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One of the individuals in our bariatric surgery group meetings went from a lapland to bypass and lost about that much weight. His band started to eat through his stomach so he had to have it removed. He was pleased with the RNY surgery results.

My Bariatric team had me get a bone density scan as a baseline and intends to repeat periodically to watch for bone complications.

It seems like the recommendations for RNY gastric bypass and Duodenal Switch surgery patients appear to be those that my surgeon follows. Supplementation after gastric bypass should include calcium citrate 1,200–1,500 mg/d, which can be taken in 2–3 split doses, 4–5 hours apart for optimal absorption. Minimum Vitamin D intake of 3000 IU/d, titrate to >30 nl/mL. Calcium citrate is preferable to calcium carbonate due to better absorption in the absence or reduction of gastric acid. Supplementation after BPD and BPD/DS should include calcium of 1800–2400 mg/d and minimum Vitamin D 3000 IU/d, titrate to >30 nl/mL. After RNY and Duodenal Switch, there are a lot of Vitamins required daily. The calcium tablets are a major inconvenience because they taste terrible (just like eating chalk), must be spaced apart throughout the day and one has to take so many of them. As a result, I had one individual in our bariatric support group meeting say they were no longer going to take Calciums. I even cut mine back a little. But when I had my annual blood tests, they found I was on the low side and recommended that I take more Calcium. THEY GOT ME. I WAS CAUGHT. So I went back to their required dosage rates. I guess the main point is that after these types of surgery, the requirement to take supplements span for the rest of our lives - PERIOD, NO EXCEPTIONS.

My sleeve was done by Dr. William Johnson (http://www.atlantabariatriccenter.com/meet-the-atlanta-bariatric-team/meet-the-surgeons) at Johns Creek Emory Hospital. My experience with him and that practice was great. My neighbor and her daughter had bypass surgery done by Dr. Hart at the same practice. Good luck with your sleeve experience. I had mine done back in November and it has truly been a life-changing experience.

And I'm so excited! I've spoken to the staff of Dr. Roberto Rumbaut and also to the staff of Dr. Miguel Zapada-- Dr. Z looks to be a bit cheaper and still highly recommended, so I'm guessing he wins this race. I've researched both surgeons as extensively as I can and asked all of the questions from the sticky about Mexican bariatric surgeons... I feel comfortable with either . Also... And THIS is a biggie... I've convinced my husband that going to Mexico is NOT "sheer idiocy" (his original wording) but rather a necessity as our health insurance is worthless in this case. I don't think he LIKES it, but... He IS willing to accompany me (I have a 6 month old nursling who'll have to be tended to while I'm in surgery-- he's gotta eat!). I'm waiting on a check in the mail before I book my surgery... And then it'll probably be about 6 weeks out as I need a deal on airfare and without booking 6-7 weeks in advance, the prices are just a bit steep for me. Now... I'm just want that check to GET HERE! It could take another couple of months, though (geez, I hope not!), so... For now I'm going to work on cutting all caloric drinks out of my diet as that could be a big problem-- even banded... And I'm going to start stocking up on Protein drinks. I hear Isopure plus is the best tasting? I'm just ready to get it done, now... I'll be stalking my mailman even moreso now!!!

Thanks everyone for your encouraging words I hit the gym hard today re packed my refrigerator with much needed fruits and veggies got a weight in to my surprise I'm up .4 pounds feeling a lot better its must be the hard work from last month that saved me feeling renewed and highly motivated

I am seeing his practice partner Dr. Chiasson in Tucson with The Southern Arizona Center for Minimally Invasive Surgery. They go through Northwest Medical Center which is "Bariatric Surgery Center of Excellence". They train other surgeons. So far so good. Insurance is paying mine. Yes the cash price is roughly $18k. I have also heard people like Dr. Robin Blackstone in Phoenix.

I am 40 years old and have been diagnosed with chronic heart failure. My cardiologist recommended bariatric surgery because of my bmi and co morbid conditions. I have already met with the surgeon at the University of Utah where I get most of my medical care but my insurance will pay me $500 to have it done elsewhere. I have now been through the beginning portions of the weight loss program at a different hospital and have my "pre op" appointment on August 26th. I hadn't considered the duodenal switch because the university doesn't offer it but the new hospital does. After all of my research, I feel relatively confident that this is the most appropriate choice for me. However, I can't find much information on the best surgery for CHF patients(if there is a difference). Most people with CHF don't seem to be able to have surgery because of the risks, primarily of anesthesia. I have had 11 surgeries including 1 in October. I don't see this as being an issue for me and the cardiologist is the one who recommended the surgery. Has anyone dealt with this?

