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Hi all! I am brandie-new to this site but I thought it looked amazing! So, I had my surgery on July 24th. I have no pain from incisions, occasional soreness but nothing too remarkable. I too am on what was referred to as Bariatric Stage 2 diet, aka liquids only. It's been a week and one day, and it feels like the longest week. I feel better. I can notice a change in mood, some sleep (I was a real bad insomniac prior to surgery), I wake up feeling a bit more refreshed and get right up vs prior I'd lay in bed in a miserable daze for about an hour. I want to do more walking etc., but I do not want to overdo it I go for recheck on Aug. 16th, so I'll discuss what I can incorporate in for physical activity then. BUT, man am I having a hard time with the liquids and I noticed the protein shakes make me a bit gassy and sometimes mildly nauseous. I am not physically hungry much at all, only mildly here and there. But yes, the liquids only for the past week and knowing I have 2 more weeks at least of it (I can do "pureed" food in one week) is rough. Doing it like the doc said but it is rough. Especially when my family all have dinner or order out, etc. Trying to keep myself busy... and hydrated! I know in my head it will get easier in time and the liquid only is not forever but it has been a frustration at times.

I'm not the young studs like you guys are i'm 61 in September but I never in a million years thought that the excess skin would look like this. I think I look terrible without cloths on. But there is no way in the world I will invest the kind of money you have to do to get rid of it. My good friend across the street from me works for a surgeon who specializes in bariatric skin removal procedures. Maybe I can get her to throw me a bone huh?

I didn't have a supervised diet before surgery, but i did receive very clear post op instructions as well as a lot of in person follow up. If I could give advice to any pre-sleevers (or other bariatric procedures) it would be to choose a surgeon/ surgical center AT LEAST as much on their support, education and follow up as any other factor. This bariatric thing is no joke, it's a lot of work and you may very well need the support in the long run.

Just trying to help - I am lucky enough to live in Salt Lake City, where there are numerous bariatric surgeons, and for self-pay I recommend Dr. Daniel Cottam or any other doctor at Bariatric Medical Institute in Salt Lake City, because they have their own surgical center, so you end up paying less than if you were going to a hospital. They are across the street from a major hospital in the event of an emergency, but he has done thousands of successful surgeries, myself being one of them. My surgery in August 2021 was $15,000 total for both doctor and surgical center. You could drive to SLC from Oregon (or have someone drive you), so no airfare either. I did not need to be near a bathroom after going home for anything other than what would be considered normal.

My medicaid is with deductible. when the bariatric doctors office sent it in my card was active but by the time medicaid got it and answered me back it was denied because my card of INACTIVE. they only activate it one month at a time depending on deductible and when u submit a bill to them as per amount . anywho, my case worker apparently is not familiar how it works and is not co operating with me she keeps arguing with me, . Should i call medicaid it self instead of the branch to make my card active??? helpppppppppp

The psychologist that I went and saw wrote a summary to my surgeon about my visit. I had to take this MMP1 (something like that) 500 question true false exam. I marked true on a lot of questions such as I have low self esteem. This is due to my weight but you can't explain that. Now the letter is summarized with "I recommend bariatric surgery with reservation" and that he recommend that I see a psychologist. Do you think this will make me exempt from UHC's requirements?

I can relate to these posts. When I had my first band placed, a day or two out of the hospital and I was at home, I discovered itchy little bumps filled with Fluid. Wouldn't you know it was a Saturday. I thought I would go insane with the itching. I also took Benydryl. Nothing I took made a difference. It was on a Sunday when it was really getting bad so I called my dermatologist, internist, and bariatric surgeon. Do not take a hot or overly warm shower. It made it worse! I would put the shower on my chest but it just pounded with pain. I was bent on going to the ER with it but my dermatologist told me to come in the following morning. I seemed to make it barely through the night without going to the ER. She treated me for the rash. I think she put my anti-biotics and a rash cream. To this day, I do not know what caused it. My doctors came up with all kinds of reasons. In my heart of hearts, I really thought I was allergic to the band! It was a foreign object and plastic that maybe my body was rejecting. I was thinking some pretty strange things. After the rash left, my internist said it could have been from being put under (the drugs they used) or the pain medication in the hospital. I took no pain medication after my surgery so that could not have been it. I have had four prior surgeries on my knees and I never had a reaction like that before. It really freaked me out. My dermatologist is the one who treated me. I went around and around on the phone with my internist. They thought maybe I caught something in the hospital. It finally went away but I will never forget that itching. I was so miserable! I would suggest if its driving absolutely mad, to go to the ER otherwise hang in there until your doctor can look at it. Good luck! Please post again to tell us how you are doing.

