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I have been told that extended release medications can work differently after any bariatric surgery, but talk to your provider and your surgeon. There are lots of options: you might be able to keep taking it if you find it still works, you might need to switch to something you have to take a few times during the day.

Alrighty! I jumped all the pre-surgery hoops, from psych profile and initial meeting with dietitian (who was great- went way beyond "food" to discussing behavior), got the cardio sign off after a chemical stress test and even though my primary was ambivalent, he talked directly to the bariatric surgeon- they know each other. It is a small medical community. Everything got submitted to Medicare for approval of insurance coverage. I use nicotine replacement therapy-- nasal spray- it helped me get off the ciggies 13 years ago and that apparently isn't a problem either. So I'm now waiting for the green light from Medicare. (I have a good supplemental program to back it up). I've got fingers crossed that it gets approved- I find my mobility worse than ever, breathing difficult given mild COPD and carrying this weight isn't just a cosmetic/ego thing- it is dragging me down. I have a hard time getting around, climbing stairs, walking any distance. Wish me luck. I'll let you know assuming I go in and get it done- I have Barrett's, GERD and atrial fib (which I attribute in part to the weight gain). I know I have work to do- this is not magic bullet, but I'm psyched! I've been on a modified FODMAP diet for a while. I'm getting close to 70 years old and want to have another ten or more years to travel and do things. I thank all of you for your support. I'm sure I'll have questions as this process continues. But, my continued thanks for this forum and its participants as a resource. regards to all, D6

I read Bariatric Foodies review of 7 of the flavors last night. Here's part one of three http://bariatricfoodie.blogspot.com/2011/11/quest-of-bariatric-foodie.html

I struggle with this as well. For me, it's a sign of a role that food is playing in my life that has nothing to do with nutrition. I might get away with it for now, but long term it's going to be a problem, and I need to address it. From time to time I find myself getting too obsessed with food blogs - even if they're bariatric-friendly recipes, too much focus on food is going to lead me to overeating, or eating the wrong things, and I have to just stop. Too much time spent grocery shopping is an indication I'm probably using food for entertainment, or as a distraction - time to figure out what I really need. With my history with food, I know I can't afford to ignore it if I want to be successful in maintenance.

I'm going to my second WLS seminar tomorrow at Fremont Kaiser. I had to go to a intro meeting at Santa Clara Kaiser first and then my PCP referred me to Fremont. They called within a couple if days and I got into this meeting. I heard this meeting is with surgeons and nutritionist but as a group. I can let you know what I find out tomorrow. I am in a similar boat except my husband may be losing Kaiser insurance at end if year unless new job offers it. Kaiser has been good to me so I'm hoping we can keep it somehow, especially for the bariatric program. Good luck to you!

It sounds like she truly believed the surgery would "solve all her problems". The results of immaturity, abuse, trauma, addiction, and mental illness is not going be "solved" by anything let alone weight loss surgery. Without surgery she would have certainly continued to abuse food and still may have turned to alcohol, drugs, and sex anyway. Blaming the surgery for her issues doesn't sound very healthy to me. What would her life been like without it? You can't compare apples to oranges. If she was unwilling to seek counseling before bariatric surgery should she have been denied? I don't know. A lot of folks of all ages go into this process blindly. Some actually learn and grow through the process. Some do not. Some people have the capacity for personal growth. Some do not. If she was a poor candidate for WLS she still might have been able to learn from the experience. If she had been a great candidate for surgery, she still might have wound up where she is today. I just don't think there is necessarily cause and effect at work here. This is much more complex than she or the article seem to acknowledge. Yes, I think there needs to be many more mental health resources both pre- and post-op for anyone who is obese. There certainly are not enough affordable mental health resources in the US period.

Hi everyone. I have bcbs and was approved within a week. I had my surgery done over at the u of m fairview and it was great! My surgeon dr. Buchwald is awesome and is literally world renowned for his work with bariatric surgeries. He has done many sleeves and has a good success rate.

South Louisiana, $14K which included surgeon, hospital, anesthesiologist, nutritionist, testing, and 1 year of follow-ups. Like Lissa, insurance has a bariatric surgery exception. The employer is self-funded and does not cover WLS at all. Of course, Murphy's Law being what it is, on May 1 our new insurance went into effect which covers Lap Band only, but I was not interested in that option.

Well folks I have started my journey. Earlier this week I went and had my Upper GI and chest X-ray done. Have appointments for the Pulmonary and several other's next month and into June. I am using my civilian insurance (Horizon NJ Health...i.e. Medicaid) since the Veteran Affairs is moving Sssooo s-l-o-w...but I have started. Should be an interesting set of experiences. I am concerned that Horizon will not cover it saying that my V.A. benefits are my primary insurance. That is a whole other can of problems just hanging there in the back ground. I keep telling Horizon that the V.A. dose not play nice with other insurance companies and I don't think they will do the type if surgery I want done. I have a problem with a surgeon who only wants "1 size fits all" bariatric surgery. It make me nervous to have him operating on me.....

