Pre-Op confusion

[ShrinkingButtercup 60]

I'm about six months pre-op. Just turned 30.

I'm not sure if I'm required to lose weight in that period but I'm trying anyway. Five pounds so far. (That I know of. I only weigh in at doctor offices for my own sanity)

I attended a class before my surgeon's appointment about changing my behaviors before surgery. It pushed, as I interpreted trying to cut carbs and sugars, up Protein and drink Water. Preparing yourself for life after. So that's what I did.

Shortly after my surgeon consult, I saw my PCP (Who doesn't seem wild about the surgery anyway) who sent me to their nutritionist. Not wanting to upset my PCP, I did so. She suggested a more balanced diet. With carbs and low sugar. Nothing about upping protein. Balanced is the key word. She also suggested that maybe I can "Do it by myself!"(I wish!)

I was left confused. Should I follow the surgeon's office's suggestions and change behaviors and diet or should I go about the balanced approach. Will doing that set me up for bad habits and poor weight loss. Six months isn't really that long so I need to hustle with whichever approach is best.

Suggestions?

Edited July 6, 2015 by pushpin

[F4T-TRAP 37]

Follow the surgeon's instructions, in my opinion. They want you to get lose weight to make the surgery easier, and also prepare you for eating better in general.

[James Marusek 5,244]

Over the years I drank Cokes and later Diet Cokes. One of the requirements after surgery is to cut out all carbonated beverages and caffeine. I decided to implement this change when I entered the medically monitored diet and exercise program in order to qualify for surgery. That change alone caused me to drop 20 pounds. I believe the carbonation was the cause of the weight loss. Carbonation is like producing microscopic explosions in the stomach which causes it to expand. The larger the stomach, the more food you can eat and as a result the more weight one gains. This also turned out to be a good change because I suffered from withdrawal syndrome when I went cold turkey on a 6 coke a day habit. So it is important to flush your body from caffeine early because you don't want to go through these withdrawal syndrome combining it with the effects of the operation.

The other thing I did pre-op was to become more conscientious about my calorie intake. I looked at the calories of everything I ate and changed my diet. I no longer ate ice cream or milk shakes. No more pizza. But Taco Bell tacos were O.K.

[Daisee68 2,493]

I had the same problem. One NUT from a WLS clinic (who also worked with dialysis patients) was way more concerned about balanced approach. The NUT I work with now is way more concerned about Protein. (I am 4 weeks post-op.) When I talked to the new NUT about 6 weeks before my surgery, he explained that NUT's who are generalists often give bad info as it relates to bariatric patients. My NUT works with bariatric patients only and has for going on 10 years, so he has figured out what works. (Even then, you will find Protein goals to differ among bariatric NUT's.) Anyway, the best advice he gave me was to just start working on changing habits. So maybe for the first 2 weeks, you make sure you are getting in 64 oz Water. Then the next 2 weeks, you add a habit such as not drinking 30 minutes before a meal, during a meal or 30 minutes after a meal and just keep building from there. Maybe 1 habit you can try is replacing one meal or snack a day with a Protein Bar (Quest bars are pretty tasty) or Protein Drink. Cutting out the carbonation is a tough one and I didn't give it up completely until the very last second (2 days before surgery) but I did start cutting back about 1 month prior. Maybe make a list of the habits you want to change, tackle one at a time and then by the time you get to surgery, these will all be old hat to you and make your transition much easier. Making some of the simple changes (including starting to exercise if you aren't) will likely lead to some weight loss naturally.

As for your PCP and their NUT, there are always going to be some who say "can't you do it on your own"? Obviously not or we wouldn't be where we are, but I will tell you it is a question I asked myself even after surgery (i.e. a bit of buyers remorse). Surround yourself with those who are supporting your decision. You have 6 months, if you get there and change your mind, no harm no foul. You have new healthy habits. But at the end of the 6 months, you will have a better grip on your new lifestyle.

By the way, not sure if your insurance requires this, but mine did (Cigna), and it was a letter from a dr other than the surgeon recommending the surgery. If your PCP is not game, that may be difficult to obtain. You might consider discussing more in depth with him now or finding a new dr before then that will be supportive of that decision so you will have someone who will write the letter if needed. (My endocrinologist was more than happy to write it and had discussed the topic with me for a couple of years before I decided to go forward.)

Hope I haven't confused you more! Bottom line- find the right kind of support and seek out the right kind of NUT. And if you don't like the NUT or DR, find a new one.

[chelsea554 3]

After my initial meeting with my surgeon, he set a weight loss goal for me of 10 pounds, I think because they want to see that I am trying to change my habits before surgery. I went to the NUT at my surgeon's office and she has been amazing. We are slowly removing sugar and Diet Coke from my diet and adding Protein and Water. This is to get me ready for the surgery. Ask the surgeon for a NUT recommendation, it is likely they work closely with one or two. I would follow either the surgeon or the NUT that is recommended diet as they will be the experts when it comes to bariatric surgery.

Also, it sucks that your PCP isn't on board. Mine is very supportive, which I think will ultimately help with long-term success. I hope everything works out for you!

[xylena88 6]

My insurance requires that I am on a 6 month medically supervised diet/ nutrition plan before I am eligable for surgery. Do I start my nutrition plan with my PCP first or do I consult with the Bariatric Program first and then they refer to the nutrionist? I ask this because I have to travel 500 miles for the procedure because my insurance also requires the the Blue Distinction center.

Also can an OBGYN also monitor the diet, since I really don't have a PCP?

Any help would be appreciated! Thank you

Edited July 11, 2015 by xylena88

[Daisee68 2,493]

@@xylena88 - I would wait until you contact the bariatric center as they will likely refer you to a nutrionist. If they are a Blue Distinction Center, they likely have one on site. If you cannot travel that far once a month (which makes sense), you might be able to do phone consults. The NUT I use is only over the phone. And I saw someone on here that posted in the articles section that does NUT visits via phone and Skype. Just be sure you communicate all this to the bariatric center. Re dr monitored, I don't think OB/GYN would be a problem. You may not actually have to have a separate doctor monitor it if the NUT works with the bariatric center as they sort of consider that being monitored by the doctor (I think - don't quote me on that). I just didn't have this issue because I always have an appt with one dr or another it seems. My endocrinologist was the one that wrote the recommendation letter (often required from someone other than the surgeon).

Hope that helps!

[Pinkpeonies1 87]

Xylena I had to do 18 nutrition classes (once a week) where I had to weight-in at least twice a month, a doctor's talk and have a psychological assessment before my insurance even considered my case. Once all that was done my PCP submitted the documentation and request to Blue Cross. Within 2 weeks I received my referral to the Bariatrics office (also a Blue distinction center). I saw the surgeon, the center had me do one more nut class and one more doctor's talk class before they submitted for surgery approval. It really depends on your insurance guidelines. I'd call the medical group and the Bariatric center to see what route to go.