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

I have my surgery scheduled for June 5 in San Antonio with Dr. Patel of Texas Bariatric Solutions. Any Texas buddies out there?

Oh gosh. I am going for my 1st appointment at Bariatric Solutions this week. I chose them because their reviews were all 5's. Now I am a little concerned. Maybe I should cancel for another place?

I'm going to KC bariatric which is through Shawnee mission Med. Sent from my iPhone using the BariatricPal App

So I did not end up falling into the crowd of people who claim they now find some foods totally gross and difficult to even ponder. Not even one. I think I have pre-surgery eyes, and well, a three-month post-op sleeve. I feel like this could cut either way... On the one hand, unaltered taste buds and a resulting appetite (even with dramatically reduced ghrelin production) that really doesn't differ from pre-surgery hunger levels, at least if you wait long enough to eat, coupled with conscious bariatric diet adherence could cause your brain to resist and reverse all of your efforts to reach a healthy weight, since it still senses deprivation, even though the ghrelin language is no longer available. It can presumably play with your emotions and your stability, not to mention complete obliterate your metabolism, unless you, so to say, put your money where your mouth is and provide the foods about which you are ruminating. On the other hand, having unchanged tastes could be a blessing in disguise. Unless we are talking about blatant slider foods that provide no satiety, I feel that providing small amounts of all the things that keep coming to mind, assuming they are appropriate for one's stage of the post-op progression, trick your brain into thinking you are still overeating, just like it wants you to. I think this is the main benefit of the sleeve...a mechanism that cooks the books and lies to your brain about its calorie finances, which will keep it fooled as long as you are eating the stuff that keeps coming to mind. In other words, you brain can sense the presence or lack of certain types of foods, but cannot accurately sense the calorie value of them...it just assumes it is as high as it was before. Your metabolism may even increase with weight loss (up to a certain point) in the way it did when you overate in the past (assuming you hadn't just done a diet from which your body was attempting to recover), except that your brain is now spending calories it won't actually get back. Does anybody else find this latter scenario working for them? Again, I am not trying to encourage people to give old, unhealthy habits another look, but as to foods that actually promote satiety (non-slider), I have found that small amounts are perfect to avoid derailing completely.

Lots of things kinda weird about this. Start with the CPT codes for all three procedures mentioned. I think they are: VSG: 43843 Band: 43770 RNY: 43644 Then call the customer service # of your insurance provider and ask the person who answers to look through your plan and tell you the BMI requirements for each procedure. I advise doing this to start because usually the BMI requirements are the same (per provider) for all three procedures, and are based on FDA guidelines. I think for all three, it's currently a BMi of 40+, or a BMI of at least 35 with 1+ (or 2+) comorbidities. When they do require higher BMI, it's usually because they aren't yet recognizing the sleeve as a standalone procedure. Do you know if your insurance covers VSG as a standalone bariatric procedure? The other part that's weird is that your surgeon's office, I would hope, would have obtained the insurance requirements and informed you up front if your BMI was sufficient or not. You should not be finding out 6 months later that you never met the criteria to begin with. Or are they considering your weightloss during the last 6 months to be the loss that made you now ineligible? What was your BMI then & now? I was initially denied for the sleeve. I wrote my own appeal, my surgeon's office submitted it, and the procedure was approved about 3 days later. Long story short I ended up having to start over with a completely different provider, totally back to square 1. I just made sure they didn't have a chance to deny me this time.

Gummy vites bariatric iron chew and castrate calcium

I'm taking Flintstones complete chewable vitamins, Bariatrics advantage calcium citrate & Bariatrics advantage b12 sublingual.

Meal Replacements in Bariatric Protein generally means the protein is fortified with additional vitamins, minerals, fiber, calcium, Iron etc. Meal replacements are great pre or post-op when you're not eating normal meals. Meal replacements like BariatricPal Protein One, actually replace your regular bariatric vitamins and you can use them long term.