Since finding out about, and deciding VSG was the right surgery for me back in August I knew that I would have to wait until after the 1st of the year to really get the ball rolling on the surgery due to finances. I initially decided on a doc, but the program fee charged plus my out of pocket maximum for my Blue cross PPO would put my out of pocket expense @ $9200 at a minimum....no F'n way I could or would swing that amount at this point in my life. After a few more seminars I have finally decided on Dr. Kelvin Higa of ALSA medical group in Fresno Ca. I did my labs and chest x-rays last Wednesday, and have my PCP appointment tomorrow @ 7:30am. I normally go to the FNP that works for the the doctor I am seeing tomorrow, but I guess he has to be the one that says I am a good candidate for bariatric surgery. My 1st appointment with Higa is on this Saturday, and my EGD is scheduled for next Wednesday. After Dr. Higa approves me as a patient I can use the Psych and Nutritionist @ Fresno Heart and Surgical free of charge. Hopefully everything is banged out before the end of January and I can get a Blue Cross approval and surgery date for the end of February.(Crossing fingers & praying) Since my PCP appointment I have had a ton of anxiety now since this is actually moving along.I'm not scared to the point of backing out(never will be either), but I feel like a 5'11 365lb 31 year old baby... I'm a worrier at heart but this is getting pretty tough. I have two little kids (5 and 2) that I'm afraid of leaving fatherless...I have faith that I will get through this ok, but it still scares the @$#% out of me. Did anybody else have this much anxiety before surgery? If so what did you do to cope with it? I really want to get my mind right for this so I don't end up being rolled into surgery crying like a big baby. I don't post much on here, but I would like to thank everybody for your stories, information and support given. It is such a great resource for people, and hopefully after I am sleeved I can become as big of a provider of help and information as the rest of you folks are.

My BCBS TX plan specifically covers bariatric surgery in the plan with a $5000 co-payment. All I had to do was meet with the surgeon and complete my psych evaluation. Once the surgeon sent in the paperwork, it was quickly approved within a week or two. The surgeon I picked required a couple of things not required by the insurance (thus not covered by the $5000 co-pay) which were a one time NUT class, and an endoscopy. The endoscopy was covered by my insurance minus my yearly deductible.

Congrats!! Being able to go to the gym does not mean kill yourself exercising. You need to take it slowly. I went to the gym the third week post op. I started two days with cardio 2 hrs and the third day I started with weights. My routine is 3 hrs 5-6 days per week with 30 mins cardio and the rest weights. The Vitamins I like are Bariatric Choice . They are cheap and they are awesome. Sent from my iPhone using the BariatricPal App

1) You shouldn't change your answers to a psychiatric evaluation. Most decent professionals / questionnaires will test for patient understanding / intent / honesty / malingering. 2) That said, here is an excellent article discussing the specific psychological contraindications for bariatric surgery. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3096263/ Here is another: https://asmbs.org/wp/uploads/2016/06/2016-Psych-Guidelines-published.pdf

I did mine online. The lady that I talked to, actually had the sleeve herself. The one I used only does Bariatric psych evaluations, so they totally get how important it is. It was just like a conversation with a friend. You will be fine! Sent from my XT1254 using BariatricPal mobile app

I called and ask Kentucky Medicaid and Anthem who is my medicaid carrier. They are still covering Bariatric surgeries. Wellcare had decided not to carry it anymore but I don't know if that's still the case.

