. When I was looking for a nutritionist who specialised in plant-based nutrition for bariathletes, his clinic was extremely helpful and didn't even charge me. You can also attend their WLS support group without charge even if you had surgery somewhere else (in-person support group on hold right now because of covid-19).

Required fuel (yes, I'm referring to the bariatric "c" word: carbs! 😂) for distance cycling and running: raw vegan superfood squares, loosely inspired by these two recipes.

well, yes. About 30% of RNY'ers dump, very few VSG'ers do. But you were saying RNYers have more eating restrictions that VSGers. We don't. Granted, there are always going to be some people who are intolerant of certain foods, for example, some people become lactose intolerant after surgery (and this could be with either surgery), but in general, we can eat the same things. I do a lot of volunteer work at my bariatric clinic. The recommended diets are the same regardless of surgery.

While I cannot speak to Dr. Wizman or CSC - I can endorse whole heartedly Dr. Shillingford (and NW medical center) as one of the finest facilities, and surgeons in Florida for WLS. There is a complete recovery wing dedicated to bariatrics with a specialized team - A knowledgable, respectful and caring staff under the direction of Dr. Shillingford. My experience 1 year and 7 months out has been a positive and excellent one! I know five other individuals who would refer him without hesitation in their WLS journey. So sorry for your delay and these current precarious circumstances. How disappointing. That being said, Dr. Shillingford is worth the wait. Best wishes and much success. Keep me posted on what transpires.

I am a 40 yr old female, starting BMI 35, and I had the sleeve 4 months ago. I didn't have diabetes yet. But I was clearly on the fast track to get there in a few years. (I also had really bad fatty liver and high triglycerides since my early 20s.) My dad got diabetes at about the age I am now, and he's absolutely miserable now in his mid 60's. I was on metformin, I was hungry all the time even after eating, and my fasting blood sugar had been in the pre-diabetic range for 4 years and was continuing to inch up. Preventing diabetes was the MAIN reason I went ahead with the surgery. Looking better is nice and all, but I take surgery pretty darn seriously and would have never done it just to lose weight. Back in January, I read some articles about how bariatric surgery cures diabetes about 80% of the time. (It also causes similar significant reductions in long term mortality from other conditions like cancer.) 2 months later I went under the knife. I did self-pay in Mexico - you may also have to do self-pay since your BMI is low. Surgery certainly comes with risks, so don't let anyone make your decision for you (surgeons always think people should have surgery. 😂) But if I had it to do over again, I would have gotten the surgery about 5 years ago if I had known these facts sooner. Diabetes is a chronic, progressive disease. Even if it's relatively controlled (or even if you're not actually diabetic yet), the fact that your blood sugar and insulin is elevated compared to a normal person is causing damage to your body every single day. The sooner you treat it, the longer you're likely live and the healthier you're going to be while you're alive. My mom was pretty worried when I told her this plan, especially since I did it in Mexico. But after she talked to my sister-in-law, who is an endocrinologist, my mom felt a lot better. My sister-in-law tends to be the cautious type, but even she told my mom that I was the perfect patient for bariatric surgery, and that earlier was better than later for my long-term health. I googled around, but couldn't find any specific information about OCD and bariatric surgery. In general, obese people tend to have more psychiatric conditions than the average population, and on average, psychiatric conditions tend to improve a bit after surgery. However, surgery does about double the suicide rate. People also can struggle with their self image changing and things like that. I'd be sure to talk to your psychiatrist/therapist before and often about this, but I wouldn't necessarily let that hold you back. As far as the eating with clients issues, I think those are manageable long term. Especially if you go with the sleeve over a bypass type surgery, what you can eat won't change too much long term - you'll just eat less. At 4 months out, I'm having steak for dinner and enjoying the heck out of them - just 4 oz instead of 12. Men are less likely to get intrusive comments about their diet and body than women, so hopefully it won't matter much in the long term. You'll want to figure out how you'll deal with it in the first few months though, while your diet is still pretty restricted, and you might be dealing with pain or nausea when you eat. You could certainly tell people you recently had some other type of gastric surgery during this time. In fact, they often repair a hiatial hernia at the same time they do a sleeve, so it wouldn't even be a lie. Gallblader removal is also a common procedure that comes with dietary changes.

check out the blog "The World According to Eggface". She's a bariatric patient (had hers several years ago) and loves to cook. She has recipes for all stages. In fact, I think that ricotta bake recipe originally came from her site

I’m so late sorry! So I waited until my appointment so I knew what to get. I got the Bariatric advantage calcium chews, chewable procare health multivitamin & some chewable biotin pills from amazon.

