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Yes. The question is SHOULD you. Alcohol after surgery can cause a few problems. 1. Addiction transfer- if you have a food addiction prior to surgery, it's a lot easier to move from one addiction to another when you can't compulsively eat anymore 2. The way your body processes alcohol after surgery is a lot different. Most people lose their tolerance and are flat out drunk after a few sips. So don't ever drink and drive after surgery. Not even one drink. For someone who is alcohol sensitive after surgery ONE alcoholic drink to a bypass patient is the same as almost SIX to someone who hasn't had the surgery. Your blood alcohol % flies through the roof really quick. Some people have no problem with it but most can't drink like they use to. 3. It's calories. As fun as drinking is (I'm 22 so I've only drank for a year and now I have given it up which is hard with my social life), it's not a necessity. My program has a flat out no alcohol for a year policy but not everyone is like that. I'm not taking the risk alcohol after surgery can bring so I plan on waiting a couple years.

I didn't have any alcohol for at least a year after surgery. But I do know people who have some at like 4 months they seem to be okay but be careful it doesn't take much!! Also, I like Crown with diet coke and found I was replacing it for foods because of the low calorie, carb count. It was like a dessert treat and I quickly put a stop to that. That is a slippery slope I don't want to go down.

Avoid any alcohol containing mouthwash. Alcohol = drying. Biotene has a great soothing mouthwash and they also have a line of other dry mouth products, toothpaste, a moisturizing gel (they have gum also but that's a no no). PLUS the mouthwash contains similar enzymes to the ones you have naturally in your saliva that help to fight the bacteria that cause tooth decay and periodontal disease. Dry mouth is BAD for your teeth. Dry mouth = increased bacteria + food we eat = the increased possibility of rampant decay. Like any of us need to also deal with that situation!

Hi newgrandma, I have arthritis in my knees right now but my mom has it in her fingers and other joints and my dad has it in his hip and back. He's had a hip replacement and invertebrea drilling before the age of 70. I have no cartilage between my knee cap and leg bone and develop spurs from the impact. Last year I had the spurs smoothed off by my surgeon but my diagnosis is stage 4 chondromalacia and he says I'm too young for knee replacements. I function OK on an anti inflammatory diet, i have salmon oil everyday, no wheat, try to limit alcohol (being sleeved has made it easier lol) and when I do mountain stuff like skiing and hiking I take lots of turmeric. I also ice afterwards. When it's really bad I'll take tylenol arthritis, it seems to work ok but i have to be in tears to take meds. I've seen what over medicating has done to my dad, he started loosing his mind at 65 and now that he's 70 he has officially been diagnosed with Parkinson's. I also think over medicating leads to cancer of the pancreas. Has your surgeon offered to do laproscopy and dremmel off any rough bits/spurs? Where do you have your arthritis? I can tell when I do my Tuesday yoga class that my L hip feels sharp when I do certain motions. I hope I'm not following too closely in my dad's footsteps.

The nurse at the hospital gave me a trick for feeling nauseious, if you put an alcohol swab or any cotton ball soaked in rubbing alcohol on the bridge of your nose and breath in through your nose slowly and out through your mouth. It really worked for me and I never heaved. As for the taste, everything changed for me I loved the chocolate pre op and then after I hated it (still do) I found I love the fruite ones (Syntax nectar Lemonaid ) is my favorite, but all the fuite ones are ok with my new pallet. I am now 4 weeks post op and eating soft food but it too is dificult to find what tastes and feels right, don't worry you just need to find what works for you. I hope you feel better soon. I am 2 days post op and feeling miserable. My left side pulls constantly, I have been dry heaving since gettin home from the hospital yesterday and have a bit of blurred vision. So please excuse any typos. I am having buyer's remorse as well. ALl I want to do is sleep. I wake every 1.5 hours though amd walk, do my respiratory therapy and drink another ounce of something. I have been taking prvacid and gasx and they are helping some but I am having strong hunger pangs as well. Nothing tastes good. I am trying to drink a Protein shake today as my 1 ounce every 15 minuts. But, I know I have missed alot of them since I keep sleeping so much. I am praying for all of us to get better. For now, I am a bit depressed and miserable.

I agree with what everyone said, but I will also add this... alcohol lowers your inhibitions, so you might eat things that aren't great choices and end up not feeling great and that would ruin the celebration... Focus on making the graduates and your family and friends the things you celebrate, not food and drinks. Become the group photographer if you need to keep your hands busy. (you can just use your cell phone for this) Or dance up a storm in a new outfit that fits your new fab self!

Three weeks post op you def dont want bubbles... also 2oz will put you over the legal limit... your body cannot process alcohol the same way now... they say no alcohol for at least a year for a reason.

You may want to speak with your doctor. I'm four months out and I haven't had any alcohol or soda. I've heard the carbonation is a killer. It's tough since it's your 21st! It's also a lot of empty calories.....but I would definitely ask. A nights worth of fun isn't worth hurting yourself! Happy Birthday!