OTR Sleever your 100% right about the types of Protein, I'm sure you already knew that, and I found an article that really explains it in detail. I thought I would share it with everyone. Thanks for setting me straight and helping me get started on the right foot. Protein supplements & Weight-loss Surgery by Kimberly Mahoney, MS, RD, LDN To view a PDF version of this article, click here. When you step into a health food store or a Vitamin shop, there is often an abundance of protein supplements to choose from and sales people claiming they are “nutritionists” trying to sell you the best liquid or powder protein products on the market. There is a large assortment of protein supplementation available to consumers; however, it is essential to recognize that some supplements are of higher quality than others. For weight-loss surgery (WLS) patients, it can be very confusing if you are not aware of what to look for when it comes to protein supplementation. Why is protein important? Proteins are a part of every cell, tissue and organ in our bodies. These body proteins are constantly being broken down and replaced. The body does not store protein for later use, therefore consuming adequate high quality protein is necessary, otherwise the body will inevitably suffer. When protein intake is not adequate, the body will break down lean body mass to compensate for poor oral intake. Loss of lean body mass is inevitable for WLS patients or individuals following a very low calorie diet. To minimize that loss, sufficient high-quality protein must be consumed. When should liquid or powder protein supplements be used? Most WLS patients rely strictly on liquids during the early post-operative phase, and the majority of their calories consumed during that time are often from protein supplements. Liquid or powder protein supplements may also be used post-operatively when patients are unable to consume adequate protein from food alone. This may be due to volume restrictions or food intolerances to protein rich foods. Is there a risk of developing protein deficiency? WLS patients, who have undergone the BPD/DS, are often at a higher risk of developing protein malnutrition. However, all WLS patients, despite the procedure, who do not comply with the recommended dietary guidelines are at risk. What is the best quality liquid or powder protein supplement? Commercial protein supplements are available in many flavors, textures, tastes, mix-ability and price; however, the product’s amino acid composition is of the most importance when choosing protein supplements. Amino acids are the building blocks of protein. There are nine indispensable (essential) amino acids (IAA) and 11 dispensable (nonessential) amino acids (DAA). The IAA must come from dietary intake because the body is incapable of producing these compounds. During rapid weight-loss, when protein supplements are the main source of dietary protein intake, it is essential to choose products that contain all of the IAA. Also, it is important when choosing protein supplements that they have a score of 100 on the protein digestibility corrected amino acid score (PDCAAS). This is a system that was developed as a method to evaluate protein quality. PDCAAS scores of as close to 100 as possible are desired to indicate that it contains the appropriate amount of IAA that the body needs. Protein supplements that are made from whey, casein, soy and egg whites have a PDCAA score of 100. It is important to recognize that many of these protein sources are sold as either concentrates or isolates. Isolates In general, isolates tend to have a higher concentration of protein than concentrate forms. For whey protein isolates, the filtration process removes a lot of the lactose, minerals and fat in the product; therefore, these products have very little or no lactose and often provide more protein in smaller volumes. These products may be beneficial to those patients who have lactose intolerance. Also, isolates tend to have a better mix ability and cleaner taste, therefore compliance is often better with these products. Concentrates Whey protein concentrates have a lower concentration of protein and higher concentration of lactose. Although the protein is of good quality, the percentage of protein will vary. Consumers can always view the nutrition label as well for accurate quantities of protein. How much protein does the WLS patient need? Many surgical weight-loss programs recommend between 60-80 grams of protein per day for the adjustable gastric band (AGB), vertical sleeve gastrectomy (VSG) and the Roux-en-Y gastric bypass (RYGB). The biliopancreatic diversion with duodenal switch (BPD/DS) requires approximately 90 grams of protein per-day to accommodate for the malabsorption associated with this procedure. These recommendations are for individuals without complications (malabsorptive procedures alter digestion, thus causing the food to be poorly digested and incompletely absorbed). Those with complications will have different protein needs. The exact requirements for postoperative WLS patients with complications are not defined. It is recommended to follow-up with your surgeon and dietitian to assess protein requirements and adequate protein intake. Protein supplements and Meal Replacement shakes – they are different It is important to also recognize that there is a difference between protein supplements and meal replacement shakes (i.e. Unjury® vs. SlimFast®). Many meal replacement supplements often have a blend of soy, casein or whey protein to enhance the texture or taste of the product. Meal replacement shakes also have higher amounts of vitamin and minerals and varying amounts of carbohydrates and Fiber. One thing to consider is that meal replacement shakes are often designed to supplement a diet that includes animal and plant sources of protein. These should not be used as the sole source of protein or calories in the diet for an extended period of time. What protein supplements should be avoided? Collagen-based protein supplements are not a good source of high-quality protein and should not be used as the sole source of protein intake in WLS patients. Collagen-based protein supplements do not contain all of the indispensable amino acids that the body needs. When consuming collagen-based products as your sole source of protein, the loss of lean body mass can occur despite meeting your daily protein goals. Do WLS patients need liquid or powder protein supplements for life? As you begin to consume more food after surgery, the need for protein supplementation often declines or ceases. Relying solely on protein supplements to meet your protein needs is not recommended after the early post-operative liquid stage. Foods of high biological value are encouraged (meat, poultry, fish, eggs, milk, etc.). WLS patients who cannot meet their protein needs from food alone may benefit from supplementation of high quality protein. What are the dangers of excessive protein intake? If you are not well hydrated, excessive protein intake may contribute to dehydration. It is also important to remember that additional protein intake, above the recommended amount, may inhibit the consumption of other important nutrients. Conclusion WLS patients are going to get the best bang for their buck when they choose supplements made from whey or soy isolate and avoid whey concentrate and collagen-based products. It is also important to remember that the use of protein supplements are typically decreased or cease throughout time as the WLS patient is able to meet daily protein goals from food of high biological value. About the Author: Kimberly Mahoney, MS, RD, LDN, is a bariatric dietitian at St. Joseph Hospital in Chicago and has been working with weight-loss surgery patients for the past five years. She is currently the chair of the Bariatric Subunit of the Weight Management Dietetic Practice Group through the American Dietetic Association.

I did compare the nutritional facts on this to bariatric infusion. Which is what my surgeon recommended and it was about the exact same so I think it's safe?!

That's great! I just saw Dr. Patrick Chiasson @ Northwest. His name was given to me by a few people on Bariatric Pal.

Hey Stac and CCBC, after waiting an hour for him to come to bed last night, I went out to get some water (I already had a full glass.. LOL). When I passed him I said, you not coming to bed? He said oh yeah, just gaming. He quickly shut it off and came right to bed. He was all lovey dovey. IDK maybe he is bi-polar. I was happy he seemed ok. He was really fussing earlier over nothing. Today he is back to himself but I still have to wonder... what the heck is going on with him. I have taken both comments to heart and I will try to be more understanding as well as show more attention. I will see if that works. I just hope that people know losing weight isn't going to make your spouse love you more. If the love is gone, nothing is going to help unless both parties make an effort. I just read The Emotional First Aid Kit for bariatric patients which touches on the whole post op weight loss jealousy. A spouse may be very worried (like CCBC said) about your getting all sexy and leaving them. I have been married 5 yrs and have 2 kids. There is nothing more important to me than family, but emotional abuse is NOT acceptable - no matter what is going on around you. If he does this again, we will need to have a heart to heart.

I have a friend who is caring for a 725+ lb female and has tried to help her loose weight so she can get the bariatric surgery. Her "skinny" husband is the enabler and though my friend fixed her a proper portioned high Protein low carb meal, her hubby went and got her a larger second plate (said it was for him) and mixed her a double portion Protein shake for her "drink". I estimate that one meal was over 3000 calories by the time he finished "feeding" his wife. She is only 27 years old. I tried to talk to her and her husband about changing things so she can succeed with loosing the weight. I doubt she will meet this goal though since she and her husband "justify" her meals as necessary.

wombat - the only way I could get to goal right now is through PS, but I'm trying...so I know how you feel. Renewed - I'm so glad you hit your goal - WTG! You must be stoaked... Nuke - hang in there girl! I'm going to the beach this weekend - and need to do good. I'm ready to see the scale moving again. I've plateau'd. Darned late fills...I finally have some restriction since my first fill on Friday...I'm hoping to lose another 4 pounds by the 4th...hopefully I can be half way there :-) Karen - congrats on your two pounds...keep it up!

Did you also see your PCP once per month or just the dietician? My bariatric center gave me a form that my PCP had to fill out every month. Plus, I had my PCP scan my food log into my medical record every month. I was approved after six months, but I had 3 comorbidities (HBP, cholesterol & sleep apnea) & a so maybe it had nothing to do with the medical record? And I didn't have BCBS but I dunno...I thought I'd throw it out there... just trying to help? So sorry! /P2P

I'm curious about that as well, because when I had my medical appointment pre-op, I was told I'd be taking Actigall (different doc in the Bariatrics dept)... but my actual surgeon never said anything about it or prescribed it for me. I have my first followup on Jan 3rd, I plan to ask him then.

I haven't read all the posts so sorry if repeating. I get days like this when I don't have my shakes. Once it starts too there is no fixing it for the day. Focus on drinking protein shakes during 9-5 to help the evening snacking. Also, is your nutritionist one that works with strictly bariatric patients? If not, find one that does. I've never heard of grains being suggested so soon after surgery

I'm so, so sorry you're struggling. Please know we are rooting for you and want to see you healthy and well. I think first and foremost, you should stick to what you know you tolerate well and do not feel aversions to. Eat as much and as often as you can to help stabilize your caloric intake. Try focusing on what you CAN eat and try to enjoy it as much as possible. Secondly, I would definitely suggest getting in to see a therapist who specializes in disordered eating. Yes, VSG changed your anatomy, your bodily needs, and maybe even your tastes, but this is not normative and getting support will likely be a game changer for you. The sadness, depression, and frustration are all completely valid given what you're going through, but you don't have to stay in this place and there can be improvement. Lastly, I'd say you might want to get in to see a GI or bariatric surgeon to discuss. I also had surgery in Mx and had a wonderful experience and have a very supportive PCP at home, but something this severe might warrant a face to face visit with a specialist. If there are any physical factors they should be addressed along with the mental/emotional pieces. Wish you the very best of luck!