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First, there is a specific Mexico/Self Pay forum here that might get more or better answers. I can't speak specifically for any of the MX practices, though my wife was self pay here in the states, Most follow up care is done by your PCP including routine labs, and those are generally covered by insurance. From what I have seen, most US bariatric practices aren't keen on doing follow up for other doctors (partly not wanting to support the competition, partly not wanting to get involved in someone else's surgery and potential problems) though longer term if revisions are needed, they are more than willing..... I would expect that the better practices would offer some kind of remote follow up (phone/fax/email/skype, etc.) for some time, but don't know for sure on that. The practice that we used here in the states was set up for travelling patients, so that is routine for them to do the periodic post-op follow ups as well as the annuals. One can also often join the support group for local surgeons to get that kind of support - many welcome patients from other practices - and that may also be a way in to see them if there are any problems that need attention (ask questions at the group meeting - I'm having this or that problem - and that may interest them enough to invite you to make an appointment, whereas they may refuse if you just call the office cold.

I have the benefit of having two pre-op diets to reflect upon. The first time around I toughed it out on sheer determination. I thought that I was doing well, but about halfway through I started dreaming of mashed potatoes and spaghetti! The 2nd time was more than 10 years later and really, for the most part, I was back to square one. The difference was that my new surgeon didn't have me on liquids only. I had a protein shake for breakfast and lunch with a "sensible" meal in the evening. Enduring this was MUCH easier, but I had a bad case of carb withdrawal after about 3 days. I had the worst headache that was constant for about 3 or 4 days and NOTHING helped it. I had brain fog, fatigue, irritability. I'll take the dreaming of mashed potatoes and spaghetti any day after that! Hang in there! It's a temporary situation and this will pass. For me, I just kept my eye on the prize. That was inspiration enough to help me stay on track and push forward.

Time for a status update: Yesterday marked my one year anniversary on Bariatricpal.com. What a year it has been and I am so grateful for all the people here that have helped me along the way. I'm also so grateful for @Alex Brecher for creating and maintaining this site for all of us. I hope that my ongoing purchases of calcium and multivitamin supplements are enough to express my gratitude. I'm a huge fan of the BariatricPal Multivitamin One 45. I kept a journal starting in July of last year starting the 2nd day after I was serious about considering bariatric surgery. Reading all the entries is very therapeutic to me. Looking back, I probably wouldn't have changed a thing about how I started and went through this process. Almost everything has gone well in this journey for me. Sure I've had my low points, but I seemed to have come out the other side very much in-tact. There's still a long road ahead once my real hunger returns, but I'm going to keep on the straight and narrow path of eating well and exercising every day until that happens and then some. In celebration of my 1 year on this site, I thought I'd share one of my early personal journal entries:

Could be. If it's strong enough to be concerning, you might want to phone the surgeon's office to ask. I had gas pains for what felt like forever, but it was probably more like 2 weeks. Felt kind of like hunger but painful.

I like the Kirkland brand. They come in a dual pack, half Chocolate Brownie and half Chocolate Chip Cookie dough. It think they are even better when slightly chilled in the fridge. I agree with the above posters and caution using protein bars on a regular basis. I found myself using them as meal replacements way too often because they were so easy and I didn't have much of an appetite. Luckily I realized what I was doing and am back to having them as an occasional snack or quick fix when unable to grab something else.

Thank you all for sharing. I’m sort of in a whirlwind of emotions at the moment. My surgery is coming up on September 30th and I’ve done a lot of “head work” to prepare. I’ve finally acknowledged exactly what my issues are so now it’s time for the action to follow.

don't expect to drop 30+ lbs the first month. The average bariatric patient is NOT a "My 600 lb Life" subject. The vast majority of us are starting at a much lower BMI than those folks. There are a few of us "normal" weight loss patients who drop that much, but they're the exception. Most of us lose in the 15-25 lb range that first month. If you lose 15 or 16 or 18 lbs that first month, you are NOT failing!

Thanks for all the replies, I'm seriously soaking in each bit of good advice. I realize I'm lower BMI (and senior age) and so my loss may be slower. I'm coming to think I may be eating too much. It's been easy for me to ingest 4-5 oz because I've had NO issues with drinking or eating. Never felt nauseous, or gotten a belly ache, cramp, nothing. Feel little to no restriction. And so I've basically been acting like I'm on a strict diet by restricting my input and calories seeming without aide from my 'tool'. Should I be measuring ounces/weight or volume as in 1/2 cup? How much volume would you suggest for near 2 months out? I do protein first, been mostly only eating protein. I've been on my treadmill at 'brisk walk' speed for a few minutes multiple times a day (being a senior with heart disease I feel that's my limit). I also just try to dance around and get sweaty housecleaning and generally be more active than usual. My concern is that I'm not losing during this 'honeymoon' stage and I don't want to be stalled at the same weight for another minute (it's going on three weeks!). I've been averaging 600-800 calories a day, is that too much this early? Also I get in 60+ gram protein & low carb. Thanks again for all the thoughtful replies. I plan to measure lower amounts today, I'm thinking 1/2 cup of chicken or salmon per meal? I've always been a big water drinker but will try to get even more in today. Gonna buy some sugar free ice pops for a late night snack (which is when I often have a bit more chicken).

if you're closely following your plan, then it's just a stall. It'll eventually break. If you're not closely following your plan, then do that. Weigh/measure and log everything you eat. also, you started out at a low BMI for a WLS patient. You are definitely not going to lose at the rate that someone starting at 300+ lbs typically does.

you really need to be committed to the eating plan - both before surgery and until you reach maintenance. Otherwise, you might not reach your goals. Forgive yourself for this, but get back on the program and stick to it...