I just turned 21 on the 26th of July. Im about 8 1/2 months out. i think it just depends on the drink and how much alcohol is in it. I drank 3 smirnoffs and was feeling a little buzzed i also tried a shot of patron on a different night and was completely drunk. HAPPY BIRTHDAY!

My program asked us up front to commit to a minimum of 6 months alcohol free. One factor is the risk of ulcers is high in our newly healing stomachs. I personally wouldn't, but it's definitely worth asking your doc.

I agree with the comment that "everyone is different". Take your time as you re-introduce spice into your food. A little at a time will tell you a lot about your tolerance. As you can read above, there are lots of us who have had no trouble with potentially troublesome foods like spice or alcohol. Good luck to you.

Like alcoholism and drug addiction obesity is a disease. Thankfully one that can be conquered with interventions, but whether biological or environmental for many people is is much more than a matter of willpower. It's not something we "get over". That doesn't make the pre-op side of my life a failure. It means there were things beyond my control that required medical intervention to tend to. Attaching shame to them much like other addictions is part of what makes people reticent to seek help. Pre-op me was a cool chick. One who was smart enough to identify a problem and address it. She was never a failure.

Here is the medical policy. The link was open one day so I copied it Does anyone understand D.....preprinted, check off forms are not acceptable. Does that mean my WW Book for the weekly weigh ins? E-Mail Us Medical_Policy@Horizon-bcbsnj.com Horizon BCBSNJ Uniform Medical Policy Manual Section: Surgery Policy Number: 022 Effective Date: 06/10/2008 Original Policy Date: 06/22/2001 Last Review Date: 11/25/2008 Date Published to Web: 08/11/2008 Subject: Surgery for Morbid Obesity Description: _______________________________________________________________________________________ IMPORTANT NOTE: The purpose of this policy is to provide general information applicable to the administration of health benefits that Horizon Blue Cross Blue Shield of New Jersey and Horizon Healthcare of New Jersey, Inc. (collectively “Horizon BCBSNJ”) insures or administers. If the member’s contract benefits differ from the medical policy, the contract prevails. Although a service, supply or procedure may be medically necessary, it may be subject to limitations and/or exclusions under a member’s benefit plan. If a service, supply or procedure is not covered and the member proceeds to obtain the service, supply or procedure, the member may be responsible for the cost. Decisions regarding treatment and treatment plans are the responsibility of the physician. This policy is not intended to direct the course of clinical care a physician provides to a member, and it does not replace a physician’s independent professional clinical judgment or duty to exercise special knowledge and skill in the treatment of Horizon BCBSNJ members. Horizon BCBSNJ is not responsible for, does not provide, and does not hold itself out as a provider of medical care. The physician remains responsible for the quality and type of health care services provided to a Horizon BCBSNJ member. Horizon BCBSNJ medical policies do not constitute medical advice, authorization, certification, approval, explanation of benefits, offer of coverage, contract or guarantee of payment. __________________________________________________________________________________________________________________________ As indicated by its name, morbid obesity is defined as an increase in weight over optimal weight, which results in significant complications and a shortened life span. For example, morbid obesity has a significant impact on cardiac risk factors, incidence of diabetes, obstructive sleep apnea, and various types of cancers (for men: colon, rectum, and prostate; for women: breast, uterus, and ovaries). The first treatment of morbid obesity is obviously dietary and life style changes. Although this strategy may be effective in some patients, frequently the weight loss is not durable with only 5%-10% of patients maintaining the weight loss for more than a few years. When conservative measures fail, some patients may consider surgical approaches. A 1991 National Institutes of Health (NIH) Consensus Conference defined surgical candidates as those patients with a body mass index (BMI) of greater than 40 kg/m2, or greater than 35 kg/m2 in conjunction with severe comorbidities such as cardiopulmonary complications or severe diabetes. Super obesity has been described as a BMI greater than 50 kg/m2. Surgery for morbid obesity, termed bariatric surgery, falls into three general categories; (1) gastric restrictive procedures that create a small gastric pouch, resulting in weight loss by producing early satiety and thus decreasing dietary intake; (2) malabsorptive procedures, which produce weight loss due to malabsorption by altering the normal transit of ingested food through the intestinal tract; and (3) combination of both restrictive and malabsorptive components. There are multiple variants of malabsorptive procedures, which differ in the lengths of the alimentary limb, the biliopancreatic limb, and the common limb, where the alimentary and biliopancreatic limbs are anastomosed. The degree of malabsorption is related to the length of the alimentary and common limbs. For example, a shorter alimentary limb (i.e., the greater the amount of intestine that is excluded from the nutrient flow) will be associated with malabsorption of a variety of nutrients, while a short common limb (i.e., the biliopancreatic juices are allowed to mix with nutrients for only a short segment) will primarily limit absorption of fat. The following summarizes the different bariatric procedures. 1. Vertical Banded Gastroplasty The stomach is segmented along its vertical axis. To create a durable reinforced and rate-limiting stoma at the distal end of the pouch, a plug of stomach is removed and a propylene collar is placed through this hole and then stapled to itself. Because the normal flow of food is preserved, metabolic complications are rare. Complications include esophageal reflux, dilation or obstruction of the stoma, with the latter two requiring reoperation. Dilation of the stoma is a common reason for weight regain. Vertical-banded gastroplasty may be performed using an open or laparoscopic approach. 