I am finding that to be so true! I sometimes feel “hungry” after I began eating and believe it is acid (the gurgling). I did have atypical GERD before surgery (although my medication isn’t that effective since the ones that are were taken off the market due to cancer concerns or caused me diarrhea). I had read info from a Bariatric surgeon who recommended a gaviacon chew with each meal in the early months. Worth a try!

It’s 3:21am on July 6 and I leave for the hospital in 3 hours to have the sleeve procedure done. I have considered and deliberated the decision to get bariatric surgery for 4 years while I was in while getting my bachelors and now I’ve just graduated with my MBA. I’m 54 and have questioned “why now?”, “am I too old?”. The truth is I don’t feel or think of myself as 54 but my body won’t let me forget it. I’ve always thought that in all aspects of my life I was in full control but my relationship with food shows me otherwise. I don’t seek to be a size 2 from a size 22, I don’t imagine myself emotionally and spiritually any different however I am changing and will be changed by my commitment to put me first. This procedure is another tool to help me to make the outside match the inside. I expect some pain and small disappoints as I walk this journey but I know that changing my relationship with food is actually me changing my relationship with myself. I want to be the best version of me and the extra 100 pounds Is a burden on my spirit as well as my frame. I wish us all a safe and healthy journey as we step in to the next chapter of our lives.

Three people in the last week have commented about how tiny I am. One, in a nursery, said I was so tiny I’d fit in the plant pot I was buying. (That was a very odd & upsetting comment.) These were the first times anyone has ever used the word ‘tiny‘ to describe me. It’s so weird. I see just average in the mirror. I also bought a pair of skinny jeans - Aust size 6/US2 - and I swear they are so small they’d fit my 10yr old niece so I hear you @2Bsmaller18. Right before my surgery, I was approached to be part of a Bariatric study here in Australia. I agreed because I felt their findings could help others in the future but I have not heard a word from them in almost 14 months except for a letter thanking me for being willing to participate. I wonder if I’ll get a letter at some stage thanking me for my contributions.

This excellent annual conference is available for free online for everyone this year because of the pandemic. Great opportunity to learn from experts in obesity and bariatric surgery, thanks to the Obesity Action Coalition. Online registration details are here. Event Details The Obesity Action Coalition (OAC) is excited to announce that our 2020 Your Weight Matters Convention & EXPO has been transformed to YWM2020 – VIRTUAL! Once again, YWM will be bringing together the most sought-after health and weight industry experts to present science-based information in an easy-to-understand format, designed to help attendees navigate the complex topic of weight management…. all easily at your fingertips in a VIRTUAL PLATFORM! YWM2020 – VIRTUAL is offered as a FREE virtual event series that is crafted with a one-of-a-kind program designed to help individuals seeking answers about their weight and health. This year’s virtual program will allow you to dive into the science behind weight, while learning key strategies and gaining access to valuable tools. If you’ve simply wanted the answers as to why weight can be such a struggle, then YWM2020 – VIRTUAL is an event you won’t want to miss! Events Program Agenda and Schedule Click here to view the full schedule. Event Dates Event 1: Saturday, July 11 1:00 pm – 3:00 pm EST/10:00 am – 12:00 pm PST Event 2: Saturday, July 18 1:00 pm – 3:00 pm EST/10:00 am – 12:00 pm PST Event 3: Saturday, July 25 and Sunday, July 26 1:00 pm – 4:00 pm EST/10:00 am – 1:00 pm PST

