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See if you can talk to a bariatric surgeon and find out which PCP's they work with often, this way you get the PCP that you know is ok with WLS and one that's already working with a particular surgeon means they already have lots of practice with getting these things processed.

I'm still a baby sleever anyways, all this BS I'm talking lol time will tell how I feel about staying active in the Bariatric community anyways. I just wish sometimes it was set up like college. I see a lot of the same discussions and I know y'all are tired of them too... Can I eat x at y days post op? Why am I not losing? Kinda want more from the discussions/ interactions but it's hard the further out from surgery you get , the site seems to cater to pre/peri-op...

Well, typically you first need to see your primary care doctor and have them refer you to a bariatric surgeon. You should also reach out to your medical insurance to see what is, and isn't covered and what restrictions or qualifying factors they are looking for to approve the procedure. Most insurances require a certain BMI or higher, or a lower BMI plus co-morbidities like sleep apnea or high blood pressure or diabetes to approve the procedure at a lower BMI. A quick search online and I found this: https://www.sos.arkansas.gov/uploads/rulesRegs/Arkansas Register/2009/oct_2009/016.06.09-036.pdf it's a bit older, but it'll at least get you into the "Ball park" range for what is and isn't covered and when.

I began my journey back in December and now my gastric sleeve surgery date has finally arrived. Back when I first started out and was attending pre-op appointments, nutritionist visits, getting various tests and lab work done, and generally jumping through a lot of hoops, it seemed like I'd never get to this point. Now that I'm here it almost seems like it's all happening too fast. I've done a lot of reading on here and other bariatric surgery forums in the past few months, but I never felt a desire to participate until now. I'll be heading to the hospital soon and I'm feeling emotional. Everyone seems to be so different in how their recovery progresses and I have a lot of anxiety over not knowing how I'll feel when I wake up and for the first few months. It's also daunting to be making such a big decision that involves a serious and irreversible change to my body. Still, I can only hope it will be better than the life I've been living. I'm only 24, but I'm physically disabled (from birth) and I've spent most of my life overweight to obese due to low activity levels, a poor relationship with food and nutrition, and a lack of positive coping skills to deal with my anxiety and depression. I'm tired of physically feeling heavy and how the weight exacerbates my disability-related pains and mobility issues. I'm tired of the slow creep towards various comorbidities. And I'm tired of looking in the mirror and being ashamed of what I see and how I got myself to this point. I also don't want food and eating to rule my life and my feelings anymore. I am scared. But the stories I've read about here and elsewhere online have inspired me. I think I'm finally ready to change my life. Wish me luck.

Your surgeon knows your medical history. They have read through your psych eval and blood work. The chioce is ultimately up to you. Since you asked about the sleeve I will give you my two cents. Each of us are more than the statistics. I lost 120 pounds in 6 months with the sleeve. My goal was 140. I am five years out and maintaining in the 130s. Nothing magic about the bariatric process. Follow your plan and behavior changes. Weight gain can happen to any type of surgery: Small or large amounts of weight. After a year you may see a ten to twenty pound bounce. It can be lost again. Maintaining is if you have a gain you go back to your bariatric plan and get the weight off. If you can't change your relationship with food and exercise you will not have long term success with any type of surgery. People with bariatrics have revisions due to different issues. (medical, not following their plan, mobility and eating disorders etc) Sleeve realities: Things to know. (1) less chance dumping syndrome if you eat sugar. (some will experience it) If sugar is an issue for you, you might want a different type of surgery. Lots of debate about stomach stretching. (yes it happens but it's rare) I am going to pass on reading any following angry posts about stomach stretching. (2a) Your restriction will be less as time passes. This is normal with the sleeve. Your stomach has not grown back or stretched. It's a new feeling of stomach capacity. It's rare to see revision due to stretching. Think of how much food you would have to binge and force down in one sitting to cause stretching to the point of revision. 2b) Many people confuse grazing with stomach stretching. Grazing is eating several meals throughout the day healthy or unhealthy foods. Your calories will seriously increase. It is as if you didn't have surgery at all. (google it) I also see some surgeons take advantage of gain due to grazing. It's a money maker to do another surgery. This is life long change with any type of surgery. It is still work after you get to gaol.