2. Adjustable Gastric Banding This is the most commonly performed restrictive procedure. Adjustable gastric banding involves placing a gastric band around the exterior of the stomach. The band is attached to a reservoir that is implanted subcutaneously in the rectus sheath. Injecting the reservoir with saline will alter the diameter of the gastric band; therefore the rate limiting stoma in the stomach can be progressively narrowed to induce greater weight loss, or expanded if complications develop. Because the stomach is not entered, the surgery and any revisions, if necessary, are relatively simple. Complications include slippage of the external band or band erosion through the gastric wall. Adjustable gastric banding has been widely used in Europe. Currently, the Lap-Band Adjustable Gastric Banding System made by BioEnterics Corporation is an approved device by the U.S. Food and Drug Administration (FDA) for marketing in the United States. Another FDA-approved device is the REALIZE Adjustable Gastric Band For Morbid Obesity which is manufactured by Ethicon-Endo-Surgery, Inc. [Please refer to specific benefit coverage under the Federal Employees Health Benefits Program (FEHBP).] 3. Gastric Bypass with Short-Limb (150 cm or less) Roux-en-Y Anastomosis The original gastric bypass surgeries were based on the observation that post-gastrectomy patients tended to lose weight. The current procedure involves division of the stomach into a smaller upper (called the pouch) and larger lower sections in association with a Roux-en-Y procedure (i.e., a gastrojejunal and a jejujejunal anastomoses). Thus the flow of food bypasses the duodenum and proximal small bowel. The procedure may also be associated with an unpleasant "dumping syndrome," in which a large osmotic load delivered directly to the jejunum from the stomach produces abdominal pain and/or vomiting. The dumping syndrome may further reduce intake, particularly in "sweets eaters." Operative complications include leakage and marginal ulceration at the anastomotic site. Because the normal flow of food is disrupted, there are more metabolic complications compared to other gastric restrictive procedures, including Iron deficiency anemia, Vitamin B-12 deficiency, and hypocalcemia, all of which can be corrected by oral supplementation. Another concern is the ability to evaluate the "blind" bypassed portion of the stomach. Gastric bypass may be performed with either an open or laparoscopic technique. 4. Mini-Gastric Bypass Recently, a variant of the gastric bypass, called the mini-gastric bypass, has been popularized. Using a laparoscopic approach, the stomach is segmented, similar to a traditional gastric bypass, but instead of creating a Roux-en-Y anastomosis, the jejunum is anastomosed directly to the stomach, similar to a Billroth II procedure. This unique aspect of this procedure is not based on its laparoscopic approach but rather the type of anastomosis used. 5. Sleeve Gastrectomy A sleeve gastrectomy has been proposed to be an alternative approach that can be performed on its own, or in combination with malabsorptive procedures (most commonly biliopancreatic diversion with duodenal switch). In this procedure, the greater curvature of the stomach is resected from the angle of HIS to the distal antrum, resulting in a stomach remnant shaped like a tube or sleeve. The pyloric sphincter is preserved, resulting in a more physiologic transit of food from the stomach to the duodenum, and avoiding the dumping syndrome (overly rapid transport of food through the stomach into the intestines) that is seen with distal gastrectomy. This procedure is relatively simple to perform, and can be done by the open or laparoscopic technique. Some surgeons have proposed this procedure as the first in a 2-stage procedure for very high-risk patients including those who are “super” obese (BMI>50). Weight loss following sleeve gastrectomy may improve a patient’s overall medical status, and thus, reduce the risk of a subsequent more extensive malabsorptive procedure, such as biliopancreatic diversion. 6. Endoscopic Gastric Reduction or Transoral Endoluminal Gastroplasty The EndoGastric Solutions StomaphyX endoluminal fastener and delivery system was approved by the FDA on March 3, 2007 through the 510(k) marketing clearance as substantially equivalent to its predicate device, the Bard EndoCinch Suturing System. It is specifically indicated for use in endoluminal trans-oral tissue approximation and ligation of the GI Tract. The device uses vacuum to invaginate tissue through a port into a chamber and fasten it using H shaped polypropylene fasteners. It has been investigated as a possible minimally-invasive endoscopic procedure for patients who gain weight after bariatric surgery (e.g., due to a dilated gastrojejunal anastomoses after a Roux-en-Y procedure). 7. Biliopancreatic Bypass Procedure (also known as the Scopinaro procedure) The biliopancreatic bypass (BPB) procedure, developed and used extensively in Italy, was designed to address some of the drawbacks of the original intestinal bypass procedures that have been abandoned due to unacceptable metabolic complications. Many of the complications were thought to be related to bacterial overgrowth and toxin production in the blind, bypassed segment. In contrast, BPB consists of a subtotal gastrectomy and diversion of the biliopancreatic juices into the distal ileum by a long Roux-en-Y procedure. The procedure consists of the following components. A. A distal gastrectomy functions to induce a temporary early satiety and/or the dumping syndrome in the early postoperative period, both of which limit food intake. B. A 200-cm long "alimentary tract" consists of 200 cm of ileum connecting the stomach to a common distal segment. C. A 300- to 400-cm "biliary tract," which connects the duodenum, jejunum, and remaining ileum to the common distal segment. D. A 50- to 100-cm "common tract," where food from the alimentary tract mixes with biliopancreatic juices from the biliary tract. Food digestion and absorption, particularly of fats and starches, are therefore limited to this small segment of bowel, i.e., creating a selective malabsorption. The length of the common segment will influence the degree of malabsorption. E. Because of the high incidence of cholelithiasis associated with the procedure, patients typically undergo an associated cholecystectomy. There are many potential metabolic complications related to biliopancreatic bypass, including most prominently iron deficiency anemia, Protein malnutrition, hypocalcemia, and bone demineralization. Protein malnutrition may require treatment with total parenteral nutrition. In addition, there have been several case reports of liver failure resulting in death or liver transplant. 