... but not for the reasons you might think. I questioned whether I should make this post in the preop section or here, but since it's my first post on the forum, it might as well serve as an introduction as well. My apologies in advance for the verbosity, as I have a tendency to ramble. At age 54, I've been morbidly obese since I was a teen. I have no personal frame of reference as to what it means to be fit or eat healthily. Sure, there's the cognitive recognition of what those concepts are and what they should mean, but nothing in my own life experiences that are relatable. I'm 6'1" and at my heaviest weighed 410. Five years ago I was diagnosed with high blood pressure, which medication has fortunately kept under control. In June of 2019, when I weighed 385, I was diagnosed with Type 2 diabetes. It was at this point, that I realized I actually needed to do something about losing weight beyond paying lip service. I've been feeling it more in my knees and ankles the last few years, and the notion that should I ever need a knee replacement or other major joint surgery, that I would likely be denied due to my weight wasn't an enticing prospect. I've made token efforts at points in my life to dieting and exercise, but nothing consistent; nothing that "stuck". So I spoke with my primary physician about bariatric surgery options and started down this road. After consultations and doing my own research, I decided on the sleeve gastrectomy. Over the several month "trial period" (not sure what the technical term is), meeting with dieticians, the surgeon, the psychologist, etc., my surgery was approved and scheduled for mid April of this year... well, you can guess what happened. Thanks to COVID-19 everything was put on hold. I freaked out a bit at that point. My work schedule is such that certain times of the year are no-go as far as being away for extended periods. What if my recovery takes longer than expected? What if due to the quarantine and stress eating (believe me, it's a thing), I gain weight again and they kick me out of the program? Having all this uncertainty on top of all the uncertainty going on in the world... being in a high-risk group for COVID, the business I work for having to completely retool how it does business, the financial market crash (at the time), the civil unrest in an election year, etc.,put my head in a not very happy place. I'm also stressed by the fact that I have no immediate support structure in the event things go wrong (either medically or if I slip with respect to eating habits). I have no family, no significant other, and I live alone. Under normal circumstances, I'm perfectly fine and dandy with all three of those things, but for the first time in my life, I'm faced with the prospect of not having support when I might need it. I've never head surgery in my life, outside of two colonoscopies, which all things considered, I've been blessed in that regard, but again I have no frame of reference of what to expect and what to do in the event things don't proceed as planned. I've avoided reading many of the threads here simply because I don't want to read about worst-case scenarios, as I know that my mind will tend to drift there, and I don't want the negatives of what *might* happen to dominate my thoughts right now. So back to the present... at the beginning of June things started to open back up in the state, at least as far as allowing elective surgeries to be back on the docket. I'm scheduled for surgery on July 13. The 14-day preop diet (which I started on June 29) that my hospital prescribes is more restrictive than many others. No meat in addition to no carbs or fats. It's a 1000-1150 calorie per day diet. As someone who normally would eat 3000-5000 calories per day, that's effectively a snack. So I'm in the middle of day 6... and everything is fine. And I have no idea why. I *SHOULD* be frothing at the mouth, hangry, threatening to eat the neighbor's cats, etc., but for some reason I'm not hungry at all, and this cognitively makes no sense to me based upon my "normal" eating habits. I've been actually eating less than 800 calories per day, not even up to the recommended 1000-1150 calories. Breakfast: protein shake (30g protein, 140-160 calories depending on brand) Morning snack: Yoplait light yogurt (90 calories) Lunch: 12-oz pouch of steamed vegetables with garlic and pepper (80-140 calories depending on what mix I use) Afternoon snack: apple slices (50-80 calories) Dinner: Another protein shake (140-160 calories) Evening snack: another yogurt (90 calories) I'll mix in sugar-free jello (5 calories) throughout the day or some celery sticks as needed, and if feeling peckish will do an extra pouch of steamed vegetables. What's freaking me out is why I'm not freaking out... if that makes any sense. It shouldn't be this easy, and I worrying that I ma be lulling myself into a false sense of security/complacency. Or is my brain somehow making this easier on me, as somewhere deep down in the depths of my subconscious I fundamentally realize that I *have* to make this work? I don't know; it's hard to convey. I was at 351 on Sunday prior to starting the diet (and yes, I pigged out on Saturday and Sunday knowing what was ahead) and am now down to 339 as of this morning, which is a good thing. Just trying to get a handle on why my brain is operating the way it is... At any rate, good to be aboard.