I was about to ask how in the world you got WC to pay for bariatric surgery to begin with, but then re-read what you wrote and now I get it. That's an interesting scenario, and I can definitely see why they'd fight having to pay for a sleeve, but I can also tell you that, having worked at the WC center for General Motors at one time, probably 95% of all lawsuits brought against the company by the employee are won, and that includes completely ridiculous ones like "I can't work because I'm an alcoholic because my job made me that way," or "I can't work because of the mental problems caused by my job..." yeah, totally serious. I'd say if the job caused removal of the band, and now you can't have another band, you'd stand an excellent chance of having your WC pay for a sleeve, maybe even without much threat from a lawyer (although you may still have to initiate that process). Hmmmm, interesting. Keep us updated!

Wow, I'm sorry your waiting for your approval. My information was sent to UHC yesterday via fax and the case manager with Bariatric Resource Services called me within 3 hours of it being sent saying I was approved. I know what greatly helped speed up my process was that i called and got an 800 number for my surgeons office to "open a case" for me and then I got a fax number for them to submit it to. I also had been working with the case manager for 6 months making sure I was meeting all the requirements so she would have everything that was needed. Good luck and I hope your hear soon!

Has anyone tried that brand???

I have tried a bunch of different Vitamins and they are all just not palatable for me. I have had samples of optisourece, Celebrate and several of the Bariatric Advantage flavors and types. I just cannot tolerate any of them. I am wondering if I will be able to use Centrum chewables. are they different than the others I have tried? Are they smaller? I like the centrum flavor burst but my nutirtionist I cannot use those, she also said no gummies of any kind were acceptable.

If I were you if sign up to attend the bariatric support group that meets monthly.

@@GummyTummy .Thank you for taking the time to write such a thoughtful response. I picked her because she set up successful bariatric program before coming to the current one and she was fully endorsed by the head of the bariactric program. That being said, I believe she is very skilled surgeon. She spent over five hour on my sleeve due to all the scar tissue I had from previous c-sections. But she seems to be only interested in the number of pounds loss. I feel she sees that number as her success not necessarily mine. I have to continue to supplement with Protein powder. There is no way I can consume that much food. As it is I'm averaging no more that 750 calories a day

So I'm thinking about giving up on my insurance fight and just switching to self-pay. I had a slipped band over a year ago. It took 6 months to get the insurance company (Fed BCBS) to finally agree to remove the band but they denied a revision to VSG stating it wasn't medically necessary because my BMI was under 35. I submitted an appeal to the Federal Office of Personnel Management in October for what was supposed to be a 60 day appeal. They "lost" my case and had to start over. Then they closed it because they didn't understand I was asking for a revision and not some sort of random partial gastrectomy. They finally sent it out for review but it sounds like they didn't select a bariatric surgeon because the answer last week came back that it isn't medically necessary because my weight isn't over a 40 BMI. The told my attorney to wait for the report and then call and talk to the nurse but I haven't heard back yet. At this point it's been almost 7 months since I submitted the appeal. This has been going on for so long I'm almost back to my original weight. If I had it to do over again I'd have done a self-pay revision with Dr. Aceves right from the start. Heck, I'd be at my goal weight by now. I just don't have it in me to keep this up. I went ahead and requested a surgery date with Dr. Aceves and put first-class airline tickets on hold on my miles. I can't think what hoops the insurance company would have next. They just don't get that the standard of care for a revision doesn't require you to regain all your weight first. I could go forward with the surgery and then sue them after the fact but I'm not sure it's worth the mental energy after all this. I had some old Microsoft stock lying around and it's almost enough for the surgery. I'm thinking that I'll never miss the money and can just get on with my life. I don't want to self-pay up here because it's really expensive and they don't cover complications like Dr. Aceves does. I could be down there next weekend having this done and just moving on. Thoughts? I could use some additional input... Thanks! Britt

Thanks VBG! I contacted my HR rep, but she didn't have access to any of the contracts or anything. She suggested that I call the customer service number for our insurance company. Hmm. I did find out that our PPO plan, Blue Shield of Washington is apparently under an umbrella of Blue Shield of California, which theoretically would give me access to Dr. Quebbermann, if the PPO covers bariatric stuff. I waited on hold *forever* Monday morning, but I'm going to call back today. Thanks for the info! I didn't know that employers could modify the policy to exclude specific things! <br /><br /><br />