8. Biliopancreatic Bypass with Duodenal Switch The duodenal switch procedure is essentially a variant of the biliopancreatic bypass described above. However, instead of performing a distal gastrectomy, a "sleeve" gastrectomy is performed along the vertical axis of the stomach, preserving the pylorus and initial segment of the duodenum, which is then anastomosed to a segment of the ileum, similar to the above procedure, to create the alimentary segment. Preservation of the pyloric sphincter is designed to be more physiologic. The sleeve gastrectomy decreases the volume of the stomach and also decreases the parietal cell mass, with the intent of decreasing the incidence of ulcers at the duodenoileal anastomosis. However, the basic principle of the procedure is similar to that of the biliopancreatic bypass; i.e., producing selective malabsorption by limiting the food digestion and absorption to a short common ileal segment. 9. Long Limb Gastric Bypass (i.e., >150 cm) Recently, variations of gastric bypass procedures have been described, consisting primarily of long limb Roux-en-Y procedures. For example, the stomach may be divided with a long segment of the jejunum (instead of ileum) anastomosed to the proximal gastric stump, creating the alimentary limb. The remaining pancreaticobiliary limb, consisting of stomach remnant, duodenum, and length of proximal jejunum is then anastomosed to the ileum, creating a common limb of variable length in which the ingested food mixes with the pancreaticobiliary juices. The stomach may be bypassed in a variety of ways, i.e., either by resection/division or stapling along the horizontal or vertical axis. Unlike the traditional gastric bypass, which is essentially a gastric restrictive procedure, these very long limb Roux-en-Y gastric bypasses combine gastric restriction with some degree of malabsorption, depending on the location of the anastomoses. Policy: [iNFORMATIONAL NOTE: When significant weight loss is achieved such as is typically the case after bariatric procedures for morbid obesity, it is not uncommon for the patients to be left with a significant amount of redundant skin (e.g., in the abdomen, breasts, thighs and arms). Procedures to remove the redundant skin are typically considered to be cosmetic. The eligibility of procedures and/or services related to, or resulting from, a prior surgical procedure for morbid obesity is determined by the patient’s specific contract benefits. When the patient’s contract does not specifically exclude such procedures and/or services, they are subject to review for medical necessity. Medical policies pertaining to the covered person’s condition should be consulted, as applicable (e.g., Policy #025 on Abdominoplasty, Policy #028 on Reduction Mammaplasty, and Policy #001 on Cosmetic Procedures including excision of excessive skin and subcutaneous tissue and suction assisted lipectomy, under the Surgery Section). The approval of a bariatric procedure for medical necessity should not be interpreted to be an automatic approval for procedures that address the sequelae of significant weight loss, nor should it create the expectation that such procedures will be approved.] I. Contract exclusions and/or limitations for surgery for morbid obesity (bariatric surgery) will determine the available benefit. [iNFORMATIONAL NOTE: Some contracts specifically exclude surgery for morbid obesity (bariatric surgery). Please refer to the group’s or individual member’s contract benefit language to determine benefit availability.] II. If it is NOT specifically excluded by the member's contract, surgery for morbid obesity (bariatric surgery) is considered medically necessary when all of the following lettered criteria are met: A. The surgical procedure is one of the following types: Laparoscopic adjustable gastric banding; [iNFORMATIONAL NOTE: Please refer to specific benefit coverage for adjustable gastric banding under the Federal Employees Health Benefits Program (FEHBP).] Vertical-banded gastroplasty; Gastric bypass with short-limb (i.e., 150 cm or less) or long-limb (i.e., greater than 150 cm) Roux-en-Y anastomosis; Biliopancreatic diversion and duodenal switch. [iNFORMATIONAL NOTE: According to the Consensus Conference Panel Statement presented at the Georgetown University Conference Center, Washington, DC, May 2004, "Standard of care for bariatric surgery includes use of laparoscopic and open techniques.] B. The member is at least 18 years of age and/or has reached full skeletal growth. Bariatric surgery is considered NOT medically necessary for members under 18 years of age unless the member has already achieved full skeletal growth and has a life threatening co-morbidity (i.e., pseudotumor cerebri, severe sleep apnea, uncontrollable hypertension, incapacitating musculoskeletal disease, etc.). [iNFORMATIONAL NOTE: According to published medical literature, bone age can be objectively assessed with radiographs of the hand and wrist.] C. The member has morbid obesity. Morbid obesity is defined as either: 1. A body mass index (BMI) greater than 40 kg/m2; or 2. A BMI between 35 kg/m2 and 40 kg/m2 with one or more of the following life-threatening, obesity-related co-morbidities which is (are) being treated or managed, and is (are) generally expected to be improved, curtailed, or reversed by obesity surgical management: coronary artery disease obesity-related cardiomyopathy congestive heart failure obstructive sleep apnea Pickwickian syndrome insulin resistance or frank diabetes mellitus clinically significant asthma chronic venous insufficiency of the lower extremities gastroesophageal reflux disease (GERD) pain and limitation of motion in any weight-bearing joint or the spine hypertension pseudotumor cerebri polycystic ovarian syndrome metabolic syndrome hyperlipidemia (hypercholesterolemia and/or hypertriglyceridemia) non-alcoholic fatty liver (NASH) osteoarthritis depression. [iNFORMATIONAL NOTE: BMI is calculated by dividing a patient’s weight (in kilograms) by height (in meters) squared. To convert pounds to kilograms, multiply pounds by 0.45 To convert inches to meters, multiply inches by .0254] D. Within the 12 months prior to the time of surgery, the member must meet all of the following requirements: 1. Documentation of successful completion of at least 6 consecutive months of supervised conservative weight loss program, diet programs/plans (e.g., Weight Watchers, Jenny Craig), or the Horizon Obesity Disease Management Program. Successful completion means formal documentation or photocopies/print-outs of progress notes of at least monthly follow-up by the supervising physician, other health care provider, or program coordinator including the patient’s weight and progress relative to the goals set at the start of the program. (NOTE: Pre-printed check-off forms and summary letters are NOT acceptable documentation for this requirement.) [iNFORMATIONAL NOTE: Programs supervised by a registered dietitian may not be a covered service under a member's contract.] 