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My mom was shocked and to her it came out of nowhere. She is a nurse, so her first question is always credentials. Mine was covered by insurance and she calmed down a bit when I told her I was at a bariatric center of excellence. But everyone in my family has at some point struggled with weight, so after the initial shock wore off, she was curious about it, particularly for my older brother who is over 300 pounds and has diabetes. I've sent her a lot of information; the biggest problem is that he would need to change his lifestyle and based on his current choices unless he was ready to do this he would probably just "eat around the sleeve or band." I feel like a jerk for even saying that, but what I really mean is that I feel like this surgery has a much greater chance of being successful if *you* are the one who wants it. Not if your mom tells you to get it. LOL The other piece of this is that I didn't tell her until I was approved, and once I was approved my surgery date was scheduled for the next week. So she had NO time to get used to the idea and then it was a done deal. I don't know if others have this issue, but my mom is also the slightest bit competitive. I don't know that she would even recognize it, but for example when I got my master's degree at 38, she told me she had gotten hers at 36 or 37. (Really??) She lost a whole lot of weight doing a liquid/protein diet, watching intake very carefully and taking appetite suppressants. This was a few years ago. Since then she's probably put back on about 20-30 pounds, but she is still much healthier than she was. So one of the things I said to her is, "I admire what you've done, but I don't want to be doing that in my 60s. I feel like if I can stop this in its tracks now I will be much happier overall." And she said that yes, she wished she had been able to accomplish it in her 40s or earlier. Moms.

Anyone here having their Surgery at the University of Penn Bariatric? Philadelphia

The hosp sold me the bariatric advantage. A huge sack of it for $100+. Latte flavor What a waste.

Most people are Vitamin D deficient. It's more a "3rd world" issue than anything else. For the most part we work in offices and rarely get enough natural sunlight because we no longer live in hunter- gatherer societies. Unless it's at dangerously low levels I wouldn't worry about it. However, most people will be asked to take the supplements. I've noticed recently this has become an issue with people who have had sleeve surgery. According to what I've read on American Society for Metabolic & Bariatric Surgery *Scroll down to table 5 vitamins and supplements are necessary. However I'm learning that my doctor tends to be more on the cautious side than other people's. Personally I'm okay with that as I have a virtually carefree surgical course and post op. I will ask them when I see them next month. It may indeed be a case of the sleeve surgery being too new to truly know.