I have BCBSNC. I called them before starting this process and was told I only had to have 6 mth of documented weight loss attempt. But it did not have to be submitted to insurance only my dr had to approve it. And this is what my policy states. My pre-op coordinator said the surgeon accepted my WW log because it was about 9 months straight within 2 yrs. So after going through all tests, etc. my file was turned over to the insurance coordinator for filing. She emails me the next day and says she cant submit without my 6 mths supervised visit & if I dont have it, I need to get started. I explained my policy doesnt require it only requires that my dr approved whatever I did and pre-op said dr approved it. She said she has been doing this a while and even if dr "approves" it doesn't mean insurance will, but she will submit "as is" if I request. I can't do 6 months supervised now because my policy renews June 1 & my deductible etc will apply all over again. We met our out of pocket is the only reason I can have to now. So it was submitted Friday. We will see. I hope she doesn't mess it up. Is bcbs asking for you to have 6 mths documented? JWow1 I just had my consultation with the surgeon's office on the 28th I had about 8 months of attempts but was told per my insurance a 6 month supervised diet is apart of my requirements. My first of 6 appointments will be on the 25th of February. One thing my coordinator told me is that it has to be a consecutive 6 months if you miss a month you have to start over. To come this far and have met your oop max I really hope they will accept your attempts.

I have BCBSNC. I called them before starting this process and was told I only had to have 6 mth of documented weight loss attempt. But it did not have to be submitted to insurance only my dr had to approve it. And this is what my policy states. My pre-op coordinator said the surgeon accepted my WW log because it was about 9 months straight within 2 yrs. So after going through all tests, etc. my file was turned over to the insurance coordinator for filing. She emails me the next day and says she cant submit without my 6 mths supervised visit & if I dont have it, I need to get started. I explained my policy doesnt require it only requires that my dr approved whatever I did and pre-op said dr approved it. She said she has been doing this a while and even if dr "approves" it doesn't mean insurance will, but she will submit "as is" if I request. I can't do 6 months supervised now because my policy renews June 1 & my deductible etc will apply all over again. We met our out of pocket is the only reason I can have to now. So it was submitted Friday. We will see. I hope she doesn't mess it up. Is bcbs asking for you to have 6 mths documented?JWow1 I just had my consultation with the surgeon's office on the 28th I had about 8 months of attempts but was told per my insurance a 6 month supervised diet is apart of my requirements. My first of 6 appointments will be on the 25th of February. One thing my coordinator told me is that it has to be a consecutive 6 months if you miss a month you have to start over. To come this far and have met your oop max I really hope they will accept your attempts. I hope so too! We'll see.

Woohoo! It looks like my insurance may cover any follow-up care. "Related Care Following Bariatric Surgery If you did not receive your surgery under UMP coverage, the plan covers medically necessary follow-up care or complications post bariatric surgery only if: 1. Your surgery was covered by another health plan or you would have met UMP criteria at the time of your surgery. You or your provider must submit medical records to UMP to show that you would have met UMP criteria. 2. The procedure performed was one of those covered by UMP (Roux-en-Y, sleeve gastrectomy, or laparoscopic adjustable gastric banding). If you do not meet the criteria above, followup care (including lap band fills) or complications after bariatric surgery are not covered. If your care was covered by UMP or meets criteria above, all care for complications or reoperation must meet UMP criteria and medical policy. Panniculectomy (removal of loose skin) is covered following bariatric surgery for a medical condition only when specific medical criteria are met. Most panniculectomies are considered cosmetic and are not covered." The only clarification I would like is whether criteria means simply meeting the BMI requirement or if they mean the six month dieting plan requirement.

Okay so my first year was phenomenal! I did so good! And this past year? Well... not so much. My loss slowed around the end of last year and continued to be slow/creeping for the first couple of months. Chalk it up to holidays, the stress after a move, poor planning, it wasn't a great time. And I should have followed that up with renewed vigor, but instead I re-introduced two things into my life that has made this year, frankly?, a complete waste! 1. Carbs! I started re-introducing them back in February. Just a little at first. But what was an occasional thing turned into an every day thing, turned into an (almost) every meal thing, turned into an (almost) every meal/every snack thing. It's a slippery slope. And the worst part about this is that I don't even enjoy them that much! They're just convenient and EVERYWHERE. 2. Snacking. Before I was mostly doing the strict 5-6 meals/snacks per day. It would occasionally deviate, but for the most part, that was my mainstay. After introducing carbs, the desire to snack became so much stronger. The more carbs I ate, the more I snacked, the more I snacked, the more I ate carbs. It was just a gross gigantic avalanche of snacking/carbing. 3. Facebook! Can I blame the fact that I re-introduced Facebook on this? I recently read (a real article, though I can't remember the name of the publication at the moment! I THINK it was NYT.) that surveys suggest that Facebook takes up more of our time than exercising, reading, and socializing per day COMBINED. COMBINED. That's... INSANE. To know that I've wasted good quality exercising (and reading!) time on Facebook (which I don't even really LIKE, which is why I avoided it for SO LONG.) is mind boggling to me. I haven't deleted the app from my phone yet, but I'm doing it tonight! I'll keep messenger because for some reason people prefer that to texting these days. STILL. This is unacceptable in my world view. How did I allow this to happen? I have not technically gained weight this year because I looked back and I'm around the same I was this time last year. So that's... something? But with gains and losses, I did gain back about 25 lbs. You could say ALMOST 30, but the only reason I ever dipped that low was because I had mycoplasma pneumonia (the one with gastrointestinal symptoms) for 2 weeks in the middle of the year. Apart from that one week period where I had lost weight because of Illness, I'd been hovering at about 255 for a pretty long time this year. Then, when I stepped on the scale one week ago I was shocked to discover that I was weighing in at 278.5. 23 and half pounds higher than my (non-pnuemonia-induced) lowest weight! The little progress that I did make this year, just kept being erased by my poor choices! I hadn't stepped on a scale since I'd been sick. I was in deep denial! I immediately joined a dietbet (which I'm going to lose because I'm losing too quickly!) and started eating right again. No carbs, veggies, Protein (at least 70/day), getting in my fluids, only eating 5/6 times/day. I began losing weight so rapidly that I couldn't believe it. Still can't. That was Dec 1st. When I weighed myself this morning. I'd already lost 12 lbs! This is TWO YEARS out from surgery. I haven't had ANY TIME this week to exercise (though I do babysit after work so I usually get all my steps in.) This tool still works! It still does EXACTLY what it's designed to do! And the REALLY remarkable part of this? Half way into this week, my dentist had to prescribe me an antibiotic AND a steroid. A steroid! Yet I still managed to lose 12 lbs. I feel like I JUST had surgery. These are astonishing numbers even if it's mostly Water weight. Even if I'd just lost 6/5 lbs this week I would have been astounded. 12 is beyond anything I ever expected. Some things I've noticed this week: 1. I still don't miss carbs (much!) It's hard to step away. But honestly? I just feel so dissatisfied with what I'm eating when I'm eating carbs. I've always been more of a meat and veggie girl. Carbs are just so abundant, so easily accessible and convenient, and so weirdly addictive even if you don't really love them, that it's just a habit I fall into that is almost exclusively environmental. I just need to REMEMBER that I control my own "food environment" if I make the time to plan! 2. I have to remember to take my Vitamins. I still have them, I just have lapsed in taking them. Now that I really need them again, it's more important to remember! 3. I am going to the bathroom very infrequently, much like I did the first year post-surgery. 4. My capacity really is not as high as I feared. When you nibble, stretch out your meals into long social affairs, snack frequently, eat slider foods, it can really be a bit of a mind trick. You start to believe that you can still eat like you used to. But you can't, you're just adapting what you CAN do, to what you WANT to do. If you want to eat more, you'll make it happen. You have to MAKE YOURSELF use your tool the way it was intended. If I eat good quality veggies and protein, eat from start to finish (no stopping to chat OR BROWSE FACEBOOK for ten minutes in between bites!), I can still only eat ABOUT a solid cup of food before I'm comfortably full. Might take a few extra bites to make me UNCOMFORTABLY full depending on what the food is. I made a double-batch of Skinnytaste's Stuffed Pepper Soup (without rice) last week. Which is not very brothy and more like a stew. Yesterday I had a cup of that for lunch. (my ladle measures exactly one cup). By the time I finished the cup, I was UNCOMFORTABLY full. I actually should have stopped a few bites before I finished. Because it was stew-like, it was way more dense. For dinner today I had about 2 ounces of roasted chicken breast (which doesn't equal a half cup if you cut it up in chunks), about a half a cup of sauteed brussels sprouts, and a little less than a tablespoon full of homemade pimento cheese melted over the top. I was perfectly full by the time I was done. Not too full. Not still hungry. Just right. 5. I'm worried this will not last. I don't mean I'm worried I will fail again. I'm sure I will and I have a plan for that. (Get back on that horse, not 10 months later, but two minutes later!, etc.) I'm worried that I'll somehow do the same thing I did this week and for some reason I won't lose. I think I told myself for a long time this year that it wasn't ME and MY CHOICES that were causing me not to lose. It was something else. So I just have to remember that I am in control and I think these worries will go away. I'm really excited to get back to the gym too. Babysteps! I'm so thrilled at this NEW START. I wonder if anyone else is in the same boat I am, or is in the same boat I was a week ago? Has anyone had long-term success with a re-start? After a period of not losing or a period of slight re-gain? What are you doing? What's working? What's not? How did you "re-boot?" Did you do the pouch test? What warnings do you have? Etc? I feel like a newbie. It feels kind of good!