2. Documentation of participation in an organized multidisciplinary surgical preparatory regimen in order to improve surgical outcomes, reduce the potential for surgical complications, and establish the member's ability to comply with post-operative medical care and dietary restrictions. The regimen should provide guidance on diet, physical activity, and behavioral and social support prior to and after the surgery. Documentation should include physician's initial assessment of the member, and the physician's assessment of the member's progress at the completion of the multidisciplinary surgical preparatory regimen. 3.Documentation of pre-operative psychological evaluation provided by a licensed mental health care professional familiar with the implications of weight reduction surgery. (Please note that psychological testing is NOT included in this requirement.) [iNFORMATIONAL NOTE: It should be noted that all bariatric surgeries require a high degree of patient compliance. For gastric restrictive procedures the weight loss is primarily due to reduced caloric intake, and thus the patient must be committed to eating small meals, reinforced by early satiety. For example, gastric restrictive surgery will not be successful in patients who consume high volumes of calorie rich liquids. In addition, patients must adhere to a balanced diet, including proper micronutrient supplementation, to avoid metabolic complications. (Micronutrients are defined as Vitamins, minerals, and trace elements.) The high potential for metabolic complications requires life-long follow-up. Therefore, patient selection is a critical process, often requiring psychiatric evaluation and a multidisciplinary team approach.] III. The following procedures are considered investigational: Mini-gastric bypass Sleeve gastrectomy (either as a sole procedure or as one step in a staged procedure); Endoscopic Gastric Reduction (also known as transoral endoluminal gastroplasty). [iNFORMATIONAL NOTE: There is limited data published in the medical literature to evaluate outcomes of sleeve gastrectomy as a stand-alone procedure and to compare its efficacy with other procedures. Furthermore, the published data on outcomes following completion of both stages of a 2-stage operation are limited to case reports and case series with very small number of patients. According to the ECRI Health Technology Assessment Information Service Custom Hotline Response on Laparoscopic Sleeve Gastrectomy for Morbid Obesity (last updated 01/22/2007), “None of the studies reported weight loss at three years or more after the operation, which we consider the most important outcome measure for these studies to report. Earlier follow-up periods may not provide data indicative of the eventual results of the surgery and do not provide sufficient time to assess the possible long-term complications of this surgery”.] IV. Repeat bariatric surgery or any subsequent modification should be handled on an individual case basis and reviewed by the medical director. Supporting documentation should at least include a clear explanation of the clinical circumstances as to why the procedure failed, the member’s BMI, and the results of any diagnostic tests or studies performed. Since members are expected to be compliant with the postoperative requirements, members who have failed bariatric surgery because of noncompliance and wish to be considered for revision surgery must be actively reintegrated into an established multidisciplinary bariatric program. These patients must demonstrate compliance to the bariatric surgeon through enrollment in a multidisciplinary bariatric program including psychological intervention nutritional counseling, and support group attendance. A distinction between clinical failure and technical failure must be established. A. A clinical failure is defined as weight regain, inspite of an intact, functional operation. In these instances, reintegration into a multidisciplinary bariatric program and psychological re-evaluation are required. If the member is able to demonstrate the probability of complying with the postoperative requirements (e.g., diet , physical activity, etc.), repeat bariatric surgery or any subsequent modification of the original bariatric surgery may be considered medically necessary. Otherwise, any further surgical intervention is considered not medically necessary. B. A technical failure is defined as a breakdown of the operation itself (i.e., staple line disruption, fistula formation, dilatation of the pouch, marginal ulceration, band slippage, anastomotic dilatation, etc.). In these instances, psychological re-assessment of the patient is not mandatory. [iNFORMATIONAL NOTE: Band adjustment is a regular part of follow-up for adjustable gastric banding. All adjustments done within 90 days from band implantation are considered part of the global surgical service. Any subsequent adjustment beyond this period is eligible for separate reimbursement if the band implantation was deemed medically necessary.] ________________________________________________________________________________________ Horizon BCBSNJ Medical Policy Development Process: This Horizon BCBSNJ Medical Policy (the “Medical Policy”) has been developed by Horizon BCBSNJ’s Medical Policy Committee (the “Committee”) consistent with generally accepted standards of medical practice, and reflects Horizon BCBSNJ’s view of the subject health care services, supplies or procedures, and in what circumstances they are deemed to be medically necessary or experimental/ investigational in nature. This Medical Policy also considers whether and to what degree the subject health care services, supplies or procedures are clinically appropriate, in terms of type, frequency, extent, site and duration and if they are considered effective for the illnesses, injuries or diseases discussed. Where relevant, this Medical Policy considers whether the subject health care services, supplies or procedures are being requested primarily for the convenience of the covered person or the health care provider. It may also consider whether the services, supplies or procedures are more costly than an alternative service or sequence of services, supplies or procedures that are at least as likely to produce equivalent therapeutic or diagnostic results as to the diagnosis or treatment of the relevant illness, injury or disease. In reaching its conclusion regarding what it considers to be the generally accepted standards of medical practice, the Committee reviews and considers the following: all credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, physician and health care provider specialty society recommendations, the views of physicians and health care providers practicing in relevant clinical areas (including, but not limited to, the prevailing opinion within the appropriate specialty) and any other relevant factor as determined by applicable State and Federal laws and regulations. ___________________________________________________________________________________________________________________________ Index: Surgery for Morbid Obesity Adjustable Gastric Banding Banding, Gastric Bariatric Surgery Biliopancreatic Bypass Procedure Biliopancreatic Diversion Bypass, Biliopancreatic Bypass, Gastric Duodenal Switch, Biliopancreatic Bypass with Endoluminal Gastroplasty, Transoral Endoscopic Gastric Reduction Gastrectomy, Sleeve Gastric Banding Gastric Bypass Gastric Reduction, Endoscopic Gastric Restrictive Surgery Gastroplasty Lap-Band Adjustable Gastric Banding System Laparoscopic Adjustable Gastric Banding Laparoscopic Gastric Bypass Laparoscopic Mini-Gastric Bypass Laparoscopic Sleeve Gastrectomy Long Limb Gastric Bypass Malabsorptive Procedures Morbid Obesity, Surgery for Mini-Gastric Bypass Obesity, Morbid, Surgery for Scopinaro Procedure Sleeve Gastrectomy Transoral Endoluminal Gastroplasty Vertical Banded Procedures References: 1. Blue Cross and Blue Shield Association. Medical Policy Reference Manual: Surgery for Morbid Obesity. 