So I guess this works as double duty - an introduction and a (kinda) question. I am a Registered Nurse...a very fat nurse! And I've been that was (fat, not a nurse ) for almost 13 years. I've done diet after diet. Acupuncture, moxibustion, hypnosis. HCG to the point I got gallstones. And each year, my weight just keeps climbing. I'm ashamed to say that the only significant weight loss I had was after I had met the love of my life, and then lost him...(but later found him...and my lost weight, grrrr!). I have stereotypical PCOS and Metabolic Syndrome (hello, black hairs on chin - I grow an impressive beard!), so that has exacerbated my weight issues. I started seriously looking into bariatric surgery 6 years ago, but didn't like the available choices of RNY, DS and then LapBand. Over the intervening years, I decided to try to get a LapBand anyways. I had one of those insurance companies that required a 6 month supervised diet, consults, etc...I jumped through all the hoops, found a surgeon I liked...and then he quit! Left private practice to accept a teaching fellowship. I was very bummed. So I figured this was my clue to try dieting again. So I went back to more failed, frustrating dieting. About this time, I was diagnosed with diabetes, which complicated matters even more. After nearly a year, I decided to go the LapBand route (again!). All my previous tests had expired, so I had to do the 6 months supervised diet and consults again...then got turned down by insurance due to an exclusion...the appealed and won!...set a surgery date and then got very, very ill. The chest xray that was done the week before my surgery showed a shadow in my lungs, so I had to see pulmonary, etc. Turned out to be nothing, but by then my precious "vacation" days from work were wasted and I had to go back. I felt ashamed and defeated, and just gave up on trying to lose weight altogether. Here it is, 2012, and I can now add hypertension, high cholesterol and tryglycerides and hypothyroid to my medical litany. And finally in January, I said....enough is enough. I'm going to make this happen! I'm 5'8, 310lbs....what would I advise a patient to do in my situation? So I called my insurance and found out that they do not cover bariatric surgery for any reason. ANY. I'm trying to not make any rough comments here, but it's terrible that I am an RN, I devote my life to the health of others, and my company has specifically excluded dietician visits for weight loss, weight loss plans and bariatrics....wtf?? But I digress. After realizing that I would get no help from insurance, deciding to self-pay was the least difficult choice. My darling husband (the aforementioned lost love who was later found ) had a RNY over 2 years ago with wonderful results, and has been very supportive. I've spent the last month researching my options, and have decided that Dr Aceves is worth my time and money. His track record and reviews have convinced me that Dr Aceves is the best choice for my new sleeve and new life. And here is where I come to the crossroads. My family is totally unsupportive of bariatrics in general, and Mexico as a whole, so I will not be telling them. The can comment ad-nauseum. I'm still pondering what to tell work - I work in a very tight-knit facility with only a handful of nurses, and my role is such that my absence for even 10 days will be sorely missed (when I fractured my foot in December and I was gone for 2 days, it was mass chaos!). I really, really don't want to tell my boss WHY I need a week and a half off, so I'm trying to figure out how to be creative. The problem I was NOT anticipating, was needing to find a new primary care physician. When I told my MD what my plans were, she began to tell me how I just needed some willpower, and that she could not support me going to some "back alley hack" in Mexico. She then implied that she would refuse to assist with my follow through care, and that if I did indeed go to Dr Aceves for a sleeve, I would need to find a new PCP. So I'm stuck on these two things - work and finding a PCP who will be ok with my having weight loss surgery out of country. Argh. I have not set a date for surgery yet...I keep thinking I need to try to get time off first and then try to make a date, but what if one's not open....? I can't afford to lose my job, too many bills! But I need to regain my health. Getting through every day at work is like running the gauntlet, in more ways than one. Anyways, sorry to ramble. I just want to add what an inspiration it has been to follow along with everyone's progress with their sleeves - I've been reading this forum for quite a while! Thank you so much for your help on my own journey -Asche, The Crazy Cat Lady

I had my surgery at HopsitalBC in Tijuana, Mx. by Dr. Illan. I did about 200 hours of research before my surgery and based on that research, finances, and other personal considerations, decided to go the medical tourism route and have been very happy with that decision. These hospitals ONLY do bariatric surgeries and are geared towards medical tourists. They run a VERY well oiled machine from intake to discharge. The process was so smooth, I was completely confident going alone. The surgeon I chose is highly accredited, has done thousands of WLS procedures, has relationships and mentorships with some of the most well known US bariatric surgeons for continuing ed, is board certified, etc. He is just as qualified, if not more so, than many of the bariatric surgeons in my area. Regarding complications, I met with my PCP beforehand and she was 100% supportive. I knew that if I had any issues post-op she would be my advocate. Additionally, US hospitals CANNOT legally refuse to treat you if you present to an ER, regardless of what caused the complications. Now, would a US bariatric surgeon agree to take you on for follow up once you've been stabilized? Maybe not. But that's why you should establish post-op care BEFORE you have surgery. Additionally the complication rate with bariatric surgeries is VERY low in general; these are long established surgeries with very good post-op outcomes. My PCP is also doing all of my labs, meds, etc. For travel, my surgeon recommends blood thinners for 7 days post-op. I also wore compression socks and a compression shirt for my flight home. I started walking as soon as I could post-op, which also helps. Blood clots are a risk with this surgery, whether stateside or abroad, and the travel aspect can increase that. So take your blood thinners and walk as much as you can. Money wasn't a huge factor, though it was a factor. I have very good insurance but after all the pre-op appointments, tests, scans, and everything else, we estimated our out of pocket would be in the $7,500 range. Out of pocket including spending money, an extra night in the hotel, and flights, I paid about $5,500 for surgery in Mx. It was also SIGNIFICANTLY faster. With the 6 month diet program and required insurance approvals, it would be about 9 months from first appt to surgery vs. less than 3 months from intake to surgery in Mx. The reality is, there are amazing surgeons in the US and just as many in Mexico and other places. Conversely, there are terrible surgeons here and everywhere else. There are pros and cons to each, and every person has different needs. Ultimately it boils down to doing your research, finding a surgeon you trust, and a program that fits your needs. For me personally, medical tourism was the right choice and I'm extremely happy with my decision. Feel free to send me a message if you have any other questions!