I always used the entire Syntrax packet as one serving - not sure about this 1/4 packet business - but I'd noticed that as well. I can't imagine most people drink less than a packet. One packet has around 100 kcal and 20-ish grams of protein, although it may depend on the flavor. most people ditch the protein shakes after the first few weeks or months (and you can as soon as you're getting all your protein needs met by real food), but some people keep up with them. They include: 1) people who malabsorb protein (like me). My protein needs are much higher than the normal bariatric patient, and a shake or two a day helps me meet them 2) people who can't stomach solid food in the morning. Some of them do a protein shake for breakfast instead 3) people who just flat-out like protein shakes (and there are some out there...)

ok ladies thanks for the advice. i called my bariatric office friday afternoon and asked if i need anything else besides mental health, and also to get an idea of when i would have surgery. the lady who runs the office is who i spoke to (i had been speaking to someone else every time i called in) and she helped me out. i asked her for those lab results. she got to looking and guess what? all they ran on me was vitamins! she was not happy. she told me she was going to have to see why the np only ran vitamins on me and left everything else off. low and behold she called me yesterday to let me know she had talked to the np and they were going to get the rest of the labs from me. so i did them today and it was like 6 different things including the hpylori that i've been so curious about. i also found out from her that i should be having surgery the first part of july which is certainly exciting. just wanted to update =)

*waves to Bariatric Pal Folks* I'm in the final stretch of the pre op six month trial period! Just had my pre surgery appointments (breast exam, GI exam, Psyche etc.) scheduled this June and I'm very excited! I liked having the time before hand as I've gotten to know the weight loss staff very well from January of this year to now. I've been focusing on getting as fit as I can before surgery so the healing will be that much better. I've gone from a 49 inch waist in January 2016 to now a 43 inch waist! Gained lean mussel mass and trimmed up all over. One thing i look forward to is not feeling so tired after workouts. Lord you should see my sweaty mug after walking out yawing. :-/ I mean I feel better, but yea I won't miss the post workout ZZzz. I've been in the 200's for almost 12 years now and almost got to 199 but shot back up due to medications. Been preparing for surgery for ten months now and I'm very excited. Here is my workout regimen I currently am on: I typically will spend 12 minutes on the stair stepper and 15 speed walking at 3.5 mph or on an elliptical stair stepper for 30 minutes or 30 on the treadmill speed-walking. I try to mix up the cardio as much as I can, same for the weights. The machines I'm on are hammer strength MAS incline press 1 set of 15 with at 30 pounds and I rest for 120 seconds (yes I count) The the ISO Lateral Low Row 2 sets of 8 reps with 25 pounds on both ends again I rest for 120 seconds The ISO Lateral Front Military Press (I love this machine ) 2 sets of 8 with 25 pounds on both ends rest for 120 seconds Lateral Bench Press again 25 on each end and 2 sets of 8 reps sometimes 25 reps depending again 120 second rest between each set Squat Machine 8 reps at 80 pounds and sometimes another 4 reps. I take this machine slow and controlled to avoid injury and because my coordination is not that great. On the other days I use the leg press machine in place of the squat machine 3 sets of 8 reps rest of 60 seconds between each. I use the abductor machine (looks weird but works) 3 sets of 8 at 60 pounds. (I switch up the days for this machine too.) And every time I go to the gym I finish off the weights with the pull up/dip machine I am in lust with this thing! My goal is to be able to do a pull up one day without any counterweights! Then it's ab work for about 10 minutes to finish up with stretching for 15 minutes. I get to the gym about 3 to 4 times a week, but this is usually what I do while there.