Anyone familiar with bariatric surgeons in the Fargo ND area?

On track to get sleeved in January. I have days where I’m super excited, and other days where I feel so scared. What did you do to push past your fear? How did you truly know you were ready? I’m told by my PCP and Bariatric office that I’m a great candidate. My husband is supportive. But I’m so scared of the “what ifs” with both surgery and life after. I’m so glad this forum exists so I can read your experiences and share mine.

There are two main reasons bariatric patients are at risk for developing vitamin and mineral deficiencies: 1. First of all, and most obviously, you’re no longer able to consume large enough amounts of foods to meet your micronutrient (i.e. vitamin and mineral) needs. 2. Secondly, your body now absorbs and processes foods differently. For example, if you had a malabsorptive weight loss surgery (e.g. gastric bypass or duodenal switch), in addition to eating smaller portions of foods, you’re also not absorbing 100% of the nutrients in the foods that you’re eating. Interestingly, even in the non-malabsorptive procedures (e.g. sleeve gastrectomy and band) we see changes in nutrient processing. For example, you may no longer have enough stomach acid in your small stomach to efficiently absorb the natural calcium found in dairy products, which is why you’ve been prescribed a special type of calcium, calcium citrate, that doesn’t require stomach acid to be absorbed. The signs and symptoms of vitamin and mineral deficiencies can be mild to severe. Some take only weeks to occur, while others take years to develop. While many deficiencies are reversible (e.g. anemia, or low iron), several micronutrient deficiencies are irreversible (e.g. osteoporosis, or bone decay due to inadequate calcium and vitamin D, and neurological damage due to inadequate B vitamins). Moral of the story? Take your vitamins! How often should I be going for blood tests? Your bariatric team will tell you how often you should have blood tests done. It’s most likely that you’ll have a blood test after your surgery, while you’re still in the hospital. Following this, your next blood test will be in three to six months and continue every three to six months until your first year after surgery, depending on the type of surgery you had. If your blood tests are looking great at one year after surgery, this is a good sign and means that you managed to get through the first risky year after bariatric surgery without having developed a deficiency! But this doesn’t mean that blood tests are no longer needed. You’ll need to do blood tests to check for nutrient deficiencies for the rest of your life. As you get older, your body needs more of some nutrients and less of others as your body changes. Some deficiencies also take a longer time to develop. For this reason, you may still develop deficiencies over time, even five to ten years after surgery. We’ve seen many patients who stopped doing their blood tests because they felt fine only to find out years later that they have multiple severe deficiencies. Feeling good doesn’t mean everything is good. And there’s a reason why. Before feeling tired, lethargic, weak, or sick, because of a nutrient deficiency, your body goes through the following stages: You’re not getting enough of a nutrient from your diet and your vitamins; Your body doesn’t have enough of the nutrient stored; You begin to have low levels of the nutrient in your body; Your organs begin to have trouble working properly; You begin feeling unwell and develop symptoms of deficiencies. Feeling unwell is the last step in this process. These steps can take only a few weeks for some nutrients, and up to several months for others. When you begin to feel unwell, your body has already been through weeks—or months—of missing an important nutrient. Blood tests can catch these deficiencies at a much earlier stage. For example, say you stopped taking your iron pill. You wouldn’t feel an anemia, or an iron deficiency, developing. Gradually, over time, you’ll begin to get tired and you might figure it’s just your busy lifestyle. You’ll begin to feel worse and wonder if you’re just not getting enough sleep. Then you’ll become increasingly lethargic and notice your hair has lost its shine and is getting brittle. Lastly, you’ll notice that you can hardly get through your morning routine without having to sit down and take a break. You’ll go to your doctor who will order blood tests. The blood tests will come back diagnosing you with anemia. Luckily, you’ll restart your iron supplement which will reverse this condition, although it’ll take about three months until you feel like yourself again. However, some deficiencies aren’t reversible which can leave you unwell permanently. The bottom line: Have your blood tests done regularly as suggested by your bariatric team. You’ll eventually only have one blood test per year, but this will only be the case at two years after bariatric surgery or until your blood tests routinely come back normal. If you no longer see your bariatric team, or live too far from your bariatric center, make sure that your family doctor is testing you for bariatric surgery-related deficiencies. The routine blood tests that your family doctor performs aren’t the same ones that your bariatric team orders. We look at so much more. Ask your family doctor if he/she is looking for all the nutrients necessary for bariatric surgery. They can receive this information from the bariatric clinic where you had your surgery.

As surgical wounds are healing, there are often some distinct changes that occur to the skin both around and near the wound. A few things that one can expect – and things to watch out for: https://advancedtissue.com/2013/12/3-ways-know-difference-healing-infected-surgical-wounds/ A study was conducted that looked at patient incision care and other discharge concerns. The study found that knowledge of incision care and amount of information received about incision care were rated low. The five most frequently mentioned postdischarge concerns included bowel trouble at home, wound pain at home, looking for wound complications, watching for wound infection, and activity limitations. (This study is 12 years old. Hopefully, knowledge of incision and discharge care has improved drastically.) https://www.o-wm.com/content/bariatric-surgery-patient-incision-care-and-discharge-concerns

I bought the starter kit of Bariatric Fusion shakes & soup mixes from the Bariatric Pal store and was so glad I got the Chicken Soup and Tomato soup packets -- I've had those for the last two days for dinner with my family and it was great to have a break from the sweet! I am so over chocolate, vanilla, banana, ick. Would I have liked these packets before surgery? I can't tell you, but they are such a welcome break from the monotony now. Chicken soup flavor was delicious.

As you know in a little,more than 2 weeks I will,be having my Bariatric surgery after 3 years of planning , trying, and continuing to try for I believe this is something the Lord has planned for me. My friends, I ask that the Great Physician "Scrubs" in with my surgeon. That with his help my surgeon's hands will be swift, sure and true. And that I be restored to health that I may continue to be of service to,others. And that God's purpose and plan for,my life continues .🙏Amen and amen!

The Society for Metabolic and Bariatric Surgery estimates that 18 million adults in the U.S. qualify for weight-loss surgery, but only about 1 percent actually do it. The length of recovery and cost concerns are the main reasons more people don't have such procedures. Endoscopic Sleeve Gastroplasty is a non-surgical weight loss procedure that is commonly referred to as ESG and also known as the incisionless gastric sleeve or the accordion procedure. Instead of incisions, stapling and removing parts of the stomach, a tiny camera and tools go down a patient's throat with a needle and thread. Specialized tools mark out guidelines in the stomach, sutures are placed in triangular patterns and the area is cinched together. Stomach size is reduced by 70 to 80 percent. ESG works by reducing the space inside your stomach and by slowing down the rate at which food empties from your stomach. Unlike the band, sleeve, and bypass, however, which are surgical procedures, the ESG procedure is non-surgical. Access to the stomach is gained not through incisions in the abdomen but endoscopically, i.e. through the mouth. Like the surgical procedures, the ESG is performed under general anesthesia, and it takes about 1 hour to complete. A device called the 'Overstitch' is inserted into the stomach and reduces the stomach capacity from the inside by stitching the stomach together with a series of approximately 6 stitches. https://www.healthierweight.co.uk/non-surgical-gastric-sleeve/esg-or-gastric-sleeve/ https://www.mooremetabolics.com/weight-loss/endoscopic-sleeve-gastroplasty/ http://bmiclinic.com.au/endoscopic-sleeve-gastroplasty/

Most of the bariatric literature on thiamine deficiency surrounds gastric bypass, but it seems sleeve gastrectomy is not immune to this problem despite that, theoretically, sleeve gastrectomy experiences fewer malabsorption issues. https://www.soard.org/article/S1550-7289(18)30222-3/fulltext Nutritional deficiencies are a recognized complication of bariatric surgery. Thiamine deficiency has been reported as a possible consequence of both restrictive and malabsorptive bariatric procedures. Most of the reported cases occurred after Roux-en-Y gastric bypass (RYGB) surgery; fewer were described after biliopancreatic diversion, vertical banded gastroplasty, or duodenal switch. Adults who have a high carbohydrate intake derived mainly from refined sugars and milled rice are at greater risk of developing thiamine deficiency because thiamine is absent from fats, oils, and refined sugars. https://www.soard.org/article/S1550-7289(05)00726-4/fulltext Thiamine was the first vitamin B to be discovered. It is absorbed in the proximal jejunum and is mainly stored in muscle as thiamine pyrophosphate. It has a biological half-life of 9-18 days. Patients who experience persistent vomiting after bariatric surgery are at risk of developing thiamine deficiency. Mild deficiency should be suspected if patients complain of apathy, anorexia, restlessness and generalized weakness. Prolonged deficiency leads to beriberi and/or Wernicke’s encephalopathy. The most common presenting symptom of thiamine deficiency is a pins-and-needles feeling in one’s extremities despite normal vitamin B12 and folate. The average time from surgery to onset of thiamine deficiency symptoms was 9 months. Persistent vomiting, alcoholism, and non-compliance with vitamins are all contributing factors to thiamine-B1 deficiency. Treatment for those suspected of thiamine-B1 deficiency: 50-100mg of thiamine twice daily. https://www.soard.org/article/S1550-7289(11)00050-5/fulltext

The Vitamin C In the orange juice does help with iron absorption but I don’t know that OJ is an appropriate drink for Bariatric patients because of its sugar content. I read somewhere that if you get Chelated Iron that it is less likely to cause constipation. Im going with my multi of choice and don’t plan on adding additional iron unless my lab work indicates I need to.

What is sodium? Sodium is a mineral and an essential nutrient. To stay healthy, you need to get at least some sodium from your diet, although that is not a challenge for most people. Sodium is an electrolyte, and it helps your body maintain water balance. It is also necessary for nerve impulses and muscle contraction. What effect does sodium have on health? Some sodium is necessary, but too much is unhealthy. A high-sodium diet raises your risk for high blood pressure, stroke, and heart disease. Too much salt may increase your risk of osteoporosis – already a concern for bariatric surgery patients – and possibly of stomach cancer. What effect does sodium have on weight? Sodium has no calories, so it cannot directly cause you to gain body fat. Still, you may have found out personally that a high-sodium meal or day can lead to water retention and a bump on the scale in the short term! Many salty foods do tend to be high in calories from other sources (many salty foods are junk foods!), and a high-salt diet can be a red flag for a high-calorie one. Which foods are high in sodium? The biggest dietary source of sodium is salt and far higher in sodium than natural sources are processed foods. Pickles, cheese, and olives. Processed meat, such as ham, turkey breast, salami, and pastrami. Many condiments, such as salad dressings, pasta sauce, salsa, and soy sauce. Canned goods, including soup, tuna, vegetables, and beans. Prepared meals, such as frozen meals, rotisserie chicken, and meatballs. Fast foods, such as burgers, tacos, sandwiches, fries, fried rice, and pizza. Bread and most breakfast cereals. Salt that you add in cooking and at the table also increases the sodium content. Which foods are low in sodium? Fresh fruit, oils and fats, grains, nuts, and beans, peas, and lentils, are naturally very low in sodium. Unprocessed meat and poultry, milk and dairy products, seafood, and vegetables naturally have a small amount of sodium. Water is sodium-free. How concerned should you be about sodium? Well…somewhat, but not overly concerned. Too much sodium is definitely not a good thing, but your sodium consumption may not be your top priority. Losing weight as a bariatric surgery patient or candidate is going to do far more for your health than cutting back on sodium. Counting calories, protein, and carbs may be as much as you can handle for now without counting milligrams of sodium. Making generally healthy choices can help you lower sodium consumption. What are some tips for lowering sodium? You can take a healthy approach to eating and reduce the amount of sodium you consume without counting each milligram. Being aware of what you are eating is a good strategy. These tips can help you cut back on sodium without making it feel like a chore. Choose lean proteins and vegetables. Hey – this fits with your WLS diet! Read labels to choose unsalted and low or reduced-sodium foods. Get dressings, sauces, and condiments on the side, and use less when you can. Choose less processed foods when you can: think tofu over veggie burgers, chicken breast over turkey slices, and fresh fish over canned tuna. Use less salt during cooking, and experiment with herbs and spices to add flavor without sodium. Only add table salt after tasting your food. Is there anything that can counterbalance sodium? Yes! Potassium is sort of an antidote to sodium because it has the opposite effect on your blood pressure. Fruit, dairy products, beans, and vegetables are all good sources of potassium, and they are healthy choices. Also, you should drink extra water if you consume extra salt. Sodium is something to be on your radar for health, even if it is not your top nutrient of concern for weight loss. It comes down to choosing an overall healthy diet and being aware of your choices – something that you are sure to be an expert at as you approach and recover from weight loss surgery.

Thank you all for your tips! I'm going to follow the post-op bariatric diet that they gave us and buy smaller plates. I gave up soda already and I'm going to do my best to decrease my carb intake as well. Hopefully I won't crave them as much. Sent from my SM-G955U using BariatricPal mobile app

I narrowed my decision to two programs. One at a larger hospital with a very structured in-house program that required participants to use their nutritionist, physiologist etc. The other program had no structure. It offered a list of possible nutritionists and psychologists to contact for pre-op evaluation. You were basically on your own in deciding what to do. The only requirement the second program had was attending a one-hour talk about bariatric surgery and nutrition with a Q&A afterward. It was very basic information and a waste of time to attend. I chose the second program. I don't like hovering professionals telling me what to do. I dislike rules and oversight and heavy-handed regimes. When I was told that I "had to" use their nutritionist (that the nutritionist I had already seen wasn't acceptable for their program), I knew that they would be sticklers every step of the way. I know some people thrive on structure and feel safe and cozy being told what to do and what not to do. I can't function that way. Even if it's for my own good, I don't like the idea of someone monitoring my behavior. While I feel as though I was tossed out on the curb sometimes, I'm doing okay. I have my primary doctor. I have my own kids (a pharmacist and two medical doctors) to look out for me, and I have myself. I'm not a clueless person waiting to be told what to do next or what I shouldn't be doing. If I ever find myself in a position in which I need help, I know how to ask for it. I just don't want "help" imposed on me. Does any of this resonate with anyone?

And on September 5th your Good Wishes will help me over that hump into post-surgeryland. To answer your original query, they usually ask why you want this surgery? They want to make sure you don't want to look like a movie star, but more deeper reasons. How hard have you tried losing weight in the past? Very few people can reduce and keep weight without surgery. Do you understand portions of your anatomy won't be the same? Some people fear surgery because they look on it as mutilation of their body. Can you understand, do you feel you can follow a different meal plan the rest of your life? This is not something you do over a weekend and then go on living a careless food life. Are you frightened of dying,either on the table or in daily life. Nobody will do surgery on someone already unstable emotionally. What are your plans for the future? Nobody will perform surgery for someone who wants only to be a centerfold in Penthouse. Besides unless the photographer positions you just right you will have 5- 7 teensy abdominal scars, nobody wants to airbrush those out or use a special lens. With some kinds of surgery you are on a lot of vitamins, with every one you are on some Can you afford up to $150 a month for vitamins? You will be eating a much less copious amount of food, maybe you'll have extra money there? Most times your vitamins will be less than that amount. Most important: Be positive -Be committed - Be Friendly But,most, Be yourself, Be Yourself, the world wants and needs You. That's why you are here, there's a spot only you can fill. Check back with us often- we support your decisions- we have or will be going through all these things and we would treasure the time we spend with YOU! Frustr8 and the Bariatric Pal Crew

I wonder what % of bariatric patients suffer from anxiety, Depression And/Or Rage after surgery? 10,20 ,33 ,45, 50 or 75% of all of them? Does Age make any difference, or gender, or even sexual orientation. Is it irrespective of marital status? I am happy, looking forward to My surgery,anxious to start my new post- surgery life. What are the chances everything is going to change for me?

A NMB Question, did any of you have to do a mag citrate cleansing before your Bariatric Surgery, or did the liquid diet immediate right before "empty" you out enough that your colon was squeaky clean.? Wonder if that has to with many days until I poo-ed group? .P.S. --of course NBM stands for Not My Business

Years ago when I had my middle child at my future location I did have a private room, now I wonder how the Bariatrics floor/wing is set up?😙

I am 63 and half way through the Supervised Medical Weight loss management. I have lost almost 20 pounds, focus on changing my attitude of food. I am trying to start this lifestyle change as I hope to get the surgery early 2019. However, my insurance is up in the air about if they are going to cover and bariatric surgery. I plan to keep going and I enjoy reading that others have gone through the gastric sleeve procedure with positive results.

Personally, I am over it. I was pretty much over it the next day. Having been heavy most of my life, I've been called much worse, in much more public circumstances, and cried real tears over it. My skin is old leather at this point. As a card-carrying member of the medical profession, I do feel an implicit and explicit duty to protect other patients from this type of behavior. Ironically, as a Family Nurse Practitioner, I will be giving referrals to practices of various specialties. This will not be one of them. Just last spring, in my first Family Nurse Practitioner rotation, I referred all my patients who were interested in learning about bariatric surgery to a different practice because there have been a few other incidents with this practice (that I experienced and some of my co-workers experienced.) I must have referred 20 people to a different practice is 4 months. So, about 5 per month. I graduate in December. If I practice for 20 years (at least), that's 20 x 5 x 12= 1200 potential customers/patients. The surgeon is about my age, so he'll likely be practicing at least that long. I'm sure they'll get along just fine without my referrals, but I'm sure they would have liked them just the same. Just saying... Anyway, thanks for your support. #longgame

My experience was almost identical to @ChaosUnlimited's except for the nurse phone calls. I thought our therapist and nutritionist were excellent and well-versed with bariatric issues. So, like Chaos, I thought I was well-prepared for what came after surgery. Yes, I wanted surgery sooner, but I think I benefitted from the delay.

My insurance required a 6 month supervised diet program, had to have frequent phone check-ins with one of their nurses to assess my readiness during that 6 months, and it required me to choose a "certified" program - which has nothing to do with an actual professional organization certification, it's the insurances own certification program that the practice has to apply for. I was so frustrated, I had to choose a program that was over 70 miles from my home rather than my local hospitals program which is <10 miles from my home. I had, like most everyone else, considered the option of surgery for a long time, and when I finally made up my mind, I wanted to do it sooner rather than later and I was devastated to find out I had to wait 6 months, even though I had been seeing my primary doctor for weight loss pills for months, and I had documented weight loss and gains over the years. Now, in retrospect, these requirements turned out to be the best thing that could have happened for me, with the exclusion of the insurance nurse phone calls - I didn't feel like I got any benefit from that. I am so happy with my surgeon and my practice, I just can't speak highly enough about their care, their program, and the hospital they use. I had the option of the duodenal switch surgery at this practice, which I am very happy with, and would not have had that option at my local hospital. And I feel like I was very well prepared for the surgery and the changes that come with it during that 6 months in which my surgeon required educational classes and follow up with their team of nutritionists. I'm not sure I would have adjusted as well to the lifestyle changes without that time of preparation, education, and support from their team. Having talked to others who participated in different programs for bariatric surgery, it seems like they didn't get nearly the amount of education for post-surgery that my program requires. Some have already started re-gaining weight after 1-2 years, which I can't predict if it will happen to me, but I feel like I still have an open line of communication with my practice and a lot of support when I have questions or issues. I often wonder when I see people posting about "cheating" on their plan within mere weeks or months of their surgery what their programs preparation requirements were and if it has any correlation to post op outcomes like compliance with diet. (This statement is not directed at anyone, it seems like these types of posts are fairly frequent here, and I'm not judging, but truly wondering if an intense preparation period makes a difference in outcomes)