i bought sample pgs from unjury.com and bariatriceating.com - i like both of them - i'm leaning towards the unflavored - i add it to my soups - just use a wisk - it really blends it well - for drinks i use a blinding ball (works like a wisk) i like to mix vanilla with coffee and a bit of sugar free caramel syrup tastes like a caramel machiatto from starbucks - i'm using the bariatric advantage (from bariatriceatingcom) vitamin crystals - mix with 16 oz water and tastes like lemonade - so today i made a shake with unjury strawberry sorbet and the vitamin water - it was YUMMY tasted like strawberry lemonade - i thought the protein shakes would be the worst thing of this whole process - but now i have several family and friends hooked on them - i just ordered vanilla and unflavored Inspire brand from bariatriceating.com i think that will be my staple - surgery 15 Jun - so still on liquids myself

Nancy - these aren't the shakes, they're just vitamins. The shakes have protein too. These are only $45 for a 30-day supply (which is 60 packets since you do use two per day). However, I spent about $40 on a 90-day supply of a bariatric multivitamin and $55 on a 30-day supply of calcium citrate chewy bites because I don't like the plain chewable ones. Therefore, for me, if I can get the multivitamin AND the calcium citrate I need for $45 per month it's great. I still need to look into things more & I'm still new to all this & am researching different products. I think, from what my dietician said, they've had the shakes for a while, but these powdered vitamin packets are something that are fairly new.

I have saved some awesome holiday recipes from Pinterest under Bariatric recipes. For the most part, I cook according to the number of people I am having, the same way I always did. My husband and I were both sleeved, and we have a small plate, and if no one wants the leftovers it goes straight in the trash. No way would I keep it in my house. I used to cook enough for a week, now I cook only enough for one meal.

All other diets I have tried suggested 6 small meals per day. This is not a diet as we all know it is a lifestyle change. I believe the lesson being taught by most of these surgeons is to only eat 3 meals per day so that we are not eating between meals and not eating when not hungry. My surgeon has performed over 3,000 bariatric procedures and knows his stuff. I trust him and my nutritionist when they tell me that lapband patients should only eat 3 meals per day.

I had my sleeve April 4 in June I had an episode in a grocery story were I passed out. The episode happened twice in about a 45 min period. Went to the hospital all tests were normal. I chalked it up to waiting to long to eat but followed up with my primary care. She did a 3 hour glucose test and found within an hour my insulin level went from 10 at fasting to 211, for those not aware that's and unheard of level, which she has seen one other time and that was in someone who had also had Bariatric surgery but she was 2 years post op not 3 months. She put me on metformin hoping to regulate and I ate about every 3 hours. I thought it was takin care of until out of nowhere I had another episode a few weeks ago and have felt pretty poorly since. I can never catch a sugar drop at least not at levels I believe should make me pass out. I get a continuous glucose monitor this week to wear for a week and have an endocrinologist appt at the end of the month. I can't find much research on this issue but my doc did give me an article about it. Essentially your body thinks its starving so it over reacts to food it gets producing too much insulin dropping your blood sugar ( sort of reactive hypoglycemia but a more intense reaction). And can actually cause your pancreas to grow. I am so pumped about my weight loss ( 80 lbs in 5 months) but I did this to be healthier too and I have followed surgeons/ nuts instructions to a T and feel very discouraged by this development. Has any one else experienced this? Essentially it's nothing I am doing wrong it's just a negative reaction my body has decided to have following surgery. But again not much research out there so I thought maybe some of you may have insight.

Good articles Hawk, especially the last one. It mentions about a 5% increase over time. I'd say that's still "not like it used to be". I like the books suggested in one of the links. I didn't know there was a Bariatrics for Dummies. Some of those are really well written.