I would start calling bariatric doctors in your new location and ask the questions. Different doctors have different requirements. For me, my doctor saw me at 3 wk, 6wk, and will again at 6 months and at a year, as well as and every year after. I am also required 6 month labs, year labs, and labs every year after.

The Latest on Nutrition and hair Loss in the Bariatric Patient by Jacqueline Jacques, ND Nutrition and Hair Loss A common fear and complaint of bariatric surgery patients is postoperative hair loss. While for most of us as people, our hair is important as part of our self-image and body image, it is not very important to our bodies. For this reason, nutrition can have a great impact on hair health because when forced to make a choice, the body will shift nutritional stores to vital organs like the brain and heart and away from hair. Hair loss has many causes. The most common type of hair loss after weight loss surgery is a diffuse loss known medically as telogen effluvium, which can have both nutritional and non-nutritional causes. Whether you are aware of it or not, for most of your life you are always in the process of both growing and losing hair. Human hair follicles have two states: anagen, a growth phase, and telogen, a dormant or resting stage. All hairs begin their life in the anagen phase, grow for some period of time, and then shift into the telogen phase,which lasts for approximately 100 to 120 days. Following this, the hair will fall out. Typically, about 90 percent of hairs are anagen and 10 percent are telogen at any give time—meaning that we are usually losing a lot less hair than we are growing, so the hair loss is not noticeable. But sometimes this can change. Specific types of stress can result in a shift of a much greater percentage of hairs into the telogen phase. The stressors known to result in this shift, or telogen effluvium, include the following: high fever, severe infection, major surgery, acute physical trauma, chronic debilitating illness (such as cancer or end-stage liver disease), hormonal disruption (such as pregnancy, childbirth, or discontinuation of estrogen therapy), acute weight loss, crash dieting, anorexia, low Protein intake, Iron or zinc deficiency, heavy metal toxicity, and some medications (such as beta-blockers, anticoagulants, retinoids, and immunizations). Nutritional issues aside, bariatric surgery patients already have two major risks of major surgery and rapid weight loss. These alone are likely to account for much of the hair loss seen after surgery. In the absence of a nutritional issue, hair loss will continue until all hairs that have shifted into telogen phase have fallen out. There is no way of switching them back to the anagen phase. Hair loss will rarely last for more than six months in the absence of a dietary cause. Because hair follicles are not damaged in telogen effluvium, hair should then regrow. For this reason, most doctors can assure their weight loss surgery patients that with time and patience, and keeping up good nutritional intake, their hair will grow back. Discrete nutritional deficiencies are known to cause and contribute to telogen effluvium. One should be more suspicious of a nutritional contribution to post-bariatric surgery hair loss if any of the following occurred: 1. Hair loss continued more than one year after surgery 2. Hair loss started more than six months after surgery 3. Patient has had difficulty eating and/or has not complied with supplementation 4. Patient has demonstrated low values of ferritin, zinc, or protein 5. Patient has had more rapid than expected weight loss 6. Other symptoms of deficiency are present. Iron Iron is the single nutrient most highly correlated with hair loss. The correlation between non-anemic iron deficiency and hair loss was first described in the early 1960s, although little to no follow-up research was conducted until this decade. While new research is conflicted as to the significance of ferritin as a diagnostic tool in hair loss, it has still been found that a significant number of people with telogen effluvium respond to iron therapy. Optimal iron levels for hair health have not been established, although there is some good evidence that a ferritin level below 40mg/L is highly associated with hair loss in women.1 It is worth noting that this is well above the level that is considered to be anemic, so doctors would not be expected to see this as a deficiency. Zinc Zinc deficiency has been tied to hair loss in both animal studies and human cases. There is data linking zinc deficiency in humans to both telogen effluvium and immune-mediated hair loss. Zinc deficiency is a well-recognized problem after biliopancreatic diversion/duodenal switch, and there is some indication that it may occur with other procedures such as gastric bypass and adjustable gastric banding. In 1996, a group of researchers chose to study high-dose zinc supplementation as a therapeutic agent for related hair loss2 in patients who had undergone vertical banded gastroplasty. The study administered 200mg of zinc sulfate (45mg elemental zinc) three times daily to postoperative patients with hair loss. This was in addition to the Multivitamin and iron supplements that patients were already taking. No labs for zinc or other nutrients were conducted. Researchers found that in patients taking the zinc, 100 percent had cessation of hair loss after six months. They then stopped the zinc. In five patients, hair loss resumed after zinc was stopped, and was arrested again with renewed supplementation. It is important to note that in telogen effluvium of non-nutritional origin, hair loss would be expected to stop normally within six months. Since the researchers conducted no laboratory studies and there was no control group, the only patients of interest here are those who began to lose hair again after stopping zinc. Thus, we cannot definitively say that zinc would prevent hair loss after weight loss surgery, and further study would definitely be needed to make this connection. A further note: The tolerable upper intake level (UL) for zinc is set at 40mg in adults. This study utilized a daily dose of more than three times that level. Not only can these levels cause gastrointestinal distress, but chronic toxicity (mostly associated with copper depletion) can start at levels of 60mg/day. Information related to this study has made its way to many a support group and chat room—even to doctor’s offices—with the message that “high-dose zinc will prevent hair loss after weight loss surgery.” Patients should be advised that high-dose zinc therapy is unproven and should only be done under supervision due to the associated risks of toxicity. A lab test to check for zinc deficiency would be best before giving a high dose such as this. Protein Low protein intake is associated with hair loss. Protein malnutrition has been reported with duodenal switch, and in gastric bypass to a much lesser degree. Little is known about incidence, as only around eight percent of surgeons track labs such as total protein, albumen, or prealbumen.3 Limited studies suggest that patients with the most rapid or greatest amounts of weight loss are at greatest risk.4 With surgical reduction of the stomach, hydrochloric acid,5 pepsinogen, and normal churning are all significantly reduced or eliminated. Furthermore, pancreatic enzymes that would also aid in protein digestion are redirected to a lower part of the small intestine. It is thus likely that maldigestion rather than malabsorption is responsible for many cases. Some studies have also implicated low protein intake.6 Research also indicates that low levels of the amino acid l-lysine can contribute to hair loss and that repletion of lysine stores may both improve iron status and hair regrowth. In a study of anemic patients with hair loss who were supplemented with 1.5 to 2g of l-lysine in addition to their iron therapy, ferritin levels increased more substantially over iron therapy alone.1 Biotin Many individuals believe that supplementing with, or topically applying, the nutrient biotin will either help to prevent hair loss or will improve hair regrowth. To date, there is no science that would support either of these presumptions. While biotin deficiency can cause dermatitis, hair loss is only known to occur in experimentally induced states in animal models or in extreme cases of prolonged diets composed exclusively of egg whites.7 Other Other nutrients associated with hair health include Vitamin A, inositol, folate, B6, and essential fatty acids. Hair loss can also be caused by systemic diseases, including thyroid disease and polycystic ovarian syndrome (PCOS), and is influenced by genetics. Conclusions Hair loss can be distressing to bariatric surgery patients, and many will try nutrition themselves to see if they can prevent it. Unfortunately, there is little evidence that early hair loss is preventable because it is most likely caused by surgery and rapid weight loss. Later hair loss, however, can be indicative of a nutritional problem, especially iron deficiency, and may be a clinically useful sign. Educating patients about the potential for hair loss and possible underlying causes can help them to make informed choices and avoid wasting money on gimmicks that may have little real value. References 1. Rushton DH. Clin Exp Dermatol. 2002;27(5):396–404. 2. Neve H, Bhatti W, Soulsby C, et al. Reversal of hair loss following vertical gastroplasty when treated with zinc sulphate. Obes Surg. 199;6(1):63–65. 3. Updegraff TA, Neufeld NJ. Protein, iron, and folate status of patients prior to and following surgery for morbid obesity. J Am Diet Assoc. 1981;78(2):135–140. 4. Segal A, Kinoshita Kussunoki D, Larino MA. Postsurgical refusal to eat: anorexia nervosa, bulimia nervosa or a new eating disorder? A case series. Obes Surg. 2004;14(3):353–360. 5. Behrns KE, Smith CD, Sarr MG. Prospective evaluation of gastric acid secretion and cobalamin absorption following gastric bypass for clinically severe obesity.Dig Dis Sci. 1994;39(2):315–20. 6. Moize V, Geliebter A, Gluck ME, et al. Obese patients have inadequate protein intake related to protein intolerance up to 1 year following Roux-en-Y gastric bypass. Obes Surg. 2003;13(1):23–28. 7. Mock DM. Biotin. In: Shils M, Olson JA, Shike M, Ross AC, eds. Nutrition in Health and Disease. 9th ed. Baltimore: Williams & Wilkins; 1999:459–466.

Just a word of caution if you are considering gaining the few pounds. Some companies require a BMI 35 or over for X years. So the fact that you are under now could start the clock at the point you go over.<br><br>Read your policy carefully. It truly sucks that we take positive steps to improve our health, have some success, need some help, and get shot in the butt for it.<br><br>In your appeal, be sure to mention the FDA's lowering of the BMI standard for lap banding. It might not make a difference, but throw everything you can into the letter! www.obesitylaw.com might have some info to help.<br><br>Best wishes!!! <div><br></div><div>Edited to add this link:</div><div><br></div><div>https://www.healthnet.com/static/general/unprotected/pdfs/national/policies/Bariatric_Surgery_Jan_11.pdf</div><div><br></div><div>I am not sure if the above link applies to all Healthnet policies, but it does say a 2 year history. But it doesn't say in the past two years...so you can make the point of 2 years out of the previous 5 if that is the case.</div><div><br></div><div><p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 10.0px Verdana">For at least 2 years or greater, the patient has clinically severe obesity (morbid obesity) defined by <b>either </b>of the following:</p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 10.0px Helvetica">• •</p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 10.0px Verdana">Body mass index (BMI)* >40 kg/m<span style="font: 6.5px Verdana">2</span>; or</p><p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 10.0px Verdana"><br></p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 10.0px Verdana">BMI of > 35 kg/m2 and < 40 kg/m<span style="font: 6.5px Verdana">2 </span>with <b>one or more </b>of the following co- morbidities which are generally expected to be improved, curtailed or reversed by obesity surgical treatment:</p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 10.0px Verdana"><span style="font: 10.0px Helvetica">→<span class="Apple-tab-span" style="white-space:pre"> </span></span>Severe, active coronary artery disease</p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 10.0px Verdana"><span style="font: 10.0px Helvetica">→<span class="Apple-tab-span" style="white-space:pre"> </span></span>Obesity-related cardiomyopathy</p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 10.0px Verdana"><span style="font: 10.0px Helvetica">→<span class="Apple-tab-span" style="white-space:pre"> </span></span>Congestive heart failure</p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 10.0px Verdana"><span style="font: 10.0px Helvetica">→<span class="Apple-tab-span" style="white-space:pre"> </span></span>Obstructive sleep apnea with use of CPAP or polysomnogram showing apnea-hypopnea index (AHI) ≥ 15 per hour</p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 10.0px Verdana"><span style="font: 10.0px Helvetica">→<span class="Apple-tab-span" style="white-space:pre"> </span></span>Pickwickian syndrome</p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 10.0px Verdana"><span style="font: 10.0px Helvetica">→<span class="Apple-tab-span" style="white-space:pre"> </span></span>Type 2 diabetes mellitus</p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 10.0px Verdana"><span style="font: 10.0px Helvetica">→<span class="Apple-tab-span" style="white-space:pre"> </span></span>Clinically significant asthma</p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 10.0px Verdana"><span style="font: 10.0px Helvetica">→<span class="Apple-tab-span" style="white-space:pre"> </span></span>Chronic venous insufficiency with pain on weight bearing and persistent edema; or</p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 10.0px Verdana"><span style="font: 10.0px Helvetica">→<span class="Apple-tab-span" style="white-space:pre"> </span></span>Respiratory insufficiency, as evidenced by pCO2 > 50 mmHg, FEV1/FVC < 65%, or DLCO < 60%</p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 10.0px Verdana"><span style="font: 10.0px Helvetica">→<span class="Apple-tab-span" style="white-space:pre"> </span></span>Hypoxemia at rest, as evidenced by pO2 < 55 mmHg on room air</p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 10.0px Verdana"><span style="font: 10.0px Helvetica">→<span class="Apple-tab-span" style="white-space:pre"> </span></span>Severe gastroesophageal reflux disease (GERD)</p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 10.0px Verdana"><span style="font: 10.0px Helvetica">→<span class="Apple-tab-span" style="white-space:pre"> </span></span>Severe pain and limitation of motion in any weight-bearing joint or the lumbosacral spine documented by physical examination in association with radiologic findings showing degenerative osteoarthritis</p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 10.0px Verdana"><span style="font: 10.0px Helvetica">→<span class="Apple-tab-span" style="white-space:pre"> </span></span>Patient has <b>at least one </b>of the following:</p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 10.0px Verdana">Bariatric Surgery Mar 11</p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 10.0px Verdana">2</p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 10.0px Verdana">a.</p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 10.0px Verdana">b. c.</p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 10.0px Verdana">3.</p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 10.0px Verdana">d.</p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 10.0px Verdana">e.</p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 10.0px Verdana">f. g.</p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 10.0px Verdana">Hypertension(bloodpressure>140mmHgsystolicand/or > 90 mmHg diastolic measured with appropriate size cuff) that has not responded to medical therapy Firstdegreerelativewithpremature(age<50) cardiovascular disease</p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 10.0px Verdana">Hypercholesterolemia > 240 mg/dL that has not responded to medical therapy</p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 10.0px Verdana">Hypertriglyceridemia>400mg/dLthathasnotresponded to medical therapy</p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 10.0px Verdana">Lowdensitylipoprotein(LDL)>130thathasnotresponded to medical therapy</p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 10.0px Verdana">Highdensitylipoprotein(HDL)<35thathasnotresponded to medical therapy</p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 10.0px Verdana">Impaired fasting glucose > 125 Pulmonaryhypertension</p></div>

Hi.. I will be changing to Blue Shield H MO after the new year. According to them, the way my husband's employer's contract was written, lap band surgery is covered...no restrictions! Almost too good to be true...I will be confirming next week. Anyway, since I see on these boards that BS H MO has covered others here, maybe I am not dreaming. I was wondering...since all bariatric surgeons are contracted....how do I know what doctor I will be referred to? I mean, usually on a H MO, you belong to a group and then any doctor you are referred to is in that group. However, bariatric surgeons are not in any group so how is the doctor decided on? I want to make sure I get a good, safe, and reputable one. Thanks- Jennie

I was happy to read that you are working with a therapist to address your continuing issues with food. Though your weight loss has progressed impressively, your relationship and beliefs about food do not seem to have made the same rate of progress. Revising your thinking about food, and the requirements for your diet with your band has to happen before you can truly be in a different place emotionally. I have never felt that having to chew many times, taking small bites, and restricting the type of foods I can have were an imposition, or that I was "missing out" with the changes I chose to make with eating. These action items were part of what I still consider to be the opportunity to have better health. I had to wait an extra year for my surgery for a variety of reasons, none of which were planned or avoidable, so when I was finally cleared medically, I had no reservations to proceed. I believe that most bandsters have some pre-op questions to themselves about if they are making the right choice. There is no easy answer, but I believe that the answer is tied to one's priorities. At the Southern Woman's Show 2 summers ago, I had the good fortune to encounter someone who had been banded the previous fall. She helped me place my concerns in the proper perspective: which is more important to you? Being able to eat anything you want to for your meals covering several minutes a day during meals, or having some rules for those meals which require attention and mindful eating? It was a no brainer after that for me. We should eat to live, not the other way around. The longer you hold onto your flawed thinking, the more of a negative attitude towards diet compliance you will have. The things you mentioned that you disliked are the same things which got most all of us to the point where we had bariatric surgery. You cannot expect a sustained weight loss without increasing resentment towards compliance unless you redefine for yourself what your relationship with food needs to be. You have done so well with your weight loss...I hope you modify your beliefs about food. and let go of the ones which got you to your band surgery. Food is not your friend...and in many ways one can be addicted to food in the same way as one can be to drugs or co-dependent relationships. Wishing you continued success with your weight loss journey.

I think complications with the band is higher. I've even read that some bariatric doctors are no longer doing the band, but have went with going with the sleeve and bypass only. Read the complications in the band forum. In two days my sister converts from band to sleeve. Slippage, scar tissue and erosion are just a few band complications. Also trying to find that "sweet spot" where your fill is perfect can take years. It did for her. You have to research and then research some more. Then at the end of the day, go with what you feel is right for you.