5:2006: Policy #7.01.47 (and its associated references). 2. ECRI. Health Technology Trends. FDA clears stomach band for obesity. Vol.13 No.7. July 2001. 3. Weiner R, Bockhorn H, Rosenthal R, et al. A prospective randomized trial of different laparoscopic gastric banding techniques for morbid obesity. Surg Endosc. 2001 Jan;15(1):63-68. 4. Cadiere G, Himpens J, Vertruyen M, et al. Laparoscopic Gastroplasty (Adjustable Gastric Banding). Semin Laparosc Surg. 2000 Mar;7(1):55-65. 5. Fielding GA, Rhodes M, Nathanson LK. Laparoscopic gastric banding for morbid obesity. Surgical outcomes in 335 cases. Surg Endosc. 1999 Jun;13(6):550-554. 6. Dargent J. Laparoscopic Adjustable Gastric Banding: Lessons from the First 500 Patients in a Single Institution. Obes Surg. 1999 Oct;9(5):446-452. 7. Belachew M, Legrand M, Vincent V, et al. Laparoscopic Adjustable Gastric Banding. World J Surg. 1998 Sep;22:955-963. 8. Improvement of physical functioning of morbidly obese patients who have undergone a Lap-Band operation: one-year study. Obes Surg. 1999 Aug;9(4):399-402. 9. Furbetta F, Gambinotti G, Robortella EM. 28-month experience with the lap-band technique; results and critical points of the method. Obes Surg. 1999 Feb;9(1):56-58. 10. DeMaria EJ, Sugerman HJ, Meador JG, et al. High Failure Rate After Laparoscopic Adjustable Silicone Gastric Banding for Treatment of Morbid Obesity. Annals of Surgery. 2001 Jun;233(6):809-818. 11. National Institutes of Health. Consensus Development Conference Panel. Gastrointestinal surgery for severe obesity. Ann Int Med 1991;115:956-61. 12. MacLean LD, Rhode BM, Forse RA. Late results of vertical banded gastroplasty for morbid and super obesity. Surgery 1990;107:20-27. 13. Willbanks OL. Long term results of silicone elastomer ring vertical gastroplasty for the treatment of morbid obesity. Surgery 1987;101:606-10. 14. Brolin RE. Results of obesity surgery. Gastroenterol Clin North Am 1987;16:317-35. 15. Kolanowski J. Gastroplasty for morbid obesity: The internist’s view. Int J Obesity 1995;19(suppl):S61-S65. 16. Melissas J, Christodoulakis M, Spyridakis et al. Disorders with clinically severe obesity: Significant improvement after surgical weight loss. Sout Med J 1998;91:1143-48. 17. Griffen WO, Printen KJ eds. Gastric bypass in surgical management of surgical obesity. New York, NY. Marcel Dekker, Inc, 1987:27-45. 18. Pories WJ, Swanson MS, MacDonald KG, et al. Who would have thought it? An operation proves to be the most effective therapy for adult onset diabetes mellitus. Ann Surg 1995;222:339-52. 19. Flickinger EG, Sinar DR, Swanson M. Gastric bypass. Gastroenterol Clin North Am 1987;16:283-92. 20. Cowan GSM, Buffington CK. Significant changes in blood pressure, glucose and lipids with gastric bypass surgery. World J Surg 1998;22:987-92. 21. Sugarman HJ, Starkey JV, Birkenhauer R. 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Hi everyone, just a quick update on where I am - three months (wow) after I last posted. I was sleeved on 1st March - starting weight 292lbs and BMI of 45! Today, I am 194lbs and my BMI is 29.4! So there's been some pretty big milestones for me - falling below 200lbs, falling below 30 BMI (I'm officially not obese anymore!). I'm now fitting into jeans with a waist of 32 inches! I went shopping a week or two ago and couldn't find jeans in my size - because the jeans that I wanted were only in store in sizes too big for me! I don't think I've ever been unable to buy something I wanted because they didn't have any that were small enough. Most days I don't even remember I've had a sleeve. I can eat everything without trouble, I can drink everything without trouble. This is good because it means that when I go out to eat, there's nothing I can't order - though naturally I tend to stick to starters, or else to food that can be easily boxed home and brought away. It also means that I can go out and drink alcohol - I'm not a big drinker but there are times when I do like to go out with friends and drink and, yes, get drunk. I know it's empty calories etc - but my view from the start is that I want to be as healthy as I can be while still living the life I want to live. For the same reason, I do allow myself carbonated drinks - only diet - even though I know a lot of people on here are dead against it. Has it stretched my sleeve? I don't think so - my appetite is still pretty low. My eating habits before surgery had two big problems - Snacks and meals. Snacks is still a problem in that I can eat chocolate, popcorn, crisps etc as if I never had surgery. So I need to be really careful with them - I haven't cut them out completely. I know some people find it easier to cut them out completely rather than try and control them but I didn't want to do that (and I know it wouldn't be sustainable for me) so I focus on control and making sure I count any snacks when I count my daily calories. Meals are where the sleeve has really helped me. I loved chips (proper British chips - not American chips) but now I can't eat more than two or three with a meal, so I never order any, instead I might steal one or two from my partner when we eat out. Before surgery, I could have a big burger, big plate of chips and a side of onion rings, and still had room for a doughnut or sweets afterwards. Now, if I was going to have a burger, I might just about manage a hamburger on its own. Most of the time, I have a sandwich at work, and I can just about manage a standard sandwich (i.e. two slices of bread and some ham or chicken). So even though I'm not perfect on snacking (and I do need to be more disciplined), I've cut down so much calories on meals. So I'm pretty happy with where I am. I still have another 30 or so lbs to lose. I know that will be slow and I'm OK with that. I also know that I need to start being more and more aware of the risk of slipping back upwards. But so far so good.

Name, real or screen~ Bandista Goal weight for May 31st~ 195 Weight on May 1st~ 204 Age~ 52 City/State~ New Hampshire Dietary goal for May~ Liver Cleansing diet, no alcohol, health protocol Exercise goal for May~ Add in new mini-elliptical exercise upstairs Personal goal for May~ Finish scanning all photos for various projects Date banded~ November 5th, 2014 Total weight loss since banding/pre op diet~ 44-46, depending on the day -- trying to get to 50 pounds down for my six month Bandaversary! Favorite Flower? Lisianthus

I'm going to have to respectfully disagree:). If we had this willpower I doubt we would have needed wls in the first place. Plus if your having a hard time controlling a craving why would you want to put yourself in such a difficult situation to begin with. Better to set yourself up for success in my opinion. A struggling alcoholic would not be smart to go to a bar so why would we do something that seems very similar to me to ourselves??? This is a lifestyle change we have to make and in order to do so we must change our environment the way a drug addict would no longer hang out with user friends. Plus I totally agree that family can benefit from a healthier diet. It's not about the fact that my son is not fat. It's about the health benefits of a good diet not just being fat or skinny. Ok so now that being said I def agree that you can't change everybody in your life and to say that if so and so eats this then I can't succeed is definitely going to cause failure. You have to take responsibility for your own actions and choices for sure. I just think if you can change the lifestyles of others around you for the better then great:). If not then find a way to work around it. Mami I think you are wonderful and such an inspiration to me and to many others and I am in no way offended by what you said It's great and inspiring that your willpower is so strong. Just for some us that may not be the case:)

fyi-per my dentist, sugar fee mints have sorbitol...an alcohol....which is drying and causes bad breath.

Im going through the same exact thing I have gain 47 pld since March of this year dont no how to get back on track I feel like a complete failure I lost my job in February and havent been the same every since my son got diagnosed with seizure scared the hell out of me im a emotional eater and just want to get back on track what can I do please help me you guys im so ready to turn this thing back around. I HAVE gerd and a alcohol problems.???????????? sorry for ya lost.

I doubt it would be allergy to the vitamins themselves, but different preparations of vitamins are full of fillers, some with sugars/sweeteners/sugar alcohols, etc.

Yeah it's awful can't do sugar alcohols...chocolate even tiny amounts fruit too is not working for me salad which I so love and miss seems to get to me too if I eat more than two bites tried one scoop of vanilla ice cream once ... Nope made me wish for death won't be doing that again was told I could have turkey breakfast sausage can only eat one tiny piece nope sleeve says bitch back off lol and I listen it's the boss now it seems

Technically if you stopped drinking and didn't change anything about your eating habits you should lose 1 to 1.5 lbs a week. A bottle of wine has about 600 calories and you need to burn 3500 calories to lose a lb. So you're taking in an extra 4200 calories a week. So if you cut those out you should lose at last a lb a week. But for someone who is drinking that much and trying to stop you may find yourself snacking more or wanting sweets which is going to cancel out some of those calories. I suggest buying some sugar free hard candies to have on hand if you need them. Coming from a family of alcoholics I urge you to get help if you need it. Don't let it t

I got a couple of free samples of Quest bars in the mail and I really liked them. They're low carb, 20g of Protein, no sugar or sugar alcohols, and around 170-210 calories each. http://www.questproteinbar.com/ They did keep me satisfied for a long time.

This point is very valid! when I was Pre op my surgeon and his team really dug deep in this topic. They really stressed that the sleeve is a TOOL and it will HELP you achieve your goals. Not do it for you. I however had it stuck in my head "yahoo I'm gonna be skinny! I'm gonna shop in a normal store" yada yada. at this point I am only 6 months Post Op, but let me tell you, yes the sleeve does wonders, but unless you really change your life and adapt to all the aspects of what it entails, you most likely will re gain your weight back. I'm not saying that I've been an angel with the sleeve. I still enjoy a beer every now and again and I still love sweets. But you will learn moderation. I am also a mindless eater, I eat when I'm bored, I eat when I'm happy, i like to sit with a bowl of pretzels while I read. But I've made the decision that I don't want to weigh 300lbs the rest of my life. unfortunately with the sleeve you cant "have your cake and eat it too" All that being said, I would highly recommend seeing a therapist of some sort and talk to someone about your vices. (I've even heard of some gals from another support group that go sit in on weight watchers meetings just to be accountable on a regular basis for what they put in their mouths, any little thing can help!) honestly we do have an eating disorder, and if you don't change the way you live, you will find something else like shopping, alcoholism, sex addict, hoarding... (NOT saying that it WILL happen, just saying were a little more prone to replace one bad habit with another). To sleeve or not to sleeve, that is the question, If this is the main concern I'd say there are resources that you can utilize so this isn't an issue. It was the BEST decision I've ever made. Best of luck with your journey, and your decision making. Its so worth it, especially with all of the resources we have at our fingertips!

I had this surgery to live a normal life. I'm about 4 months out now and can eat basically anything. I've had fast food, I've had chips and candy, I've had alcohol. Nothing has caused me much problems. Obviously it's all in moderation. I eat well, make good choices, and make sure my Protein levels are where they should be. I work out a lot. If, at the end of the day, I have a couple hundred calories left, I'll allow myself a treat. I'm down about 45lbs now and have another 30ish to go. I still lose 1-2lbs a week steadily and I'm happy with that! I'm happy that I can eat what I want, but less of it. That's exactly what I hoped for from surgery.

I do tend to lose more on days that I take a moment to praise God before I step on the scale. It can't hurt! More Protein and Water would help if you are low in those areas. Sounds like you have stepped it up on the exercise already which is good. You might not see results immediately w/the extra exercise, but hang in there because it really does make a difference in the long run. The only other thing you might consider is if you are getting any empty calories any other ways. For me, I was still drinking alcohol when my weightloss started to slow. It was pretty obvious I had to give it up. Since giving it up (a month ago) and upping my exercise, I am losing a lot better now.