There are *many* evidence-based clinical bariatric surgical and nutrition guidelines available to health care professionals. They are updated regularly based on the quantity and quality of the best available scientific studies. I’m attaching just one example here: it’s the most recent (2019) guideline provided by the American Association of Clinical Endocrinologists, The Obesity Society, American Society for Metabolic & Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologist (and endorsed by the American Society for Nutrition, American Society for Parenteral and Enteral Nutrition, International Federation for the Surgery of Obesity and Metabolic Disorders, International Society for the Perioperative Care of the Obese Patient, and Obesity Action Coalition). In my experience at the intersection of biology and medicine, I've observed that eminence-based medicine tends to be the rule, not the exception. Medicine functions in the gulf between ideas/beliefs and science. Science is based on doubt. Medicine is a road built upon a foundation of good ideas and beliefs put into practice, but it is also a road literally paved with the cadavers of every good idea and belief that didn’t pan out. Even when they do pan out, they still need to be meticulously studied and regularly verified and updated to determine precisely how, why, and which patients benefit the most and the least. The results are not straightforward because bodies are not straightforward: there are incalculable external/environmental variables that are constantly in flux colliding with incalculable internal/genetic variables that are constantly in flux. I don't know any good scientist or clinician that wouldn't trade everything they know for everything they didn't know in a heartbeat. All researchers and practitioners, including bariatric clinicians, should ideally continually examine and assess their own results, making changes where and when necessary, to ensure they are delivering the best outcomes for their patients. Even though this inevitably leads to variations in form -- but not function -- it's just good medical practice. Clinical Practice Guidelines for the Perioperative Nutrition, Metabolic, and Nonsurgical Support of Patients Undergoing Bariatric Procedures 2019 Update.pdf

You're welcome! My clinic -- and it's not alone in this -- also advises patients to be cautious about where and how time is spent on online bariatric forums. The main reason is that they are rife with false and inaccurate information, and BariatricPal is no exception. It's not as unbridled as Facebook, but it's still social media: brimming with opinions and beliefs and thoughts, not evidence-based science and medicine. Given the vulnerabilities many bariatric patients face in the immediate pre-op period -- but especially the hormonal, emotional, and interpersonal vulnerabilities that can arise during the post-op period -- and the numerous studies correlating the link between social media use and stress, anxiety, and depression, perhaps it would be wise to limit time on bariatric forums in order to mitigate the potential stress-cortisol-nutrition-weight connection.

Thank you both so much, I really appreciate the compliment! Confession: I do sell photos (just not for a living) and also had a food blog for many years, so have taken a food pic or two before 😉. I haven't updated it for a number of years now, but let's just say that I never used tricks such as hairspray or glue to enhance anything: I cooked the food, styled it naturally, then ate it afterwards... now here I am on a bariatric forum, so we'll leave it at that 😂😂😂😂. I kept a few of the food styling props like dishes and bowls, and have a good camera, lenses, lights, reflectors, etc. Since I haven't been able to do photography outside of my home during the pandemic, I set a goal of taking a photo a day during this time just to keep up -- and hopefully improve -- my skills. Sometimes it's food, but usually it's not 😊.

In her essay, Gay described the decision to have bariatric surgery as "the last straw", clearly a pragmatic choice shaped by a lifetime of cultural and personal indignities and abuses. Her exquisite honesty is balm for a crude world, and a lesson in humanity. Attitudes and decisions about weight, body image, and health are profoundly personal, but burdened and fraught. Many people make the arrogant assumption that they have a vote in what obese strangers – particularly women – decide to do (or not do) with their bodies, something Gay herself doesn’t subscribe to. She's never condemned the choices of other women, advocates for (and fully embodies) having painfully honest conversations, and makes it abundantly clear that she has "nothing but empathy for anyone who decides on weight loss surgery... or not." Weight management, including bariatric surgery, is a complex, multifactorial decision, just as obesity is a complex, multifactorial disease. It should begin and end with respect for the individual, with the goal of improving health – nothing more, nothing less. It was the right decision for me at the right time in my life, but I fully identify with the ambivalence, the resentment, the resistance to surrendering, and the replacement of one set of anxieties with another – and this is without the unimaginable, colossal pressure of worrying about publicly betraying fat positivity.

Stomach Intestinal Pylorus-Sparing (SIPS) surgery has been around for about 8 years. It's a simplified DS procedure, and lots of bariatric surgeons perform it. Long term SIPS outcomes are similar to any other bariatric surgery.