Will see how it goes and report back. I'm anxious for some reason, to the point of getting heartburn. They said expect this first appt to be 2 1/2-3 hrs. I've done WW off and on for years...know how to track, now just need to learn how to change what I'm eating to be in-line with bariatric surgery. It will be eye opening in sure, as like many people out there, even eating healthy includes carbs like bread, fruit and yogurt. Wish me luck! Sent from my iPhone using the BariatricPal App

Have anyone ever tried the "Bariatric Advantage" Ready to Shake Meal Replacements? They kind of are chalky! I ordered my Unjury and can't wait ti try - from what I have read it seems like people enjoy it. So yep this is what I am having for breakfast - yummo! :tired

This link was very informative about several different kinds of insurance and what the requirements were for each. Hope it helps! http://www.stvincents.org/healthservices/bariatrics/informationinsurance.cfm

Pianoguy, I would really recommend St Lukes..I am a week away from surgery and the support system and entire program have been a great asset. I attended a preop class which let me know what to expect- ive attended support groups-ive met with a very helpful nutritionist who as part of my surgery cost I get to see 3 more times after surgery. The insurance specialist for the bariatric surgeons really goes above and beyond to help you through that process. Its also considered a center of excellence which some insurance companies require. Good luck!

Hi there. Does anyone know which Dept of Veterans Affairs hospitals do the sleeve? The system is divided by regions, and the VA does not put out a lot of info about the bariatric programs. I have Tricare Prime too, but they do not cover the sleeve. BUMMER... I am a service-disabled vet too and am able to use all services at VA hospitals too. Thanks for any info you can provide. Shan

Most bariatric centers will be able to tell you if your insurance will cover any of the cost, and what the requirements are. Talk to people i your area, get recommendations for surgeons. Make a consult appointment, talk to a surgeon. Gather all the information you can. Watch you tube videos, knowledge is power, it helps prepare you! My fave vlogger is vsg kirk. Good luck!!

Hi, my name is Lynne and I'm just getting started on my wls journey. I have two education sessions this week coming up and my first appointment the following week. I'm planning on bypass but will come to a complete decision after speaking with the bariatric folks. Very excited to get started! So, I'm a wife to Jim for 16 years (almost) and have a 9 year old son. Also two cats and a dog! Can't forget my furbabies! I've been battling my weight most of my life to some degree. My most severe issues started once I hit college. Like everyone here, I've run the gammut of diets! I've done low carb, low cal, liquid, etc. Lost a lot and gained A LOT back! I'm so very ready to reclaim my life and participate and not just watch! I'm a bit of a shy person until I get comfortable so please, if I have a slow start here it's just me being socially awkward lol Really looking forward to getting to know everyone and sharing our journeys together!

I am Amazed !!! I have been getting so many phone calls from Dr. Jose Rodriguez and Dr. Elmo's patients. I would say so far about 10 phone calls and many emails and everyone raved about the service and how awesome the surgeon and the team was. ...I am now confident about my Decision and can put my mind at Ease. I also did not know that Dr. Jose Rodriguez received his Bariatric training from UPMC HOSPITAL in Pittsburg Pennsylvania... A nurse practitioner, one of his patient told me all about his training at UPMC because she worked there at the time. It makes me feel so much better knowing that he had some sort of training in the USA.... Now I am doing the happy dance.

I watched as many VSG and bariatric surgery videos on Youtube as I could. I wanted to know the good, the bad and the ugly. I chose to watch people that had posted at least a year of videos covering their progress.

The American Society for Metabolic and Bariatric Surgery has developed a chart for the treatment of bariatric patients in the ER. The download contains information for the treatment of leaks, sepsis, intra-abdominal bleeding, obstructions etc... The download comes in a PDF format so that you can download it for FREE before you go to the Emergency Room. You can download this PDF for here: http://asmbs.org/store/