No, you're not the only one. There's a pretty good explanation, too. I did a little research: Researchers at the University Hospitals of Leicester looked at the relationship between taste, smell, and appetite among 103 patients who’d undergone gastric bypass surgery between 2000 and 2011. Nearly half of the patients polled reported their sense of smell changed following weight loss surgery and 73 percent noticed changes in the way food tasted. Topping the list for patients experiencing taste changes is increased sensitivity to sweet foods and sour foods. Reduced tolerance and cravings for sweets and fast foods are common changes are reported by many patients. Some patients may become so sensitized that even Protein Shakes and powders taste overly sweet and are difficult to tolerate. (Some tips that may help include thoroughly chilling the Protein shakes to improve taste.) Food aversions usually develop immediately following surgery and may lessen or disappear over time. In studies, animal Proteins top this list with patients steering clear of chicken, steak, ground beef, lamb and cured meats like bacon, sausage, and ham. eggs, dairy products including ice cream, cheese and milk and starches such as rice, Pasta or bread also ranked high on the list of disliked foods. Interestingly, very few patients reported aversions to fruits or vegetables. Some patients even report loving veggies like broccoli or cauliflower even more. Patients may feel turned off to foods for a variety of reasons including smell, appearance, texture or consistency. Sometimes a change in preparation method can help improve tolerance. Simple adjustments like stewing meat instead of baking or grilling and poaching eggs instead of frying may prevent the often-reported feeling of food “sticking” on the way down. While the exact cause is unknown, many experts believe sensory changes occur as a result of fluctuating hormones in the gut and their effects on the central nervous system. This gut-brain axis as it’s known and its relationship to bariatric surgery is a subject of much research and speculation. In a nutshell, the nervous system relays countless transmissions about your hunger, satiety, and cravings each day between your GI tract and your brain. Because the carriers of these messages are affected by changes in weight and the removal of a portion of the stomach, it is highly likely they have an impact on taste, smell, gratification and other sensory perceptions. Leptin and ghrelin are hormones that are known to have a prominent role in the relationship between hunger and satiety. Ghrelin also plays a role in determining how much of what we eat is burned for fuel versus stored as fat. Weight loss alone results in an increase in ghrelin, which explains why we tend to feel hungry as soon as we restrict calories and begin to shed pounds. Surgically induced weight loss, however, in which a portion of the stomach is removed or bypassed, reduces the production of ghrelin while restricting the volume of food consumed. This unique combination explains, at least in part, why bariatric patients are able to eat less but not feel hungrier as a result. Leptin also plays an important role in telling your body when you are full and how calories are stored. It is believed that weight loss improves the body’s sensitivity to the messages leptin delivers to the gut and brain. This, in turn, may result in greater food satisfaction with smaller quantities and less flavor intensity.

I've really been struggling for the last 2-3 weeks. I had RNY on May 11/15. As of today I am 178 lbs, down from 250 lbs (72 lbs). At 5 & 1/2 months out I feel I should have lost a little more. My weight loss has been quite slow since about the beginning of August. Today I finally came out of a 3 week stall. However, I know that the slowed weight loss is entirely my doing. My appetite has definitely returned and I have been making bad choices quite regularly over the last month or so. I do fairly well during the day, although I have had a slice of pizza more often than I should. However, it's mainly the evenings that are my downfall. After the kids are in bed and chores are done I end up snacking and the Snacks have changed from veggies & fruit to chips, pretzels, popcorn...anything salty and crunchy! I know it's not wise and everyday I tell myself today I won't succumb to the cravings...but I really feel like I'm losing the battle. I truly don't want to screw this up but it's so hard! I've recently joined a gym and have a personal trainer who requires that I keep a food journal but even that doesn't seem to be helping! I am due to see my nutritionist as well as the bariatric centre's psychologist in a couple of weeks and I'm hoping that they will have some support and tools to offer. I just don't know how to wire my brain to keep the motivation. Feeling so down.

I'm wondering if anyone else is having to complete the following checklist from their PCM with Tricare Prime? I'm actually Tricare overseas Prime Remote. I just spent the entire AM on the phone trying to explain that this is not the requirements per the Tricare Manual Chapter 4 Section 13.2. After I couldn't get a clear explanation on how they came up with this checklist through International SOS (3rd party used by Tricare Prime overseas for referrals) I spoke with the regional Tricare office in Germany. I was informed they came up with this checklist so "not just anyone" could get the surgery. I was then informed I could just go to the PCM and have them submit a letter addressing my Hx of attempts, comorbid Dx and etc. But was informed approval was on a case by case basis and if denied could appeal. (Duh Rolling eyes) So aggravated that the requirements are not the same across the board for Tricare Prime. I'm 5'1 and approx 198lbs with sleep apnea. I'm aware that b/c I'm not 100lbs overweight according to Metlife charts I will be denied although my BMI is and has been above 35 with the comorbidity for >5 years. I have tried every diet known to man as I'm sure you all did too. I loose the weight but it never stays off. We have been overseas now for 6 years but I don't have the documentation they are requesting in my medical record b/c we are remote (not at a MTF) and these diets are not covered by Tricare therefore paid for out of pocket. I also recently read in the Fed Recorder that the requirements will change from the Metlife Chart to BMI on 3-16-2011. Anyone else aware of this and have spoken with Tricare in regards to the change. Right now I'm afraid that I've stirred the pot too much and will be denied just for demanding where they came up with this checklist. If anyone has a better contact through Tricare I'd love the name and number. Any advice is appreciated. Wish me luck. I plan on seeing a PCM on the 16th of March and keeping my fingers crossed. Step 1: Patient Review (All items must be checked by the PCM and applicable to the patient) Documented morbid obesity for 5 years. Meets definition; body weight is 100 pounds over ideal weight for height and bone structure, according to the most current Metropolitan Life Table, and such weight is in association with severe medical conditions known to have higher mortality rates in association with morbid obesity; or, the body weight is 200% or more of ideal weight for height and bone structure. List any co-morbid conditions: ________________________________________________________________________________ DEROS date at least 12 months from the anticipated surgical date. Date of DEROS: _____________ Participation in a documented nutrition/exercise program for a cumulative total of 6 months with documented ability to lose 10- 15 lbs within the last two years. (Patient‘s inability to comply with a diet and exercise regimen prior to surgery indicates poor compliance and an increased risk of adverse outcomes) Comprehensive evaluation and review of significant medical or psychiatric history by their Primary Care Manager (PCM), surgeon or mental health professional/counselor indicating good candidacy, readiness for bariatric surgery, and confirmation of positive family support system. Education regarding the need for lifelong follow up. The patient has been advised that TRICARE policy does not cover breast lifts, thigh and arm reduction, and that a panniculectomy must be deemed medically necessary to be covered by TRICARE. Step 2: Post-operative Management Primary Care Manager must acknowledge capability to provide appropriate post operative medical management to include: (all items must be checked in order to be considered for approval): Dietary Counseling Mental Health assessment or referral Laboratory assessment plan for possible nutritional deficiency _________________________________ __________________________