You have difficult decisions to make and it’s completely understandable that you’re obsessing about all of it – how could you not? I, too, am a strong advocate of the “think a million times, cut once” philosophy. With regard to being a pioneer patient, from extensive research conducted prior to my own bariatric surgery, and as a medical scientist, please allow me to offer an assessment: no surgeon would select a ultra-low or even low-volume surgeon for him-/herself or his/her relatives for any surgery. The correlation between high volume and quality of surgical outcomes is empirically well documented, meaning that the outcome of every surgical procedure is directly dependent on the number of operations performed at a given hospital as well as by the designated surgeon. In other words, the higher the number of operations of a specific type a surgeon performs, the more likely optimum treatment results and low complication rates are achieved. This fact is supported by a large volume* of studies and meta-analyses that have been conducted, peer-reviewed, and published between 1979 and 2019. Because of comorbidities and lower cardiopulmonary reserve thresholds, bariatric patients are often high risk patients. In complex procedures like bariatric surgery – and particularly with riskier procedures such as RYGB, BPD/DS, and SIPS – it is worth paying extra attention to the correlation of procedure-specific skills of the surgeon and the complication rate. Since you’re several months away from surgery, I’d encourage you to keep researching extensively, and talk with as many people as possible who have recently had DS and VSG, and particularly those who are at least 5 years out from both surgeries. I hope that by the time you reach a final decision, you’re able to do so with clarity and a sense of ease. Wishing you all the very best! ****** *A small sampling of available data includes: 1. Zevin B, Aggarwal R, Grantcharov TP: Volume-outcome association in bariatric surgery: a systematic review. Ann Surg 2012;256:60-67. 2. Nguyen NT, Paya M, Stevens CM, Mavandadi S, Zainabadi K, Wilson SE: The relationship between hospital volume and outcome in bariatric surgery at academic medical centers. Ann Surg 2004;240:586-593; discussion 593-594. 3. Birkmeyer NJ, Dimick JB, Share D, Hawasli A, English WJ, Genaw J, Finks JF, Carlin AM, Birkmeyer JD; Michigan Bariatric Surgery Collaborative: Hospital complication rates with bariatric surgery in Michigan. JAMA 2010;304:435-442. 4. Birkmeyer JD, Finks JF, O'Reilly A, Oerline M, Carlin AM, Nunn AR, Dimick J, Banerjee M, Birkmeyer NJ; Michigan Bariatric Surgery Collaborative: Surgical skill and complication rates after bariatric surgery. N Engl J Med 2013;369:1434-1442. 5. Chowdhury MM, Dagash H, Pierro A: A systematic review of the impact of volume of surgery and specialization on patient outcome. Br J Surg 2007;94:145-161. 6. Luft HS, Bunker JP, Enthoven AC: Should operations be regionalized? The empirical relation between surgical volume and mortality. N Engl J Med 1979;301:1364-1369. 7. Birkmeyer JD, Siewers AE, Finlayson EVA, Stukel TA, Lucas FE, Batista I, Welch HG, Wennberg DE: Hospital volume and sugical mortality in the United States. N Engl J 2002;346:1128-1137. 8. Amato L, Colais P, Davoli M, Ferroni E, Fusco D, Minocci S, Moirano F, Sciatella P, Vecchi S, Ventura M, Perucci CA: Volume and health outcomes: evidence from systematic reviews and from evaluation of Italian hospital data (Article in Italian). Epidemiol Prev 2013;37(suppl 2):1-100. 9. Pieper D, Mathes T, Neugebauer EAM, Eikermann M: State of evidence on the relationship between high-volume hospitals and outcomes in surgery: a systematic review of systematic reviews. J Am Coll Surg 2013;216:1015-1025. 10. Al-Sahaf M, Lim E: The association between surgical volume, survival and quality of care. J Thorac Dis 2015;7(suppl 2):152-155. 11. Maruthappu M, Duclos A, Lipsitz RS, Orgill D, Carty MJ: Surgical learning curves and operative efficiency: a cross-specialty observational study. BMJ Open 2015;5:e006679. 12. Schrag D, Panageas KS, Riedel E, Cramer LD, Guillem JG, Bach PB, Begg CB: Hospital and surgeon procedure volume as predictors of outcome following GI resection. Ann Surg 2002;236:583-592.

Hi, I’m going through Kaiser too. I’m in San Diego. Down here the protocol once done with 12 week classes is second set of labs, then appointment with psychologist, then appointment with surgeon, and then that department will submit to my insurance for approval. Once I get approval it will say if I get a Kaiser surgeon or a Scripps Surgeon. Kaiser is contracted with Pacific Bariatrics through Scripps Mercy. I have already done majority of steps but I’m waiting on my last appointment with the psychologist so I can finally meet with the surgeon. I’m almost there! How did your appointment go?