Apologies in advance for my "brain dump" but there is a LOT to consider as you research surgeons in Mexico. Everyone who has posted on this thread have very specific and valid personal reasons they have selected their surgeon. Based on their high level of research, I have every confidence they will have a great experience because they know what to expect before they arrive. And that is what I hope for ALL of us, we do the research so we can have a good experience. When I began to consider Mexico as an option for weight loss surgery, I learned a lot. There were several factors important to me in selecting a surgeon: 1. A surgeon who has performed a lot of weight loss surgery. 2. Member of the American College of Surgeons and the American Society of Bariatric & Metabolic Surgery (i.e. I wanted to be able to verify their credentials) 3. The doc should have a lot of positive internet “buzz”, or testimonials on weight loss surgery forums so I could contact those and get some independent feedback. 4. Would like to go to a part of Mexico WITH NO TRAVEL RESTRICTIONS from the US State Department 5. The icing on the cake would be if they were at an International Center of Excellence as designated by the Surgical Review Corporation – same body that designates US bariatric Centers of Excellence 6. Oh, and I wanted to contact the surgeon DIRECTLY, not through a surgery coordinating company THE SHORT LIST 1. Dr. Guillermo Alvarez in Piedras Negras http://www.endobariatric.com/doctor.htm 2. Dr. Alberto Aceves in Mexicali http://gastricsleevesurgeon.com 3. Dr. Pompa in Tijuana http://www.limarp.com/en/dr_liza.php 4. Dr. Ortiz in Tijuana http://www.obesitycontrolcenter.com I checked prices. I spent a great deal of time on each website to understand the process, review photos, verify credentials, etc. Both Dr. Pompa and Dr. Ortiz are practicing at International Centers of Excellence. And I liked the fact Tijuana does not have a travel warning from the US State department. Dr. Alvarez wrote a book about the sleeve. I purchased his e-Book. It’s an easy read and provides a great deal of information about the sleeve procedure, how he performs it, and what you need to do pre-surgery and post-surgery for diet. Ultimately, I selected Dr. Ortiz. Why? • He has a TON of YouTube videos available. I watched many of them and learned a lot about the surgery, recovery, diet, his philosophy, got to see the surgical team working together, pictures of the facility, etc. Also, he has a great video about the difference between healthcare in the US vs. Mexico and was spot on. This video actually made my decision for me. (He even addressed the sombrero issue. I’m in! Ha ha!) Check the video • Confirmed they are a International Center of Excellence for Bariatric Surgery http://www.surgicalreview.org/locate/cmcoem/ • Confirmed Dr. Ortiz is a member of the American College of Surgeons http://web2.facs.org/acsdir/public/DetailMember.cfm?CHKDGTS=88010816878 • Confirmed Dr. Ortiz is a member of the American Society for Metabolic & Bariatric Surgery http://asmbs.org/member-search/ (search for last name Lagardere, as in Ariel A. Ortiz Lagardere) • Tijuana is in Baja California, the only Mexican border state that does not have a travel warning from the US State Department. http://travel.state.gov/travel/cis_pa_tw/tw/tw_5815.html All other border states have a “defer non-essential travel” warning My hope is that you find a surgeon and location that are right for YOU! Just by being on these forums and becoming educated on your options - I have a feeling you will have GREAT results.

I saved like crazy for the surgery. I'm not gonna lie, cost WAS a factor in deciding which doctor to go to, but I didn't just go to the cheapest doctor I could find. If money was no object, I would have gone to Dr. Alvarez... but I realized that there were many well qualified and competent doctors in Tijuana that were about half the price of Alvarez. You'll find that many of the doctors who using the major booking companies (R4C, ALM, MBC, MT) are well qualified and have done a LOT of surgeries before they are accepted by a booking company and begin working on American/Canadian patients. One of the single biggest determining factors of complication rates, is number of bariatric procedures that the surgeon has performed. Higher volume surgeons/hospitals have lower complication rates. (no a point, you don't want a doctor who does 15 surgeries a day, but you don't want one who only does two a week either) on average, a doctor who has done fewer than 200 bariatric procedures has more than twice the complication rate of a doctor who has done more than 1000 procedures.

I got an estimate today for the VSG since I am also a Tricare patient. Facility charges are $46,000 alone. I definitely can't afford this procedure without insurance but I am set on the sleeve, I don't want the RNY or Lapband. Our MTF is just starting to do bariatric procedures. (Few months away) May be my only chance.