Maybe call the bariatric practice and ask what all tests you should ask for, and then go and request them through your primary doctor so they are covered. I am sure the bariatric center would be happy to try and work with you if you call and explain the situation. I'm sorry this is happening!

I've recently had a horrible experience, need to vent, and wondered if anyone else went through something similar. This past Sunday, I got stuck and vomited. Not the first time it's happened, so I expected to spend the next couple days on liquids. Monday morning I tried a couple sips of warm tea and it came up almost immediately. I called my MD's nurse and explained the situation; she asked me to come in Wednesday at 1PM and she would get me worked in. (My MD is in the clinic all day Monday and half a day on Wed/Fri, other days he is in surgery, doing rounds at the hospital, or at a nonbariatric clinic right on the same block as the bariatric clinic. Also, he is the only person who does fills/unfills. He has no partner or another person trained.) I agreed with her suggestion thinking that the band would loosen up enough to dring at least by Tuesday morning. Unfortunately, I was wrong. I couldn't swallow my own spit much less Water. So, I called the clinic again on Tuesday. By this time I'm desperately thirsty, I've lost 10 lbs since Sunday, I'm vomiting up what little spit I'm producing and accidentally swallowing at least every 2 hours. My temperature is over 100 and my skin turgor is getting worse; my eyelids and skin over my knuckles would stay up in a little peak if I pinched them. I was peeing in small amounts sporadically. I knew I was dehydrated and voiced my concern to the nurse. She responded that he was in surgery all day, and she would try to get ahold of him. And, if she didn't call back, come in the previously arranged time on Wednesday. I responded that I didn't think I could wait that long. Her answer to this was to go to the ER. I was astounded! During the year and a half that I've been a patient, the MD and staff have constantly hammered into me to just give them a call if I need anything . I take this to mean that if an urgent situation like this arises, I can call and get their help quickly. I was very wrong. She did call back and told me to be at the clinic at 0830 Wednesday morning; the MD would come in between hospital rounds. I was so tired by this point and agreed. The next morning my husband drove me to the clinic (by this time I'm very weak, I'm down 12 lbs d/t Fluid loss). I check in and am told that it could be one hour or even three hours before he comes by. By this time I'm so tired and dispirited that I can hardly think. I burst into tears and say I'm going to have him take out all of the fill, I haven't had anything to drink in nearly three days, I've tried to get an appointment for the past two days, my husband has to be at work at 10, etc... I can't even completely remember everything I said, my brain was so clouded. I sit and the desk clerk tells me he has been paged. By the time I see him, it's nearly 11AM!! I had him take all of the fill out although he was initially going to just take a bit out to "decompress", but I insisted. I have a one-month appointment made, but I'm really debating going back. I love my band and don't regret having it done, but don't wish to risk a repeat of this experience. I am about 20 lbs away from my healthy weight and have learned a lot of great habits, so I don't doubt that I could do it. It would just be more slowly. Has anyone else had an experience like this? How did your doctor respond? Sorry so long and thanks for reading:redface: